Rajiv Gandhi University Of Health Sciences,

Bangalore, Karnataka.
REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the Candidate and Address :
DR. BHAVYA BALASUBRAMANYA
POST GRADUATE STUDENT
ST. JOHNS MEDICAL COLLEGE
JOHN NAGAR,
SARJAPUR ROAD,
BANGALORE 560 034.
2. Name of the Institution :
ST. JOHNS MEDICAL COLLEGE , BANGALORE
3. Course of study and subject :
MD COMMUNITY MEDICINE
4. Date of Admission to the Course :
16th APRIL , 2012
5. Title of the Topic :
NUTRITIONAL STATUS OF SCHOOL GOING ADOLESCENTS
IN DOMLUR WARD, BANGALORE CITY.

6. Brief Resume of intended work :

INTRODUCTION :

The World Health Organization (WHO) defines

adolescents as individuals aged 10-19 years. 1 The
term adolescent is derived from the latin word
adolescere meaning to grow up .
There are around 1.2 billion adolescents worldwide,
comprising 20 % of the global population. One in
every five people in the world is an adolescent. 87%
of adolescents reside in developing countries. 1
UNICEF estimates that there are approximately 243
million adolescents in India, constituting 20% of the
total population.
Adolescence is a phase, a phase of rapid growth, a
phase of physical, sexual and emotional change.
Sadly this group of individuals is the most neglected
2
as they are neither children nor adults. Yet they
experience a variety of health and social problems
like early marriage, teenage pregnancy, sexually
transmitted
diseases,
drug
abuse,
juvenile
delinquency, injuries, learning disabilities, mental
illness and malnutrition.
There are 2 types of malnutrition undernutrition and
overnutrition. Prevalence of undernutrition is
approximately 40%3 and overnutrition around 6.03%
4
in Indian adolescents.
Nutrition is the foundation for good health and
development. Adolescence is an important period,
during which an individual gains 50% of the adult
weight and skeletal mass.5 It is also a period of catchup growth for previously undernourished children.
Hence this gap needs to be bridged in developing
countries.
NEED FOR THE STUDY :

India has the largest adolescent population in the

world, and the numbers are likely to increase rapidly
in the next 30 years due to population momentum
effect. 6
Adolescents are a vulnerable group of individuals
who are exposed to numerous health problems, a
major one being malnutrition. Malnutrition denotes
impairment of health arising either due to
deficiency/excess/imbalance of nutrients in the body. 7
Malnutrition leads to a vicious cycle of poor health
loss of productivity.
Most Indian and International studies have looked
into nutrition of adolescent girls in depth. Very few
studies have been done in adolescent boys, hence
there is scope to explore this area further.
There is also a need to look at various factors having
an effect on nutritional status of adolescents in
Bangalore city, as very few studies have been done
in South India and Karnataka in particular.
Knowledge
about
the
nutritional
status
of
adolescents
will
help
formulate
a
National
Programme for Adolescent Health and Nutrition.
REVIEW OF LITERATURE :
1. Adolescents :
Adolescents constitute 20% of the global population
1
. Adolescents constituted 22.8% of Indias population
as on 1st March 2000 8. This number is rapidly on the
rise.

2. Prevalence of Malnutrition :
In the study Nutritional status of adolescents in
rural and urban Rohtak, Haryana done by B.M
Vashist et al, stunting ( height for age) and thinness (
BMI for age ) were calculated and analysed
separately for boys and girls. 9
SEX
MALE
FEMALE

Stunted
Thin
Stunted
Thin

RURAL
10.9 %
27.05 %
12.7 %
15.1 %

URBAN
12.7 %
26.7 %
10.8 %
13.7 %

In both rural and urban settings, prevalence of

thinness was more among boys.
Jagdish P Goyal et al, in their study Determinants of
overweight and obesity in affluent adolescents in
Surat city showed the overall prevalence of obesity
and overweight was 6.66% and 13.9%. 10
A study done by Venkaiah et al , by the National
Institute of Nutrition in 1998, showed prevalence of
undernutrition ( weight for age) was more in boys
(53.1%) than in girls (39.5%). 11
The study Anthropometric assessment of Nutritional
Status of Adolescents of Kolkata, West Bengal by
Mukhopadhyay et al showed that undernutrition ( BMI
for age < 5th percentile WHO) was more in boys
(41.08%) than in girls (30.61%). 12
In the study Nutritional status of school going
adolescents in a rural block of Darjeeling, West
Bengal by Biswas R et al, 40% of the adolescents
were undernourished ( BMI z score WHO ). Severe
malnutrition was found in 29% of girls and 27% of

boys. 44% were stunted ( WHO z score height for

age) . 0.5% had BMI greater than 2SD. 3
Shaw C et al, in their study done in adolescent girls
from an urban slum in S.India in 2009, showed 28.3%
stunting and 22.9% underweight according to Indian
Standards. 13
K. Anand et al, in their study showed that prevalence
of stunting and thinness was higher among males
( 37.2 % & 43.8% ) as compared to females ( 19.9 %
& 30.1% ). 14
Saha S et al, in their study Nutritional status of
Tripuri adolescent boys of West Tripura district , in
2012, showed the following 4 :

Urban
Rural

Thinness
17.81%
38.37%

Stunting
7.6%
27.9%

Overweight
6.03%
0.39%

3. Factors influencing Nutrition :

Seema Choudhary et al , in their study Correlates of
nutritional status of adolescent girls in the rural area
of Varanasi in 2009, showed a significant
association between literacy status of the father ,
main occupation of the family and menstrual history
with nutritional status of adolescent girls. 15
In the Surat study by Jagdish P goyal et al, it was
found that important determinants of obesity were
low levels of physical activity, consuming junk food
and carbonated drinks, watching television and
playing computer games for long hours. 10

In the study Double burden of underweight and

overweight among children (10-19 years) of
employees working in Industrial units by Jeemon P
et al in 2009, according to Indian standards,
overweight was highest in highly urban areas
( 19.1%) and underweight was more in peri urban
areas (30.2 %). The level of urbanization and
frequency of meals outside the house ( >25% weekly
meals) were important determinants of overweight.
16

Ramesh K Goyal et al , in their study, Prevalence of

overweight and obesity in Indian adolescent school
going children : its relationship with socio economic
status and associated lifestyle factors in 2010,
showed the following results 17

Overweight
Obesity

Boys
14.3%
2.9%

Girls
9.2%
1.5%

The problem of overweight was seen to be more in

middle socio economic status, and obesity was found
to be more in high socio economic status.
A study on consciousness of adolescent girls about
their body image by Swati Dixit et al showed that
74% of girls were satisfied with their body image.
20.5% of girls showed aspiration to become thin
among those who already perceived their body
image as too thin. Among girls satisfied with their
body weight, 32.8% were underweight and 38.4%
were stunted. 32.8% of girls over estimated their
weight and 4.9% had under estimated it. 18

OBJECTIVES OF THE STUDY :

- To assess the nutritional status of adolescents in

schools in Domlur Ward of Bangalore City.
- To study factors associated with nutritional status
of the study population.

7. Materials and Methods :

7.1
Study Design : It is a cross sectional study.
Study Area : All government and private schools in
Domlur Ward of Bangalore City.
Sampling Unit : School going adolescents in Domlur
Ward of Bangalore City.
Sample Size :
According to the study by Vashist et al, the
prevalence of malnutrition ( BMI for age < 5 th
percentile WHO ) for urban school going adolescents
was shown to be 20% (average for boys and girls) . 9
Sample size will be calculated using the formula :
N = z2 * p * q
d2
N = sample size
p = prevalence = 0.2
q = 1-p = 0.8
z = 1.96 ( considering 95% confidence level)
d = relative precision of 15%= 15% of 0.2 = 0.03
N = 1.96 * 1.96 * 0.2 * 0.8
0.03 * 0.03
= 682.95

Sample size = 683 school going adolescents

7.2 METHOD OF COLLECTING DATA :

Sampling Procedure : Stratified Random Sampling
- A list of all the government and private schools in
Domlur Ward will be made. All the schools in that
Ward will be selected for the study.
- The Principal of each school will be approached for
permission to conduct the study. Only those schools
who grant permission will be included in the study.
- Using Population Proportional to Size, the
number of students to be examined in each school
will be determined.
- A list of students from 5th standard to 12th standard
will be obtained from the school. The number of
students to be examined in each standard will also be
determined using Population Proportional to Size
and also according to gender distribution.
- Further students in each standard will be randomly
picked for the study.
- Written informed consent from the parents and
assent from the student will be obtained. If the
parents do not consent, another student will be
picked randomly, to replace the previous one.
- Once parental consent is obtained, each subject will
be given a pre tested structured questionnaire. They
will be given clear instructions on how to fill the
questionnaire. Following which anthropometry and
clinical examination will be done.

Study Period : January 2013 to December 2013

Study Population :
Inclusion Criteria :
- Both boys and girls in the age group 10-19 years
attending
government and private schools in
Domlur Ward of Bangalore City.
Exclusion Criteria :
- Students suffering from an acute illness on the day
of study or within a period of 2 weeks prior to the
study .

The study will comprise of 3 parts :

1. A structured questionnaire : This is a self
administered questionnaire, which will be handed
out to each student. They will be given clear
instructions on how to fill the questionnaire.
2. Anthropometric Measurements : The weight
and height of each student shall be measured.
3. Clinical Examination : For obvious signs of
micronutrient deficiency ie Pallor/ Koilonychia /
Thyroid enlargement / Glossitis / Cheilitis / Angular
Stomatitis / Aphthous ulcers .
Prior to beginning the study there will be,
- Validation of the weighing scale used.
- Translation of the structured questionnaire into the
local language ie Kannada.
- Validation of the structured questionnaire by an
expert Nutritionist

- A Pilot study will be conducted in a school other

than those in the study area.

Analysis of Data :
-The data collected will be entered in Microsoft Excel.
-The anthropometric data will be analyzed using
percentages, mean, median, standard deviation and
z-scores.
-The various factors and their association with
nutritional status will be studied using test of means,
Chi square test and logistic regression analysis as
applicable.
-Results will be depicted as tables and graphs.
-The data will be analyzed using a standard statistical
package.

7.3 Does the study require any investigation or

interventions to be
conducted on patients or
other humans or animals?
No
7.4 Has ethical clearance been obtained from your
institution?
Yes

8. LIST OF REFERENCES :
1. WHO official website
www.searo.who.int/EN/section13/section1245_4980.html
www.who.int/features/factfiles/adolescent_health/en/index.
html
[ Cited on July 27th, 2012 ]

2. Kathleen M Kurz ; Symposium on Adolescent Nutrition

Are we doing enough? ; University of Aberdeen ; July 1995.
3. Dey I, Biswas R , Ray K, Chakraborty M, Pal P ; Nutritional
status of school going adolescents in a rural block of
Darjeeling, West Bengal, India ; The Health ; 2011; 2(3) :
pp.75-77.
4. Sarkar S.R, Saha, Roy S and Sil S.K ; Nutritional status of
tribal Tripuri adolescent boys of W.Tripura district ; Indian
Journal of Paediatrics ; 2012 ; 49(6) : pp.494-495.
5. World Health Organization Physical Status : The Use and
Interpretation of Anthropometry Technical Report Series :
854 ; Geneva ; WHO ; 1995 ; pp. 263-308.
6. United Nations Fund for Population Activity ; The South
East Asia Conference on Adolescents ; UNFPA , Kathmandu
; 1998.
7. Aparajita Dasgupta, Arindam Butt, Tushar Kanti Saha,
Gandhari Basu, Amitava Chattopadhaya and Anindya
Mukherjee
;
Assessment of
malnutrition
among
adolescents Can BMI be replaced by MUAC ; Indian
Journal of Community Medicine ; April 2010 ; 35(2) ;
pp.276-279.

8. Ghai O.P, Gupta P and Paul V.K ; Essential Paediatrics ; 6th

Edition; New Delhi ; CBS Publishers and Distributors;
2005 ; pp. 66-81.
9. B.M Vashisht, Joyti and M.K Goel ; Nutritional status of
adolescents in rural and urban Rohtak, Haryana ; Health
and Population Perspectives and Issues ; 2009 ; 32(4) :
pp.190-197.
10.
Jagadish P Goyal, Nagendra Kumar, Indira Pamar,
Vijay B Shah, Bharat Patel ; Determinants of overweight
and obesity in affluent adolescents in Surat city, south
Gujarat region, India ; Indian Journal of Community
Medicine ; October 2011 ; 36(4) : pp.296 300.

11.
Venkaiah K, Damayanti K, Nayak M.U and
Vijayraghavan K; Diet and nutritional status of rural
adolescents in India; European Journal of Clinical
Nutrition ; 2002 ; 56(11): pp.1119-1125 ; Nature
Publishing Group
12.
Mukhopadhyay A, Bhadra M and Bose K;
Anthropometric assessment of nutritional status of
adolescents of Kolkata, West Bengal ; Journal of Human
Ecology ; 2005 ; 18(3): pp. 213-126 ; Kamla Raj.
13.
Prashant K, Shaw C ; Nutritional status of adolescent
girls from an urban slum area in South India ; Indian
Journal of Paediatrics ; 2009 May ; 76(5) :pp. 501-504 ; E
pub.
14.
K. Anand, S.Kant, S.K. Kapoor; Nutritional status of
adolescent school children in rural north India; Indian
Journal of Paediatrics ; 1999 ; 36: pp.810-815.
15.
Seema C, C.P Mishra, K.P Shukla ; Correlates of
Nutritional status of adolescent girls in the rural area of
Varanasi ; The International Journal of Nutrition and
Wellness ; 2009 ; 7 (2).
16.
Jeemon P, Prabhakaran D, Mohan V, Thankappan K
R, Joshi P P, Ahmed F, Chaturvedi V, Reddy K.S ; Double

burden of underweight and overweight among children

(10-19 years) of employees working in industrial units ;
The National Medical Journal of India ; 2009 ; (4) : pp.172176.
17.
Ramesh K Goyal, Vithaldas N Shah, Banshi D Saboo,
Sanjiv R Phatak, Navneet N Shah, Mukesh C Goel, Prahlad
B Raval, Snehal S Patel ; Prevalence of overweight and
obesity in Indian adolescent school going children : its
relationship with socio economic status and associated
lifestyle factors ; Journal of Association of Physicians of
India ; 2010 ; 58 : pp.151-158.
18.
Swati Dixit, G.G Agarwal, J.V Singh , Surya Kant,
Neelam Singh ; A study on consciousness of adolescent
girls about their body image ; Indian Journal of Community
Medicine; July 2011 ; 36(3); pp. 197 202 .

9.Signature of the candidate :

10. Remarks of the Guide :

11. Name and Designation of :

11.1 Guide : DR. T. SULEKHA
ASSOCIATE PROFESSOR
DEPARTMENT OF COMMUNITY HEALTH
ST.JOHNS MEDICAL COLLEGE
11.2 Signature :

11.3 Co-Guide : DR. AVITA ROSE JOHNSON

ASSISTANT PROFESSOR
DEPARTMENT OF COMMUNITY HEALTH

ST.JOHNS MEDICAL COLLEGE

11.4 Signature :

11.5 Head of Department : DR. ARVIND KASTHURI

PROFESSOR & HEAD
DEPARTMENT OF
COMMUNITY HEALTH
ST. JOHNS MEDICAL
COLLEGE
11.6 Signature :

12.1 Remarks of the Dean :

12.2 Signature :