# Dietary Diversity, Haemoglobin and Anaemia in Nepali Adolescent Girls: A Longitudinal Study

## TL;DR

This study tracks dietary habits and anemia in Nepali adolescent girls over three years, finding that factors like education, sanitation, and caste influence their health outcomes.

## Contribution

The study provides longitudinal evidence linking dietary diversity, haemoglobin levels, and anemia with socioeconomic and geographic factors in Nepali adolescent girls.

## Key findings

- Dietary diversity remained low, with an average of four out of ten food groups consumed.
- Anaemia prevalence increased from 20.6% in 2017 to 24.8% in 2019.
- Post-menarche status was associated with lower haemoglobin and higher odds of anaemia.

## Abstract

Adolescent girls and young women in Nepal are vulnerable to poor diets and anaemia, yet the extent of these risks remains overlooked. We assessed changes in dietary diversity, haemoglobin, and anaemia, and identified associated factors among adolescent girls and young women in Nepal. We analysed data from a longitudinal panel study including never‐married and not‐pregnant participants, enroled at 10–19 years in 2017 (n = 770) and followed up in 2018 (n = 682) and 2019 (n = 618). We used descriptive statistics and mixed‐effects regression analyses. The dietary diversity score was on average four out of 10 food groups, haemoglobin remained between 12.7 and 12.8 g/dL throughout the study period, and anaemia prevalence increased from 20.6% (2017) to 24.8% (2019). In adjusted models, we found positive associations between more schooling and dietary diversity and between access to improved toilet and haemoglobin. Living in the terai and hills, and disadvantaged caste/ethnicity were negatively associated with dietary diversity, and haemoglobin, while living in the terai and disadvantaged caste/ethnicity were negatively associated with anaemia. Food insecurity was negatively associated with dietary diversity only. Post‐menarche status was associated with lower haemoglobin and higher odds of anaemia. Adolescent nutrition should be prioritised within national health, education, and social protection frameworks. Multi‐sectoral interventions particularly in terai and hills, should focus on scaling up micronutrient supplementation, enhancing government‐led school meal programme to provide balanced, culturally appropriate meals (including vegetarian protein sources for lacto‐vegetarians), improving educational uptake, ensuring access to sanitation facilities, and delivering targeted, sustained interventions around menarche throughout adolescence.

Post‐menarche girls show lower haemoglobin and higher anaemia risk, indicating critical windows for school‐ and community‐based micronutrient supplementation and nutrition education around menarche.Access to improved sanitation also correlates with better haemoglobin status, highlighting the importance of multisectoral approaches including WASH interventions.Greater schooling and household food security are positively associated with dietary diversity, though programmes must also address social and cultural barriers to further education, and equitable food access.Adolescent girls in Nepal's terai and hills and disadvantaged caste/ethnicity groups have lower dietary diversity and lower haemoglobin, while those in the terai and disadvantaged groups have higher anaemia prevalence, underscoring urgent need for targeted nutrition interventions.Further mixed‐method research on caste/ethnicity and agroecological zone disparities is needed to design equitable, context‐specific nutrition policies and programmes.

Post‐menarche girls show lower haemoglobin and higher anaemia risk, indicating critical windows for school‐ and community‐based micronutrient supplementation and nutrition education around menarche.

Access to improved sanitation also correlates with better haemoglobin status, highlighting the importance of multisectoral approaches including WASH interventions.

Greater schooling and household food security are positively associated with dietary diversity, though programmes must also address social and cultural barriers to further education, and equitable food access.

Adolescent girls in Nepal's terai and hills and disadvantaged caste/ethnicity groups have lower dietary diversity and lower haemoglobin, while those in the terai and disadvantaged groups have higher anaemia prevalence, underscoring urgent need for targeted nutrition interventions.

Further mixed‐method research on caste/ethnicity and agroecological zone disparities is needed to design equitable, context‐specific nutrition policies and programmes.