Nutritional Status among the UrbanMeitei Children and Adolescents of Manipur , Northeast India

Purpose.Todetermine the nutritional status (underweight and overweight) amongMeitei children and adolescents.Methods.Crosssectional data on 854 subjects (384 boys and 470 girls) were collected during the months of May 2009 to August 2009 following house-to-house survey. An anthropometric rod and a weighing scale were used to measure height and weight. e presence of underweight and overweight has been evaluated using the international cutoff points for children and adolescents. MS-Excel soware was used for all statistical analyses. Results. A high prevalence of underweight (30.21%) and overweight (3.12%) in the present study was found among children and adolescent boys, respectively. Among girls, the prevalence of both underweight (33.86%) and overweight (5.18%) was reported higher among children than adolescents, and the differences in the distribution were signi�cant at 0.05 levels. e overall prevalence of underweight (28.29%) was found more or less the same among boys and girls, but overweight (5.10%) was reported higher among girls than boys (2.34%).Conclusion.epossible reasons for both forms of malnutrition amongMeitei children and adolescents could be traced through poverty, low dietary intake, socioeconomic condition, nutrition transition, and changing lifestyles. e other possible reasons could be due to peer pressure, eating habits, or emotional factor.


Introduction
Adolescence is a period of transition between childhood and adulthood that demands extra nutrients and energy-rich food for rapid growth and maturation [1].Inadequate diet and unfavourable environmental condition in developing nations like India may adversely affect the growth and nutrition of adolescents.Malnutrition, both undernutrition and overnutrition, refers to an impairment of health, resulting from a de�ciency or from an excess or imbalance of nutrients.It is of public health signi�cance among adolescents across the world [2].e coexistence of overweight/obesity and underweight is rather common in developing countries and is found to be increased proportionally over time [3,4].Several studies have investigated the nutritional status of children and adolescents from different parts of India [5][6][7].In India alone, there are approximately 60 million children who are underweight [8], this prevalence is higher in rural areas compared to urban areas [9].India has one of the highest underweight burdens in the world, even twice that of sub-Sahara region.However, India is now also beginning to experience the emerging problem of overweight [10,11].A recent study among Indian children in the age group 6-18 years suggests the existence of a double burden of underweight and overweight [12].Parallel to persistent undernutrition, obesity rates are increasing globally, including those of many low-and middle-income countries that previously had a very low prevalence [13,14].Globally, an estimated 10 percent of school-aged children between 5 to 7 years of age are overweight or obese [15], and around 43 million children under age �ve are overweight [16].Studies also show that the prevalence of overweight and obesity in Punjab, Maharashtra, Delhi and Chennai �uctuates between 11 and 23 percent [17].In Northeast India, the prevalence of undernutrition (53.9%) is found among school-aged children in Assam [18].Another study among Khasi boys aged 3-18 years of Meghalaya shows the prevalence of underweight at 60.0 percent [19].e prevalence of overweight among Mishing boys and girls is found to be 1.95 percent and 1.96 percent, respectively [20].
No or little research on this has yet been undertaking on other populations in the Northeast, the urban Meitei children and adolescents in Manipur state among them.e present study aims to �ll this gap.

Materials and Methods
Manipur is a hilly region.Only about 10 percent of the area is plain and is surrounded by rolling hills.In the Imphal Valley, the Meitei constitute the bulk of Manipur's population besides the Muslims (Meitei Pangals) and Schedule Castes people residing in the valley.In addition to this, a small percentage of other groups have migrated from time to time from the hills and other parts of mainland India.In the past few years, Manipur has undergone tremendous changes, rapid urbanization and socioeconomic development among them.Such a transition has, over the years, resulted in changes among Meitei population in terms of occupation, economy, food consumption, dietary intake, physical activity levels, and overall lifestyles.A nutritional transition characterised by growing consumption of energy-rich diet, processed and fast food from restaurants, and roadside vendors is observed among Meitei children and adolescents.e present study was conducted among Meitei children and adolescents residing in the urban areas of Lamphel subdivision under Imphal West District of Manipur.Crosssectional data on 384 Meitei boys and 470 Meitei girls aged 8-18 years were collected for the present study.Since the range of age distribution was wide, the study subjects were divided in two age groups: 8-12 years age group, considered to be children, and 13-18 years age group, considered to be adolescents [21,22].e data on each subject were collected by the random sampling method, using houseto-house visit during the months of May 2009 to August 2009.Measurements were taken on those subjects who were willing and cooperative.Most of the subjects for the present study belonged to lower income family groups (47.18%), followed by middle-income family groups (27.98%), and high-income family groups (24.82%).An anthropometric rod and a weighing scale to the nearest of 0.1 cm and 0.5 kg, respectively, was used to measure height and weight following the standard technique of Lohman et al. [23].e parameters taken were analyzed statistically to �nd out the mean and the standard deviation.In order to test the level of signi�cance, both t-test and chi-square test have been used.e values of    and    were used to �nd different signi�cant levels of calculated t-test and chi-square value.e presence of underweight and overweight has been evaluated using the international cutoff points for children, and adolescents [24].MS-Excel soware was used for all statistical analyses of the present research.

Results
e mean, standard deviation, and t-value with the level of signi�cance of both height and body weight among boys and girls are given in Tables 1 and 2. e tables show that both height and body weight increased along with the increase in age.e mean height (159.6 cm) was found higher among adolescent boys than among children (129.8 cm).e difference in the mean height was found to be statistically sig-ni�cant (  ).Similarly, the mean height (151.2 cm) was also reported higher among adolescent girls as compared to that of children (131.9 cm), and the difference was signi�cant statistically (  ).e mean body weight was observed to be heavier among adolescent boys (47.4 kg) and adolescent girls (44.4 kg) when compared to that of the children (Table 2).e results further show that the mean height and weight among children (8-12 years) was reported higher among girls than boys, whereas among adolescents (13-18 years), it was found higher among boys.
Table 3 shows the distribution of mean BMI values among boys and girls.e mean BMI values show increases along with the increase in age in both sexes.e mean BMI (18.54) was found higher among adolescent boys than children (15.54).Similarly, mean BMI (19.34) was also recorded higher among adolescent girls than children (15.75%).e increase in mean BMI value between children and adolescents was found to be statistically signi�cant (  ) in both sexes.
e prevalence of underweight and overweight among boys and girls is given in the Table 4. is table shows that the prevalence of underweight was very high when compared to overweight in all of the different age groups in both boys and girls.A high prevalence of underweight (30.21%) and overweight (3.12%) was found among children and adolescent boys, respectively.e differences were not signi�cant statistically.In the case of girls, the prevalence of both underweight (33.86%) and overweight (5.18%) was found to be higher among children than adolescents.e differences in the prevalence of underweight and overweight were signi�cant ( 2 = 8.477,   ).e table further indicated that the overall prevalence of underweight (28.29%) was found more or less the same among boys and girls, but overweight (5.10%) was reported higher among girls than boys (2.34%).

Discussion
e present study shows that height and body weight increases along with the advancing of age in both Meitei boys and girls.Overall socioeconomic development in the last few decades and improvements in nutrition are likely among the factors that explain the increase in both height and body weight observed in the present research.e age groups wise comparison also shows that girls are slightly taller and heavier than boys in the age group 8-12 years, whereas boys are taller and heavier than girls in the age group 13-18 years.e probable reasons for this include the early occurrence of adolescent growth spurt among girls.An increasing trend of overweight and obesity in combination with a high prevalence of underweight is found to be common in many developing countries [3].e present study shows high occurrence of underweight, which is more or less the same in both sexes.However, the prevalence of overweight is found higher among girls than boys.e frequency of overweight is low compared to that of underweight.One possible reason for the high occurrence of underweight could be traced to poverty, low dietary intake, excessive energy out�ows due to hard labour, and chronic infections [25].e other possible reasons could be explained through factors such as biological, emotional, physical appearance, and behavioural factors.is, however, needs to be asserted by further research.In any case, several studies show that peer pressure, eating habits or emotional factors, and need to maintain an acceptable physical appearance are important factors that may result in underweight [13,26].e nutritional problems due to nutrition transition could be another reasons for both forms of malnutrition occurring in Manipur similar to those experienced in many developing countries [13].
e new millennium has signalled an important transition for our species with more people being overweight than underweight globally [10,27].In several of the developing nations across the world and even Africa, a continent usually associated with starvation, the prevalence of overweight/obesity is increasing [27,28].e basic reasons accounting for this change over the last three decades are attributed to a nutrition transition [29].is transition involves a shi in diets of populations towards increasing consumption of energy dense foods and high calorie liquids, as well as an increasing and more stable access to low-priced processed foods [30,31].Improvements in socioeconomic status of populations are oen attributed as another reason [32,33].Increasing levels of urbanization, mechanization of jobs, transportation, and dependence on television for leisure along with parallel declines in physical activity have increased sedentary behaviours of both children and adults [29,[34][35][36][37][38][39].ese rapidly changing diets and lifestyles are fuelling the global obesity epidemic [39].e globalization of fast food is also beginning to affect children's eating patterns in many countries undergoing nutrition transition [40].
Likewise, Imphal has beginning to experience tremendous changes along above lines.Urbanization has accelerated, and so has socioeconomic status of many of its inhabitants improved signi�cantly.is, in turn, has resulted in signi�cant changes in the overall lifestyle of the Meitei population.e impact of nutrition transition can be seen through the changing food environment in Manipur [41].Such a transition has come together with changes in food habits, especially in terms of increasing consumption of processed foods, fast foods, and meals prepared by roadside vendors.is is likely among the reasons explaining the prevalence of overweight among Meitei children and adolescents, which is concluded by the present research.
e patterns of overweight/obesity differ by age, sex, rural or urban residence, and socioeconomic position and vary between and within countries [42].e higher prevalence of overweight among girls in the present study is consistent with the gender differences in other Indian studies and other parts of the world [43][44][45][46][47][48].is higher prevalence of overweight among girls may be related to the adolescent growth spurt and the effects of hormonal surge that occurs earlier in girls [49].
In conclusion, our study highlights the double burdens of underweight and overweight, though underweight is a more urgent problem than overweight among Meitei children and adolescents.erefore, to reduce both forms of malnutrition, with special attention to underweight, it is essential to educate and create awareness programmes at the community levels.Government and nongovernmental organizations should be involved in creating and protecting an environment that supports the healthy growth and development of children and adolescents.Health education programs and effective policies are urgently required to promote healthy eating and physical activity and to ensure adequate access to health services.Further studies need to be conducted in order to understand clearly whether the coexistence of underweight and overweight among Meitei children and adolescents is related to the in�uence of socioeconomic conditions, nutritional status, due to cultural and lifestyles, or any other yet unanticipated reasons.
T 1: Basic data on height among children and adolescents Meitei boys and girls.
T 3: Distribution of mean BMI value among children and adolescents Meitei boys and girls.