Transitions to adulthood and the changing body mass index of adolescent girls in Zambia

Abstract

Adolescent girls in low-and middle-income countries often experience several important life transitions, includingschool-leaving, marriage, and childbearing. Understanding how these transitions are associated with changes in the nutritional status of adolescent girls and young women (AGYW) is crucial for programs that aim to improve nutritional outcomes among youth and promote healthy transitions to adulthood. We investigated the associations between adolescent transitions and body mass index (BMI) among a cohort of 4887 adolescent girls in Zambia aged 10-19 years when first interviewed in 2013. Estimating fixed-effects models controlling for constant and timevarying confounders, we found that school-leaving, marital status, and childbearing are associated with the nutritional status of AGYW in diverse ways. School-leaving was associated with higher BMI and increased odds of overweight/obesity. Marriage was not only associated with increased odds of undernutrition, particularly in rural areas, but also with increased odds of overweight/obesity among older girls. Motherhood was associated with lower BMI and lower odds of overweight/obesity, particularly among breastfeeding mothers. Our results provide evidence of characteristics of AGYW that would be useful for targeted nutritional interventions and behavior change programming, including girls leaving school, recently married, and young women undergoing a marital separation, as well as young mothers and their children.

Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial

“…While evidence from high-income countries has indicated decreasing adolescent sexual activity for incremental increases in BMI [ 53 ] (assumedly due to the importance of slimness for romantic success), our study indicates that this association does not hold in settings like rural western Kenya. While limited data on adolescent BMI exist in these contexts, it has been suggested that being underweight in these areas is perceived as not having good health (particularly in HIV endemic regions), or being physically immature [ 54 ]. While the interrelationship between both pubertal markers (early menarche and BMI) is still being established, evidence to date suggests that elevated BMI at young ages leads to faster growth velocity and earlier menarche among adolescents [ 47 , 55 , 56 ], possibly highlighting the crucial role proper nutrition plays in girls’ long-term SRH.…”

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

“…Due to cultural norms, in our study population, women typically eat last among all the household members [ 29 ]. Despite early marriage being linked with child undernutrition, however, very few studies have investigated its direct association with maternal nutritional status, and the results are heterogeneous across societies [ 25 , 30 , 31 ].…”