Skip to content

Advertisement

  • Research
  • Open Access
  • Open Peer Review

Food consumption patterns of adolescents aged 14–16 years in Kolkata, India

Nutrition Journal201716:50

https://doi.org/10.1186/s12937-017-0272-3

  • Received: 17 March 2017
  • Accepted: 16 August 2017
  • Published:
Open Peer Review reports

Abstract

Background

The nutrition transition has brought about rapid changes in the structure of the Indian diet. The replacement of traditional home-cooked meals with ready-to-eat, processed foods has contributed to an increased risk of chronic diseases in urban Indians. Improving the nutrition of Indians by promoting healthy food consumption in early life and in adolescence would help to reduce these health risks. However, little is known about the quality and quantity of foods and beverages consumed by urban Indian adolescents. Therefore, the aim of this study was to describe the food consumption patterns in a sample of urban Indian adolescents.

Methods

A self-administered, semi-quantitative, 59-item meal-based food frequency questionnaire (FFQ) was developed to assess the dietary intake of adolescents over the previous day. A total of 1026 students (aged 14–16 years) attending private, English-speaking schools in Kolkata, India completed the survey.

Results

Overall, the adolescents reported poor dietary intakes; over one quarter (30%) reported no consumption of vegetables and 70% reported eating three or more servings of energy-dense snacks, on the previous day. Nearly half of the respondents (45%) did not consume any servings of fruits and 47% reported drinking three or more servings of energy-dense beverages. The mean consumption of food groups in serves/day varied from 0.88 (SD = 1.36) for pulses and legumes to 6.25 (SD = 7.22) for energy-dense snacks. In general, girls had more nutritious dietary intakes than boys.

Conclusions

The Indian adolescents reported poor food consumption patterns, and these findings highlight the need to design effective nutrition promotion strategies to encourage healthy eating in adolescence and targeting food supply and availability.

Keywords

  • Food habits
  • India
  • Adolescents
  • Gender

Background

Triggered by a complex mix of marketing, social, and economic policies, the Indian nutrition transition [1] has been associated with a significant change in the lifestyles and the dietary habits of urban Indians [24]. The rapid proliferation of multinational fast food companies in the Indian food market and the influence of Western culture have replaced traditional home cooked meals with ready-to-eat, processed foods in urban Indian households [5, 6]. These changing food preferences have contributed to the increased risk of chronic degenerative diseases, thus affecting the quality of life and health of about 1.2 billion Indians [2, 6]. This highlights the need to nurture healthy eating habits among Indians from an early age.

Adolescence (10–19 years) is a vulnerable period of life as health-related behaviours that drive the major chronic degenerative diseases start or are reinforced during this time [7]. Adolescents’ food habits are important determinants of both their present and future health [8, 9]. The food intakes of adolescents in developed countries such as USA, UK and Australia do not meet dietary guidelines [1012]. Adolescents from these countries have high rates of consumption of energy-dense, nutrient-poor foods and inadequate consumption of fruits and vegetables [1013]. In addition, adolescents also exhibit unhealthy eating habits such as meal skipping and snacking on fast foods [1416]. Although limited, evidence from developing countries including India also report similar findings [1720]. These food behaviours may set in train unhealthy eating trends for adult life [8, 9], and contribute to a number of health problems including overweight and obesity, metabolic syndrome, diabetes and a number of cancers [6, 21]. Improvement of the food habits of adolescents is therefore one avenue to reduce the prevalence of these health problems.

Adolescents’ food consumption tends to vary according to gender [22, 23]. Studies across a number of countries have consistently shown that females’ dietary patterns are healthier than those of males [2426]. Women are more likely to avoid high-fat foods, consume more fruits and fibre and limit salt intake [24] than men. For example in Australia, adolescent girls had a higher average daily intake of fruits compared with male counterparts and boys tended to consume more carbonated beverages than girls [27]. Similarly, British girls preferred eating fruits and vegetables more than boys, whereas boys preferred eating nutrient-poor foods more than girls [28]. Given the consistency of these observations across different cultural groups, it is expected similar dietary patterns may be common among Indian adolescents.

To date, little is known about the food intakes of Indian adolescents. Neither the National Family Health Survey-3 [29] nor the National Sample Survey Office [30] have examined the dietary habits of urban Indian adolescents. This lack of evidence about the food consumption patterns of Indian adolescents is a significant barrier to the development of effective nutrition promotion and disease prevention measures. Therefore, the present study was undertaken to examine the food consumption patterns of a sample of Indian adolescent boys and girls residing in Kolkata city, West Bengal, India.

Methods

Research design and sampling

The Dietary and Lifestyle (DAL) survey was conducted among secondary school students attending private schools in Kolkata metropolitan area, India. Convenience sampling informed the selection of nine English-medium (i.e. English speaking) schools (two co-educational schools, two single-sex boys’ schools, and five single-sex girls’ schools). Only year nine students were included in the study because it was expected that these students would have well-developed individual food preferences [31]. Moreover, their academic schedule was less hectic in comparison to those of students in other years, making the administration of the survey more feasible. This cross-sectional survey was reviewed and approved by Deakin University’s Health Ethics Advisory Group (HEAG-H 187_2014). A detailed description of the survey has been reported previously [32].

Survey instrument

Questions regarding vegetarianism, meal consumption patterns, food and beverage intake, snacking practices, household food rules, home food environment, secondary school nutrition curriculum, school canteen, acquisition of food skills, exposure to media, consumerism, family characteristics and demographics were included in the Dietary and Lifestyle Questionnaire (DALQ). Secondary school students and their nutrition educators in India were extensively involved in the development of this 15-page paper-based questionnaire. Only findings that relate to food and beverage intakes are reported in this paper.

Development of the FFQ

The FFQ was an integral component of the DALQ. The Childhood Determinants of Adult Health (CDAH) study [33] and the first pass of ASA24-Kids-2014 program [34] informed the structure of the food list i.e. meal categorisation in the FFQ. Both the CDAH study [33] and the ASA24-Kids program [34] use a meal-based enquiry tool which allows respondents to record different meals and snacks consumed at various time intervals during a particular day. A meal-based FFQ accommodates a wide variety of meals and snacks including mixed dishes [35]. Therefore, the current FFQ was designed to provide data on meal patterns across the day and not just overall food intake.

In order to establish the list of meals and snacks included in the FFQ, 54 adolescents (aged 14–15 years) attending a private school in Kolkata were asked to recall the food and beverage items consumed on the previous day for two consecutive days including one weekday and one weekend day. These data were used to inform the development of the meal-based FFQ. As all foods were consumed in frequencies ≥5 occasions by the students, all recalled food items were included in the FFQ (Table 1). The foods reported by the adolescents yielded 59 novel food items for inclusion in the FFQ (Table 1). No food items recorded in the food recalls were omitted from the FFQ food list.
Table 1

The list of 59 food and beverage items comprising the FFQ and their reported frequencies

Food items

Frequency a

Cereals

 Breakfast cereal

42

 Bread/Toast

49

 Sandwich

37

 Semolina

5

 Rice flakes

5

 Chapati (Indian bread)

54

 Parantha (shallow-fried Indian bread)

24

 Luchi/Puri/Kachori (deep-fried Indian bread)

12

 Rice

52

 Idli (a savoury cake made by steaming a fermented batter of rice and de-husked black lentils)

9

 Dosa (a pancake made from a fermented batter of rice and de-husked black lentils)

5

 Puffed rice

24

Pulses and Legumes

 Pulse dish e.g. lentils, green gram pulse

29

 Legume dish e.g. red kidney beans

13

Vegetables

 Potato dish e.g. mashed potato

45

 Green leafy vegetable dish e.g. spinach curry

19

 Other vegetable dish e.g. stuffed bitter gourd, pumpkin curry, vegetable korma (an aromatic and spicy curry with mixed vegetables), vegetable jhalfarezi (a semi-dry recipe with a mix of vegetables cooked in a tomato based gravy).

33

Fruits

 Apple

15

 Banana

26

 Sweet lime

8

 Pear

9

 Grapes

5

 Orange

5

 Fruit Juice (Tetrapack/Fresh)

13

Milk and milk products

 Milk

49

 Lassi (a yogurt-based drink)

13

 Cottage cheese (paneer) dish e.g. paneer butter masala (cottage cheese cooked in crème sauce), matar paneer (a preparation of peas and cottage cheese in a tomato based sauce)

28

Non-vegetarian food products

 Boiled egg/omelette

20

 Egg dish e.g. egg curry,

9

 Chicken dish e.g. chilli chicken

12

 Fish dish e.g. fish fry

14

 Red meat dish e.g. mutton curry

5

Energy-dense snacks

 Biscuits/cookies

14

 Cake/pastries

23

 French fries

39

 Pav bhaji (a thick vegetable curry usually prepared in butter and served with a soft bread roll)

25

 Samosa (fried triangular-shaped pastry shell with a filling of spiced potatoes, onion, peas, cheese or noodles)

45

 Packaged potato chips

40

 Pizza

24

 Burger

29

 Chole bhature (a combination of spicy chick peas and fried breads made of refined wheat flour)

17

 Ice cream

24

 Ice candy

9

 Chocolates

24

 Pani puri (fried puff-pastry balls filled with spiced mashed potato, spiced water and tamarind juice)

39

 Vegetable roll/wrap

11

 Chicken roll/wrap/nuggets

14

 Egg roll

5

 Momos (a steamed refined wheat flour dumpling filled with meat/vegetables)

19

 Indian savoury e.g. bhujia (a crispy deep-fried snack prepared by using gram flour and spices)

12

 Popcorn

33

 Noodles

39

Energy-dense beverages

 Tea e.g. black tea, milk tea, Irish tea

29

 Coffee e.g. cold coffee, black coffee

15

 Health drink e.g. Bournvita, Horlicks (brand name for health drinks)

44

 Soft drink e.g. Sprite, Coke, Pepsi

46

 Energy drink e.g. Red Bull, Gatorade

22

 Hot chocolate

13

Water i.e. Household or school tap water and mineral (bottled) and non-mineral (bottled) water

54

aFood frequencies calculated from the food recalls of 54 participants

The 59 food and beverage items were distributed across different time intervals of the day. Seven time slots for the previous day (i.e. 24 h from 6.00 am to 5.59 am) comprising 6.00 am – 9.59 am, 10.00 am – 11.59 am, 12.00 noon – 2.59 pm, 3.00 pm – 5.59 pm, 6.00 pm – 7.59 pm, 8.00 pm – 10.59 pm and 11.00 pm – 5.59 am were included in the FFQ. A number of food items were included twice or three times in the FFQ as they may be consumed across multiple meal or snack occasions. For example, apple was listed three times between 6.00 am and 9.59 am, 10.00 am and 11.59 am, and 6.00 pm and 7.59 pm. Therefore, there was a total of 131 food listings in the FFQ. No identifiers such as ‘Breakfast’ or ‘Lunch’ were assigned to these times.

Three point serving response scales were employed to record the previous day’s food consumption. These response scales were calibrated according to the type of food or beverage. For example, food items like vegetable dishes were assessed in katoris (e.g., ½ katori = 1 serving, 1 katori = 2 servings, and 2 katoris or more = 3 or more servings; katori is Indian equivalent of a bowl). For beverage items like coffee, responses were measured in cups (e.g. ½ cup = 1 serving, 1 cup = 2 servings, and 2 cups or more = 3 or more servings). These serving sizes specified in the FFQ do not relate to any national dietary guidelines.

Pictorial depictions of serving measures i.e. katori (1 katori = 150 ml), glass (1 glass = 250 ml; ½ glass = 1 serving, 1 glass = 2 servings, 2 glasses or more = 3 or more servings) and cup (1 cup = 200 ml) were presented in the questionnaire to aid reporting. Detailed instruction for completing the FFQ was provided: “Tell us what you ate and drank yesterday. (Circle foods and beverages consumed by you at different intervals of day from the list given on page No. 2 to page No. 8 (Q6-1 to Q6-131). Also mention the serves (katoris/pcs/glasses/packets) for the food/meal/snacks/drink consumed by you. The serve guide given on the following page will help you in reporting the serves.)” A detailed description of the serving sizes is presented in Table 2.
Table 2

Description of serving sizes included in the FFQ

One serving

Two servings

3 or more servings

Food/Beverage items

½ katori

1 katori

2 katoris or more

Breakfast cereal, Semolina, Rice flakes, Rice, Puffed rice, Pulse dish, Legume dish, Pulse dish, Potato dish, Green leafy vegetable dish, Other vegetable dish, Grapes, Cottage cheese dish, French fries, Indian savoury e.g. Bhujia, Popcorn, and Noodles.

1 piece

2 pieces

3 pieces or more

Bread/Toast, Sandwich, Chapati, Parantha, Luchi/Puri/Kachori, Idli, Dosa, Apple, Banana, Sweet lime, Pear, Orange, Boiled egg/omelette, Egg dish, Chicken dish, Fish dish, Red meat dish, Biscuits/cookies, Cakes/pastries, Pav Bhaji, Samosa, Pizza, Burger, Chole bhatura, Chocolates, Pani puri, Vegetable roll/wrap, Chicken roll/wrap/nuggets, Egg roll, and Momos

½ glass

1 glass

2 glasses or more

Fruit juice, Milk, Lassi, Health drink, Soft drink, Hot chocolate, Energy drink, and Water

½ cup

1 cup

2 cups or more

Tea and coffee

½ packet

1 packet

2 packets or more

Packaged potato chips

1 scoop

2 scoops

3 scoops or more

Ice cream

1 stick

2 sticks

3 sticks or more

Ice candy

For the purpose of data analysis, the 59 food and beverage items in the FFQ were classified into nine food groups: cereals, pulses and legumes, vegetables, fruits, milk and milk products, non-vegetarian food products, energy-dense snacks, energy-dense beverages, and water. Out of these nine food groups, six food groups were consistent with food group naming used in Bowman’s FFQ [36]; a validated FFQ suitable for use among urban and rural adult Indian populations [36]. However, this validated FFQ [36] did not include snacks, beverages, and water, therefore, these three food groups were incorporated into the present FFQ.

The food intakes of the adolescents were calculated by summing the serving scores of all the food items within the nine food group categories. For example, for ‘cereals’ consumption, an adolescent who reported consuming two servings (two slices of bread) of bread between 6.00 am and 9.59 am (scored 2), three or more servings of rice between 12.00 noon and 2.59 pm (scored 3), one serving of puffed rice between 3.00 pm and 5.59 pm (scored 1) and one serving of chapatti between 8.00 pm and 10.59 pm (scored 1) was allocated a total score for cereals of 2 + 3 + 1 + 1 = 7 servings/day.

Initially, the FFQ was pre-tested to elicit students’ (n = 47; aged 14–16 years) opinions regarding the length, logical structure and readability of the questionnaire to inform further modification of the questionnaire. No changes to the FFQ were made as the participants found the questionnaire readable and positive feedback was obtained.

A total of 37 Year 9 students (15 boys and 22 girls; age: 14–16 years) studying in a private Indian secondary school participated in the test-retest reliability study. The participants completed the FFQ on two occasions, four weeks apart between August and September 2015. The test-retest reliability of the FFQ was assessed using Pearson’s correlation coefficient (r). The test-retest correlations (Pearson’s correlation coefficient) for the food groups ranged from r = 0.48 for cereals to r = 0.85 for fruits, reflecting fair to moderate reproducibility [37, 38] (Table 3). All correlations were statistically significant (p < 0.01).
Table 3

Pearson correlation coefficient (r) values for test-retest reliability of food groups included in the FFQ (n = 37)

Food group

r (Pearson’s correlation) a

Cereals

0.48

Pulses and Legumes

0.67

Vegetables

0.56

Fruits

0.85

Milk and milk products

0.59

Non-vegetarian food products

0.69

Energy-dense snacks

0.67

Energy-dense beverages

0.62

Water

0.64

aAll (r) values significant at p < 0.01

Data collection

Prior to the commencement of the DAL survey, the school principals and teachers were given a brief oral introduction to the survey procedures. All year nine students (n = 1095) from the nine participating schools were informed about the study through announcements made in the morning assembly. Participation in the survey was voluntary and students were free to opt of the survey anytime. The school authorities distributed the recruitment pack including a Plain Language Statement and a Consent Form to the students. Students (n = 1079) with written parental consent were allowed to participate in the survey. The questionnaire was administered to students (n = 1026; 53 students were absent on the day of survey) in class time on a weekday (i.e. any day between Tuesday and Friday as per each school’s discretion) under the supervision of class teachers and the lead researcher (NR) between December (winter) 2015 and April (early summer) 2016. The survey was not administered on Mondays because weekly academic tests were scheduled for this day in majority of the participating schools. The students did not receive any gifts for participation.

Data analysis

The Statistical Package for Social Sciences (SPSS, version 22.0) was used to conduct the data analyses. Descriptive statistics were calculated. Since, the majority of the variables were non-normally distributed, the Mann-Whitney Test, a non-parametric test was used to compare the mean food group scores of the boys and girls. Cross-tabulation and chi-square analyses were performed to investigate the variations in the intakes of individual foods and beverages by gender.

Type 1 error is a common shortcoming associated with population-based surveys [39]. To reduce this error rate, a stringent criterion for determining statistical significance was adopted: an alpha level of p < 0.01 was selected to determine statistical significance [39].

Results

In total, 356 boys and 670 girls completed the survey, the response rate was 95% of eligible students with written parental consent and 94% of all invited students. The socio-demographic characteristics of the respondents are shown in Table 4. The majority of the pupils were within the 14–15 years of age group, the remainder (14%) reported their age as 16 years. Hinduism was followed by 71% of the students.
Table 4

Socio-demographic characteristics of students (n = 1026)

 

Total

% (n)

Boys

% (n)

Girls

% (n)

χ2

df

p-value

Gender

100.0 (1026)

34.7 (356)

65.3 (670)

N.A

N.A.

N.A.

Age

   

36.438

2

<0.001

 14 years

44.0 (451)

51.7 (184)

39.9 (267)

   

 15 years

42.1 (432)

43.0 (153)

41.6 (279)

   

 16 years

13.9 (143)

5.3 (19)

18.5 (124)

   

Religion

   

96.378

8

<0.001

 Christianity

0.9 (9)

0.8 (3)

0.9 (6)

   

 Hinduism

70.7 (725)

77.0 (274)

67.3 (451)

   

 Islam

16.9 (173)

3.1 (11)

24.2 (162)

   

 Jainism

7.0 (72)

11.8 (42)

4.5 (30)

   

 Sikhism

0.8 (8)

1.7 (6)

0.3 (2)

   

 Zoroastrianism

0.1 (1)

0.0 (0)

0.1 (1)

   

 Any other

0.3 (3)

0.3 (1)

0.3 (2)

   

 None

2.1 (22)

2.8 (10)

1.8 (12)

   

 Don’t know

1.3 (13)

2.5 (9)

0.6 (4)

   

N.A Not Applicable

Among the nine food groups (excluding water), energy-dense snacks was the most commonly consumed food group (6.25 servings/day; SD = 7.22) (Table 5). After this group in decreasing order of average daily serving intake were cereals, energy-dense beverages, vegetables, fruits, milk and milk products, non-vegetarian food products, and pulses and legumes. The adolescents consumed a mean 10.47 (SD = 5.54) servings of water each day. Overall, the Mann-Whitney test results indicate that food intakes of girls significantly varied from boys (Table 5).
Table 5

Mean serves/day consumption of food groups (n = 1026)

Food group

Total

(n = 1026)

Mean (SD)

Boys

(n = 356)

Mean (SD)

Girls

(n = 670)

Mean (SD)

p-value*

Cereals

5.52 (3.75)

4.87 (4.30)

5.87 (3.38)

<0.001

Pulses and Legumes

0.88 (1.36)

0.77 (1.32)

0.94 (1.38)

0.014

Vegetables

2.30 (2.25)

1.69 (2.10)

2.62 (2.27)

<0.001

Fruits

2.17 (3.22)

1.35 (2.29)

2.61 (3.54)

<0.001

Milk and milk products

2.07 (2.27)

2.78 (2.54)

1.69 (2.01)

<0.001

Non-vegetarian food products

1.41 (2.14)

1.33 (3.19)

1.46 (1.91)

<0.001

Energy-dense snacks

6.25 (7.22)

7.31 (8.52)

5.68 (6.35)

0.017

Energy-dense beverages

3.96 (5.11)

5.32 (6.53)

3.24 (3.99)

<0.001

Water

10.47 (5.54)

11.69 (5.44)

9.83 (5.49)

<0.001

*p-value obtained with Mann-Whitney Test

Many adolescents failed to consume food items from all eight food groups daily (Table 6). Almost two-thirds (59%) did not consume pulses and legumes. About half (52%) refrained from eating non-vegetarian food products (i.e. egg, fish, chicken, and meat) and a similar proportion did not consume any fruit (45%). Vegetables (30%) and milk and milk products (36%) were not consumed by many students.
Table 6

Proportion of adolescents consuming foods from each of the eight food groups (n = 1026)#

 

Total

% (n)

Boys

% (n)

Girls

% (n)

χ2

df

p-value

Cereals

   

77.209

3

<0.001

 No intake

4.8 (49)

10.7 (38)

1.6 (11)

   

 One serving

2.4 (25)

3.9 (14)

1.6 (11)

   

 Two servings

10.1 (104)

16.3 (58)

6.9 (46)

   

 Three or more servings

82.7 (848)

69.1 (246)

89.9 (602)

   

Pulse and Legumes

   

7.446

3

0.059

 No intake

59.3 (608)

64.9 (231)

56.3 (377)

   

 One serving

14.1 (145)

11.5 (41)

15.5 (104)

   

 Two servings

16.4 (168)

14.3 (51)

17.5 (117)

   

 Three or more servings

10.2 (105)

9.3 (33)

10.7 (72)

   

Vegetables

   

71.340

3

<0.001

 No intake

30.1 (309)

44.1 (157)

22.7 (152)

   

 One serving

11.9 (122)

8.4 (30)

13.7 (92)

   

 Two servings

17.5 (180)

21.1 (75)

15.7 (105)

   

 Three or more servings

40.4 (415)

26.4 (94)

47.9 (321)

   

Fruits

   

54.134

3

<0.001

 No intake

45.3 (465)

56.2 (200)

39.6 (265)

   

 One serving

7.9 (81)

11.2 (40)

6.1 (41)

   

 Two servings

15.9 (163)

15.2 (54)

16.3 (109)

   

 Three or more servings

30.9 (317)

17.4 (62)

38.1 (255)

   

Milk and milk products

   

48.440

3

<0.001

 No intake

36.4 (373)

26.4 (94)

41.6 (279)

   

 One serving

7.0 (72)

4.8 (17)

8.2 (55)

   

 Two servings

26.2 (269)

25.6 (91)

26.6 (178)

   

 Three or more servings

30.4 (312)

43.3 (154)

23.6 (158)

   

Non-vegetarian food products

   

35.773

3

<0.001

 No intake

51.9 (533)

64.0 (228)

45.5 (305)

   

 One serving

12.8 (131)

7.6 (27)

15.5 (104)

   

 Two servings

13.5 (138)

9.3 (33)

15.7 (105)

   

 Three or more servings

21.8 (224)

19.1 (68)

23.3 (156)

   

Energy-dense snacks

   

0.543

3

0.909

 No intake

9.7 (100)

9.6 (34)

9.9 (66)

   

 One serving

7.7 (79)

7.0 (25)

8.1 (54)

   

 Two servings

12.0 (123)

12.6 (45)

11.6 (78)

   

 Three or more servings

70.6 (724)

70.8 (252)

70.4 (472)

   

Energy-dense beverages

   

21.709

3

<0.001

 No intake

22.7 (233)

17.7 (63)

25.4 (170)

   

 One serving

5.8 (59)

4.2 (15)

6.6 (44)

   

 Two servings

24.9 (255)

21.6 (77)

26.6 (178)

   

 Three or more servings

46.7 (479)

56.5 (201)

41.5 (278)

   

#Examples of servings given below

A. For food items likes like pulses and legumes, servings were assessed katoris (e.g., ½ katori = 1 serving, 1 katori = 2 servings, and 2 katoris or more = 3 or more servings; katori is the Indian equivalent of a bowl)

B. For beverage items like tea, servings were assessed in cups (e.g. ½ cup = 1 serving, 1 cup = 2 servings, and 2 cups or more = 3 or more servings)

There were gender differences in the numbers of servings consumed from the eight different food groups. More females consumed cereals, vegetables, fruits and non-vegetarian food products than their male counterparts (Table 6, p < 0.001). In contrast, more males consumed three or more servings of milk and milk products and energy-dense beverages (Table 6, p <0.001). However, there were no significant gender differences in the consumption of pulses and legumes (p = 0.059) or energy-dense snacks (p =0.909).

Discussion

The present findings highlight the overconsumption of energy-dense, nutrient-poor foods and under consumption of vegetables, pulses and animal foods among this sample of adolescents residing in Kolkata City, India. These unhealthy dietary intakes may increase the risk of nutrient inadequacy [40] and weight gain among nutritionally vulnerable Indian adolescents [4144]. Considering the likely tracking of food behaviours into adulthood [8, 45], there is an immediate need to modify such behaviours during this pubertal phase, thus, enabling adolescents to develop healthy food practices for their adulthood.

As a consequence of food globalisation, the consumption of energy-dense and nutrient-poor foods and sugar-sweetened beverages has increased substantially, particularly, in urban regions [6]. This overconsumption is quite evident in the present study as nearly three quarters of the sample consumed three or more servings of energy-dense snacks and about half of the respondents consumed three or more servings of energy-dense beverages. Singh and colleagues also found that about one third (32.1%) of secondary school students (n = 510; aged 12–18 years) in New Delhi area consumed fast food (e.g. burgers, pizzas, fried foods etc.) three or more times per week [46].

Because of their hyper palatability, attractiveness and ready-to-eat attributes [47], these non-essential foods are becoming a frequent and dominant component of adolescents’ diets in most economically developed countries [22, 4850] as well as developing countries like India [51, 52]. Data from the current study further support these observations. Frequent consumption of non-essential foods may contribute to a variety of negative health outcomes [53], including obesity [54], insulin resistance [55] and heart disease [56]. To prevent these diet-related chronic diseases, energy-dense snacks and beverages should be consumed sparingly or not all [6].

The study participants consumed a mean of 2.3 serves/day of vegetables. This is similar to findings from an Australian study which found that adolescents (aged 14–16 years) consumed 2.0 and 2.2 serves/day of vegetables between 1995 and 2007 [57]. Gupta and colleagues reported that secondary school girls (aged 13–15 years) of New Delhi, India consumed 175 g/day of vegetables (both green leafy and other vegetables) [58]. The Indian dietary guidelines recommend a daily intake of three portions of vegetables (1 portion of green leafy vegetable and 2 portions of other vegetables; 1 portion = 100 g) for adolescents (aged 10–18 years) [6]. In light of this recommendation, it appears that the study participants had vegetable intakes below current national guidelines.

Almost half of the students (45%) reported consuming no serves of fruit over the previous day. Again, this is consistent with other evidence. For example, the Global School-Based Health Survey data from 16,084 adolescents (aged: 13–15 years) from five Southeast Asian countries (India, Indonesia, Myanmar, Sri Lanka and Thailand) suggest that nearly a quarter of the sample (28%) reported consuming fruits less than once per day [59]. Likewise, Deka and colleagues found that 52% of the adolescents (n = 400; aged: 10–19 tears) residing in Jhansi district, Uttar Pradesh, India did not consume any fruit on daily basis [17]. Both the present and previous findings underscore the need for encouraging daily fruit consumption among adolescents.

Unfortunately the students also reported low intakes of pulses and legumes (0.88 serves/day) and cereals (5.52 serves/day). Nationwide surveys also echo similar findings [60, 61]. Such poor intakes could be attributed to the progressive decrease in per capita availability of pulses from 69 g 1961 to 32 g in 2005 [62]. Typically, cereals form the staple diet of the Indian population [3]; however, cereal consumption by Indians has waned in recent decades, with a substantial proportion of the population failing to meet cereal intake recommendations [3, 63]. At the national level, cereal intake dropped from 353 g to 331 g/person/day in the urban areas and from 447 g to 404 g/person/day in rural areas over the period of 1993–94 to 2004–05 [60]. Similar decline in the consumption of whole grains have also been reported in French children, adolescents and adults [64]. This declining trend in cereal consumption has been accompanied by a shift towards energy-dense foods as a source of energy in diets [3, 6]. Perhaps, these inadequate intakes could be a reflection of the global decline in per capita cereal output from 335 kg per year in 1980–1985 to 310 kg by 2000–2005 [62].

India is the largest producer of milk in the world [62]; however, nearly two-fifths (36%) of the participants did not report any consumption of milk and milk products. Comparatively, only a small proportion (4.6%) of Indian children and adolescents (n = 1000; aged: 5–18 years) living in Jaipur, Rajasthan failed to consume milk and milk products on a daily basis [19]. In line with this, one-tenth of the Jordanian adolescents (n = 302; aged: 11–18 years) also reported no serving of milk consumption [65]. Nevertheless, the consumption of milk and dairy products among adolescents has diminished considerably in industrialised nations over the recent past [66].

Over half of the respondents (52%) did not consume meat and meat derivatives. Similar proportion (51%) of rural adolescents (n = 150; aged: 11–19 years) from Himachal Pradesh, India followed a vegetarian diet i.e. they did not consume egg, fish, and meat [67]. The present sample was dominated by Hindu population (71%) and this could partly explain the low intakes of fish, meat, and poultry. This dominance of vegetarianism in the Indian culture [68] is triggered by religious beliefs i.e. Hinduism, Jainism and Buddhism supports abstinence from meat and meat derivatives [69]. A recent literature review describing trends in food and nutrition intake patterns in the different states of India indicates that majority of the Indians are vegetarians and animal foods are generally consumed less frequently [68]. One the other hand, evidence from predominantly meat-eating countries like Bangladesh [70], Pakistan [71], Bahrain [72], USA [73] and northern European nations [13] show high popularity of meat and meat products among adolescents.

Indian vegetarians mostly derive their protein from milk and its products as well as pulses and legumes [3]. Nonetheless, low intakes of pulses and legumes as well as other protein rich food sources may increase the underlying disease burden from undernutrition and micronutrient deficiency [7478]. Considering the enduring prevalence of nutritional deficiencies, Indian adolescents should be encouraged to consume foods rich in micronutrients like pulses, fruits, vegetables, oilseeds and animal foods [68, 79].

More girls in the present study demonstrated food habits that were more closely aligned with the national and international dietary guidelines [80, 6, 81] than the boys. Previous studies reflect similar gender differences observed in economically developed countries [22, 28, 82]. These gender differences could be attributed to greater health consciousness among women [24]. Moreover, compared to male adolescents, adolescent women may be more concerned with weight-control behaviours [83]. In addition, the masculinity literature suggests that masculine ideologies and norms play a significant role in discouraging men from eating healthily [8486].

The present study provides new evidence about the food intake patterns of adolescents in Kolkata City. An important message from the above findings is that dietary intakes in these adolescents consist of excess intakes of energy-dense, nutrient-poor foods and inadequate intakes of nutrient-dense foods. This supports the need for healthy eating initiatives aimed at increasing the consumption of fruits and vegetables, milk products, pulses and legumes while decreasing the consumption of energy-dense, nutrient-poor foods, and sugar-sweetened beverages in adolescents.

The health benefits associated with the consumption of nutritious foods like fruits, vegetables, and dairy products have been published widely [8790]. For example, vegetable intake is linked to reduced cardiovascular, cancer and all-cause mortality [88]. Similarly, regular fruit consumption reduces the risk of developing chronic diseases [89, 91]. Milk and milk products provide energy, protein, micronutrients and bioactive compounds essential for bone and dental integrity and maintenance of healthy body composition [66]. A systematic review and meta-analysis of dairy intake and adiposity suggest a modestly protective effect on adiposity during adolescence [90]. These numerous positive health outcomes highlight the significance of incorporating nutritious foods in adolescents’ daily diets.

Therefore, in order to encourage healthy eating among adolescents, Indian schools could perhaps incorporate the newly evolved food literacy concept [92] into its academic curriculum as food literacy has the potential of increasing fruit and vegetable intake in teenagers [93, 94]. An additional way to improve the dietary habits of adolescents may be through the implementation of effective school canteen policies. Healthy school canteen policies have been successful in improving the availability, accessibility, variety and affordability of healthy food choices in canteens [21, 9597], thus supporting students in consuming nutritious foods.

Strengths and limitations

The present findings need to be treated with caution since the self-administered FFQ was limited to food and drink items predominantly consumed in West Bengal and other parts of eastern India and do not represent all the foods eaten in other parts of India. Direct comparisons could not be drawn between the present findings and previous findings as different dietary assessment methodologies were employed. Moreover, the food items comprising the food groups in the current survey may not be identical to those used in other dietary surveys. Hitherto, studies have commonly used FFQ to monitor dietary assessment over a period of time (e.g. month) [22, 36] or 24 h dietary recall for estimating previous day’s food intake [98, 99]. However, the present study employed a novel dietary assessment technique - a meal-based FFQ was developed to assess the frequency of servings of food and beverage items consumed over the last 24 h. The use of convenience sampling might have affected the generalisability of the present findings as the study sample may not be representative of all the private secondary school students in the Kolkata metropolitan area, public school students or adolescents in other parts of India. However, considering, the high prevalence of overweight and obesity among private school adolescents [41], this cross-sectional survey was carried out in private schools. Moreover, private schools are responsible for providing education to 40% adolescents in urban India [100].

In addition, the present findings may be confounded by the seasonal variation in dietary intakes and social desirability bias. The use of self-administered FFQ could also pose certain limitations as dietary recall is dependent on the memory, literacy and numerical skills of the respondent [35, 101]. The FFQ also did not classify cereals as whole grains or refined cereals. Because of logistic limitations, criterion or convergent validity [35, 101] of the FFQ was not examined in this study. However, the FFQ was developed through extensive collaboration with students and therefore has high face validity, adding strength to the study. Moreover, the observed sex differences in reported food intake reflect known sex differences in food intakes [22, 28, 82] supporting the discriminative validity of the FFQ. Nevertheless, further validation of this FFQ is required. Another limitation is lack of data on demographic characteristics like weight status, body mass index (BMI), socio-economic status (SES) of parents and country of birth. Future research could explore the impact of these characteristics on Indian adolescents’ food consumption patterns. Regardless of these shortcomings, the high response rate, the large sample size, and the uniqueness of the dietary assessment tool, tailored to adolescents’ food habits, form the strengths of the study [22, 28, 82].

Conclusions

Overall, adolescents attending private secondary schools in Kolkata demonstrate unhealthy dietary patterns. Their frequent consumption of energy-dense, nutrient-poor foods and sugar-sweetened beverages and the omission of a variety of healthy foods from their daily diets puts them at risk of developing chronic degenerative diseases. In the light of the increasing prevalence of obesity and diet-related diseases, actions should be taken to enable adolescents to eat more healthily. These include effective public health initiatives such as the adoption of healthy school food policies and food literacy curricula to foster healthy eating habits among India’s 238 million adolescents.

Abbreviations

BMI: 

Body mass index

DAL: 

Dietary and Lifestyle

DALQ: 

Dietary and Lifestyle Questionnaire

FFQ: 

Food frequency questionnaire

HEAG: 

Health Ethics Advisory Group

SES: 

Socio-economic status

Declarations

Acknowledgements

The authors would like to thank all the adolescents, teachers and school principals who took part in the survey.

Funding

NR is supported by the Victoria-India Doctoral Scholarship. This research work received internal funding from the School of Exercise and Nutrition Sciences, Deakin University.

Availability of data and materials

The datasets used and analysed during the current study are available from the lead author on reasonable request.

Authors’ contributions

NR, LR, and AW conceived the study and its original design. NR drafted the initial form and all revisions of this paper. NR collected the data and analysed the data. NR, LR, and AW reviewed and approved the final manuscript.

Ethics approval and consent to participate

This cross-sectional survey was reviewed and approved by Deakin University’s Health Ethics Advisory Group (HEAG-H 187_2014).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia

References

  1. Kapil U, Sachdev HP. Urgent need to orient public health response to rapid nutrition transition. Indian J Community Med. 2012;37:207–10.View ArticlePubMedPubMed CentralGoogle Scholar
  2. Shetty P. Nutrition transition and its health outcomes. Indian J Pediatr. 2013;80:21–7.View ArticleGoogle Scholar
  3. Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L. Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes. 2011;3:278–92.View ArticlePubMedGoogle Scholar
  4. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21.View ArticlePubMedPubMed CentralGoogle Scholar
  5. Goyal A, Singh NP. Consumer perception about fast food in India: an exploratory study. Br Food J. 2007;109:182–95.View ArticleGoogle Scholar
  6. National Institute of Nutrition. Dietary guidelines for Indians : a manual. 2nd ed. Hyderabad: National Institute of Nutrition; 2010.Google Scholar
  7. World Health Organization: WHO calls for stronger focus on adolescent health. http://www.who.int/mediacentre/news/releases/2014/focus-adolescent-health/en/ (2016). Accessed 29 Nov 2016.
  8. Kelder SH, Perry CL, Klepp K-I, Lytle LL. Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health. 1994;84:1121–6.View ArticlePubMedPubMed CentralGoogle Scholar
  9. Wennberg M, Gustafsson PE, Wennberg P, Hammarström A. Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood. Public Health Nutr. 2015;18:122–9.View ArticlePubMedGoogle Scholar
  10. Rangan AM, Kwan J, Flood VM, Louie JCY, Gill TP. Changes in ‘extra’food intake among Australian children between 1995 and 2007. Obes Res Clin Pract. 2011;5:e55–63.View ArticleGoogle Scholar
  11. Zahra J, Ford T, Jodrell D. Cross-sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children. Child Care Health Dev. 2014;40:481–91.View ArticlePubMedGoogle Scholar
  12. Zapata LB, Bryant CA, McDermott RJ, Hefelfinger JA. Dietary and physical activity behaviors of middle school youth: the youth physical activity and nutrition survey. J Sch Health. 2008;78:9–18.View ArticlePubMedGoogle Scholar
  13. Diethelm K, Jankovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, Gonzalez-Gross M, Leclercq C, Gottrand F, Gilbert CC. Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (healthy lifestyle in Europe by nutrition in adolescence) study. Public Health Nutr. 2012;15:386–98.View ArticlePubMedGoogle Scholar
  14. Hong S, Bae HC, Kim HS, Park E-C. Variation in meal-skipping rates of Korean adolescents according to socio-economic status: results of the Korea youth risk behavior web-based survey. J Pre Med Public Health. 2014;47:158–68.View ArticleGoogle Scholar
  15. Savige G, MacFarlane A, Ball K, Worsley A, Crawford D. Snacking behaviours of adolescents and their association with skipping meals. Int J Behav Nutr Phys Act. 2007; doi:10.1186/1479-5868-4-36.
  16. Larson NI, Miller JM, Watts AW, Story MT, Neumark-Sztainer DR. Adolescent snacking behaviors are associated with dietary intake and weight status. J Nutr. 2016; doi:10.3945/jn.116.230334.
  17. Deka MK, Malhotra AK, Yadav R, Gupta S. Dietary pattern and nutritional deficiencies among urban adolescents. J Family Med Prim Care. 2015;4:364–8.View ArticlePubMedPubMed CentralGoogle Scholar
  18. Joseph N, Nelliyanil M, Rai S, YP RB, Kotian SM, Ghosh T, Singh M. Fast food consumption pattern and its association with overweight among high school boys in Mangalore city of southern India. J Clin Diagn Res. 2015; doi:10.7860/JCDR/2015/13103.5969.
  19. Jain A, Jain A, Pankaj J, Sharma B, Paliwal A. The study of obesity among children aged 5-18 years in Jaipur, Rajasthan. Muller J Med Sci Res. 2016;7:125–30.View ArticleGoogle Scholar
  20. Bachani D, Sogarwal R, Shukla SK, Shelat T, Gupta S. Dietary practices and physical activity performed by adolescent in selected districts of India. Indian J Community Health. 2013;25:171–7.Google Scholar
  21. Weichselbaum E, Buttriss JL. Diet, nutrition and schoolchildren: an update. Nutr Bull. 2014;39:9–73.View ArticleGoogle Scholar
  22. Savige GS, Ball K, Worsley A, Crawford D. Food intake patterns among Australian adolescents. Asia Pac J Clin Nutr. 2007;16:738–46.PubMedGoogle Scholar
  23. Lake AA, Mathers JC, Rugg-Gunn AJ, Adamson AJ. Longitudinal change in food habits between adolescence (11–12 years) and adulthood (32–33 years): the ASH30 study. J Public Health. 2006;28:10–6.View ArticleGoogle Scholar
  24. Wardle J, Haase AM, Steptoe A, Nillapun M, Jonwutiwes K, Bellisie F. Gender differences in food choice: the contribution of health beliefs and dieting. Ann Behav Med. 2004;27:107–16.View ArticlePubMedGoogle Scholar
  25. Fagerli RA, Wandel M. Gender differences in opinions and practices with regard to a "healthy diet". Appetite. 1999;32:171–90.View ArticlePubMedGoogle Scholar
  26. Rappoport L, Peters GR, Downey R, McCann T, Huff-Corzine L. Gender and age differences in food cognition. Appetite. 1993;20:33–52.View ArticlePubMedGoogle Scholar
  27. Australian Bureau of Statistics: Australian Health Survey: Nutrition First Results - Food and Nutrients, 2011–12. Canberra: Australian Bureau of Statistics, Commonwealth of Australia; 2014.Google Scholar
  28. Cooke LJ, Wardle J. Age and gender differences in children's food preferences. Br J Nutr. 2005;93:741–6.View ArticlePubMedGoogle Scholar
  29. National Family Health Survey-3: NFHS-3 Full Report India. Mumbai: International Institute for Population Sciences; 2007.Google Scholar
  30. National Sample Survey Office. Report of the National Sample Survey 66th round (July 2009–June 2010):nutritional intake in India. New Delhi: Ministry of Statistics and Programme Implementation, Government of India; 2012.Google Scholar
  31. Nu CT, MacLeod P, Barthelemy J. Effects of age and gender on adolescents' food habits and preferences. Food Qual Prefer. 1996;7:251–62.View ArticleGoogle Scholar
  32. Rathi N, Riddell L, Worsley A. Secondary school students’ views of food and nutrition education in Kolkata, India. Health Educ. 2017;117:310–22.View ArticleGoogle Scholar
  33. Smith KJ, Blizzard L, McNaughton SA, Gall SL, Dwyer T, Venn AJ. Daily eating frequency and cardiometabolic risk factors in young Australian adults: cross-sectional analyses. Br J Nutr. 2012;108:1086–94.View ArticlePubMedGoogle Scholar
  34. National Cancer Institute: ASA24. http://appliedresearch.cancer.gov/asa24/respondent/childrens.html#age_groups (2014). Accessed 12 Oct 2015.
  35. Nelson M, Bingham SA. Assessment of food consumption and nutrient intake. In: Margetts BM, Nelson M, editors. Design concepts in nutritional epidemiology. 2nd ed. New York: Oxford University Press; 1997. p. 123–69.View ArticleGoogle Scholar
  36. Bowen L, Bharathi AV, Kinra S, DeStavola B, Ness A, Shah E. Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India. Asia Pac J Clin Nutr. 2012;21:355–9.PubMedGoogle Scholar
  37. Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr. 2002;5:567–87.View ArticlePubMedGoogle Scholar
  38. Willett W. Nutritional epidemiology. 3rd ed. New York: Oxford University Press; 2013.Google Scholar
  39. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.View ArticlePubMedGoogle Scholar
  40. Kotecha PV, Patel SV, Baxi RK, Mazumdar VS, Misra S, Mehta KG, Diwanji M, Modi E. Dietary pattern of schoolgoing adolescents in urban Baroda, India. J Health Popul Nutr. 2013;31:490–6.PubMedPubMed CentralGoogle Scholar
  41. Subashini K, Sunmathi D, Nalinakumari S. Prevalence of overweight and obesity among private and government school children. Int J Adv Eng Sci. 2015;4:48–66.Google Scholar
  42. Maiti S, De D, Kazi MA, Bera TK, Ghosh D, Paul S. Overweight and obesity among early adolescent school girls in urban area of West Bengal, India: prevalence assessment using different reference standards. Int J Prev Med. 2013;4:1070–4.PubMedPubMed CentralGoogle Scholar
  43. Gupta S, Taraphdar P, Roy TG, Haldar D, Dey SK, Purkait B. The silent burden of anemia in school age children: a community based study in West Bengal. Indian J Med Sci. 2012;66:163–8.View ArticlePubMedGoogle Scholar
  44. Isharwal S, Arya S, Misra A, Wasir JS, Pandey RM, Rastogi K, Vikram NK, Luthra K, Sharma R. Dietary nutrients and insulin resistance in urban Asian Indian adolescents and young adults. Ann Nutr Metab. 2008;52:145–51.View ArticlePubMedGoogle Scholar
  45. Ambrosini GL, Emmett PM, Northstone K, Jebb SA. Tracking a dietary pattern associated with increased adiposity in childhood and adolescence. Obesity. 2014;22:458–65.View ArticlePubMedGoogle Scholar
  46. Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr. 2006;73:901–6.View ArticlePubMedGoogle Scholar
  47. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013;14:21–8.View ArticlePubMedGoogle Scholar
  48. Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA, Aït-Khaled N, Anderson H, Asher M, Björkstén B. Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study. BMJ Open. 2014; doi:10.1136/bmjopen-2014-005813.
  49. Dong D, Bilger M, van Dam RM, Finkelstein EA. Consumption of specific foods and beverages and excess weight gain among children and adolescents. Health Aff. 2015;34:1940–8.View ArticleGoogle Scholar
  50. Powell LM, Nguyen BT, Dietz WH. Energy and nutrient intake from pizza in the United States. Pediatrics. 2015;135:322–30.View ArticlePubMedPubMed CentralGoogle Scholar
  51. Kaushik JS, Narang M, Parakh A. Fast food consumption in children. Indian Pediatr. 2011;48:97–101.View ArticlePubMedGoogle Scholar
  52. Mahajan N, Grover K, Batra I. A comparison of food consumption pattern of urban and rural adolescent boys in Ludhiana District of Punjab. J Dairy Foods Home Sci. 2012;31:34–41.Google Scholar
  53. Jaworowska A, Blackham T, Davies IG, Stevenson L. Nutritional challenges and health implications of takeaway and fast food. Nutr Rev. 2013;71:310–8.View ArticlePubMedGoogle Scholar
  54. Smith KJ, McNaughton SA, Gall SL, Blizzard L, Dwyer T, Venn AJ. Takeaway food consumption and its associations with diet quality and abdominal obesity: a cross-sectional study of young adults. Int J Behav Nutr Phys Act. 2009; doi:10.1186/1479-5868-6-29.
  55. Pereira MA, Kartashov AI, Ebbeling CB, Van Horn L, Slattery ML, Jacobs DR, Ludwig DS. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005;365:36–42.View ArticlePubMedGoogle Scholar
  56. Duffey KJ, Gordon-Larsen P, Steffen LM, Jacobs DR, Popkin BM. Regular consumption from fast food establishments relative to other restaurants is differentially associated with metabolic outcomes in young adults. J Nutr. 2009;139:2113–8.View ArticlePubMedPubMed CentralGoogle Scholar
  57. Rangan AM, Kwan JS, Louie JC, Flood VM, Gill TP. Changes in core food intake among Australian children between 1995 and 2007. Eur J Clin Nutr. 2011;65:1201–10.View ArticlePubMedGoogle Scholar
  58. Gupta N, Shah P, Goel K, Misra A, Rastogi K, Vikram NK, Kumari V, Pandey RM, Kondal D, Wasir JS. Imbalanced dietary profile, anthropometry, and lipids in urban Asian Indian adolescents and young adults. J Am Coll Nutr. 2010;29:81–91.View ArticlePubMedGoogle Scholar
  59. Peltzer K, Pengpid S. Fruits and vegetables consumption and associated factors among in-school adolescents in five southeast Asian countries. Int J Environ Res Public Health. 2012;9:3575–87.View ArticlePubMedPubMed CentralGoogle Scholar
  60. National Sample Survey Organisation. Report of the National Sample Survey 61st round (July 2004–June 2005): nutritional intake in India 2004–2005. New Delhi: Ministry of Statistics and Programme Implementation, Government of India; 2007.Google Scholar
  61. Bureau NNM. Diet and nutritional status of rural population and prevalence of hypertension among adults in rural areas. Hyderabad: National Institute of Nutrition; 2006.Google Scholar
  62. Swaminathan M, Bhavani R. Food production & availability-essential prerequisites for sustainable food security. Indian J Med Res. 2013;138:383–91.PubMedPubMed CentralGoogle Scholar
  63. Ramachandran P. Nutrition transition in India. NFI Bull. 2011;32:1–8.Google Scholar
  64. Bellisle F, Hébel P, Colin J, Reyé B, Hopkins S. Consumption of whole grains in French children, adolescents and adults. Br J Nutr. 2014;112:1674–84.View ArticlePubMedPubMed CentralGoogle Scholar
  65. El-Qudah JM. Food habits and physical activity patterns among Jordanian adolescents aged 11-18 years. World Appl Sci J. 2014;29:1213–9.Google Scholar
  66. Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev. 2014;72:68–81.View ArticlePubMedGoogle Scholar
  67. Das G, Pathania R, Das G. Assessment of dietary pattern of adolescents in Himachal Pradesh of India. J Paramed Sci. 2016;7:1–7.Google Scholar
  68. Vecchio MG, Paramesh EC, Paramesh H, Loganes C, Ballali S, Gafare CE, Verduci E, Gulati A. Types of food and nutrient intake in India: a literature review. Indian J Pediatr. 2014;81:17–22.View ArticlePubMedGoogle Scholar
  69. Jayanthi V. Vegetarianism in India. Perit Dial Int. 2001;21:S322–5.PubMedGoogle Scholar
  70. Alam N, Roy SK, Ahmed T, Ahmed AS. Nutritional status, dietary intake, and relevant knowledge of adolescent girls in rural Bangladesh. J Health Popul Nutr. 2010;28:86–94.PubMedPubMed CentralGoogle Scholar
  71. Paracha P, Bakht S, Paracha S, Vriesekoop F, Alam I, Din Z, Ullah N. Nutritional status, dietary practic-es and physical activities of adoles-cents in public and private schools of Karachi. Pakistan Obes Res. 2016;3:30–9.Google Scholar
  72. Musaiger AO, Bader Z, Al-Roomi K, D’Souza R. Dietary and lifestyle habits amongst adolescents in Bahrain. Food Nutr Res. 2011; doi:10.3402/fnr.v55i0.7122.
  73. Agarwal S, Fulgoni VL, Berg EP. Association of lunch meat consumption with nutrient intake, diet quality and health risk factors in US children and adults: NHANES 2007–2010. Nutr J. 2015; doi:10.1186/s12937-015-0118-9.
  74. Saeed A, Tariq I, Atukorala S, Arlappa N. Micronutrient deficiencies in South Asia - current status and strategies. Trends Food Sci Technol. 2013;31:55–62.View ArticleGoogle Scholar
  75. Rajagopalan S. Nutrition challenges in the next decade. Food Nutr Bull. 2003;24:275–80.View ArticlePubMedGoogle Scholar
  76. Sabale RV, Kowli SS, Chowdary PH. Prevalence of anemia and its determinants in urban school-going children of Mumbai. Int J Med Public Health. 2013;3:325–9.View ArticleGoogle Scholar
  77. Sinha A, Jonas JB, Kulkarni M, Nangia V. Vitamin a deficiency in school children in urban central India: the Central India children eye study. Arch Ophthalmol. 2011;129:1095–6.View ArticlePubMedGoogle Scholar
  78. Chaudhary C, Pathak R, Ahluwalia S, Goel R, Devgan S. Iodine deficiency disorder in children aged 6–12 years of Ambala, Haryana. Indian Pediatr. 2013;50:587–9.View ArticlePubMedGoogle Scholar
  79. Gibson R, Donovan U, Heath AM. Dietary strategies to improve the iron and zinc nutriture of young women following a vegetarian diet. Plant Foods Hum Nutr. 1997;51:1–16.View ArticlePubMedGoogle Scholar
  80. Australian Government: Healthy eating for children. https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55f_children_brochure.pdf (2016). Accessed 27 Sept 2016.
  81. United States Department of Agriculture: USDA: ChooseMyPlate.gov. https://www.choosemyplate.gov/MyPlate (2016). Accessed 12 Dec 2016.
  82. World Health Organization: Young People's Health in Context: Health Behaviour in School-aged Children (HBSC) study: International report from the 2001/2002 survey. Copenhagen: World Health Organization, Regional Office for Europe; 2004.Google Scholar
  83. Sweeting H, West P. Gender differences in weight related concerns in early to late adolescence. J Epidemiol Community Health. 2002;56:700–1.View ArticlePubMedPubMed CentralGoogle Scholar
  84. Wang WC, Worsley A, Cunningham EG. Social ideological influences on reported food consumption and BMI. Int J Behav Nutr Phys Act. 2008; doi:10.1186/1479-5868-5-20.
  85. Vartanian LR, Herman CP, Polivy J. Consumption stereotypes and impression management: how you are what you eat. Appetite. 2007;48:265–77.View ArticlePubMedGoogle Scholar
  86. Prättälä R, Paalanen L, Grinberga D, Helasoja V, Kasmel A, Petkeviciene J. Gender differences in the consumption of meat, fruit and vegetables are similar in Finland and the Baltic countries. Eur J Pub Health. 2006;17:520–5.View ArticleGoogle Scholar
  87. Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012;3:506–16.View ArticlePubMedPubMed CentralGoogle Scholar
  88. Oyebode O, Gordon-Dseagu V, Walker A, Mindell JS. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of health survey for England data. J Epidemiol Community Health. 2014; doi:10.1136/jech-2013-203500.
  89. Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4:384S–92S.View ArticlePubMedPubMed CentralGoogle Scholar
  90. Dror D. Dairy consumption and pre-school, school-age and adolescent obesity in developed countries: a systematic review and meta-analysis. Obes Rev. 2014;15:516–27.View ArticlePubMedGoogle Scholar
  91. Manganaris GA, Goulas V, Vicente AR, Terry LA. Berry antioxidants: small fruits providing large benefits. J Sci Food Agric. 2014;94:825–33.View ArticlePubMedGoogle Scholar
  92. Vidgen HA, Gallegos D. Defining food literacy and its components. Appetite. 2014;76:50–9.View ArticlePubMedGoogle Scholar
  93. Utter J, Denny S, Lucassen M, Dyson B. Adolescent cooking abilities and behaviors: associations with nutrition and emotional well-being. J Nutr Educ Behav. 2016;48:35–41.View ArticlePubMedGoogle Scholar
  94. Burrows TL, Lucas H, Morgan PJ, Bray J, Collins CE. Impact evaluation of an after-school cooking skills program in a disadvantaged community: back to basics. Can J Diet Pract Res. 2015;76:1–7.View ArticleGoogle Scholar
  95. Worsley T. Nutrition promotion: theories and methods, systems and settings. Crows Nest, New South Wales: Allen & Unwin; 2008.Google Scholar
  96. Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, Karpyn A, Kumanyika S, Shults J. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121:794–802.View ArticleGoogle Scholar
  97. Townsend N, Murphy S, Moore L. The more schools do to promote healthy eating, the healthier the dietary choices by students. J Epidemiol Community Health. 2011;65:889–95.View ArticlePubMedGoogle Scholar
  98. Baird DL, Syrette J, Hendrie GA, Riley MD, Bowen J, Noakes M. Dairy food intake of Australian children and adolescents 2-16 years of age: 2007 Australian National Children's nutrition and physical activity survey. Public Health Nutr. 2012;15:2060–73.View ArticlePubMedGoogle Scholar
  99. Rangan AM, Randall D, Hector DJ, Gill TP, Webb KL. Consumption of 'extra' foods by Australian children: types, quantities and contribution to energy and nutrient intakes. Eur J Clin Nutr. 2008;62:356–64.View ArticlePubMedGoogle Scholar
  100. Kingdon GG. The progress of school education in India. Oxford Rev Econ Pol. 2007;23:168–95.View ArticleGoogle Scholar
  101. Magarey A, Watson J, Golley RK, Burrows T, Sutherland R, McNaughton SA, Denney-Wilson E, Campbell K, Collins C. Assessing dietary intake in children and adolescents: considerations and recommendations for obesity research. Int J Pediatr Obes. 2011;6:2–11.View ArticlePubMedGoogle Scholar

Copyright

Advertisement