Changes in anemia and anthropometry during adolescence predict learning outcomes: findings from a 3-year longitudinal study in India

Abstract

Background Anemia and poor physical growth during adolescence have far-ranging consequences, but limited longitudinal evidence exists on how changes in these factors relate to changes in learning skills as adolescents mature. Objectives We examined the association between changes in anemia and physical growth during adolescence and learning outcomes. Methods We used longitudinal data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project, which surveyed adolescents aged 10–19 years in northern India in 2015–16 and 2018–19 (n = 5963). We used multilevel mixed-effects logistic regression models to examine associations between changes in anemia/thinness/stunting status (four groups: never, improved, new, and persistent) and reading (ability to read a story) and math proficiency (ability to solve division problems) at follow-up. Results Persistent anemia and stunting were higher among girls than boys (46% vs.8% and 37% vs. 14%, respectively), but persistent thinness was lower (7% vs. 16%). Improvement in anemia, thinness and stunting was 1.4–1.7 times higher among boys than girls. Boys who were anemic in both waves were 74% (adjusted odds ratio [AOR] 0.26, 95% confidence interval [CI)]: 0.12,0.59) and 65% (AOR 0.35, 95%CI: 0.16,0.76) less likely to be able to read a story and solve division problems, respectively, compared to boys who were non-anemic in both waves. Persistent thinness in boys was negatively associated with both reading (AOR 0.37, 95% CI: 0.21,0.66) and math proficiency (AOR 0.27, 95% CI: 0.16,0.46). Persistent stunting contributed to lower reading and math proficiency in boys and girls (AORs: 0.29 to 0.46). Boys whose anemia or thinness status improved and girls whose stunting status improved had similar learning skills at follow-up as those who were never anemic/thin/stunted. Conclusions Persistent anemia, thinness and short stature during adolescence was associated with poor learning. Programs targeted at adolescents should contribute to nurturing environments that foster healthy growth and learning.

Relationship between Anemia and Academic Performance in Chinese Primary School Students: Evidence from a Large National Survey

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