- Open Access
Food consumption patterns of adolescents aged 14–16 years in Kolkata, India
Nutrition Journal volume 16, Article number: 50 (2017)
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.
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.
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.
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.
Triggered by a complex mix of marketing, social, and economic policies, the Indian nutrition transition  has been associated with a significant change in the lifestyles and the dietary habits of urban Indians [2,3,4]. 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 . 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 [10,11,12]. Adolescents from these countries have high rates of consumption of energy-dense, nutrient-poor foods and inadequate consumption of fruits and vegetables [10,11,12,13]. In addition, adolescents also exhibit unhealthy eating habits such as meal skipping and snacking on fast foods [14,15,16]. Although limited, evidence from developing countries including India also report similar findings [17,18,19,20]. 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 [24,25,26]. Women are more likely to avoid high-fat foods, consume more fruits and fibre and limit salt intake  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 . Similarly, British girls preferred eating fruits and vegetables more than boys, whereas boys preferred eating nutrient-poor foods more than girls . 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  nor the National Sample Survey Office  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.
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 . 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 .
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  and the first pass of ASA24-Kids-2014 program  informed the structure of the food list i.e. meal categorisation in the FFQ. Both the CDAH study  and the ASA24-Kids program  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 . 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.
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.
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 ; a validated FFQ suitable for use among urban and rural adult Indian populations . However, this validated FFQ  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).
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.
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 . 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 .
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.
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).
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.
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).
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  and weight gain among nutritionally vulnerable Indian adolescents [41,42,43,44]. 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 . 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 .
Because of their hyper palatability, attractiveness and ready-to-eat attributes , these non-essential foods are becoming a frequent and dominant component of adolescents’ diets in most economically developed countries [22, 48,49,50] 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 , including obesity , insulin resistance  and heart disease . To prevent these diet-related chronic diseases, energy-dense snacks and beverages should be consumed sparingly or not all .
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 . 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) . 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) . 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 . 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 . 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 . Typically, cereals form the staple diet of the Indian population ; 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 . Similar decline in the consumption of whole grains have also been reported in French children, adolescents and adults . 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 .
India is the largest producer of milk in the world ; 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 . In line with this, one-tenth of the Jordanian adolescents (n = 302; aged: 11–18 years) also reported no serving of milk consumption . Nevertheless, the consumption of milk and dairy products among adolescents has diminished considerably in industrialised nations over the recent past .
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 . 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  is triggered by religious beliefs i.e. Hinduism, Jainism and Buddhism supports abstinence from meat and meat derivatives . 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 . One the other hand, evidence from predominantly meat-eating countries like Bangladesh , Pakistan , Bahrain , USA  and northern European nations  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 . 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 [74,75,76,77,78]. 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 . Moreover, compared to male adolescents, adolescent women may be more concerned with weight-control behaviours . In addition, the masculinity literature suggests that masculine ideologies and norms play a significant role in discouraging men from eating healthily [84,85,86].
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 [87,88,89,90]. For example, vegetable intake is linked to reduced cardiovascular, cancer and all-cause mortality . 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 . A systematic review and meta-analysis of dairy intake and adiposity suggest a modestly protective effect on adiposity during adolescence . 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  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, 95,96,97], 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 , this cross-sectional survey was carried out in private schools. Moreover, private schools are responsible for providing education to 40% adolescents in urban India .
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].
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.
Body mass index
Dietary and Lifestyle
Dietary and Lifestyle Questionnaire
Food frequency questionnaire
Health Ethics Advisory Group
Kapil U, Sachdev HP. Urgent need to orient public health response to rapid nutrition transition. Indian J Community Med. 2012;37:207–10.
Shetty P. Nutrition transition and its health outcomes. Indian J Pediatr. 2013;80:21–7.
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.
Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21.
Goyal A, Singh NP. Consumer perception about fast food in India: an exploratory study. Br Food J. 2007;109:182–95.
National Institute of Nutrition. Dietary guidelines for Indians : a manual. 2nd ed. Hyderabad: National Institute of Nutrition; 2010.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Weichselbaum E, Buttriss JL. Diet, nutrition and schoolchildren: an update. Nutr Bull. 2014;39:9–73.
Savige GS, Ball K, Worsley A, Crawford D. Food intake patterns among Australian adolescents. Asia Pac J Clin Nutr. 2007;16:738–46.
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.
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.
Fagerli RA, Wandel M. Gender differences in opinions and practices with regard to a "healthy diet". Appetite. 1999;32:171–90.
Rappoport L, Peters GR, Downey R, McCann T, Huff-Corzine L. Gender and age differences in food cognition. Appetite. 1993;20:33–52.
Australian Bureau of Statistics: Australian Health Survey: Nutrition First Results - Food and Nutrients, 2011–12. Canberra: Australian Bureau of Statistics, Commonwealth of Australia; 2014.
Cooke LJ, Wardle J. Age and gender differences in children's food preferences. Br J Nutr. 2005;93:741–6.
National Family Health Survey-3: NFHS-3 Full Report India. Mumbai: International Institute for Population Sciences; 2007.
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.
Nu CT, MacLeod P, Barthelemy J. Effects of age and gender on adolescents' food habits and preferences. Food Qual Prefer. 1996;7:251–62.
Rathi N, Riddell L, Worsley A. Secondary school students’ views of food and nutrition education in Kolkata, India. Health Educ. 2017;117:310–22.
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.
National Cancer Institute: ASA24. http://appliedresearch.cancer.gov/asa24/respondent/childrens.html#age_groups (2014). Accessed 12 Oct 2015.
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.
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.
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.
Willett W. Nutritional epidemiology. 3rd ed. New York: Oxford University Press; 2013.
Cohen J. A power primer. Psychol Bull. 1992;112:155–9.
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.
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.
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.
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.
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.
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.
Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr. 2006;73:901–6.
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.
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.
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.
Powell LM, Nguyen BT, Dietz WH. Energy and nutrient intake from pizza in the United States. Pediatrics. 2015;135:322–30.
Kaushik JS, Narang M, Parakh A. Fast food consumption in children. Indian Pediatr. 2011;48:97–101.
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.
Jaworowska A, Blackham T, Davies IG, Stevenson L. Nutritional challenges and health implications of takeaway and fast food. Nutr Rev. 2013;71:310–8.
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.
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.
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.
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.
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.
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.
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.
Bureau NNM. Diet and nutritional status of rural population and prevalence of hypertension among adults in rural areas. Hyderabad: National Institute of Nutrition; 2006.
Swaminathan M, Bhavani R. Food production & availability-essential prerequisites for sustainable food security. Indian J Med Res. 2013;138:383–91.
Ramachandran P. Nutrition transition in India. NFI Bull. 2011;32:1–8.
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.
El-Qudah JM. Food habits and physical activity patterns among Jordanian adolescents aged 11-18 years. World Appl Sci J. 2014;29:1213–9.
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.
Das G, Pathania R, Das G. Assessment of dietary pattern of adolescents in Himachal Pradesh of India. J Paramed Sci. 2016;7:1–7.
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.
Jayanthi V. Vegetarianism in India. Perit Dial Int. 2001;21:S322–5.
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.
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.
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.
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.
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.
Rajagopalan S. Nutrition challenges in the next decade. Food Nutr Bull. 2003;24:275–80.
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.
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.
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.
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.
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.
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.
Sweeting H, West P. Gender differences in weight related concerns in early to late adolescence. J Epidemiol Community Health. 2002;56:700–1.
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.
Vartanian LR, Herman CP, Polivy J. Consumption stereotypes and impression management: how you are what you eat. Appetite. 2007;48:265–77.
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.
Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012;3:506–16.
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.
Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4:384S–92S.
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.
Manganaris GA, Goulas V, Vicente AR, Terry LA. Berry antioxidants: small fruits providing large benefits. J Sci Food Agric. 2014;94:825–33.
Vidgen HA, Gallegos D. Defining food literacy and its components. Appetite. 2014;76:50–9.
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.
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.
Worsley T. Nutrition promotion: theories and methods, systems and settings. Crows Nest, New South Wales: Allen & Unwin; 2008.
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.
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.
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.
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.
Kingdon GG. The progress of school education in India. Oxford Rev Econ Pol. 2007;23:168–95.
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.
The authors would like to thank all the adolescents, teachers and school principals who took part in the survey.
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.
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).
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The authors declare that they have no competing interests.
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Rathi, N., Riddell, L. & Worsley, A. Food consumption patterns of adolescents aged 14–16 years in Kolkata, India. Nutr J 16, 50 (2017). https://doi.org/10.1186/s12937-017-0272-3
- Food habits