Adolescent nutrition in rural Bangladesh : Studies on diet, cardiometabolic indicators, physical activity and fitness in the MINIMat cohort

Sammanfattning: Adolescent nutrition is crucial for curbing non-communicable disease burden among transitioning populations in resource-limited settings. This thesis explored the gender and socio-economic stratification of diet, physical activity (PA) and fitness, and the relationship of these modifiable dimensions of nutrition with cardiometabolic risk among adolescents of a birth cohort in rural Bangladesh. Data were collected during the 15-year follow-up of the MINIMat (Maternal and Infant Nutrition Interventions in Matlab) cohort through household survey incorporating a 24-hour dietary recall, accelerometry, fitness tests, anthropometric assessment and plasma assay. Statistical descriptive methods, cluster analysis and regression models were employed.The prevalence of inadequate dietary diversity (DD) was 42.3%. Nearly 83% adolescents consumed at least one ultra-processed or deep-fried item. Adolescents from the poorest and food insecure households were more likely to have inadequate DD. Cluster analysis identified four dietary patterns including one marked by fairly high DD concurrent with greater consumption of unhealthy foods. The odds of consuming unhealthy foods were substantially higher among the boys. The adolescents spent about 69% of the daily awake time being sedentary and another 7% in moderate-to-vigorous activity (MVPA). The girls were more sedentary and engaged in moderate-intensity PA more than boys; whereas total and vigorous-intensity activity (VPA), and fitness were higher among the boys. Higher socio-economic status was associated with higher sedentary time and lower PA and fitness. Small, negative associations of Fish- and Meat-dominant diet clusters with plasma triglyceride were observed among the boys. Sedentary time displayed weak, positive associations with waist circumference (WC) and insulin resistance. Greater MVPA and VPA, and higher muscular fitness were associated with lower levels of cardiometabolic indicators. The associations were notably strong for VPA and upper body muscular fitness, and generally more pronounced among the boys – except those with WC.The findings underscored a clear gender and socio-economic stratification of diet, PA and fitness alongside beneficial impacts of PA and muscular fitness on cardiometabolic risk profile at 15 years of age. VPA represents a potential target for preventive measures tailored to adolescents. Adolescent-responsive policies and continued efforts to alleviate poverty are needed for improving adolescent nutrition in rural Bangladesh.