Dietary behavior of school going adolescents in Bhutan - Findings from the Global school-based student health survey in 2016

Abstract Background Bhutan is experiencing dual burden of undernutrition and overnutrition among adolescents. Understanding dietary behavior is vital to designing evidence-based interventions to improve adolescent nutrition and prevent non-communicable diseases (NCD) in adults. We aimed to assess the pattern of dietary behavior and associated socio-demographic, behavioral and metabolic risk factors among school-going adolescents in Bhutan. Methods Bhutan Global School based Student Health Survey 2016 studied students in grade 7 to 11(n= 7576), sampled from 50 schools, randomly selected based on probability proportional to enrolment size, using a standardized self-administered questionnaire. Consumption of adequate fruits and vegetables (each ≥ twice/day, or a combination ≥5 times/day), high protein food (≥2 times/week) in the past 30 days, no fast food in the past week and no carbonated/sweetened drinks in the past 30 days were studied. Weighted prevalence of dietary behaviors and adjusted prevalence ratio (95% confidence interval) for factors associated with them were calculated. Results Of 5809 aged 13-17years comprising 3255(56%) females and 3184(54.8%) day students, 1166(20.1%) were underweight, 1655(28.5%) were tobacco users and 1349(23.2%) were alcohol users. Adequate fruit and vegetable intake, high protein consumption, not consuming fast foods and carbonated beverages were reported by 29.6%, 31.8%, 9.6% and 14.9%, respectively. Being a day student, gender and not reporting health risk behaviors were significantly associated with any healthy dietary behaviour. Conclusion Healthy eating behaviour was low among Bhutanese adolescents. Policies influencing availability, affordability and acceptability of healthy diets through peer led, school and community-based interventions are required to promote adolescent health and prevent NCDs.