Double Burden of Malnutrition and Nutrition Knowledge Gaps Among Rural School-Going Adolescent Girls: Evidence from Netrokona, Bangladesh
Adolescents Nutritional Status and Knowledge Gaps of Netrokona Bangladesh
Abstract
Adolescence is a critical stage of physical and cognitive development, when adequate nutrition is essential for optimal growth and long-term health. The current study aims to assess the nutritional status, dietary practices and nutritional knowledge status of rural adolescent girls at netrokona Bangladesh. A cross-sectional survey was conducted among 635 school-going girls to collect data on socio-demographic characteristics, dietary patterns and BMI-for-age using WHO standards distribution. There is a notable gap in comprehensive data regarding adolescent health and nutritional status in netrokona Bangladesh, particularly for rural areas. The findings indicate a double burden of malnutrition among adolescents in netrokona district, with 38.7% classified as thin, 48.5% as having normal BMI, 10.4% as overweight, and 2.4% as obese. Moreover, their daily dietary practice results showed that 28%, 46%, and 13.39% of adolescents do not intake vegetables, fruits and meat or fish respectively. In addition, 10.7% adolescents were skipping breakfast and 77.01% did not consume milk daily. Among the participants 54.8% washed vegetables after cutting indicating nutritional knowledge gap in daily dietary practices. Regarding to address nutritional knowledge status present study found only 10.39% adolescents having better nutritional knowledge and the majority of adolescents had poor to average understanding of healthy nutritional practices. Nutritional knowledge analysis estimated strong positive correlation with maternal education, BMI for age and vegetable consumption but not with fruit, egg intake, or healthy practices. These findings suggest that better nutritional practices found specially when coupled with maternal education, might contribute to improve adolescents' nutritional status. However, these factors alone cannot overcome structural and socioeconomic barriers in rural netrokona, Bangladesh. Therefore, for sustainable improvement an integrated approach including education, economic empowerment, and community-based nutritional interventions are crucial for netrokona Bangladesh.
References
World Health Organization, Nutrition in Adolescence: Issues and Challenges for the Health Sector. Geneva: WHO, 2005.
B. A. Spear, “Adolescent growth and development,” J. Am. Diet. Assoc., vol. 102, no. 3 Suppl, pp. S23–S29, 2002.
R. E. Black, C. G. Victoria, S. P. Walker, et al., “Maternal and child undernutrition and overweight in low-income and middle-income countries,” Lancet, vol. 382, no. 9890, pp. 427–451, 2013, doi: 10.1016/S0140-6736(13)60937-X.
UNICEF, WHO, World Bank Group, Levels and Trends in Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates, 2023.
M. Rahman and N. Hossain, “Socioeconomic determinants of adolescent nutritional status in Bangladesh,” Asia Pac. J. Clin. Nutr., vol. 24, no. 2, pp. 253–263, 2015, doi: 10.6133/apjcn.2015.24.2.11.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International, Bangladesh Demographic and Health Survey 2017–18. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International, 2020.
B. F. Sunguya, K. C. Poudel, L. B. Mlunde, et al., “Poor nutrition and adolescent development: Systematic review of household and community determinants in low- and middle-income countries,” BMC Public Health, vol. 13, p. 100, 2013, doi: 10.1186/1471-2458-13-100.
A. D. Jones, S. B. Ickes, L. E. Smith, et al., “WHO child growth standards and the double burden of malnutrition in adolescents,” PLoS One, vol. 9, no. 12, e111739, 2014, doi: 10.1371/journal.pone.0111739.
I. R. Contento, “Nutrition education: Linking research, theory, and practice,” Asia Pac. J. Clin. Nutr., vol. 17, Suppl 1, pp. 176–179, 2008, doi: 10.6133/apjcn.2008.17. s1.32.
N. Larson and M. Story, “A review of adolescent breakfast consumption: Correlates and consequences,” J. Am. Diet. Assoc., vol. 113, no. 7, pp. 927–934, 2013, doi: 10.1016/j.jada.2013.04.010.
S. A. Kim, K. Soon Woo, M. J. Lee, et al., “Nutritional knowledge and dietary behaviors of adolescents: A cross-sectional study,” Nutrients, vol. 10, no. 2, p. 196, 2018, doi: 10.3390/nu10020196.
G. Barba, E. Troiano, P. Russo, et al., “Nutritional knowledge and eating habits in adolescents,” Public Health Nutr., vol. 9, no. 4, pp. 478–485, 2006, doi: 10.1079/PHN2005843.
World Health Organization, Adolescent Nutrition: A Review of the Situation in Selected South-East Asian Countries. WHO Regional Office for South-East Asia, 2021.
Bangladesh Bureau of Statistics, Statistical Yearbook of Bangladesh 2020. Dhaka, Bangladesh: BBS, 2020.
I. Spronk, C. Kullen, C. Burdon, and H. O’Connor, “Relationship between nutrition knowledge and dietary intake,” Br. J. Nutr., vol. 111, no. 10, pp. 1713–1726, 2014, doi: 10.1017/S0007114513004452.
M. de Onis, A. W. Onyango, E. Borghi, et al., “Development of a WHO growth reference for school-aged children and adolescents,” Bull. World Health Organ., vol. 85, no. 9, pp. 660–667, 2007, doi: 10.2471/BLT.07.043497.
FAO and FHI 360, Minimum Dietary Diversity for Women: A Guide to Measurement. Rome: FAO, 2016.
T. G. Lohman, A. F. Roche, and R. Martorell, Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books, 1988.
L. Korkalo, S. Rautiainen, S. Salo, et al., “Breakfast consumption and academic performance among adolescents,” Nutrients, vol. 11, no. 11, p. 2770, 2019, doi: 10.3390/nu11112770.
Y. Wang and H. Lim, “The global childhood obesity epidemic and the association between socio-economic status and childhood obesity,” Int. Rev. Psychiatry, vol. 24, no. 3, pp. 176–188, 2012, doi: 10.3109/09540261.2012.688195.
A. M. Thow, et al., “The role of dietary diversity in adolescent nutrition and health,” Public Health Nutr., vol. 14, no. 9, pp. 1626–1636, 2011, doi: 10.1017/S1368980011000251.
P. Osei-Fosu, et al., “Adolescent nutritional status and diet in rural settings: Evidence from Ghana,” BMC Nutr., vol. 5, p. 51, 2019, doi: 10.1186/s40795-019-0296-4.
R. Nuri, et al., “Food safety and hygiene practices among school-going adolescents in rural Bangladesh,” Int. J. Environ. Res. Public Health, vol. 18, no. 12, p. 6543, 2021, doi: 10.3390/ijerph18126543.
FAO, Guidelines for Measuring Household and Individual Dietary Diversity. Rome: FAO, 2013.
C. Rutterford, A. Copas, and S. Eldridge, “Methods for sample size determination in cluster randomized trials: A tutorial,” Trials, vol. 16, p. 549, 2015, doi: 10.1186/s13063-015-0724-9.
. de Onis, M., Onyango, A. W., Borghi, E., Siyam, A., Nishida, C., & Siekmann, J. (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 85(9), 660–667. https://doi.org/10.2471/BLT.07.043497.
A. Bhargava, et al., “Breakfast skipping and academic performance among school children,” J. Adolesc. Health, vol. 33, no. 4, pp. 262–269, 2003, doi: 10.1016/S1054-139X(03)00128-2.
N. Alam, S. K. Roy, T. Ahmed, et al., “Nutritional status, dietary intake, and relevant knowledge of adolescent girls in rural Bangladesh,” Public Health Nutr., vol. 13, no. 10, pp. 1579–1586, 2010, doi: 10.1017/S1368980010001243.
T. Redwan, B. Sutradhar, M. M. Rahman, et al., “Analyzing the socio-economic factors of adolescent malnutrition in Bangladesh: A Best–Worst Method approach,” Springer Plus, vol. 10, no. 1, pp. 1–11, 2025, doi: 10.1186/s40064-025-1077-3.
S. Ghosh, et al., “Dietary patterns and nutrition knowledge among adolescents in South Asia: A systematic review,” Public Health Nutr., vol. 20, no. 11, pp. 1958–1971, 2017, doi: 10.1017/S1368980017000.
IBM Corp., IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp, 2017.
World Health Organization, WHO Anthro Plus for Personal Computers Manual: Software for Assessing Growth of the World’s Children and Adolescents. Geneva: WHO, 2009.
UNICEF, Improving Adolescent Nutrition in Bangladesh: Strategies and Interventions. Dhaka: UNICEF Bangladesh, 2017.
R. Galloway, et al., “Household factors influencing dietary habits of adolescents in rural Bangladesh,” Food Nutr. Bull., vol. 21, no. 4, pp. 451–458, 2000, doi: 10.1177/156482650002100407.
A. Bhattacharya, et al., “Micronutrient deficiencies among rural adolescents in Bangladesh,” J. Nutr. Sci. Vitaminol. (Tokyo), vol. 60, no. 6, pp. 399–407, 2014, doi: 10.3177/jnsv.60.399.
M. B. Hossain, et al., “Double burden of malnutrition among adolescents in rural Bangladesh,” Nutrients, vol. 13, no. 2, p. 478, 2021, doi: 10.3390/nu13020478.
M. M. Rahman, et al., “Socio-economic determinants of undernutrition among adolescents in Bangladesh,” BMC Nutr., vol. 6, p. 65, 2020, doi: 10.1186/s40795-020-00380-0.
N. Choudhury, et al., “Breakfast consumption and academic performance: Evidence from rural Bangladesh,” Appetite, vol. 136, pp. 1–8, 2019, doi: 10.1016/j.appet.2019.02.021.
M. Hasan, et al., “Consumption of fruits and vegetables among adolescents in Bangladesh,” J. Health Popul. Nutr., vol. 38, p. 25, 2019, doi: 10.1186/s41043-019-0180-8.
K. G. Dewey, et al., “Nutrition in adolescence: Implications for growth and development,” Food Nutr. Bull., vol. 23, Suppl. 2, pp. S64–S74, 2002, doi: 10.1177/15648265020236S209.
World Health Organization, Adolescent Nutrition: A Review of the Situation in South-East Asia. Geneva: WHO, 2017.
T. Ahmed, et al., “Nutritional status of adolescent girls in rural Bangladesh: Evidence from national surveys,” BMC Nutr., vol. 6, p. 18, 2020, doi: 10.1186/s40795-020-00351-5.
R. Chowdhury, et al., “Socio-demographic determinants of adolescent nutritional status in Bangladesh,” BMC Public Health, vol. 19, p. 1210, 2019, doi: 10.1186/s12889-019-7530-5.
T. Nahar, et al., “Dietary diversity and micronutrient adequacy in rural adolescent girls,” Nutr. J., vol. 17, p. 89, 2018, doi: 10.1186/s12937-018-0402-0.
M. Sarker, et al., “Breakfast consumption and nutrient intake in Bangladeshi adolescents,” Appetite, vol. 127, pp. 76–83, 2018, doi: 10.1016/j.appet.2018.04.010.
S. Chowdhury, et al., “Fruit and vegetable consumption among adolescents in rural Bangladesh,” BMC Nutr., vol. 5, p. 38, 2019, doi: 10.1186/s40795-019-0301-x.
S. Hossain, et al., “Egg consumption patterns among adolescent girls in Bangladesh,” Nutr. J., vol. 19, p. 77, 2020, doi: 10.1186/s12937-020-00592-8.
S. Rahman, et al., “Food hygiene knowledge and practices of rural adolescents in Bangladesh,” J. Health Popul. Nutr., vol. 38, p. 20, 2019, doi: 10.1186/s41043-019-0173-7.
M. Mahfuz, et al., “Double burden of malnutrition in rural Bangladeshi adolescents,” Public Health Nutr., vol. 21, no. 15, pp. 2772–2781, 2018, doi: 10.1017/S1368980018001583.
Copyright (c) 2025 Most. Altaf- -Un- Nahar, Md Ashfaq Sadat, Md. Abdur Razzak, Rahana Akther, Mursaleen Zebin Turin, Md. Shariful Islam, Elora Parvin

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright for this article is retained by the author(s), with first publication rights granted to the journal. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (https://creativecommons.org/licenses/by-nc-nd/4.0/).