Food Access and Nutritional Status of Rural Adolescents in India: Pune Maternal Nutrition Study

Published:January 22, 2020DOI:


      The relationships among food access, foods consumed, and nutritional status and health in developing countries are not well understood. Between 2013 and 2018, differences in the rural food environment and access to food, nutritional status, and body size in the rural villages where the Pune Maternal Nutrition birth cohort was recruited were measured and analyzed.


      Food access measures included the number of shops per 1,000 population, water availability, and distance from the highway. A total of 418 adolescents (223 boys, 195 girls) aged 18 years had diet assessed by a quantitative food frequency questionnaire; height, weight, and waist measured; body fat percentage determined by dual x-ray absorptiometry; and blood biomarkers (vitamin B12 and hemoglobin) assayed.


      By village, the number of shops per 1,000 population ranged from 3.85 to 23.29. Boys and girls from the 2 villages with the highest food access, year-round water availability, and closest to the highway were heavier and had higher BMI, waist circumference, and body fat percentage compared with those from the lowest tertile of food access (p<0.05 for all, adjusted for SES). Across all villages, dietary diversity was poor and B12 insufficiency and anemia were prevalent. With easier access to food, consumption of staple foods decreased and outside food increased. On multivariate regression analysis, higher BMI of the adolescents was significantly associated with higher food access, along with higher weight at birth, socioeconomic scores, and daily energy consumption.


      Results demonstrate a strong link between rural food access, foods consumed, and measures of nutritional status in an undernourished, mostly vegetarian, rural population.
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        • Sharkey JR.
        Measuring potential access to food stores and food-service places in rural areas in the U.S.
        Am J Prev Med. 2009; 36: S151-S155
        • Gundersen C
        • Ziliak JP
        Food insecurity and health outcomes.
        Health Aff (Millwood). 2015; 34: 1830-1839
        • Ministry of Home Affairs, Office of the Registrar General & Census Commissioner
        Census of India. New Delhi.
        Published 2011
        Date accessed: October 23, 2019
        • Lock K
        • Smith RD
        • Dangour AD
        • et al.
        Health, agricultural, and economic effects of adoption of healthy diet recommendations.
        Lancet. 2010; 376: 1699-1709
      1. Turner C, Kalamatianou S, Drewnowski A, Kulkarni B, Kinra S, Kadiyala S. Food environment research in low- and middle-income countries: a systematic scoping review. Adv Nutr. In press. Online May 11, 2019.

        • Widener MJ
        Spatial access to food: retiring the food desert metaphor.
        Physiol Behav. 2018; 193: 257-260
        • Matthews SA
        • Moudon AV
        • Daniel M
        Work Group II: using geographic information systems for enhancing research relevant to policy on diet, physical activity, and weight.
        Am J Prev Med. 2009; 36: S171-S176
        • Odoms-Young AM
        • Zenk S
        • Mason M
        Measuring food availability and access in African-American communities implications for intervention and policy.
        Am J Prev Med. 2009; 36: S145-S150
        • Debnath S
        • Nitish M
        • Sen J
        Double burden of malnutrition among adolescents in India: a review.
        Hum Biol Rev. 2019; 8: 155-178
        • Yajnik CS
        • Fall CH
        • Coyaji KJ
        • et al.
        Neonatal anthropometry: the thin-fat Indian baby. the Pune Maternal Nutrition Study.
        Int J Obes Relat Metab Disord. 2003; 27: 173-180
        • Ganpule A
        • Yajnik CS
        • Fall CH
        • et al.
        Bone mass in Indian children–relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study.
        J Clin Endocrinol Metab. 2006; 91: 2994-3001
        • Kennedy GL
        • Pedro MR
        • Seghieri C
        • Nantel G
        • Brouwer I
        Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children.
        J Nutr. 2007; 137: 472-477
        • Longvah T
        • Ananthan R
        • Bhaskarachary K
        • Venkaiah K
        Indian food Composition Tables.
        National Institute of Nutrition, Hyderabad, IndiaPublished 2017
        • Kennedy G
        • Ballard T
        • Dop M
        Guidelines for measuring household and individual dietary diversity.
        FAO, Rome, ItalyPublished 2013
        Date accessed: October 23, 2019
        • FAO and FHI 360
        Minimum dietary diversity for women: A guide to measurement.
        FAO, Rome, ItalyPublished 2016
        Date accessed: October 23, 2019
        • WHO. Physical status
        the use and interpretation of anthropometry: report of a WHO Expert Committee.
        WHO, Geneva, SwitzerlandPublished 1995
        • Sohn K.
        Sexual stature dimorphism as an indicator of living standards?.
        Ann Hum Biol. 2016; 43: 537-541
        • Fleischhacker S
        • Byrd RR
        • Ramachandran G
        • et al.
        Tools for Healthy Tribes: improving access to healthy foods in Indian country.
        Am J Prev Med. 2012; 43: S123-S129
        • Ambikapathi R
        • Rothstein JD
        • Yori PP
        • et al.
        Food purchase patterns indicative of household food access insecurity, children's dietary diversity and intake, and nutritional status using a newly developed and validated tool in the Peruvian Amazon.
        Food Secur. 2018; 10: 999-1011
        • Na M
        • Gross AL
        • Wu LSF
        • Caswell BL
        • Talegawkar SA
        • Palmer AC
        Internal validity of the Food Access Survey Tool in assessing household food insecurity in rural Zambia.
        Food Sec. 2016; 8: 679-688
        • Na M
        • Gross AL
        • West Jr, KP
        Validation of the food access survey tool to assess household food insecurity in rural Bangladesh.
        BMC Public Health. 2015; 15: 863
        • Sharkey JR
        • Horel S
        • Han D
        • Huber Jr, JC
        Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of Colonias.
        Int J Health Geogr. 2009; 8: 9
        • Boone-Heinonen J
        • Gordon-Larsen P
        • Kiefe CI
        • Shikany JM
        • Lewis CE
        • Popkin BM
        Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study.
        Arch Intern Med. 2011; 171: 1162-1170
        • Burns C
        • Bentley R
        • Thornton L
        • Kavanagh A
        Associations between the purchase of healthy and fast foods and restrictions to food access: a cross-sectional study in Melbourne, Australia.
        Public Health Nutr. 2015; 18: 143-150
        • Thornton LE
        • Bentley RJ
        • Kavanagh AM
        Fast food purchasing and access to fast food restaurants: a multilevel analysis of VicLANES.
        Int J Behav Nutr Phys Act. 2009; 6: 28
        • Abeykoon AH
        • Engler-Stringer R
        • Muhajarine N
        Health-related outcomes of new grocery store interventions: a systematic review.
        Public Health Nutr. 2017; 20: 2236-2248
        • Fleischhacker SE
        • Evenson KR
        • Rodriguez DA
        • Ammerman AS
        A systematic review of fast food access studies.
        Obes Rev. 2011; 12: e460-e471
        • Caballero B.
        The global epidemic of obesity: an overview.
        Epidemiol Rev. 2007; 29: 1-5
        • White M
        Food access and obesity.
        Obes Rev. 2007; 8: 99-107
        • Drewnowski A.
        Obesity and the food environment: dietary energy density and diet costs.
        Am J Prev Med. 2004; 27: 154-162
        • Ver Ploeg M
        • Dutko P
        • Breneman V
        Measuring food access and food deserts for policy purposes.
        Appl Econ Perspect Policy. 2015; 37: 205-225
        • Cummins S
        • Macintyre S.
        “Food deserts”–evidence and assumption in health policy making.
        BMJ. 2002; 325: 436-438
        • Shetty PS.
        Nutrition transition in India.
        Public Health Nutr. 2002; 5: 175-182
        • National Institute of Nutrition
        Dietary guidelines for Indians: a manual.
        National Institute of Nutrition, Hyderabad, IndiaPublished 2011