Dietary Diversity and Anthropometric Shifts in School-Going Adolescents: A Pre-Post Intervention Study in Urban India
Abstract
Background: Indian adolescents face a severe dual burden of malnutrition driven by poor dietary choices. This study evaluated changes in Individual Dietary Diversity Scores (IDDS) and anthropometric measurements following a six-month structured, school-based nutritional counselling intervention among 400 urban school-going adolescents (200 boys and 200 girls; aged 12–16 years) selected via purposive sampling from two schools in Gurgaon, Haryana, India.
Methods: Anthropometric measurements and 24-hour dietary recalls, stratified using the 9-group Individual Dietary Diversity Score (IDDS) (Food and Agriculture Organisation) framework, were assessed pre- and post-intervention. The six-month intervention comprised interactive sessions on balanced nutrition, recommended dietary allowances, healthy cooking methods, food hygiene, and healthy snack alternatives.
Results: Post-intervention data revealed significant (p<0.001) improvements in anthropometric parameters and dietary optimization. Underweight prevalence declined from 41% to 18% in boys and from 54% to 38% in girls, with corresponding shifts into the normal-weight category while overweight and obesity rates remained stable. Mean IDDS improved for boys (4.12 to 4.78) and girls (3.54 to 4.59), driven by increased consumption of micronutrient-dense greens, vitamin A-rich produce, and quality proteins. Comparative analysis demonstrated that for boys, overall dietary diversity maintained a significant (p<0.05) positive correlation with linear growth and healthy mass accumulation. Conversely, girls' anthropometric changes were associated with specific food groups rather than overall scores; notably, regular intake of milk and milk products showed a negative correlation with BMI (p<0.001), suggesting a potential stabilizing effect against excessive adiposity.
Conclusions: Structured school-based nutritional education was associated with enhanced dietary diversity and positive anthropometric changes in this cohort. The findings highlight distinct gender-specific nutritional responses and suggest that school-based interventions may offer a promising strategy to address adolescent malnutrition.
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Introduction
Indian adolescents face a double burden of malnutrition on a national scale, characterized by high rates of undernutrition alongside emerging overnutrition. The Comprehensive National Nutrition Survey indicated that stunting and thinness affected 27% and 24% of adolescents, respectively, while overweight and obesity rates stood at 5% and 1%. Nutritional disparities are heavily driven by socio-demographic factors (income, education, and location), with older adolescents facing higher odds of stunting and urban, younger demographics showing increased vulnerability to overweight (Pandurangi et al., 2022).
The anthropometric dual burden is accompanied by a widespread crisis of micronutrient deficiencies and escalating metabolic risks, driven largely by poor dietary diversity. Nationally, half of all adolescents suffered from anaemia, impacting 40% of girls and 18% of boys. Furthermore, metabolic markers indicated early risks for non-communicable diseases, with 50% of adolescents presenting with at least one cardiovascular and metabolic risk factor, including hypertension, low high-density lipoprotein cholesterol (HDL) (affecting roughly 25% to 39% of various demographic groups), or elevated haemoglobin A1c (HbA1c) levels, which put up to 20% of older adolescents at risk for diabetes (Comprehensive National Nutrition Survey [CNNS], 2019).
Dietary diversity acts as a crucial qualitative indicator of both household food access and individual nutrient adequacy. An increasing reliance on low-quality foods and a lack of dietary diversity directly mirror physiological risks. Alarmingly, fewer than 20% of adolescents consumed pulses and green leafy vegetables, and less than 10% consumed fruits daily. The dietary shift from healthy to low-nutrient items is further reflected in data showing that ultra-processed foods contribute over 16% of total daily energy intake (371 kcal) (CNNS, 2019; Jain & Mathur, 2020). Consequently, replacing nutrient-void options with wholesome, low-fat, low-sodium, and low-sugar snacks is essential to safely meet the heightened micronutrient and energy demands of the developmental phase (Dietary Guidelines for Indians, 2024; Hu, 2002; Kennedy et al., 2010).
Expanding dietary diversity is a critical factor for metabolic health; low dietary diversity scores are positively associated with a higher prevalence of obesity. To bridge this gap, structured nutritional counselling and education serve as vital interventions. Targeted nutrition education has been shown to substantially enhance nutritional knowledge and directly translate into higher dietary diversity among adolescents. Notably, the benefits of educational strategies extend beyond dietary practices, showing a strong positive correlation with improved academic performance (Idrees et al., 2024; Sumiati et al., 2024; Yazew et al., 2024).
This study analyzed changes in dietary diversity scores and anthropometric measurements among Indian adolescents from two schools in Gurgaon, and evaluated the relationship between these parameters from baseline to post-intervention following a structured nutritional counselling program.
Conclusion
The study demonstrated that a six-month structured school-based nutritional counselling intervention was associated with improved dietary diversity and positive anthropometric changes among urban Indian adolescents. The intervention was associated with a substantial decline in underweight prevalence, driven by increased consumption of protective, micronutrient-dense food groups. The findings highlight distinct gender-specific nutritional responses: for boys, overall dietary diversity was significantly associated with physical development, while for girls, specific food groups—particularly dairy products—showed stronger associations with anthropometric outcomes.
The results suggest that structured school-based dietary education may be a promising strategy to address the dual burden of adolescent malnutrition. However, the pre-post design without a control group limits causal inference, and further research with randomized controlled designs, longer-term follow-up, and diverse settings is warranted to confirm these findings and establish the effectiveness and scalability of this approach.
The gender-specific findings underscore the importance of tailoring nutritional interventions to meet distinct biological requirements. As India continues to face a dual burden of undernutrition and emerging overnutrition among adolescents, evidence-based, scalable interventions that address gender-specific needs and improve dietary quality are urgently needed.
References
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