A PATH ANALYSIS ON THE NOURISHMENT DIRECTED HAEMOGLOBIN STATUS AND RESULTING ENDURANCE CAPACITY OF ADOLESCENT INDIAN RURAL GIRLS

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1 J. Dairying, Foods & H.S., 29 (1) : 47-51, 21 AGRICULTURAL RESEARCH COMMUNICATION CENTRE / indianjournals.com A PATH ANALYSIS ON THE NOURISHMENT DIRECTED HAEMOGLOBIN STATUS AND RESULTING ENDURANCE CAPACITY OF ADOLESCENT INDIAN RURAL GIRLS Seeja Thomachan Panjikkaran and V. Usha. College of Horticulture, Kerala Agricultural University, Vellanikkara, Thrissur , India ABSTRACT A significant positive correlation of blood hemoglobin status and the endurance capacity as the function of nutritional status of a cross-sectional population of adolescent rural girls (13-15 years) of Thrissur district, Kerala State, India has been reported. Anthropometric measurements revealed that mean body weight and height of adolescent girls were low compared to Indian standards and BMI indicated a high prevalence (44 per cent) of chronic energy deficiency-grade III. Very high portion (88.7 per cent) of the rural population of adolescent girls had energy intakes below normal standards. The prevalence of major deficiency diseases like dental caries, pigmented skins, glossitis and anaemia were also studied as functional responses. More than half of the population was suffering from either or more of the deficiencies and among the clinically identified symptoms, iron deficiency anaemia was most prevalent (3. per cent). Only 4 per cent had acceptable levels of haemoglobin (>12g/dl). Though none of the adolescent girls had excellent or even good endurance capacity, two-way frequency analysis revealed a consistent increase in the same with acceptable levels of haemoglobin (Y = 3.33 X ) and the nutritional status. The alarming status of malnutrition and its implications on rural girls is detailed hereunder. Key words: Adolescence, Anaemia, BMI, Endurance-capacity, Haemoglobin, Iron deficiency, Nutrition. INTRODUCTION and productivity (Satyanarayana, 1989). Work Adolescence is a vulnerable period in human capacity and work output depends on the quantity life cycle (Mussein, 199) characterized by rapid and quality of their calorie and nutrient intake and growth and development coupled with innumerous the resulting nutritional status. Prevalence of physiological and psychological changes (NNMB, malnutrition among adolescent girls is a matter of 2). During the period of adolescent growth, more concern from the point of view of the quality of future than a third of adult weight and nearly half of the generation. With these points in consideration, this adult height is acquired. The gain in skeletal weight study was conducted to understand the nutritional is most rapid during the adolescent growth spurt. status, level of haemoglobin and its relation to the Blood volume and muscle mass increase and this in endurance capacity, prevalence of anaemia and any turn are found to increase the need for haemoglobin other deficiency diseases in a cross sectional formation. Endurance is undoubtedly one of the most population of the rural adolescent girls of India. important criteria that measure the nutritional and MATERIAL AND METHODS health status of the population. This assumes the One hundred and fifty school-going maximum dynamism especially in the adolescent adolescent girls from Thrissur district of Kerala State, phase of human development. Incidence of lower South India (Latitude 1.3 o N, Longitude o E), haemoglobin levels leading to anaemia during between the age group of years, were adolescents is high in girls due to rapid growth, onset selected for the study. The subjects were selected of menarche and under nutrition. This is particularly using two stage simple random sampling and the important in rural mass of developing countries (Patel study was for a period of two years. Results from et al., 27). Anaemia, irrespective of iron deficiency the anthropometric survey on the height and weight induced or physiological, impairs physical efficiency were used to calculate the Body Mass Index (Weight For correspondence, seejathomachan@gmail.com, Phone: ,

2 48 J. DAIRYING, FOODS & H.S. (kg)/height (M 2 ) and compared with the relations defined by James et al., (1988). Clinical examination was conducted with the help of a qualified physician to identify manifestation of symptoms related to malnutrition. Haemoglobin levels were measured using cyanmethaemoglobin method suggested by National Institute of Nutrition (NIN, 1983) and based on the specifications by WHO (1992), the population was classified in Deficient, Low (mild), Low (normal) and Acceptable. A one day food weighment survey was conducted to determine the actual food and nutrient intake. Endurance capacity of adolescent girls had been assessed by Harvard s step test (Duration of exercise in seconds/ (2.2XPulse count) and standard classification defined by Brouha, (1943) was followed. Statistical assessment techniques included were student t-test, correlation and regression analyses. For arriving at the quantitative relation between haemoglobin levels (g/ dl) and endurance capacity, mean haemoglobin content of a particular class was compared with the cumulative endurance of the population under study (product of the mean endurance index of that particular class and the per cent population falling in that particular category) using regression analysis. RESULTS AND DISCUSSION BMI had shown a good correlation with fatness of the population under study. An alarmingly high (44.) per cent of the population was revealed to be suffering from Chronic energy deficiency (CED) of Grade III (Table 1). Grade I and II chronic energy deficiency has claimed an equal prevalence of 18 per cent, making the chronic energy deficiency of the population under study, as high as 8 per cent. Only 1 per cent of adolescent girls were having normal nutritional status. A noteworthy point may be that unlike the developed countries the obesity levels were as low as 1.3 per cent, that too under the grade I. Manifestation of clinical deficiency symptoms were observed among half of the population under study (Table 2). Anaemia, an indicator of iron deficiency, was observed to be the major (3%) deficiency symptom. Prevalence of dental caries, an indicator of calcium deficiency was also significant (13.3%). Other deficiencies such as glossitis and pigmented skin were also observed (3.3 and 3.4 per cent respectively), though not as high as anaemia or dental caries. Clinical estimation of blood haemoglobin studies had shown that 2 and 4 per cent of the population were suffering from mild or moderate anaemia respectively (Table 3). Actual food and nutrient intake of the adolescent girls was assessed by a one day food weighment survey. The food intake was compared with the Recommended Dietary Allowance (RDA) values (ICMR, 1989). The mean values regarding consumption of green leafy vegetables, other vegetables, fruits, milk and milk products, fats/ oils, meat/ fish/ egg, sugar and jaggery were significantly low when compared to RDA values using t test. Among nutrient intake only energy intake was found Table 1: Distribution of adolescent girls (13 15 years) based on BMI BMI Nutritional status (James et al., 1988) Girls (%) < >3 Chronic energy deficiency (CED) Grade III Chronic energy deficiency (CED) Grade II Chronic energy deficiency (CED) Grade I Low normal Normal Obese grade I Obese grade - II Total 1

3 Table 2: Deficiency symptoms in the population under study as revealed through the clinical examination of adolescent girls Prevalence and types of deficiencies Girls ( % ) Clinical symptoms Present Absent Type of clinical symptoms a) Dental caries b) Pigmented skin c) Glossitis d) Anaemia Vol. 29, No. 1, Total 5. Table 3: Haemoglobin levels of adolescent girls WHO-Hb levels (g/dl) Presumptive diagnosis Girls (%) < >12 Deficient Low (Mild) Low (Normal) Acceptable Table 4: Classes of adolescent girls based on their endurance capacity Index < >9 Physical condition (Brouha, 1943) Poor Low average High average Good Excellent Girls (%) to be adequate. The intake of all other nutrients was significantly low when compared to RDA values (Gopalan et al., 1989). On analyzing the endurance capacity using Harvard s step test and classifying the population by following the guidelines given by Brouha, (1943), it was found that none of the adolescent girls in the entire population had excellent or even good endurance capacity. The entire population had only an average endurance capacity of which per cent had belonged to low average class (Table 4). Endurance capacity and haemoglobin levels of adolescent girls revealed that girls with acceptable haemoglobin had high average endurance capacity (Pearson bivariate coreelation, r=.96 at 1% significance). Further, two-way frequency analysis had confirmed that there was a consistent increase in the endurance capacity (as assessed by weight for age and height for age) of the girls as their nutritional status improved and this linear relationship is presented in Figure 1. Table 5 again reveals a general increase in the endurance capacity of the population under study with the haemoglobin levels. Dependence of endurance capacity on haemoglobin was estimated by the regression Y = 3.33 X The regression was significant at 1 per cent level. Body Mass Index revealed high prevalence (44%) of chronic energy deficiency (CED) of Grade III. The standard grading system as proposed by James et al. (1988) points to the fact that in a common population, Grade III energy deficiency should not exceed 5 per cent. The BMI was found to be useful for the assessment of the short duration malnutrition among infants, preschool children and adults (Rao, 1987). Prevalence rate of CED is used as a measure of (adult) nutrition and health status for any region or country. That these rates in India have been rather high particularly for women is a matter of concern. As Floud (1992) and Fogel (1997) have shown that among several anthropometric measures weight-for-height or (BMI) is an effective predictor of morbidity and mortality rates. BMI is shown to indicate the current nutritional status thereby reflecting the difference between food intake and the demand on these intakes. The present study uses this indicator as a measure of health status. Due to limited information base on BMI, very few studies in India have analysed the determinants of CED, (which is the current status) and even far fewer studies estimating the persons vulnerable to it (that is future status). This condition is quite grave, demanding immediate concern on nutritional

4 5 J. DAIRYING, FOODS & H.S. Table 5: Endurance capacity and haemoglobin levels of adolescent girls Haemoglobin levels (g/dl) Endurance capacity Poor<55 Low average55-64 High average65-75 Total Deficient (<8) Low Mild (8-1) 2 2 Low Normal (1-12) Acceptable (>12) 4 4 Total Figure 1: Surface plot showing significant positive correlation between endurance capacity (Y-axis) and the haemoglobin levels (X-axis) in the population supplementation (Rao and Vijayaraghavan, 1996). Previously, a similarly high prevalence of chronic energy deficiency of grade III in India was reported from Rajasthan (North-Western India, Chaturvedi et al., (1996) and Uttar Pradesh (Northern Central India, Maithili et al., 26) among adolescent girls at the age group of 1 15 years. This suggests that with no regional and temporal bias, malnutrition is wide prevalent in rural India. Clinical examination is the most important part of nutritional assessment as direct information of signs and symptoms of prevalent dietary deficiencies are obtained (Swaminathan, 1986). Suman, (2) also has reported a high prevalence of dental caries and anaemia among adolescents in Kerala in the age group of years. She had further shown that a reduction in the prevalence of anaemia in a population of adolescent girls is possible through a dietary supplementation with amaranth, an iron rich vegetable (Gopalan et al., 1989). This shows the major reason for the anaemia in Indian population is Iron deficiency leading to poor haemoglobin status. In the present study, more than 5 per cent of adolescent girls were having low haemoglobin levels and this chronic condition is referred as silent killing (WHO, 1992). Vasanthi et al., (1994) also reported that 25 5 per cent of girls becoming anaemic by the time they reach menarche. Apart from these, pigmented skin, a Niacin deficiency disease and Glossitis, a Riboflavin

5 deficiency symptom were also prevalent, though comparatively lesser than the anaemia, were also observed as confirmatory for the ill-nourished status of the rural Indian girls. Majority of the population had average or low average endurance capacity. Results of the two-way frequency analysis are direct to the point of malnutrition since there was a consistent increase in the endurance capacity with nutrition. An association between small body size and impaired work capacity is an accepted fact and the parametrical proof for this is given by Satyanarayana et al. (198). Similarly, the path of the correlation between nutrition and endurance was better clarified with the highly significant correlation between endurance capacity and haemoglobin levels. Girls with acceptable haemoglobin showed high average endurance capacity. Bakalion et al. (1994) found that physical performance of school girls (11 Vol. 29, No. 1, years) with anaemia was low when compared with the performance of normal individuals. This is because anaemic subjects have to use higher heart rates for the same level of work compared to normal subjects and thus have poor endurance capacity. CONCLUSION Prevalence of malnutrition as revealed in this study is alarming, especially in adolescent girls. The most common nutritional deficiency disease observed among adolescent girls was anaemia and further more, half of the surveyed population have lower levels of haemoglobin. The outcome of the malnutrition was immediately visible as complete absence of good endurance capacity in the entire randomly sampled population. It is peak time for governments elsewhere in the world to look at this silent killing most seriously since the outcome is immediate, leading to a low efficient generation, as this study reveals. REFERENCES Bakalion F, et al (1994). British J Nutrition 72(3): Brouha, L (1943). Res. Quartely 14(1):31. Floud R (1992). In: Nutrition and poverty, WIDER Research Studies in Development Economics, Osmani SR, ed. Oxford University Press. Fogel RW (1994). Amer Eco Revi 84(3): Chaturvedi S, et al (1996). Indian J. Paediatrics 33(3): Gopalan, C, et al (1989). Nutritive Value of Indian Foods. National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India, pp ICMR, Indian Council of Medical Research (1989). Nutritional Requirements and Recommended Dietary Allowances for Indians. New Delhi, p.1. James WPT, et al (1988). Am. J. Clin. Nutr. 42: Maithili R, et al (26). In: Proceedings on Workshop on Health and Nutrition, Centre for Development Economics, Delhi School of Economics, 24th March, 26. Mussein GM (199). Physiology. Little Brown Publishing Co., New York, p NIN, National Institute of Nutrition (1983). A Manual of Laboratory Techniques. Raghuramulu, N. ed) NIN-Hyderabad, India, pp NNMB, National Nutrition Monitoring Bureau, India (2). Report on National Status of Adolescence 1 (6): Patel KV, et al (27). Blood 19: Rao VK (1987). Indian J Nut Dietet 24: Rao, DH, Vijayaraghavan, K (1996). Anthropometric Assessment of Nutritional Status. Text book of Human Nutrition. Bamji, M.S., et al ed) Oxford and IBH Publishing Co. Pvt. Ltd., Calcutta, pp Satyanarayana, K. (1989). Proc. Nutr. Soc. India. National Institute of Nutrition, Hyderabad. 35 (1):25-26 Satyanarayana, K., et al. (198). Ann.Hum. Biol. 7:35 Suman KT (2). M.Sc. Thesis, Kerala Agricultural University, Thrissur, India, p.88 Swaminathan M (1986). Principles of Nutrition and Dietetics. The Bangalore Printing and Publishing Co. Ltd., Bangalore, p.18 Vasanthi, G.E., et al (1994). Indian J. Paediatrics, 31: WHO, (World Health Organization) (1992). Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care, A Guide for Health Administrators and Programmer Managers, Geneva p.14