ABSTRACT
Background:
Proper nutrition is vital for health and development. A lack of proper nutrition can lead to malnutrition, which is serious public health issue that can have lifelong consequences. Disabled children may have feeding difficulties, which can impact their nutrient intake. This study aims to assess the nutritional status of adolescents with disabilities using anthropometric measurements.
Methodology:
This research employed a school-based cross-sectional descriptive study design and focused on adolescents with disabilities attending special schools in Dehradun district. Nutritional status was evaluated through anthropometric measurements, including height, weight, and skinfold thickness.
Results:
A total of 142 study participants were included, with a mean age of 14.32 (±0.20) years. Notably, 93% of the study subjects had disabilities since birth, indicating congenital malformation. The majority of the participants, accounting for 52.1%, were classified as having a normal BMI, while 18.3% were categorized as overweight or obese.
Conclusion:
We found that the mental disability (38%) was the most common disability among adolescents. A relatively higher prevalence of underweight was seen in adolescent with hearing disability (47.8%).
Keywords: Adolescent, differently abled, disability, nutrition status, special school
Introduction
Nutrition is a critical part of health and development.[1] Adequate nutrition is essential for maintaining optimal physical and mental health throughout the lifespan and is critical for growth and development in childhood and adolescence. A lack of proper nutrition can lead to malnutrition, which is a serious public health issue that can have lifelong consequences. According to the WHO, disability affects >1 billion people globally, making up around 15% of the world’s population.[2]
The National Sample Survey (NSS) conducted in 2018–2019 provides more recent data on disability prevalence in India, including adolescents as well. According to this survey, the total prevalence of impairment among people aged 5 years and above was 2.2%.[3] Disability is unevenly distributed, with a higher prevalence observed in countries with low or middle incomes due to various factors, including inadequate healthcare, poverty, malnutrition, limited access to education and employment opportunities, and higher rates of injuries and infectious diseases.[4,5]
In addition, disabled children may have feeding difficulties or require feeding assistance, which can impact their nutrient intake and overall nutritional status.[6] This study aims to fill this gap by providing valuable insights into nutritional status of disabled adolescents. With this background in mind, this study was planned and conducted in District Dehradun.
Material and Methods
Study Design: School-based descriptive cross-sectional study
Study Population: A Special Schools in District Dehradun
Sampling Technique: Simple random sampling was used in this study to choose schools from sampled community blocks in District Dehradun [Figure 1].
Figure 1.
Methodology process
The sample size for this study was calculated using the formula: where P is the prevalence of stunting 52% in adolescents.[7]
Z = 1.96 (at two-sided interval)
P = 0.52
d was absolute error taken as 10%
n = (1.96) 2 × 0.52 × (1–0.52)/0.1
n = 3.84 × 0.52 × 0.48/0.01
n = 95.8, n = 96
By taking a 10% non-responsive rate, the minimum sample size calculated was 106. We enrolled 142 adolescents with disabilities.
Inclusion Criteria for Adolescents with Disabilities:
Age between 10 and 19 years.
Diagnosis of a disability (e.g., cerebral palsy, down syndrome, intellectual disability, hearing impairment, visual impairment, etc.).
Cooperative and able to communicate and understand the language used in the research.
Exclusion Criteria:
Severe illness or medical conditions that may affect nutritional status.
Taking medication that may affect nutritional status (nutrition supplements/drugs, multi-vitamins, Vitamin B12, etc.).
Study Measures: This study assessed nutritional status through anthropometry, including measurements of height, weight, and skinfold thickness.
Ethical Consideration: The university ethics committee approved the study before it began (SRHU/HIMS/E-1/2023/77). Informed consent was taken from the authorities of the special schools as well as parents of study participants.
Data entry and statistical analysis were carried out with Microsoft Excel and SPSS version 22.0 software. Statistical significance was defined as P < 0.05.
Result
The present study involved 142 adolescents with impairments who were residing in Dehradun district and attended special schools. The following observations were made:
The average age of the study participants was 14.32 years (±0.20 years). Most of the participants (54.9%) were between the ages of 14 and 17 (middle adolescence). Regardless of gender, more than half of the respondents (69.7%) resided in nuclear families. Regarding the presence of disability, 93% of the study subjects had a disability since birth (congenital), while 7% acquired disability after birth. The difference between these two groups was not statistically significant (P = 0.720) [Table 1].
Table 1.
Gender-wise distribution of sociodemographic details of the study participants
| Biosocial character | Total (n=142) (%) | Gender | P | ||
|---|---|---|---|---|---|
|
| |||||
| Male (n=105) (%) | Female (n=37) (%) | ||||
| Age (in completed years) | 10–13 | 49 (34.5) | 37 (35.2) | 12 (32.4) | 0.786 |
| 14–17 | 78 (54.9) | 58 (55.2) | 20 (54.1) | ||
| 18–19 | 15 (10.6) | 10 (9.6) | 5 (13.5) | ||
| Religion | Hindu | 130 (91.5) | 97 (92.4) | 33 (89.2) | 0.062 |
| Muslim | 7 (4.9) | 3 (2.8) | 4 (10.8) | ||
| Sikh | 5 (3.6) | 5 (4.8) | 0 (0) | ||
| Type of Family | Nuclear | 99 (69.7) | 72 (68.6) | 27 (73) | 0.616 |
| Joint | 43 (30.3) | 33 (31.4) | 10 (27) | ||
| Marital Status of Parents | Married | 130 (91.5) | 96 (91.4) | 34 (91.9) | 0.835 |
| Separated/Divorced | 1 (0.7) | 1 (1) | 0 (0) | ||
| Widow/Widower | 11 (7.8) | 8 (7.6) | 3 (8.1) | ||
| Number of Family Members | <6 | 133 (93.7) | 98 (93.3) | 35 (94.6) | 0.787 |
| >6 | 9 (6.3) | 7 (6.7) | 2 (5.4) | ||
| Disability present | Since birth (congenital) | 132 (93) | 98 (93.3) | 34 (91.9) | 0.720 |
| After birth | 10 (7) | 7 (6.7) | 3 (8.1) | ||
Table 2 represents the gender-wise distribution of types of disability among the study participants. Mental disability was the most common disability found among study participants, with 35.2% in males and 45.9% in females. Autism accounted for 22.9% in males and 24.3% in females, followed by hearing impairment at 17.1% in males and 13.5% in females. Intellectual disability was reported in 17.1% of males and 5.4% of females, while other disabilities accounted for 7.6% in males and 10.8% in females. However, the observed differences in disability prevalence among genders were not found to be statistically significant (P = 0.378).
Table 2.
Gender-wise distribution of type of disability among study participants
| Disability | Total (n=142) (%) | Gender | P | |
|---|---|---|---|---|
|
| ||||
| Male (n=105) (%) | Female (n=37) (%) | |||
| Autism | 33 (23.2) | 24 (22.9) | 9 (24.3) | 0.378 |
| Hearing Impairment | 23 (16.2) | 18 (17.1) | 5 (13.6) | |
| Intellectual Disability | 20 (14.1) | 18 (17.1) | 2 (5.4) | |
| Mental Disability | 54 (38) | 37 (35.2) | 17 (45.9) | |
| Other Disabilities@ | 12 (8.5) | 8 (7.7) | 4 (10.8) | |
@Cerebral palsy, down syndrome, learning disability, locomotors disability
Table 3 depicts the gender-wise distribution of anthropometric measurements among study participants. The median (IQR) height of the study subjects was 146 cm (135–156 cm), the mean (±SD) weight of the study participants was 40.44 kg (±1.090 kg), the mean (±SD) biceps skinfold thickness of the study participants was 18.15 mm (±0.489 mm), and the mean (±SD) triceps skinfold thickness of the study participants was 20.90 mm (±0.524 mm). Among study participants, it is worth noting that the mean triceps skinfold thickness of females was greater than that of males, measuring 22.24 mm (±7.17 mm).
Table 3.
Gender-wise distribution of anthropometric measurements among study participants
| Anthropometric measurements | Descriptive statistics | ||
|---|---|---|---|
|
| |||
| Male (n=105) | Female (n=37) | Total (n=142) | |
| Height (cm) (Median [IQR]) | 148 (133–156) | 146 (136–155) | 146 (135–156) |
| Weight (Kg) (Mean±SD) | 40.99±13.69 | 38.89±10.7 | 40.44±1.090 |
| Biceps skinfold thickness (mm) (Mean±SD) | 18.10±5.6 | 18.32±6.3 | 18.15±0.489 |
| Triceps skinfold thickness (mm) (Mean±SD) | 20.44±5.8 | 22.24±7.17 | 20.90±0.524 |
Figure 2 illustrates the gender-wise distribution of study participants according to the CDC BMI classification. Out of 142 participants, 52.1% were classified as having a normal BMI. When comparing genders, a higher number of males (56.2%) had a normal BMI compared to females (40.5%). Approximately 29.6% of the study subjects were classified as underweight, with a greater number of females being underweight compared to males. Males were found to be more overweight (13.3%), whereas females were found to be more obese (13.5%).
Figure 2.
Gender-wise distribution of study participants according to BMI classification (CDC)
Figure 3 reveals the distribution of study participants according to CDC BMI classifications across types of disability. Among participants with Autism, 69% had a normal BMI, 15.2% were overweight, 9.1% were obese, and 6.1% were underweight. 47.8% participants with hearing impairment were underweight, 34.8% had a normal BMI, and 17.4% were overweight. Regarding intellectual disability 40.5% participants were found with a normal BMI, 35% were underweight, 15% were overweight, and 10% were obese. Regarding participants with mental disability 51.9% had normal BMI, 37% were underweight and 5.6% were overweight or obese. Lastly, participants with other disabilities had 58.3% with a normal BMI, 25% were overweight, and 16.7% were underweight.
Figure 3.
Distribution of type of disability according to BMI- classification (CDC)
Discussion
In our study, the gender distribution among the study participants showed that more than half of the participants were males 74%, and the remaining were females 26%. Similarly, a study conducted in Bangalore 2021 where the proportion of males to females was 60.7% and 39.3%, respectively.[8] Another study conducted in Karnataka found that the proportion of males to females was 49.5% and 50.5%, respectively.[9] The age distribution of the study participants revealed that the majority fell within the 14–17 years age group (54.9%). This finding aligns with studies conducted in other regions which have also identified a higher proportion of adolescents with disabilities within this age range.[8,10] Regarding the timing of disability onset, the present study found that the majority of participants had disabilities since birth (93%), while a smaller proportion acquired disabilities after birth (7%). Previous studies have also reported a higher prevalence of disabilities since birth.[11]
The finding that mental disability was the most prevalent type of disability among both males and females was consistent with previous research conducted on adolescents with disabilities.[12] On the contrary higher prevalence of disabilities among males has been reported in other studies.[10,13,14]
In the current study, 29.6% were reported as underweight, 12.7% as overweight, and 5.6% as obese. These observations are alike to the study conducted in Bangalore in 2021 which was reported 33.1% underweight, 6.2% overweight, and 4.1% were obese.[15] On the contrary, other studies had observed that 9.1% were underweight, and 15.6% were obese.[16] Another study also reported that 22.2% of participants were overweight.[17] The reason for this could be due to differences in the samples that are taken in the studies together with standard of living of the participants and differences in dietary patterns which varies according to the region.
The present study conducted among adolescents with various disabilities provided insights into the BMI classification patterns within each disability group. Among adolescents with Autism, the majority (69%) had a normal BMI, indicating a relatively healthier weight status. This aligns with previous research conducted on adolescents with Autism, which also reported a higher prevalence of normal weight (58%) compared to overweight (26%) and obesity (12%).[18]
For adolescents with hearing impairment, the study revealed a higher prevalence of underweight status (47.8%) compared to other disabilities. Similar results were found in a previous study, which highlighted a higher risk of underweight status in individuals with hearing impairment.[19]
Regarding intellectual disability, the majority of participants had a normal BMI (40%), but there was a significant prevalence of underweight (35%) and overweight/obesity (25%). These findings correspond with similar studies, which observed that most of the study participants were underweight and overweight/obesity among adolescents with intellectual disability compared to the general population.[20,21]
In the case of mental disability, the study reported that 51.9% of study participants had a normal BMI, while a significant proportion (37%) were classified as underweight. This highlights a higher risk of underweight status among individuals with mental disability.[19,22]
Limitations
Limitation of our study was its relatively short duration and the inclusion of a small sample size, which may restrict the generalizability of the findings. Another limitation of the study pertained to the possibility of some measurement errors in anthropometric measurements, specifically in skinfold thickness.
Conclusion
We found that the mental disability (38%) was the most common disability among adolescents. Regarding BMI, around 1/3rd of the study participants were underweight (30%). A relatively higher prevalence of underweight was seen in adolescent with hearing disability(47.8%), where as remaining of the adolescents with autisum had a normal BMI.
Recommendation
To prevent nutritional problems among adolescents with disabilities, future efforts should focus on tailored nutritional interventions, promoting physical activity, and raising awareness among caregivers and schools about the specific dietary and exercise needs of this vulnerable population. Collaboration between healthcare providers, educators, and parents is crucial for effective prevention and management.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors are thankful to Swami Rama Himalayan University for enabling us to carry out the study. Authors are also grateful to authorities of Special Schools and participants for their cooperation during entire study period.
Funding Statement
Nil.
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