A comparative analysis of the nutrition status, nutrition knowledge and food frequency of adolescents attending an urban versus a peri-urban school in Hilton, KwaZulu-Natal.

Abstract

Adolescence is an important stage in human development. Optimum nutrition is crucial during this period, as additional nutrient requirements are needed to promote growth and maturation. With the nutrition transition in low-to-middle-income countries (LMICs), adolescents are increasingly exposed to energy-dense, nutrient poor foods; however it is not entirely clear the impact of socioeconomic status, in particular household food insecurity, on the consumption frequency of these foods. The impact nutrition knowledge may have on the dietary choices adolescents make is also unclear. Poor food choices among adolescents can contribute towards overweight/obesity and stunting, leading to the susceptibility to both communicable and non-communicable diseases (NCDs) in adulthood. The objective of this study was to determine the prevalence of overweight/obesity and stunting among South African adolescents from different socioeconomic backgrounds, in relation to their nutrition knowledge, household food insecurity status, and frequency of food consumption. The study consisted of a cross-sectional descriptive survey conducted among learners from a high-income, private urban school and a low-income, government peri-urban school in Hilton, KwaZulu-Natal. A total of 98 grade nine to eleven learners from the urban school and 111 grade nine to eleven learners from the peri-urban school volunteered to participate (N= 209). Nutritional status was determined by anthropometric measurements that included weight, height and MUAC. Subsequently BMI was calculated. Nutrition knowledge and food frequency were determined via non-quantified nutrition knowledge and food frequency questionnaires. A socio-demographic questionnaire (SDQ) was used to collect information on parental level of education and employment status. Household food security was determined using the Household Food Insecurity Access Scale (HFIAS). A higher prevalence of overweight and obesity was observed among urban learners compared to their peri-urban counterparts, however only for the boys as peri-urban girls had a notable prevalence of overweight and obesity compared to urban girls. Stunting was present among peri-urban learners but virtually absent in their urban counterparts, which was indicative of a double-burden of overweight/obesity and stunting within the peri-urban group. Peri-urban learners had parents with lower education and employment levels compared to urban learners. Adolescents with mothers that were educated up to tertiary level were associated with a higher nutrition knowledge scores (NKS). Urban learners had a higher mean NKS than peri-urban learners; however it did not necessarily reflect healthier food choices, as urban learners had a high consumption frequency of fatty red and processed meat, white bread and fizzy drinks. Peri-urban learners reported a higher preference for deep-fried, high-fat snacks such as vetkoeks and samosas; which may be related to the high levels of household food insecurity that was noted. Among grade ten peri-urban learners, 50% reported having no food to eat of any kind in the household, with 5% reporting that it occurred often. Poor dietary habits among adolescents in general were observed in this study; although food sources varied between urban and peri-urban learners possibly due to differences in cost and availability of food items. A lower SES was an underlying factor for the consumption of energy-dense foods among peri-urban learners; while a higher SES was associated with the consumption of more expensive fatty foods among urban learners. Thus, the risk of malnutrition (overweight/obesity and stunting) and subsequent disease susceptibility is present in both groups as a result.