adolescents, diets and nutrition

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Suggested citation: Sethi V, Lahiri A, Bhanot A, Kumar A, Chopra M, Mishra R, Alambusha R, Agrawal P, Johnston R and

de Wagt A. Adolescents, Diets and Nutrition: Growing well in a Changing World, The Comprehensive National Nutrition

Survey, Thematic Reports, Issue 1, 2019.

Adolescents, Diets and Nutrition

Growing Well in a Changing World

The CNNS Thematic Reports, Issue 1, 2019

Birth to Adolescence

Contents

Summary 1

Adolescents, Diets and Nutrition: Fast Facts 5

1 Introduction 9

2 Methods 11

3 Findings 15

3.1 How many adolescents suffer from visible forms of malnutrition? 15

3.2 How many adolescents suffer from anemia and micronutrient defi ciencies? 22

3.3 Risks for non-communicable diseases 37

3.4 Adolescents diets – are they healthy or unhealthy? 47

3.5 What are the physical activity patterns among adolescents? 91

3.6 What are the decision making patterns in adolescent girls? 97

3.7 What is the co-coverage of school-based nutrition services? 102

4 Opportunities 115

Maps 117

Annexure 1: Sociodemographic characteristics of analytical sample based on

which fi ndings are presented in this report 147

Annexure 2: Where do the poorest adolescents live in India (%) 149

Annexure 3: Nutrient rich sources (Top 10) and consequences of defi ciency/excess

among adolescents 150

Acknowledgements 156

References 157

1The CNNS Thematic Reports, Issue 1, 2019

Investing in the nutrition of the 1.2 billion

adolescents (10-19 years aged population)

will shape the world’s future. A fi fth of these

adolescents – 253 million – live in India.

Ensuring India’s adolescents are nourished

and growing well is critical to achieving India’s

demographic dividend.

Adolescents receive several health and

nutrition services in India. These include

biannual health check-ups, biannual

deworming, Weekly Iron Folic Acid

Supplementation (WIFS), counselling for

mental and reproductive health conditions.

Girls also receive menstrual hygiene services.

Longer duration of schooling is critical for

preventing early marriage and adolescent

pregnancy. In India, education is free and

compulsory till age of 14 years. School going

adolescents are also entitled to a mid-day

meal providing almost a third of energy and

protein requirements for 200 school-days in a

year in all government schools.

On 8 October 2019, the Ministry of Health and

Family Welfare, Government of India, released

the national report of the Comprehensive

National Nutrition Survey (CNNS) 2016-18

– birth to adolescence. The CNNS data-set

provides unparalleled new insights into all

types of macronutrient and micronutrient

malnutrition, dietary habits, life skill behaviours,

access to services (school, health and

nutrition) and physical activity throughout

adolescence 10-19 years and for both boys

and girls.

The CNNS survey data comes at an opportune

time, two years after the launch of the National

Nutrition Mission (POSHAN Abhiyaan) which

can provide valuable insights to support

healthy growth throughout childhood and

adolescence. Additionally, focusing on

Summary

adolescent girls, before they become mothers,

is critical to break India’s intergenerational

cycle of malnutrition. Schools are a cross-

sectoral platform to address good nutrition

– diets, services and behaviours. CNNS gives

important program insights on strengthening

nutrition in school premises.

Adolescents, Diets and Nutrition: Growing

well in a changing world, is the fi rst CNNS

thematic report based on unit-level data

analysis. It deep-dives in the CNNS data-

set to provide insights in lives of adolescents

in India in the 21st century. The analyses

provide national and state estimates on

adolescents 10-19 years (disaggregated by

boys and girls) for levels of malnutrition-

both its visible (thin, short and overweight/

obese) and hidden forms (anemia and six

micronutrient defi ciencies (iron, vitamin B12

,

folate, vitamin A, vitamin D and zinc)), risks for

non-communicable diseases, diets, physical

activity patterns, life style and beliefs and

access to services (health, social safety net

and nutrition) for early adolescents (10 to 14

years) and late adolescents (15 to 19 years).

Analytical sample on the basis of which

the fi ndings are presented include 35,856

adolescents 10-19 years (and a sub-set of

16,181 for biological samples).

Summary Findings

Every second Indian adolescent is either too

short or too thin or overweight/obese. Girls

are shorter than boys, but boys are thinner

than girls. Thinness is highest in 10-12 year

olds, with vast in-state variations among

10-14 year olds and 15-19 year olds

Every third adolescent girl and every fourth

adolescent boy 10-19 years is too short for

their age. More boys than girls are thin for

2 ADOLESCENTS, DIETS AND NUTRITION

their age in both 10-14 age group (32% boys,

23% girls) and 15-19 age group (26% boys,

14% girls). Highest prevalence of thinness is

seen between 10-12 years for both boys and

girls. In 10-14 age group, 1 in 2 short girls and

1 in 3 short boys, are also thin. At least, 5%

adolescents 10-14 years and 4% adolescents

15-19 years are overweight. In most states

of India at least 1 in 5 girls and boys are too

short for their age. Thinness in adolescence

is a problem of public health concern in most

Indian states. Twelve states have overweight/

obesity prevalence over 10% in 10-14 years

age group itself. Within states, there is variation

in prevalence of malnutrition between 10-14

year olds and 15-19 year olds. For example in

Bihar 18% girls are short in 15-19 years age

group, much higher than 36% in the 10-14

years age group. In Telangana this trend is

reverse with few shorter girls 10-14 years (17%)

compared to 44% short girls 15-19 years.

One in two adolescents suffer from at least

two of the six micronutrient defi ciencies

(iron, folate, vitamin B12

, vitamin D, vitamin

A and zinc)

Of the six micronutrient defi ciencies studied,

only 14% girls and 21% boys had none of the

six micronutrient defi ciencies. Over 50% of

the girls suffered from two of six micronutrient

defi ciencies. Out of the six micronutrient

defi ciencies studied, the most common

among adolescent girls is vitamin D defi ciency,

followed by folate and iron defi ciency. Among

adolescent boys, the highest burden is of folate

defi ciency, followed by vitamin B12

and zinc

defi ciency. Punjab is the only state to have

high proportions of adolescents affected by

fi ve different micronutrient defi ciencies (iron,

vitamin B12

, vitamin D, vitamin A and zinc).

Anemia affects 40% adolescent girls and 18%

boys. Co-existence of anemia and thinness is

higher among girls and 15-19 year olds

Anemia affects 32% girls 10-14 years and 48%

girls 15-19 years. Among boys 10-19 years,

~20% are anemic. Co-existence of anemia

and thinness among girls is twice more than

boys in early adolescence (10-14 years) and

four times higher in late adolescence (15-19

years). Among girls 10-14 years, anemia is a

severe public health problem in eight states

(Jharkhand, Tripura, West Bengal, Assam,

Chhattisgarh, Gujarat, Telangana and Uttar

Pradesh). Among 10-14 year old boys, anemia

is a severe public health problem in one state-

West Bengal. Among 15-19 year olds, anemia

is a severe public health problem in 19 states

in girls. There is no state in India where anemia

is a severe public health problem among boys

15-19 years.

Diabetes and cardiovascular diseases risk

and hypertension among adolescents is

increasing. At least 1 in 2 adolescents

affected by at least one of these risks.

1 in 10 adolescent girls and boys 10-14 years

and 2 out of 10 adolescents 15-19 years are at

risk of diabetes on the basis of HbA1c levels.

One in 4 (26%) boys 10-14 years have low

good cholesterol (low HDL cholesterol). The

proportion of adolescent boys 15-19 years

with low HDL cholesterol levels increases

to 39% indicating increasing risks in the

transition from early to late adolescence in

boys. Among girls 10-19 years, 1 in every 4

adolescents have low HDL cholesterol. A small

proportion (5%) adolescent boys and girls

suffer from hypertension, based on systolic

and diastolic blood pressure. Among girls,

proportion with hypertension is highest (8%)

at 11 years and 18 years. Among boys, highest

proportion is noted at 19 years (7%). One in 2

adolescents have at least one of the three non-

communicable disease risks (high HbA1c, high

diastolic/systolic blood pressure and low HDL

cholesterol levels). At least two such risks are

seen in 1 in 3 adolescents. None of the states

have zero risk for diabetes and heart disease

among adolescents 10-14 years of age.

Girls suffer more: They have multiple

nutritional deprivations and little autonomy

More girls suffer from co-existence of

shortness and thinness than boys in both


early (10 to 14 years) and late (15 to 19 years)

adolescence. Co-existence of anemia and

thinness among girls is twice more than boys

in early adolescence (10 to 14 years) and four

times higher in late adolescence (15 to 19

years). Their situation is exacerbated by the

fact that girls have little say in their own life

choices around What to buy? Whom to marry?

When to marry? There are states like Goa and

Mizoram that do exceptionally well on girls'

autonomy but they are heavily outnumbered

by those which perform poorly.

Malnutrition in several forms is higher and/

or peaks in early adolescence

While there are more than 1 in 5 short

adolescents at all ages from 10 to 19 years,

prevalence of thinness and obesity peaks in

early adolescence (10 to 14 years) for both

girls and boys. Thus, reaching adolescents with

nutrition services early is imperative. Vitamin A,

vitamin D and zinc defi ciencies peak in early

adolescence (10 to 14 years). Also, risks for

non-communicable diseases are established

in childhood and adolescence. Thus, within

the second decade of life (10 to 19 years),

most opportune time to intervene is in early

adolescence.

Almost all adolescents have “unhealthy”

diets

Only 2 out of 5 adolescents (~45%) take milk

in their daily diet. Only 1 out of 5 adolescents

(~20%) take pulses and green leafy

vegetables. Less than 1 out of 5 adolescents

(<10%) consume fruits daily. Six out of 10

adolescents reported zero consumption

of fruits even once a week. Every fourth

adolescent reported zero consumption of

green leafy vegetables even once a week.

At the same time, at least once a week

consumption of fried foods was reported

by 30% adolescents and sweets by 15%.

Consumption of fried foods was reported by

5% adolescents, sweets and aerated drinks

by 2% adolescents. Two percent adolescents

reported at least thrice a week consumption

of junk foods. Adolescent girls and boys who

are short, thin, or anemic most often do not

eat fruits, egg, fi sh/chicken, dark green leafy

vegetables and pulses. Pulses and dark green

leafy vegetable consumption increases around

ages 12 to 14 years but these gains are lost in

later years. Intake of all avoidable foods peaks

at 17 years among boys. States of Delhi and

Goa have lowest compliance of fried foods,

junk foods, aerated drinks and sweets. Punjab

emerges as a state with lowest compliance

of adolescents consuming recommended

frequencies of nutritive foods (pulses, dark

green leafy vegetables, eggs, chicken/fi sh)

and highest levels of micronutrient defi ciencies

(iron, vitamin B1 2

, vitamin D, vitamin A, zinc).

Almost all adolescents fail to meet the daily

requirements of physical activity for their age

All girls and boys are unable to meet the 60

minutes per day recommended outdoor sports

and exercise time. On an average, girls in late

adolescence spend only 10 minutes per day

on such activities. Boys do relatively better,

with exercise time of 40 to 50 minutes per day.

Decision making on matters that shape a

girl’s life course

Girls aged 15 to 19 years are least involved in

decisions that determine when they will marry

(25%) and whom they will marry (36%).

More than half have little say on what will be

purchased for them or for the family, including

foods of choice. Odisha emerges as a state

where girls have least autonomy with minimum

say in decisions on market purchases, when to

marry and whom to marry and Mizoram with

the highest.

School-based services (noon meal, IFA

supplementation, deworming and biannual

health checkups) co-coverage is low and

variable across states

About 20 to 25% of girls and boys do not

receive any of the four school based services.

Weekly IFA supplementation has the least


penetration with 10% or lower proportion

of school going adolescents covered. State

with best coverage (Sikkim, Manipur) and

worst coverage (Nagaland) for weekly IFA

supplementation belong to the same north-

eastern region of the country. While receipt

of MDM is 67%, WIFS provided on the same

platform is low at 11%.

The analysis presented in this report is critical

evidence to inform POSHAN Abhiyaan for

holistic programming for improving nutritional

status of adolescent girls and boys, especially

through schools. Campaigns on healthy food

choices should be centered around promotion

of a variety of items in appropriate proportions

in the food plate. As the POSHAN Abhiyaan,

enters its third year, the timing is right to review

how the “would be mothers and fathers” be

provided the right nutrition to prevent the

intergeneration cycle of malnutrition.


Adolescents, Diets and Nutrition: Fast Facts

(All fi gures are in percentage except for physical activity)

Visible forms of Malnutrition (%)

10-14 years 15-19 years 10-19 years

Girls Boys Girls Boys Girls Boys

Too thin for one’s age 23 32 14 26 18 29

Too short for one’s age 29 23 30 28 29 25

Overweight/Obese for one’s age 5 5 4 4 5 5

Anemia (%)



Anemic 32 17 48 18 40 18

Hidden Malnutrition (Micronutrient Defi ciencies) (%)



Iron defi ciency 24 14 39 8 31 12

Folate defi ciency 36 36 32 44 34 39

Vitamin D defi ciency 35 16 34 12 35 14

Vitamin B12

defi ciency 26 30 28 41 27 35

Vitamin A defi ciency 19 18 12 13 16 16

Zinc Defi ciency 27 36 30 34 28 35

Prevalence of more than one micronutrient

defi ciency (out of six listed above)

No defi ciency 14 21 14 22 14 21

Any 1 defi ciency 35 35 35 36 35 35

Any 2 defi ciencies 29 32 31 29 30 30




Risk of Non-Communicable Diseases (%)



Low HDL cholesterol (risk of heart disease) 26 26 24 39 25 32

HbA1C (risk of diabetes) 8 7 16 11 8 11

Hypertension 5 5 5 5 5 5

Diet Diversity – were Foods Consumed as per Frequency Recommended in Dietary

Guidelines (%)



Milk and milk products (daily) 45 47 44 47 44 47

Pulses or Beans (daily) 24 22 26 22 25 22

Green leafy vegetables (daily) 19 15 20 17 19 16

Fruits (daily) 9 8 9 8 9 8

Eggs (at least 3 times/week) 10 11 18 21 9 12

Fish/chicken/meat (at least 2 times/week) 17 18 9 14 17 19

Zero Diet Diversity – Food groups not consumed even once in the last week (%)



Milk and milk products (zero consumption) 42 38 43 35 42 37

Pulses or Beans (zero consumption) 17 14 15 13 16 14

Fruits (zero consumption) 59 58 60 57 60 57

Green leafy vegetables (zero

consumption)

26 23 24 21 25 22

Eggs (zero consumption) 67 62 69 62 68 62

Fish/chicken/meat (zero consumption) 66 63 65 61 65 62


Unhealthy Foods – Daily, at least three times a week or zero consumption (not

consumed even once in the last week) (%)



Fried foods (poori, pakora, vada, samosa,

tikki etc.) (daily consumption)

4 4 4 6 4 6


tikki etc.) (at least 3 times a week

consumption)

12 13 12 18 12 15


tikki etc.) (zero consumption)

67 62 60 66 66 61

Junk foods (burger, pizza, pasta, instant

noodles) (daily consumption)

1 1 1 1 1 1


noodles) (at least 3 times a week

consumption)

3 4 3 5 3 4


noodles) (zero consumption)

91 88 90 86 91 88

Sweets (Indian sweets, pastries/cakes,

doughnuts) (daily consumption)

1 2 2 2 2 2


doughnuts) (at least 3 times a week

consumption)

5 5 4 7 4 6


doughnuts) (zero consumption)

85 84 86 81 86 83

Aerated drinks (daily consumption) 1 1 1 1 1 2

Aerated drinks (at least 3 times a week

consumption)

3 4 3 8 3 6

Aerated drinks (at least once a week

consumption) (zero consumption)

93 89 93 83 93 86

Physical activity: average hours spent per day



Outdoor sports/exercise/ PA at school 0 1 0 1 0 1

Screen time 1 1 2 2 1 1

Leisure time physical activity 1 1 3 1 3 1

Travel to school 1 1 1 1 1 1

Sitting time 2 2 2 3 2 1


Access to Nutrition and Health services in Schools (%)



Consumption of IFA supplements in the

last one week

13 11 11 6 12 9

Received mid day meal 67 61 NA NA NA NA

Health camps organised in the last one

year

42 37 29 24 37 32

Provision of Albendazole tablet

(deworming) in the last 6 months

41 34 23 20 34 29

None of the services 21 25 26 45 22 26

Any one of the services 25 30 NA NA NA NA

Any two of the services 27 24 NA NA NA NA

Any three of the services 22 17 NA NA NA NA

All 4 services 5 4 NA NA NA NA

Decision Making (%)



Duration of study 70 NA 70 NA 70 NA

Going to the market 43 NA 50 NA 47 NA

Whom to marry 25 NA 29 NA 27 NA

When to marry 30 NA 36 NA 32 NA

Currently going to school 85 87 63 37 72 78

NA- Not Applicable


1 Introduction

India is home to 253 million adolescents - 120

million girls and 133 million boys1. These are the

largest numbers of adolescents in any country,

globally2. India’s economic growth is dependent

on its adolescents who are its demographic

advantage and hence, it's important that they are

nourished and growing well.

The age of adolescence is divided into early

and late phases, from 10 to 14 years and 15

to 19 years. Ten to 14 years are critical years

for both girls and boys as they achieve their

maximum growth spurt. Annual height and

weight gains may be as high as 9 cm and 8 to

10 kg, respectively3,4. Early adolescence is also

an opportune time to catch-up on height and

weight defi cits suffered in childhood5. Girls have

added physiological stress due to the onset of

menstruation and increased risk of anemia and

micronutrient defi ciencies. The growth spurt

continues into late adolescence (15 to 19 years),

especially for boys. In the late adolescence

phase, some girls in India do enter pregnancy

and with low height, weight and hemoglobin

levels, and will not be able to properly support

healthy fetal growth or themselves. In a vicious

cycle, babies born to adolescent girls are at an

increased risk of being born too early or with

a low birthweight. Those who conceive later

with compromised nutritional status will face

similar birth outcomes. Children of malnourished

adolescent mothers are more at risk to suffer

growth failure during the fi rst 1,000 days (from

conception to age two). Without correct nutrition,

these children are at risk of growing up physically

and cognitively stunted and are at risk of carrying

this burden into adolescence and adulthood

which fuels the intergenerational cycle of

malnutrition.

Many of these individual behaviours are

associated with poor nutritional status and

increased risk of non-communicable diseases

in adulthood, such as lack of physical activity

and eating disorders. While national estimates

for physical activity were unavailable, global

estimates suggest 8 in 10 adolescents were not

physically active enough with girls being less

active than boys6. Similar fi ndings were noted in

smaller scale studies from north, north-east and

south India7,8,9.

Body changes are accompanied by rapid

increase in cognitive and emotional development

and increased inclination to assert own choices

and identity formation. The CNNS data-set also

provides important insights into self-worth and

decision-making choices of adolescents for

strengthening this component of adolescent

friendly health services.

Schools are a cross-sectoral platform to address

good nutrition – diets, services and behaviours.

CNNS gives important programme insights on

strengthening nutrition in schools, adolescents

are entitled to several health and nutrition

services through schools such as biannual

health check-ups, biannual deworming, weekly

iron folic acid supplementation (WIFS), referral

for counselling and treatment for reproductive

health conditions and hygiene services for girls.

Education is free and compulsory till age of 14

years; longer duration of schooling being critical

for preventing early marriage and adolescent

pregnancy. School-going adolescents are also

entitled to a mid-day meal providing almost a

third of energy and protein requirements for 200

days a year in all government schools. These

services are being provided through government

of India’s national programs implemented by


Ministry of Health (Anemia Mukt Bharat, Rashtriya Bal Swasthya Karyakram and Rashtriya Kishore Swasthya Karyakram) and Ministry of Human

Resource Development (mid-day meal scheme

and menstrual hygiene and water sanitation and

hygiene services)

On 8 October 2019, the Ministry of Health and

Family Welfare, Government of India, released

the national report of the Comprehensive

National Nutrition Survey (CNNS) 2016-18

– birth to adolescence. The CNNS data-set

provides unparalleled new insights into all types

of macronutrient and micronutrient malnutrition,

dietary habits, life skill behaviours, access to

services (school, health and nutrition) and

physical activity throughout adolescence

10-19 years and for both boys and girls.

The CNNS survey data comes at an opportune

time, two years after the launch of the National

Nutrition Mission (POSHAN Abhiyaan) which

can provide valuable insights to support healthy

growth throughout childhood and adolescence.

Additionally, focusing on adolescent girls, before

they become mothers, is critical to break India’s

intergenerational cycle of malnutrition. The

potential of schools as a cross-sectoral platform

to address good nutrition – diets, services and

behaviours – remains largely untapped even in

POSHAN Abhiyaan’s fi rst two years. CNNS gives

important programme insights on strengthening

school-based services.

Adolescents, Diets and Nutrition: Growing well

in a changing world, is the fi rst CNNS thematic

report of the unit level analysis of the CNNS. It

deep-dives in the CNNS unit level data-set into

lives of adolescents in India in the 21st century.

We analyze and provide national and state

estimates on adolescents 10-19 years, levels of

malnutrition both its visible and hidden forms,

risks for non-communicable diseases, diets,

physical activity patterns, life style and beliefs

and access to services (health, social safety net

and nutrition) for early adolescents (10 to 14

years) and late adolescents (15 to 19 years). The

analytical sample included 35,856 adolescents

10-19 years (and a sub-set of 16,181 for biological

samples).

The thematic report answers the following

questions for girls and boys aged 10 to 14 years

and 15 to 19 years, separately. How these answers

vary across all states of India is also presented.

1. How many adolescents suffer from visible

forms of malnutrition?

2. How many adolescents suffer from anemia

and micronutrient defi ciencies?

3. How many adolescents are at risks for non-

communicable diseases?

4. How many adolescents eat as per

recommendation?

5. What foods are most commonly missed in

diets of malnourished adolescents?

6. What are the physical activity patterns among

adolescents?

7. What are the decision making patterns in

adolescents?

8. What is the co-coverage of school-based

nutrition services?

This report provides critical evidence to inform

POSHAN Abhiyaan for holistic programming for

improving nutritional status of adolescent girls

and boys, especially through schools. As the

POSHAN Abhiyaan enters its third year, the timing

is right to review how the “would be mothers

and fathers” be provided the right nutrition to

prevent the intergeneration cycle of malnutrition

and stregthen the human capital responsible for

India’s future growth and development.


2 Methods

Adolescents, Diets and Nutrition: Growing

well in a changing world is based on unit level

analysis of the 10-19 years age-group sub-set of

the CNNS data-set which contains information

on 0-19 years. Briefl y, the CNNS used a multi-

stage sampling design to select a representative

sample of households and individuals aged 0-19

years across 28 states and 2 union territories.

In the CNNS, the total sample for 10 to 14 years

aged adolescents was 18,388 with 8,845 girls

and 9,543 boys. The total sample for 15 to

19 years aged adolescents was 17,442 with

8,560 girls and 8,882 boys. The sample for

biochemical testing was 8,662 in the 10 to 14

years age-group (4,147 girls and 4,515 boys) and

7,520 in the 15 to 19 years age-group (3,818 girls

and 3,702 boys). This sample size formed the

analytical sample for this report.

Analysis For Malnutrition

First, we present the CNNS estimates on

prevalence of different visible and hidden forms

of malnutrition. Second, we extrapolate these

estimates on the Census, 2011, fi nal population

estimates for 10 to 14 years and 15 to 19 years

aged girls and boys to determine the burden of

different forms of malnutrition. Third, we provide

the co-existence of different forms of malnutrition

to estimate double and triple burden. Fourth,

estimates for each completed age from 10 to 18

years are also presented. Finally, we present the

variation in different forms of malnutrition across

states of India against public health signifi cance

or threshold prevalence at which the prevalence

becomes a population-level problem. WHO

thresholds of public health issues are used where

available. Where thresholds are unavailable 10%

or 20% intervals have been considered as per

distribution of prevalence.

Visible forms of malnutrition

Measuring lower in height for age (short),

weighing less for height (thin) and weighing

more for height (overweight/obese) constitute

the visible and commonly measurable forms

of malnourishment. The weight for height

measurement is also referred to as Body Mass

Index (BMI). That an adolescent is short, thin or

overweight/obese is determined by comparing

her/his height and BMI with standards developed

for a normal girl or boy of the same age; the

standards being the WHO Growth Reference

for 5-19 years10. How far a girl or boy is from

this reference is used to classify short, thin or

overweight/obese adolescent.

Hidden forms of malnutrition

Defi ciency of vitamins and other essential

micronutrients result in malnutrition where in the

manifestations are not as obvious with mild or

moderate defi cits. Thus, these are collectively

referred to as hidden forms of malnutrition. In this

report we include anemia and six micronutrient

defi ciencies (iron, vitamin B12

, folate, vitamin A,

vitamin D and zinc) to present the spectrum of

hidden malnutrition. Blood and urine tests are

undertaken to determine existence of these

forms of malnutrition, comparing an adolescent’s

whole blood or blood serum or urine levels with

WHO standard threshold values. We also present

analyses of how many adolescents are facing

at least one to all six micronutrient defi ciencies

to provide data on prevalence of multiple

micronutrient defi ciencies in an adolescent

population.


Analysis for risks of non-

communicable diseases

First, we present the CNNS estimates

on prevalence of different risks of non-

communicable diseases. Three risks are

included in our analysis- risk for diabetes, risk

for cardiovascular diseases and hypertension.

Second, we provide the co-existence of different

risks among adolescent girls and boys. Third,

estimates for risks for non-communicable

diseases for each completed age from 10 to

18 years are presented. Finally, we present the

state-wide variations against globally endorsed

thresholds for increased risks.

Risk of diabetes

Fasting plasma glucose and glycosylated

hemoglobin (HbA1c) are diagnostic tests used

Defi ciency/defi ciency disorder Threshold value

Anemia Whole blood hemoglobin level

10 to 14 y : <11.5 g/dl (10-11 y), <12 g/dl (12-14y)

15 to 19 y : <12 g/dl (girls), <13 g/dl (boys)

Mild anemia 10 to 14 y : 11 to 11.4 g/dl (10-11 y), 11 to 11.9 g/dl (12-14y)

15 to 19 y : 11 to 11.9 g/dl (girls), 11 to 12.9 g/dl (boys)

Moderate anemia 8 to 10.9 g/dl

Severe anemia <8 g/dl

Micronutrient Defi ciencies

Iron

Vitamin B12

Folate

Vitamin A

Vitamin D

Zinc

Serum ferritin <15 μg/l

Serum vitamin B12

<203 pg/ml

Serum erythrocyte folate <151 ng/ml

Serum retinol concentration <20 μg/dl

Serum 25(OH)D concentration <12 ng/ml (30 nmol/L)

Serum zinc concentration

<70 μg/dL (morning fasting) <66 μg/dL (morning non-fasting)

to screen persons for diabetes11. HbA1C indicates

plasma glucose levels over eight to 12 weeks.

Diagnostic test Threshold value

Fasting plasma glucose >100 mg/dl

HbA1c >5.6%

Source: Global IDF/ ISPAD guidelines for diabetes in childhood and

adolescence. International Diabetes Federation, International Society

of Pediatric and Adolescent Diabetes. 2011

Measure Short Thin Overweight/obese

Height for age <-2SD - -

BMI for age - <-2SD >+1SD

Risk of cardiovascular diseases

The early onset of lipid disorders including

elevated total or low-density lipoprotein (LDL)

cholesterol levels (bad cholesterol), low levels of

high-density lipoprotein (HDL) cholesterol (good

cholesterol), and high levels of triglycerides (fats)

is alarming as these conditions in adolescence

are predictive of elevated risk for cardiovascular

disease in adulthood12.


recommendation in the 10 to 14 years and 15

to 19 years age-group. Second, we estimated

compliance to food frequency recommendation

at each completed age from 10 to 19 years for

girls and boys. Third, we estimated the variation

in this compliance across states of India and

fi nally we present the lack of compliance to

recommendation among adolescents with

visible and hidden forms of malnutrition. We

did a detailed investigation of compliance to

recommended food frequency among those

with visible and hidden forms of malnutrition,

against a standard for those who did not have

these forms of malnutrition. We also compared

daily intake of foods to be avoided among those

who are overweight/ obese, have risk of diabetes,

high LDL cholesterol, low HDL cholesterol, high

triglycerides and hypertension, against those who

had none of these risks.

Analysis of physical

activity

We calculated mean time spent on physical

activity every day for girls and boys aged 10 to

14 yeasr and 15 to 19 years. We also calculated

mean time spent in each activity by exact ages

from 10 to 19 years. Finally, we compare mean

time spent on selected activities across states of

India against global recommendations presented

below.

Under the CNNS, physical activity is divided

under fi ve domains - sitting time, travel to school,

screen time, leisure time physical activity and

outdoor sports/exercise/physical activity at

school.

Total time spent on each activity by domain was

calculated by adding up the number of hours

spent on it from Monday to Sunday by each girl

and boy. Mean time spent per day was calculated

by dividing the total number of hours spent during

the entire week by seven. The observations were

compared against recommendations on screen

time and physical activity per day for this age

group as follows14:


Total cholesterol 200 mg/dl

High LDL cholesterol 130 mg/dl

Low HDL cholesterol <40 mg/dl

Triglycerides 130 mg/dl

Source: National Cholesterol Education Programme, Expert Panel on

Cholesterol Levels in Children, 2012


Systolic blood pressure 140 mmHg

Diastolic blood pressure 90 mmHg

Source: National Cholesterol Education Programme, Expert Panel on

Cholesterol Levels in Children, 2012

Hypertension

Hypertension in adolescence predicts

hypertension in adults and is most commonly

associated with obesity13. Hypertension is

diagnosed by measurement of blood pressure

against standard threshold values.

Analysis for eating as per

recommendation

As per national guidance adolescent girls and

boys in both early and late phases should eat

nine types of foods daily (cereals, pulses/beans,

milk/milk products, dark green leafy vegetables,

other vegetables, roots and tubers, fruits, fats/oils

and sugar/jaggery), eggs three time a week and

chicken/fi sh at least two days in a week4. Both

fats/oils and sugar/jaggery are to be consumed

in moderation, that is, in the range of 20 g to

45 g per day4. Guidance is to avoid a set of

foods including fried foods (poori, pakora, vada,

samosa, tikki, etc) , junk food (burger, pizza,

pasta, instant noodles), sweets (Indian sweets,

pastries/cakes, donuts) and aerated drinks

completely or to have these rarely.

We calculated the frequency of consumption of

each of these foods by each girl and boy and

estimated the proportion that complied with the


Screen time: <2 hours of screen time per day

Physical activity:

1. At least 60 minutes of moderate- to vigorous-

intensity physical activity daily

2. Most of the daily physical activity should be

aerobic

3. Vigorous-intensity activities should be

incorporated, including those that strengthen

muscle and bone (such as running, jumping),

at least 3 times per week

Analysis of decision

making

In the CNNS questionnaire four questions

pertaining to girl’s decision making about her life

choices were probed. These questions relate to:

1. Duration of schooling

2. Making independent purchases (going to

market)

3. Whom to marry, and

4. Age of marriage

We present the proportion of girls 10 to 14 years

and 15 to 19 years, who responded positively on

these four questions and state-wide variations in

these proportions.

Analysis of school-based

health and nutrition

services access

Schools are mandated to provide at least four

health, food security and nutrition services

under the Anemia Mukt Bharat, Rashtriya Bal

Swasthya Karyakram, Rashtriya Kishore Swasthya

Karyakram and mid-day meal scheme. The

services are – 1) weekly IFA supplementation, 2)

bi-annual deworming, 3) bi-annual health check-

ups with counselling and referral and 4) mid-day

hot cooked meal.

We present the proportion of school-going

adolescent girls and boys receiving these services

for 10 to 14 years and 15 to 19 years age-group.

We then present the state-wide variations in

receipt of these services. Finally, we assess

what proportion of girls and boys receive a

combination of services.

Domain Activities as per the CNNS

Sitting time

Travel to school

Screen time

Leisure time physical activity

Outdoor sports/exercise/ physical

activity at school

Sitting, doing homework, reading, study, tuition, eating, chatting

Travel by walking/cycling, bus/school/auto/metro

Watching TV, playing on computer, using smart phones

Listening/singing music, play indoor games, paying musical instrument, art

and craft, painting, drawing, bike riding/scooter, playing with pet, household

work (cleaning house, watering plants, washing utensils, washing clothes,

pressing clothes, kitchen work)

Football, basketball, volleyball, cricket, dancing, hockey, martial arts, rugby/

kabbadi, running/jogging, swimming, cycling, tennis/badminton/squash,

dancing, walk for exercise, stretching exercise, yoga, gym, aerobics, skipping


3 Findings

3.1 How many adolescents suffer from visible forms of

malnutrition?

Key messages

Every third adolescent girl and every fourth adolescent boy 10-19 years is too short for their

age.

More boys than girls are thin for their age in both 10-14 years age-group (32% boys, 23%

girls) and 15-19 years age-group (26% boys, 14% girls). Highest prevalence of thinness is

seen between 10-12 years for both boys and girls.

In 10-14 years age-group, one in two short girls and one in three short boys, are also thin.

5% adolescents 10-14 years and 4% adolescents 15-19 years are overweight.

In most states of India at least 1 in 5 girls and boys are too short for their age. Thinness in

adolescence is a problem of public health concern in most Indian states. Twelve states have

overweight/obesity prevalence over 10% in 10-14 years age-group itself. Within states, there

is variation in prevalence of malnutrition between 10-14-year olds and 15-19 year olds. For

example, in Bihar 18% girls are short in 15-19-years age-group, this increases to 36% in

10-14 years age-group. In Telangana, this trend is reverse with fewer short girls 10-14 years

(17%) compared to 44% shorter girls 15-19 years.

Being short is an indication of chronic or long-term undernutrition while thinness and overweight/obesity

are indicative of acute or short-term malnutrition. Adolescent girls who are short are more likely to have

low birth weight, small for gestational age and preterm babies. Girls who are thin and whose condition

remains unchecked before pregnancy are likely to have similar birth outcomes. Those entering pregnancy

with obesity, face complications throughout pregnancy like hypertension and gestational diabetes as well

as in labor due to large sized fetus.

1 in 3 girls and boys (30%)

and (28%), respectively) are short

Short

Early adolescence (10 to 14 years)

More than 1 in 4 girls

(29%)

Nearly 1 in 4 boys

(23%)

Late adolescence (15 to 19 years)


Thin


Overweight/obese


Nearly 1 in 4 girls

(23%) are thin

More than

1 in 10 girls are

thin (14%)

1 in 3 boys (32%) boys are thin

More than 1 in 4 boys

are thin (26%)


Thinness is more prevalent among

boys than girls

Prevalence of thinness in boys is nearly double

that among girls in the age-group of 15 to 19 years

1 in 20 (5%) girls and boys are

overweight/obese

1 in 25 (4%) girls and boys are

overweight/obese


Figure 1: Prevalence of visible forms of malnutrition in adolescents aged 10 to 14 years (%)

35

23 23

32

2930

25

20

15

10

55 5

0

Girls

Boys

Thin Short Overweight/Obese


3.1.1. Co-existence of visible forms of malnutrition

Age-group Short Thin Overweight/obese

Girls

10 to 14 y 18 million (29%) 14.5 million (23%) 3 million (5%)

15 to 19 y 17 million (30%) 8 million (14%) 2 million (4%)

10 to 19 y 35 million (29%) 22.5 million (18%) 5 million (5%)

Boys

10 to 14 y 16 million (23%) 24 million (32%) 3.5 million (5%)

15 to 19 y 18 million (28%) 17 million (26%) 2.5 million (4%)


Figure 2: Prevalence of visible forms of malnutrition in adolescents aged 15 to 19 years (%)

Girls

Boys

14

28

26

3030

25

20

15

10

5 4 4

0

Thin Short Overweight/Obese

Short and thin


1 in 2 short girls

are also thin (50%)

1 in 3 short

girls are also thin

(31%)

1 in 3 short boys

are also thin (32%)

1 in 10 short

boys are also thin

(12%)


Short and overweight/obese


(2%) and (3%) of

short girls and boys are

also overweight/obese

(3%) and (4%) of

short girls and boys are

also overweight/obese


Numbers in millions are approximate fi gures based on data from Census 2011.


3.1.2. Peak ages for different

forms of visible malnutrition

Short

Among girls, from 10 to 18 years of age, there is

not much variation in prevalence. Among boys,

highest proportion of short adolescents is at 17

and 18 years (34%).

Thin

Among girls, highest prevalence of thinness is

noted at age 11 years (27%). It declines steadily

thereafter with a slight increase at 18 years of age.

Among boys, prevalence of thinness plateaus

from 10 to 12 years and increases marginally to

reach highest level at 13 years (34%). From 15 to

18 years, prevalence of thinness rises.

Overweight/obese

Due to the overall low prevalence of overweight

and obesity, there is not much variation in

prevalence among both girls and boys. Among

girls, prevalence of overweight/obesity peaks at

14 years (6%) and among boys at 11 years (7%).

Figure 3: Prevalence of Thinness and Stunting in Adolescents aged 10-18 years (%)

Thin Girls Thin Boys Stunted Girls Stunted Boys

Age (in years)

60.0

50.0

40.0

30.0

20.0

10.0

0.010 11 12 13 14 15 16 17 18

Pe

rce

nta

ge

Thinness is defi ned as BMI-for-age<-2SD and Stunting as Height-for-age <-2SD below the WHO Growth Reference for 5-19 years

Age-group Neither short, nor thin

nor overweight/obese

Affected by one condition

(short or thin or overweight/

obese)

Affected by two conditions

Short and thin or Short and

overweight/obese

Girls




Boys






3.1.3. State variations in visible

forms of malnutrition

Short


Among girls, shortness varies from 11% (Kerala)

to 43% (Assam) in early adolescence. In late

adolescence it varies from 9% (Tripura) to 52%

(Meghalaya). In Jharkhand and Meghalaya,

shortness is high while in Goa it is low in both

age-groups. From early to late adolescence,

Telangana transitions from a better performing

state to one with high prevalence of shortness,

while the trend reverses in Bihar. Among boys,

shortness varies from 13% (Haryana) to 45%

(Meghalaya) in early adolescence. In late

adolescence it varies from 14% (Uttar Pradesh) to

65% (Nagaland). In Meghalaya and Nagaland,

shortness is high, while in Goa it is low in both

age-groups. From early to late adolescence,

Haryana transitions from a better performing

state to one with high prevalence of shortness.

Thin

Among girls, thinness is a public health problem

(BAZ <-2SD is 20%) in half the states in early

adolescence but drops to fi ve states in late

adolescence (Madhya Pradesh (21%), Himachal

Pradesh (22%), Telangana (22%), Gujarat

(22%) and Goa (23%)). Among boys, thinness

is a public health problem in 22 states in early

adolescence and in 17 states in late adolescence.

Overweight/obese

Among girls, more than 1 in 10 girls are

overweight/obese in one-third states of India

(Goa 20%, Tamil Nadu 17%, Delhi 17%, Arunachal

Pradesh and Nagaland 13%, Tripura, Himachal

Pradesh and Jammu Kashmir 12%, Mizoram and

Odisha 11%) in early adolescence but this drops

to three states (Sikkim 13%, Karnataka 11% and

Arunachal Pradesh 11%) in late adolescence.

Among boys more than 1 in 10 are overweight/

obese in one-third states of India (Goa 17%, Tamil

Nadu 17%, Arunachal Pradesh 15%, Delhi and

Nagaland 13%, Andhra Pradesh, Kerala, Manipur

and Tripura 11%) in early adolescence but in late

adolescence it drops down to just 2 states (Kerala

and Punjab).

Figure 4: Prevalence of Overweight/Obesity in Adolescents aged 10-18 years (%)

Overweight/Obesity Girls Overweight/Obesity Boys

Age (in years)

Overweight and obesity are defi ned as BMI-for-age > +1SD and >+2SD above the WHO Growth Reference for 5-19 years

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.010 11 12 13 14 15 16 17 18

Pe

rce

nta

ge


States Adolescent Girls Adolescent Boys

Thin Short Overweight/

Obese


Obese

India 22.9 27.8 5.3 31.8 23.2 5.3

Andhra Pradesh 20.7 24.1 11.0 24.0 21.6 8.0

Arunachal Pradesh 6.5 25.8 14.6 12.0 19.9 12.5

Assam 21.1 42.9 7.6 27.1 34.1 4.2

Bihar 16.1 36.4 1.3 30.0 28.7 1.9

Chhattisgarh 13.9 22.6 3.9 28.8 24.2 5.2

Delhi 26.1 22.6 13.4 21.3 15.3 17.4

Goa 16.4 13.7 19.9 20.3 13.6 17.3

Gujarat 26.3 30.6 9.7 37.5 21.1 7.3

Haryana 23.1 17.1 3.1 22.5 13.1 6.1

Himachal Pradesh 38.4 24.4 3.8 30.1 19.4 12.0

Jammu & Kashmir 16.6 18.6 8.1 19.1 14.2 12.2

Jharkhand 28.2 39.2 2.0 37.1 20.6 2.3

Karnataka 25.0 28.5 6.4 35.0 25.4 6.8

Kerala 20.0 11.0 11.4 20.7 16.7 8.8

Madhya Pradesh 29.7 33.5 1.6 40.9 24.5 1.5

Maharashtra 23.2 27.7 4.9 33.0 29.2 10.0

Manipur 6.3 20.3 10.8 6.9 26.0 10.2

Meghalaya 6.3 37.4 5.0 6.2 45.4 4.2

Mizoram 7.3 29.4 9.4 9.1 30.7 10.7

Nagaland 11.8 41.3 13.4 14.6 41.3 12.9

Odisha 19.9 30.6 7.7 22.8 23.4 11.3

Punjab 19.0 18.7 6.9 21.4 16.5 12.3

Rajasthan 29.8 20.8 4.7 36.6 17.6 2.8

Sikkim 10.3 19.2 10.6 14.6 19.1 9.6

Tamil Nadu 16.2 17.1 16.5 28.4 17.1 16.7

Telangana 23.4 16.6 5.8 33.2 18.7 5.6

Tripura 18.1 34.8 11.2 22.6 36.6 12.2

Uttar Pradesh 22.3 28.9 3.3 32.2 22.5 0.8

Uttarakhand 18.1 28.9 6.0 21.9 16.1 6.2

West Bengal 27.3 18.3 8.1 35.2 26.4 9.1

Table 1: Nutritional Status of Adolescents aged 10-14 years, CNNS 2016-18 (%)

< 20%

< 10%

< 5%

20–39.9%

10–20%

5–9%

20–30%

9–14%

> 40%

> 30%

> 14%

Thin:

Short:

Overweight

/Obese:


States Adolescent Girls Adolescent Boys


Obese


Obese

India 14.2 30.2 4.1 26.3 28.3 4.4

Andhra Pradesh 9.4 30.7 9.9 21.7 27.2 7.1

Arunachal Pradesh 1.9 39.3 10.8 9.4 41.5 5.6

Assam 9.1 30.0 2.6 17.2 56.1 1.2

Bihar 17.3 35.0 2.3 29.5 27.0 2.7

Chhattisgarh 11.0 29.3 3.7 18.7 28.6 4.1

Delhi 14.1 30.7 6.7 22.8 17.2 9.7

Goa 22.7 22.0 9.3 28.8 20.6 9.2

Gujarat 22.3 29.2 6.2 33.3 21.2 8.9

Haryana 13.4 17.9 3.9 21.9 17.0 4.5

Himachal Pradesh 21.7 22.4 2.2 32.7 13.6 3.6

Jammu & Kashmir 4.6 17.7 9.3 11.0 24.4 4.4

Jharkhand 17.2 46.7 1.4 26.6 32.8 1.8

Karnataka 15.5 27.8 10.7 32.4 29.6 6.1

Kerala 9.5 14.7 9.2 30.1 14.9 10.0

Madhya Pradesh 21.2 26.5 1.7 34.5 37.1 1.9

Maharashtra 12.1 27.0 6.0 26.2 40.3 6.3

Manipur 4.2 23.5 7.1 6.7 40.0 5.7

Meghalaya 1.1 52.0 4.3 12.1 50.5 0.2

Mizoram 2.9 22.5 6.5 5.3 32.9 3.9

Nagaland 2.7 20.3 4.1 8.3 64.9 3.6

Odisha 11.8 29.3 4.9 17.4 27.8 6.3

Punjab 17.3 8.7 6.3 13.0 19.7 10.1

Rajasthan 15.2 16.7 1.5 32.9 15.9 2.2

Sikkim 1.0 25.9 13.2 14.2 33.9 2.1

Tamil Nadu 13.4 19.9 9.4 26.0 22.4 6.2

Telangana 21.8 29.7 7.0 35.5 18.7 4.8

Tripura 10.5 36.7 6.0 12.8 52.1 7.6

Uttar Pradesh 10.9 34.9 2.7 23.7 26.5 1.7

Uttarakhand 8.1 19.8 4.4 10.2 19.0 3.7

West Bengal 11.9 43.8 3.6 24.9 33.8 9.2

Table 2: Nutritional Status of Adolescents aged 15-19 years, CNNS 2016-18 (%)

< 20%

< 10%

< 5%

20–39.9%

10–20%

5–9%

20–30%

9–14%

> 40%

> 30%

> 14%

Thin:

Short:

Overweight

/Obese:


Key messages

Anemia and iron defi ciency is one-fold higher in girls compared to boys.

Anemia affects 32% girls 10-14 years and 48% girls 15-19 years. Among boys 10-19

years, ~20% are anemic.

Iron defi ciency affects 24% girls 10-14 years and 39% girls 15-19 years. ~10% boys 10-19

years are iron defi cient.

Every third adolescent girl is B12

or folate defi cient. More boys 15-19 years compared to girls

15-19 years are defi cient in B12

, (41% boys, 28% girls) and folate (44% boys, 32% girls).

Every fi fth adolescent 10-14-years and every tenth adolescent 15-19 years is Vitamin A

defi cient.

There is three-fold higher vitamin D defi ciency in girls compared to boys (every third girl

and every tenth boy affected). Vitamin D defi ciency is higher in early adolescence (10 to 14

years) among both girls and boys.

At least one in three adolescents are defi cient in zinc.

Out of the six micronutrient defi ciencies studied, the most common form of hidden

malnutrition among adolescent girls is vitamin D defi ciency, followed by folate and iron

defi ciency. Among adolescent boys, the highest burden is of folate defi ciency, followed

by vitamin B12

and zinc defi ciency. Double burden of anemia and thinness among girls is

twice more than boys in early adolescence (10 to 14 years) and four times higher in late

adolescence (15 to 19 years).

Punjab is the only state to have high proportions of adolescents affected by fi ve different

micronutrient defi ciencies (iron, vitamin B12

, vitamin D, vitamin A and zinc).

Of the six micronutrient defi ciencies studied, only 14% girls and 21% boys had no

micronutrient defi ciency and over 50% of them suffered from at least two defi ciencies.

3.2 How many adolescents suffer from anemia and

micronutrient defi ciencies?

Anemia

Anemia is caused by inadequate bioavailability of micronutrients (iron, folate, and vitamin B12

); parasitic

infections such as malaria and helminthic infestation of hookworms and other parasitic worms and

fl ukes; genetic hemoglobinopathies such as thalassemia and sickle cell disease; chronic infection and

infl ammation; and chronic disease conditions such as renal failure15,16,17. Anemia results in fatigue, poor

productivity and predisposition to infections. Girls who enter pregnancy with anemia are at increased

risk of hemorrhaging during labor; babies may be low birth weight or premature. A prevalence of 40% is

considered a severe public health problem, 20 to 39.9% a moderate public health problem, 5 to 19.9% a

mild public health problem and less than 5% as not a public health problem18.


Early adolescence (10 to 14 years) Late adolescence (15 to 19 years)

1 in 3 girls (32%) and nearly

1 in 5 boys (17%) are anemic

(mild or moderate or severe). Of those that

are anemic (either sex), 40% anemia is of

moderate to severe form

1 in 2 girls (48%) and 1 in 5 boys (18%)

are anemic (mild or moderate or severe). Of those

girls who are anemic, nearly 50% have anemia of

moderate or severe in nature. However, in boys

who are anemic, 90% anemia is mild in nature

Iron defi ciency

Iron defi ciency is the most common nutritional defi ciency and most common cause of nutritional anemia

world-wide. Even in absence of anemia, iron defi ciency has negative impact on motor and cognitive

development14.





1 in 4 girls (24%) girls and 1 in 10 boys

(14%) suffer from iron defi ciency

Nearly every third adolescent

10-14 years

(26% girls and 30% boys)

has vitamin B12

defi ciency

More boys 15-19 years

compared to girls have

vitamin B12

defi ciency

(41% boys, 28% girls)

2 in 5 girls (39%) girls and less than 1 in

10 boys (8%) have iron defi ciency

Vitamin B12

defi ciency

Vitamin B12

defi ciency is associated with anemia, impaired nerve function and poor cognitive function19.



Every third girl and boy

10-14 years has

folate defi ciency

1 in 3 girls (32%) girls and

2 in 5 boys (44%) boys

have folate defi ciency

Folate defi ciency

Folate defi ciency is also associated with anemia as well as increased cardiovascular risks15.

Age-group Anemia Iron defi ciency Vitamin B12

defi ciency Folate defi ciency

Girls

10 to 14 y 20 million (32%) 14.5 million (24%) 16 million (26%) 23 million (36%)

15 to 19 y 27 million (48%) 22 million (39%) 16 million (28%) 18 million (32%)

10 to 19 y 47 million (40%) 35 million (31%) 22 million (27%) 42 million (34%)

Boys

10 to 14 y 11.5 million (17%) 9.5 million (14%) 21 million (30%) 25 million (36%)

15 to 19 y 11.5 million (18%) 5 million (8%) 26 million (41%) 28 million (44%)

10 to 19 y 23 million (18%) 14.5 million (12%) 47 million (35%) 56 million (39%)

Vitamin A

In addition to impaired vision, vitamin A defi ciency is associated with impaired bone growth, delayed

sexual maturation and increased predisposition to infections20. A prevalence of 20% is a severe public

health problem, 10 to 19.9% a moderate public health problem, 2 to 9.9% a mild public health problem and

less than 2% not a public health problem21.


Nearly 1 in 5 girls and boys

(19% and 18%, respectively) have

vitamin A defi ciency

Slightly over 1 in 10 girls and boys (12% and

13%, respectively) have vitamin A defi ciency



Vitamin D

Vitamin D is essential for bone mineralization and attaining full height potential. Defi ciency may result in

stunting and increased risk of osteoporosis in adulthood22.



1 in 3 girls (35%) girls have

vitamin D defi ciency

More than 1 in 4 girls

(27%) have zinc

defi ciency

More than 1 in 3 boys

(36%) have zinc

defi ciency

1 in 3 girls and boys (30% and

34%, respectively) have

zinc defi ciency

1 in 3 girls (34%)

have vitamin D

defi ciency

Almost 1 in 5 boys (16%) have

vitamin D defi ciency

1 in 10 boys (12%) have vitamin D

defi ciency



Prevalence of vitamin D defi ciency among girls is almost

thrice than that in boys in the age-group of 15 to 19 years

Zinc

Among adolescents zinc defi ciency may delay sexual maturation. It also has a role in bone growth;

defi ciency may limit attainment of full height potential23.

Age-group Vitamin A Vitamin D Zinc

Girls




Boys






Figure 5: Prevalence of Anaemia and Micronutrient Defi ciencies among Adolescents aged

10-14 years (%)

Girls Boys

32

17

24

27

36

26

36 36

30

35

16

19 18

14

Anemia Iron

defi ciency

Folate

defi ciency

Vitamin B12

defi ciency

Vitamin D

defi ciency

Vitamin A

defi ciency

Zinc

defi ciency

Figure 6: Prevalence of Anemia and Micronutrient Defi ciencies among Adolescents aged

15-19 years (%)

Girls Boys

48

44

41

34

12 1213

30

34

8

18

39

32

28

Anemia Iron

defi ciency

Folate

defi ciency

Vitamin B12

defi ciency

Vitamin D

defi ciency

Vitamin A

defi ciency

Zinc

defi ciency

3.2.1. Co-existence of visible and hidden forms of malnutrition


1 in 3 anemic girls

are short

More than 1 in 4 anemic

boys (28%) are short1 in 3 anemic girls (35%)

and boys (34%) are short


Anemic and short


Anemic and thin

Anemic and iron, vitamin B12

or folate defi cient


Almost 2 in 5 anemic girls (38%)

are thin

More than 2 in 5 anemic girls (44%)

are thin

1 in 5 anemic boys (19%)

are thin

More than 1 in 10 anemic boys (14%)

are thin



1 in 4 anemic girls have iron (26%) or folate

(25%) defi ciency, 1 in 3 anemic girls (32%)

have vitamin B12

defi ciency 1 in 5 anemic girls (22%)

have iron defi ciency. 2 in 5

have vitamin B12

(37%) or

folate defi ciency (40%)

2 in 5 anemic boys (42%) have iron defi ciency.

Over 1 in 4 have vitamin B12

defi ciency (26%) or



Half the anemic boys (54%)

have iron defi ciency. Over 1 in 4

boys have vitamin B12

(26%) or


Anemic and overweight/obese


4% and 5% of anemic girls and

boys are overweight/obese

2% and 4% of anemic girls and

boys are overweight/obese



Micronutrient

defi ciencies (N)

0 1 2 3 4 5 6

Girls

10 to 14 y 14% 86% 51% 22% 6% 1% 0%

15 to 19 y 14% 86% 51% 21% 6% 1% 0%

10 to 19 y 14% 86% 51% 21% 6% 1% 0%

Boys

10 to 14 y 21% 79% 44% 12% 2% 0% 0%

15 to 19 y 22% 78% 42% 14% 2% 0% 0%

10 to 19 y 21% 79% 43% 13% 2% 0% 0%

Of the six micronutrient defi ciencies studied,

among both 10 to 14 years and 15 to 19 years

aged adolescents, only 14% girls and 21% boys

had no micronutrient defi ciency. Over half the

girls have at least two types of micronutrient

defi ciencies and a fi fth of the girls have at least

three types of micronutrient defi ciencies.


forms of hidden malnutrition

Anemia

Among girls, prevalence of anemia peaks at 16

years (49%) and persists at that level for another

year. There is a marginal decline in prevalence

thereafter. Among boys, prevalence peaks at 15

years (30%) after a sharp rise in levels at 14 years.

Prevalence falls rapidly after 16 years of age.

Iron defi ciency

Among girls, iron defi ciency anemia peaks at

17 years (44%) after a steady increase from 10

years of age. Among boys the trend is different

from girls as prevalence of iron defi ciency

increases marginally to reach peak at 13 years

(17%), after which it declines consistently.

Vitamin B12

defi ciency

Among girls, vitamin B12

defi ciency peaks at 16

years of age (35%). It falls sharply at 17 years

(10% points) but increases marginally after that.

Figure 7: Prevalence of Anemia and Iron Defi ciency in Adolescents aged 10-19 years (%)

Anemia Girls Anemia Boys Iron defi ciency Girls Iron defi ciency Boys

Age (in years)

Anemia

Adolescent Girls: Hemoglobin levels <11.5 g/dl for 10–11 years, <12.0 g/dl for 12–14 years and <12.0 g/dl for 15–19 years

Adolescent Boys: Hemoglobin levels <11.5 g/dl for 10–11 years, <12.0 g/dl for 12–14 years and <13.0 g/dl for 15–19 years

Iron Defi ciency: Serum ferritin levels <15 μg/l; excluding cases with C-reactive protein >5 mg/L

60.0

50.0

40.0

30.0

20.0

10.0

0.010 11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

Multiple micronutrient defi ciencies have been estimated based on respective cut-offs for each micronutrient (iron, folate,

vitamin B12

, vitamin A, vitamin D and zinc); excluding cases of high infl ammation (C-reactive protein level > 5mg/L)



Among boys, prevalence peaks at 15 years (44%)

after increasing steadily from 10 years of age.

Folate defi ciency

Among girls, folate defi ciency peaks at 13 years

(43%) but declines consistently thereafter.

Among boys, it peaks later at 17 years (50%).

Vitamin A defi ciency

Among girls, vitamin A defi ciency peaks at

12 years (22%). In boys, it peaks earlier at

11 years (22%).

Vitamin D defi ciency

Among girls, vitamin D defi ciency peaks at 13

years (41%) and remains around this level for

two consecutive years. Among boys, vitamin D

defi ciency is highest at age of 10 years (19%)

after which it declines almost consistently.

Zinc defi ciency

Among girls, zinc defi ciency is highest at 19 years

(34%), following a steady increase since age of

10 years. Among boys, zinc defi ciency peaks at

11 years (40%).

Figure 8: Prevalence of Folate and Vitamin B12

Defi ciency in Adolescents aged 10-19 years (%)

Folate defi ciency Girls Folate defi ciency Boys Vitamin B12

defi ciency Girls Vitamin B12

defi ciency Boys

Age (in years)

Folate defi ciency: Serum erythrocyte folate < 151 ng/ml Vitamin B12

defi ciency: Serum vitamin B12

< 203 pg/ml

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Pe

rce

nta

ge

10 11 12 13 14 15 16 17 18 19

Figure 9: Prevalence of Vitamin A and Vitamin D Defi ciency in Adolescents aged 10-19 years (%)

Vitamin A defi ciency Girls Vitamin A defi ciency Boys Vitamin D defi ciency Girls Vitamin D defi ciency Boys

Age (in years)

Vitamin A defi ciency: Serum retinol concentration <20 μg/dL; excluding cases with C-reactive protein >5mg/L

Vitamin D defi ciency: Serum 25(OH)D concentration <12ng/mL (30 nmol/L)

45.0

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30.0

25.0

20.0

15.0

10.0

5.0

0.0

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10 11 12 13 14 15 16 17 18 19


3.2.3 State variations

in prevalence of hidden

malnutrition

Anemia

Among girls, anemia is a severe public health

problem (prevalence 40%) in fi ve states in early

adolescence and worsens to 19 states in late

adolescence. At the same time states with mild

to no public health concern for anemia reduces

from fourteen states in early adolescence to

nine states in late adolescence. Among boys,

anemia is a moderate public health problem in

ten states in early adolescence and eleven states

in late adolescence. Nagaland was the only state

with zero prevalence of anemia for boys in late

adolescence.

Iron defi ciency

Among girls, iron defi ciency ranges from 6%

(Jharkhand) to 53% (Maharashtra) in late

adolescence and from 5% (Nagaland) to 69%

(Goa) in late adolescence. In Jharkhand and

Mizoram, prevalence of iron defi ciency is low

in both age-groups while in Punjab it is high

in both age-groups. Among boys, it ranges

from 0 (Nagaland) to 56% (Punjab) in early

adolescence and from 0 (Mizoram, Nagaland,

Uttarakhand) to 28% (Uttar Pradesh) in late

adolescence.

Vitamin B12

defi ciency

Among girls, vitamin B12

defi ciency ranges from

1% (West Bengal) to 47% (Rajasthan) in early

adolescence and from 0 (West Bengal) to 55%

(Odisha) in late adolescence. In Chhattisgarh

and Punjab, prevalence is high in both age-

groups while in Manipur, Nagaland and West

Bengal it is low in both. Among boys, prevalence

ranges from <1% (Nagaland) to 51% (Uttar

Pradesh) in early adolescence and from 5%

(Telangana, West Bengal) to 61% (Chhattisgarh).

As among girls, prevalence is high in both early

and late adolescence in Chhattisgarh, Punjab, and

low in Nagaland, West Bengal.

Folate defi ciency

Among girls, folate defi ciency varies from 0

(West Bengal) to 89% (Andhra Pradesh) in early

Figure 10: Prevalence of Zinc Defi ciency in Adolescents aged 10-19 years (%)

Zinc Defi ciency Girls Zinc Defi ciency Boys

Age (in years)

Zinc Defi ciency: Serum zinc concentration < 70 μg/dl (morning fasting) and <66 μg/dl (morning non-fasting) in non-pregnant females

and < 74 μg/dl (morning fasting) and < 70 μg/dl (morning non-fasting) in males.

45.0

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30.0

25.0

20.0

15.0

10.0

5.0

0.0

Pe

rce

nta

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10 11 12 13 14 15 16 17 18 19


Table 3: Prevalence of Anaemia in Adolescents, CNNS 2016-19 (%)

< 5% 5–19.9% 20–39.9% 40%

States 10-14 years 15-19 years

Girls Boys Girls Boys

India 32.1 17.1 47.5 18.1

Andhra Pradesh 28.0 9.8 39.4 13.3

Arunachal Pradesh 22.3 20.5 48.2 17.8

Assam 35.2 24.9 53.4 39.1

Bihar 23.0 20.4 46.0 16.4

Chhattisgarh 42.1 21.0 41.4 21.0

Delhi 32.0 12.5 56.5 18.8

Goa 14.2 5.8 32.1 6.2

Gujarat 44.2 21.6 47.8 20.6

Haryana 29.6 23.2 54.2 20.5

Himachal Pradesh 12.1 4.4 28.0 21.1

Jammu & Kashmir 15.6 6.7 31.9 5.6

Jharkhand 50.2 17.6 53.7 15.0

Karnataka 16.5 4.8 34.9 12.7

Kerala 6.4 2.9 21.4 5.2

Madhya Pradesh 23.3 12.1 34.1 19.8

Maharashtra 27.6 21.2 47.5 20.3

Manipur 8.1 7.3 14.9 12.5

Meghalaya 32.1 23.8 60.1 20.5

Mizoram 16.0 13.0 35.7 9.0

Nagaland 9.0 15.5 6.0 0.0

Odisha 31.1 18.2 50.2 17.5

Punjab 24.1 16.5 46.9 13.7

Rajasthan 31.1 6.0 50.3 17.1

Sikkim 30.7 17.8 45.5 10.5

Tamil Nadu 11.4 9.2 40.2 5.3

Telangana 37.8 16.7 55.2 20.3

Tripura 41.3 25.7 67.1 33.0

Uttar Pradesh 39.9 17.9 49.2 16.9

Uttarakhand 17.0 7.0 23.7 15.9

West Bengal 56.0 31.2 67.6 28.0


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adolescence and from 0 (Gujarat, Telangana,

Uttar Pradesh) to 88% (Nagaland) in later years.

In Delhi from almost no cases of folate defi ciency

in early adolescent, almost every girl (81%) is

affected in late adolescence. Among boys, the

prevalence ranges from 0 (Kerala, Odisha) to

93% (Nagaland) in early adolescence and from 0

(Telangana) to 96% (Nagaland).

Vitamin A defi ciency

Among girls, prevalence ranges from 0

(Rajasthan) to 43% (Jharkhand) in early

adolescence and from 1% (Meghalaya,

Telangana) to 27% (Jharkhand) in late

adolescence. It is a public health problem

(prevalence 20%) in nine states in early and

four states in late adolescence. Among boys

it ranges from 0 (Delhi) to 44% (Mizoram) in

early adolescence and from 0 (Goa, Gujarat,

Nagaland) and 39% (Maharashtra) in later years.

It is a severe public health problem in 10 states

which drops to two states (Jharkhand and Tamil

Nadu) in late adolescence.

Vitamin D defi ciency

Among girls vitamin D defi ciency varies from

11% (Telangana) to 81% (Punjab) in early

adolescence and from 7% (Meghalaya) to

80% (Bihar) in late adolescence. In Manipur,

prevalence of vitamin D defi ciency is high in

both age groups. Among boys, it varies from

2% (Meghalaya) to 64% (Punjab) in early

adolescence and from 1% (Maharashtra) to 53%

(Tripura) in late adolescence. As among girls,

vitamin D defi ciency prevalence is high in both

age-groups among boys.

Zinc defi ciency

Among girls, zinc defi ciency varies from

0 (Nagaland) to 54% (Punjab) in early

adolescence, and from 9% (Arunachal Pradesh)

to 58% (Maharashtra) in late adolescence.

Prevalence is high in both age groups in the states

of Manipur and Odisha. Among boys, prevalence

ranges from 1% (Mizoram) to 67% (Jharkhand) in

early and 2% (Nagaland) to 63% (Meghalaya)

in late adolescence. Prevalence is high in both

age-groups in the state of Jharkhand.


Key messages

1 in 10 adolescent girls and boys 10-14 years and 2 out of 10 adolescents 15-19 years are at

risk of diabetes on the basis of HbA1c levels.

26% boys 10-14 years have low good cholesterol which is indicative of low physical activity

in addition to imbalanced diet. The proportion of adolescent boys 15-19 years with low

HDL levels increases to 39% in 15-19 age-group. Among girls 10-19 years, 1 in every 4

adolescents have low HDL cholesterol levels. Thus, physical inactiveness is higher in boys

compared to girls in 15-19-years age-group.

5% adolescent girls and boys suffer from hypertension, based on systolic and diastolic

blood pressure. Among girls, proportion with hypertension is highest (8%) at 11 years and 18

years. Among boys highest proportion is noted at 19 years (7%).

One in 2 adolescents have at least one of the three non-communicable disease risk (high

HbA1C, high systolic/systolic blood pressure and low HDL levels). At least two such risks are

seen in 1 in 3 adolescents 10-14 years. Pattern and proportion affected by risk of the three

non-communicable diseases in 15-19 years age-group is similar to 10-14 years.

None of the states have zero risk for diabetes and heart disease among 10-14 years aged

adolescents.

3.3 Risks for non-communicable diseases

Risk of cardiovascular disease

Cardiovascular diseases include a range of conditions that affect the heart, which could be congenital or

lifestyle related. Conditions related to lifestyle factors are more common and are a result of “unhealthy”

diets, smoking, stress, excessive alcohol and caffeine intake. Diabetes and high blood pressure also

contributes to increased risk of cardiovascular diseases. The early onset of lipid disorders including

elevated total or LDL cholesterol levels (bad cholesterol), low levels of HDL cholesterol (good cholesterol),

Risk of diabetes

Pre-diabetes is a condition resulting from lack of physical activity and being overweight/obese. A high

carbohydrate diet also contributes to the risk. Pre-diabetes often leads to type 2 diabetes.


1 in 10 adolescent girls

and boys 10-14 years

are at risk of diabetes

on the basis of fasting

HbA1c levels

(8% girls, 12% boys)

1 out of 10 adolescents

15-19 years are at risk

of diabetes on the basis

of fasting HbA1c levels

(11% boys and

7% girls)


Adolescence (10 to 19 years)

5% adolescent girls and boys suffer from hypertension,

based on systolic and diastolic blood pressure.

Hypertension

High blood pressure or hypertension is also most commonly lifestyle related. Smoking, alcohol

consumption, high salt in diets, lack of physical activity and stress are contributing factors.

Risk of diabetes

(HbA1c)

Risk of cardiovascular diseases Hypertension

High LDL Low HDL High Triglycerides

Girls

10-14 y 5 million (8%) 3 million (4%) 16 million (24%) 13 million (20%) 3 million (5%)



Boys




Burden in numbers


and high levels of triglycerides (fats) is alarming as these conditions in adolescence are predictive of

elevated risk for cardiovascular disease in adulthood.

1 in 4 (26%) of girls and boys 10-14 years

have low HDL cholesterol (occurs largely due to low

physical activity). 1 in 4 girls (24%) 1 in 3 boys

(39%) and 15-19 years have low

HDL cholesterol

High triglycerides in adolescents 10-14 years is seen in

more girls than boys (20% girls, 13% boys).

This may be largely contributed by high consumption

of high calorie junk foods, fried foods, sweets and/or

aerated drinks rich in fats and refi ned carbohydrates.

High triglycerides in adolescents 15-19

years is seen in 16% girls and boys



Figure 11: Prevalence of Risk Factors for Non-communicable Diseases among Adolescents aged

10-14 years (%)

Girls Boys

5 5

HypertensionHigh

triglycerides

20

13

26 26

Low HDL (Good)

cholesterol

44

High LDL (Bad)

cholesterrol

12

8

High

HbA1c

Figure 12: Prevalence of Risk Factors for Non-communicable diseases among Adolescents aged

15-19 years (%)

Hypertension

5 5

High

HbA1c

7

11

Low HDL (Good)

cholesterol

24

39

High LDL (Bad)

cholesterrol

4 3

16 16

High

triglycerides

Girls Boys

3.3.1. Co-existence of three non-communicable disease risks –

diabetes, hypertension and cardiovascular diseases.


Pattern and proportion affected by three

non-communicable disease risks in 15-19 year

age group is similar to 10-14 years

~1 in 2 adolescents have

at least one of the three

non-communicable

disease risks.

At least two such

risks are seen in

1 in 3 adolescents

10-14 years


Risks of three non-


10 to 14 years 15 to 19 years 10 to 19 years


None 45% 44% 46% 36% 45% 40%

One risk 32% 38% 32% 39% 32% 39%

Two risk 17% 12% 18% 17% 18% 14%

Three risks 5% 5% 4% 7% 4% 6%

High HbA1C, high fasting plasma glucose, high systolic/systolic blood pressure, overweight/obesity, high total cholesterol,

high LDL cholesterol, high trigycerides and low HDL cholesterol levels

High HbA1C is indicative of risk of diabetes. High systolic/systolic blood pressure is indicative of hypertension and high total

cholesterol, high LDL cholesterol, high trigycerides, low HDL cholesterol levels is indicative of risk for cardiovascular diseases.


risks of non-communicable

disease

Risk of diabetes

The prevalence of high HbA1c peaks at 13 years

for both girls (11%) and boys (14%).


At the age of 10 years the proportion of both girls

and boys with low levels of “good” cholesterol is

lowest in the range to 18% to 20%. Among girls

it peaks at 14 years (32%) and among boys at

16 years (43%). Among girls prevalence lowers

with age but among boys it persists at high

levels attained at 16 years. Proportion with high

Figure 13: Prevalence of Risk Factors for Diabetes in Adolescents aged 10-19 years (%)

Pre-diabetic Status Girls Pre-diabetic Status Boys

Age (in years)

Pre-diabetic Status: Glycosylated Haemoglobin (HbA1c) level >5.6% & 6.4%

20.0

18.0

16.0

14.0

12.0

10.0

8.0

6.0

4.0

2.0

0.0

Pe

rce

nta

ge

10 11 12 13 14 15 16 17 18 19


Figure 14: Prevalence of High "Bad" Cholesterol in Adolescents aged 10-19 years (%)

High LDL cholesterol Girls High LDL cholesterol Boys

Age (in years)

High LDL or “Bad” cholesterol 130 mg/dl

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Pe

rce

nta

ge

10 11 12 13 14 15 16 17 18 19

triglycerides is highest at 12 years (23%) among

girls and 18 years among boys (18%). Other risks for

cardiovascular disease have overall low prevalence

and little variation across ages 10 to 19 years.

Hypertension

Among girls, proportion with hypertension is

highest (8%) at 11 years and 18 years. Among

boy highest proportion is noted at 19 years (7%).

Figure 15: Prevalence of Low “Good” Cholesterol and High Triglycerides in Adolescents aged

10-19 years (%)

Low HDL cholesterol Girls Low HDL cholesterol Boys High Triglycerides Girls High Triglycerides Boys

Age (in years)

Low HDL or “Good” cholesterol < 40 mg/dl

High Triglycerides 130 mg/dl

50.0

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

Pe

rce

nta

ge

10 11 12 13 14 15 16 17 18 19


Figure 16: Prevalence of Hypertension in Adolescents aged 10-19 years (%)

Girls Boys

Age (in years)

Hypertension

systolic blood pressure level 140 mmHg, or

diastolic blood pressure level 90 mmHg

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Pe

rce

nta

ge

10 11 12 13 14 15 16 17 18 19

3.3.3. State variations in

prevalence of risks for non-


Risk of diabetes


Among girls, risk of diabetes based on elevated

HbA1c levels, ranges from 1% (Sikkim) to 28%

(Goa) in early adolescence and from 0%

(Assam, Nagaland) to 17% in Haryana in late

adolescence. Among boys, it ranges from <1%

(Nagaland) to 34% (Goa) in early adolescence

and from 1% (Bihar) to 24% (Haryana) in late

adolescence. Thus, risks for diabetes are higher in

Goa and Haryana for both girls and boys.

Among boys, the highest prevalence is 13% in

both early and late adolescence (Uttar Pradesh

and Goa, respectively).


Among girls, those with low levels of “good”

cholesterol range from 9% (Mizoram) to 53%

(Meghalaya) in early adolescence and from

0% (Mizoram, Nagaland, Telangana) to 29%

(Goa) in late adolescence. Among boys it ranges

from 3% (Nagaland) to 50% (Meghalaya) in

early adolescence and from 8% (Nagaland) to

65% (Delhi). Nagaland does best on low risk of

cardiovascular risk based on this indicators, while

Chhattisgarh, Delhi and Meghalaya have very

high proportion of adolescents with low levels of

“good” cholesterol.

Hypertension

Among girls, there are no cases of hypertension

in fi ve states- Haryana, Jharkhand, Kerala,

Punjab and Uttarakhand in early adolescence

and in six states- Haryana, Himachal Pradesh,

Nagaland, Telangana, Punjab and West Bengal

in late adolescents. The highest prevalence

of hypertension is in Tamil Nadu (10%) in

early adolescence and 13% (Odisha) in late

adolescence.

Among boys, 1 in 10 are hypertensive in Delhi

and Tamil Nadu, in early adolescence and same

proportion in Uttar Pradesh in late adolescence.


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3.4 Adolescents diets – are they healthy or unhealthy?

Key messages

Six out of 10 adolescents reported no consumption of fruits in the past week. Every fourth

adolescent reported no consumption of green leafy vegetables in the past week.

Foods most commonly missed from the food plate of an adolescent are fi sh/chicken, eggs,

fruits and dark green leafy vegetables.

At least once a week consumption of fried foods was reported by 30% adolescents and

sweets by 15%.

Daily consumption of fried foods and junk foods was reported by 5% and 1% adolescents,

respectively.

Dark green leafy vegetables and pulses consumption increases around ages 12 to 14 years

but these gains are lost in later years. Intake of all unhealthy foods peaks at 17 years among

boys.

Adolescent girls and boys who are short, thin, or anemic most often do not eat fi sh/chicken,

eggs, fruits, dark green leafy vegetables and pulses. Milk is not consumed more often by

those short than those thin or anemic.

In states like Delhi and Goa high proportion of adolescents are consuming fried and junk

food. These two states also have more overweight/obese adolescents in addition to Tamil

Nadu and higher prevalence of risks for non-communicable diseases. Punjab emerges as

a state with lowest compliance of adolescents consuming recommended frequencies of

nutritive foods (chicken/fi sh, eggs, dark green leafy vegetables and pulses) and highest

levels of micronutrient defi ciencies (iron, vitamin B12

, vitamin D, vitamin A, zinc).

Foods to be consumed daily

The food plate of an adolescent should have at least eleven food groups of which nine food groups require

to be consumed daily in the diet, in recommended quantity. These nine food items include – 1. cereals, 2.

milk or curd, 3. pulses or beans, 4. dark green leafy vegetables, 5. other vegetables, 6. roots and tubers, 7.

fruits, 8. fats and oils and 9. sugar/jaggery.

(Continued)



(~85%) eat cereals daily

2 out of 5 adolescents (~45%) take milk in their

daily diet. However, another 2 out of 5 adolescents

did not consume milk even once during the past week


Foods to be consumed at least two days a week

The food plate of an adolescent needs to have heme iron-rich foods like chicken/fi sh at least twice a

week and egg at least thrice a week.

(Continued)

3 out of 5 adolescents (~70%)

have daily intake of food rich in fats/

oils and sugar/jaggery

Less than 1 out of 5 adolescents (<10%) consume fruits

daily and as high as 3 out of 5 adolescents (~70%) did

not consume fruits even once during the past week.

1 out of 5 adolescents (~20%) take pulses and green leafy vegetables. However, another

1 out of 5 adolescents did not consume pulses even once in the past week and 2 out of 5

adolescents did not consume any green leafy vegetables even once during the past week


The pattern established for food items to be consumed

daily across late adolescence is the same as in early

adolescent phase. Excepting that more 15-19 years

(~20% eat eggs thrice a week compared to ~10% in 10-14 age group). This indicates that the food

frequency pattern is established in early phases.

~




(~20%) take fi sh/chicken

at least two days a week

Less than 1 out of 5

adolescents (~10%) take fi sh/

chicken at least two days a week

Less than 1 out of 5

adolescents (10%) have

eggs thrice a week


(~20%) have eggs at

least thrice a week

3 out of 5 adolescents did

not consume fi sh/egg/chicken

even once during the past week

3 out of 5 adolescents did

not consume fi sh/egg/chicken

even once during the past week


Foods to be avoided

The food plate of an adolescent should not include or include rarely – junk foods, fried foods, sweets and

aerated drinks.


1%

adolescents

ate junk food

daily

1%

consumed

aerated drinks

daily

2%

adolescents

ate sweets

daily

2%

adolescents ate

junk food 3 times

a week

Junk foods Sweets Aerated drinks

2%

consumed

aerated drinks

3 times a week

2%

adolescents ate

sweets 3 times a

week

Consumption of food groups by 10-14 year old girls and boys, by percentage, CNNS

2016-18 (India)

1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5

6 7 8

9

10

11

<25% 25–50% 51–75% >75%

1 – Cereals

2 – Milk or curd

3 – Pulses or beans

4 – Dark green leafy vegetables

5 – Other vegetables

6 – Roots and tubers

7 – Fruits

8 – Fats and oils

9 – Sugar and jaggery

10 – Fish/chicken

11 – Eggs

The India donut graph for 15-19 year old adolescents as well, in the same manner as above.

Consumption of food groups by 15-19 year old girls and boys, by percentage, CNNS

2016-18 (India)

<25% 25–50% 51–75% >75%

1 – Cereals

2 – Milk or curd

3 – Pulses or beans

4 – Dark green leafy vegetables

5 – Other vegetables

6 – Roots and tubers

7 – Fruits

8 – Fats and oils

9 – Sugar and jaggery

10 – Fish/chicken

11 – Eggs

The India donut graph for 15-19 year old adolescents as well, in the same manner as above.

1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5 6 7 8

9

10

11


3.4.1 Age wise compliance to

eating as per recommended

frequency


Girls are most compliant to daily milk/milk

product intake at 13 years and 17 years.

Pulses/beans intake daily is highest at 14 years.

Daily intake of green leafy vegetables also peaks

at 14 years.

Daily fruit intake is high at 13 years and 17 years.

Boys are most compliant to daily milk/milk

product intake at 17 years.

Pulses/beans intake daily is highest at 12 years.

Daily intake of green leafy vegetables also peaks

at 11 years and again at 19 years.

Daily fruit intake is overall low, but highest at 19

years.

Figure 17: Daily Consumption of foods by Adolescent Girls aged 10-19 years (%)

Milk and Milk products

Roots and tubers

Green Leafy Vegetables

Fruits

Pulses or Beans

Other Vegetables

60.0

50.0

40.0

30.0

20.0

10.0

0.0

10 11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

(%

)

Age (in years)


Intake of junk foods, sweets and aerated drinks was

similar to adolescents 10-14 years. Daily and 3 times

a week consumption of junk foods were slightly higher

than 10-14 years at 5% and 6%, respectively.

Fried foods

1 out of 20 adolescents (5%)

ate fried food 3 times a week

1 out of 25 adolescents (4%) ate fried food daily

~


Figure 19: Consumption of eggs and fi sh/chicken/meat as per recommendation by

Adolescent Girls aged 10-19 years (%)

Egg Fish/chicken/meat

25.0

20.0

15.0

10.0

5.0

0.0

10 11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

(%

)

Age (in years)

Figure 18: Daily Consumption of foods by Adolescent Boys aged 10-19 years (%)


Roots and tubers


Fruits

Pulses or Beans

Other Vegetables

60.0

50.0

40.0

30.0

20.0

10.0

0.0

10 11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

(%

)

Age (in years)

Foods to be consumed at least two days

a week

Highest proportion of girls consume fi sh/chicken

at least two days per week at 17 years of age.

Highest proportion of boys consume fi sh/chicken

at least two days per week at 19 years of age.

Highest proportion of girls consume eggs at least

three days per week at 11 years and 17 years.

Among boys, proportion consuming eggs at least

three days per week is above 15% at and after 17

years and peaks at 19 years.


Foods to be avoided

Among girls, consumption of all avoidable food

fl uctuates throughout adolescence with different

peak consumption ages for the four foods we

investigated. Fried food intake three times per

week peaks at 15 years while daily at 17 years

though it is close to peak value at 15 years too.

Junk food intake three times a week is marginally

higher at 17 years of age compared with other

ages. Daily sweet intake increase steadily among

girls with increasing age and peaks at 16 years

and daily intake of aerated drinks peaks at 19

years of age.

Among boys, there is a very distinct pattern of

increasing consumption in late adolescence

compared with early adolescence for all avoidable

foods. When daily intake is considered fried foods

intake peaks at 15 years, junk foods at 17 years,

sweets at 16 years and aerated drinks at 18 years.

6

5

4

3

2

1

0

10 11 12 13 14 15 16 17 18 19

Fried foods Junk foods Sweets Aerated drinks

Pe

rce

nta

ge

(%

)

Age (in years)

Figure 21: Foods to be Avoided: Daily Consumption by Adolescent Girls aged

10-19 years (%)

Figure 20: Consumption of eggs and fi sh/chicken/meat as per recommendation by

Adolescent Boys aged 10-19 years (%)

Egg Fish/chicken/meat

30.0

25.0

20.0

15.0

10.0

5.0

0.0

10 11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

(%

)

Age (in years)


Figure 24: Foods to be Avoided: Consumption (3 times/week) by Adolescent Boys

aged 10-19 years (%)


12

10

10

8

6

4

2

0

11 12 13 14 15 16 17 18 19

Pe

rce

nta

ge

(%

)

Age (in years)

Figure 23: Foods to be Avoided: Consumption (3 times/week) by Adolescent Girls

aged 10-19 years (%)


Age (in years)

Pe

rce

nta

ge

(%

)

10

8

0

1

2

3

4

5

6

7

11 12 13 14 15 16 17 18 19

Figure 22: Foods to be Avoided: Daily Consumption by Adolescent Boys aged

10-19 years (%)

6

7

5

4

3

2

1

0

10 11 12 13 14 15 16 17 18 19


Age (in years)

Pe

rce

nta

ge

(%

)


3.4.2 Variation in compliance

to eating as per recommended

frequency across states



Cereals

Among girls, more than 75% consume cereals

daily across 22 to 24 states in 10 to 14 and 15

to 19 years age-groups. In fi ve states- Goa,

Karnataka, Maharashtra, Mizoram and Sikkim,

daily cereal consumption is a concern with levels

ranging from 6% to 33%.

Observations were similar among boys with

daily cereal consumption almost universal in

most states, exceptions being Goa, Karnataka,

Maharashtra, Mizoram and Sikkim.

Milk/milk products

Among girls, in Haryana, Punjab, Rajasthan

and Tamil Nadu, over 75% girls have milk/

milk products daily. However, in 8 to 10 states

daily consumption of milk/milk products daily

is low (ranging from less than 10% to 25%).

In Arunachal Pradesh, Assam, Chhattisgarh,

Manipur, Meghalaya, Mizoram, Odisha and

Tripura daily milk/milk product consumption

is low in both age groups. Among boys, daily

consumption of milk is higher than 50% in 11

states; highest being in Delhi (91%). However, in

10 states less than 25% have milk every day.

Pulses/beans

In Himachal Pradesh and Odisha daily

consumption of pulses is high among both girls

and boys and in both age-groups. Among girls,

lowest daily consumption of pulses is in Manipur

(2%, early adolescence) and Punjab (3%, late

adolescence); among boys it’s in Manipur (2%,

early adolescence) and Jammu and Kashmir

(4%, late adolescence).

Dark green leafy vegetables

Among girls, daily green leafy vegetables

consumption ranges from 1 to 2% (Telangana) to

~50% (Odisha) in both early adolescence and

late adolescence. Among boys, it ranges from 2%

(Kerala) to ~50% (Odisha) in early adolescence;

in late adolescence lowest consumption is in

Telangana (<1%) and highest in Odisha (45%).

Fruits

Fruit intake is very low in most states. The highest

compliance to daily fruit intake among girls and

boys is in Delhi in the range of 28% to 34%.

Proportion of adolescents consuming fats/oils

and sugars are high in most states of India.

Exceptions are - Arunachal Pradesh, Manipur and

Sikkim where fat consumption is less than 20%

among both girls and boys and in both age groups.

Foods to be consumed at least three

days a week

Among girls, egg consumption at least three

days a week, ranges from <1% (Haryana) to 45%

(Tamil Nadu) in early adolescence and from <1%

(Punjab) to 82% (Goa) in late adolescence.

Among boys, compliance to egg consumption

ranges from <1% (Himachal Pradesh) to Tamil

Nadu (45%) early adolescence and from <1%

(Himachal Pradesh) to Goa (77%). In Haryana,

Himachal Pradesh, Madhya Pradesh, Punjab,

Rajasthan and Uttar Pradesh consumption of

eggs as per recommendation is less than 10%

among both girls and boys.

Foods to be consumed at least two days

a week

Among girls, in Goa and Kerala more than 70%

girls have fi sh/chicken at least two days per week

in early adolescence but there are nine states with

less than 10% compliance. In late adolescence,

compliance is lower and ranges from 1%

(Himachal Pradesh) to 33% (Mizoram).

Among boys compliance to fi sh/chicken

consumption ranges from <1% (Himachal

Pradesh) to 74% (Goa) in early adolescence and

much lower, from 2% (Himachal Pradesh) to 38%

(Tamil Nadu) in late adolescence.


Percentage of adolescent girls and boys with

consumption as per ICMR-NIN recommendation

1 – Cereals 2 – Milk or curd 3 – Pulses or beans 4 – Dark green leafy vegetables 5 – Other vegetables

6 – Roots and tubers 7 – Fruits 8 – Fats and oils 9 – Sugar and jaggery 10 – Fish/chicken 11 – Eggs

<25% 25–50% 51–75% >75%

India 1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5

6 7 8

9

10

11

Andhra

Pradesh

4

64

Arunachal

Pradesh 1

2

3

4

5 6 7 8

9

10

11

1

2

3

4

5 6 7 8

9

10

11

1

2

3

5 6 7

8

9 10

11

1

2

3

5

7 8

9

10

11




<25% 25–50% 51–75% >75%

Assam

7

1

2

3

4

5

6

8

9

10

11

1

2

3

4

5

6

8

9

10

11

7

Chhattisgarh

11

1110

7

Delhi 1

2

3

4

5

6

7

8

9

10

11 1

2

3

4

5 6

7

8

9

10

11

Bihar

6 5

4

3

1

2

3

4

5

6

8 9

10

1

2

3

4

5

6

8

9

10

11

11

7

7

1

2

3

4

5

6

8

9

1

2

3

4 5

6

7

8

9

10




<25% 25–50% 51–75% >75%

6

Goa11

Gujraat

1011

10 11

Haryana

Himachal

Pardesh 1

2

3

4

5 6 7

8 9

1

2 3

4 5 6 7

8 9

11

11

10

10

1

2

3

4

5 6

7

8

9

1

2

3

4

5 6 7

8

9

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

7

8

9

10

11

1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5

6 7

8

9

10

11




<25% 25–50% 51–75% >75%

Jammu &

Kashmir

5

56

1

2

3

4

6 7 8

9

10

11

1

2

3

4

7

8

9

10

11

6

4

4

KeralaKarnataka 1

2 3

4

5

6 7 8

9

10

11

Jharkhand 1

2

3

4

5

6

7

8 9

10

11

1

2

3

4

5

6

7

8

9

10

11

1

2 3

4

5

6 7

8

9

10

11

1

2

3

5

6

7

8

9

10

11 1

2

3

5

7

8

9

10

11




<25% 25–50% 51–75% >75%

1 2

9

10

11

11

10

7

7

10

11

5

Madhya

Pradesh Maharastra

Manipur Meghalaya 1

2

3

4

5

6

7

8

9 10

11

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7 8

9

10

11

1

2

3

4

5

6

7 8

9 10

11

1

2

3

4

5

6

8

9

1

2

3

4

6

8

9

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5 6

7

8

9

10

11




<25% 25–50% 51–75% >75%

Mizoram 1 2

3

4 5

6

7

8

9

10

11

7

Nagaland 1

2

3

4

5

6 7

8

9

10

11

Odisha 1

2

3

4

5

6

7

8

9

10

11

Punjab

6

1

2

3

4

5 6 7

8

9

11

11

10

10

1 2 3

4

5

6

7

8

9

10

11

1

2

3

4

5

6 8

9 10

11

1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5 7 8

9




<25% 25–50% 51–75% >75%

1

2 3

4

5 6 7 8

9

10

11

Rajasthan

11

11

10

10

1

2

3

4

5 6 7

8

9

Tamil Nadu 1

2 3

5

6 7

8

9

10

11

1

2

3

5

7 8

9

10

11

4

4

6

Telangana

4

4

5

5

6

6

1

2

3

7

8

9

10

11

1

2

3

7

8

9 10

11

Sikkim 1

2

3

4

5

6 7

8

9 10

11 1

2

3

4

5 6 7 8

9




<25% 25–50% 51–75% >75%

Tripura

7

7

1

2

3

4

5

6

8 9

10

11

1

2

3

4

5

6

8

9

10

11

Uttarakhand 1

2

3

4

5

6

7

8

9

10 1

1 1

2

3

4

5

6

7

8

9

10

11

West Bangal 1

2

3

4

5

6

7 8

9

10

11

11

11

Uttar

Pradesh

1

2

3

4

5

6

7 8

9

10

11

1

2

3

4

5

6 7

8

9

10

1

2

3

4

5 6 7

8

9

10




<25% 25–50% 51–75% >75%

Percentage of adolescent girls and boys with

consumption as per ICMR-NIN recommendation

Andhra

Pradesh

India 1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5

6 7 8

9

10

11

4

64

Arunachal

Pradesh 1

2

3

4

5 6 7 8

9

10

11

1

2

3

4

5 6 7 8

9

10

11

1

2

3

5 6 7

8

9 10

11

1

2

3

5

7 8

9

10

11




<25% 25–50% 51–75% >75%

Assam 1

2

3

4

5

6

7

8

9

10

11

Chhattisgarh

5

10

Delhi 1

2 3

4

5

6

7

8

9

10

11

1

2 3

4

5

6

7

8

9

10

11

Bihar 1

2

3

4

5

6 7

8

9

11

10

10

1

2

3

4

5

6

7 8

9

10

11

1

2

3

4 5 6

7

8

9

11

7

7

1

2

3

4

5

6

8

9 11

1

2

3

4

6

8

9

10

11




<25% 25–50% 51–75% >75%

Goa

6

Himachal

Pardesh 1

2

3

4

5 6 7

8

9

1

2 3

4 5 6 7

8 9

10

10

11

11

Gujraat

10

3

Haryana

10

1011

1

2

3

4

5 6 7

8

9

11 1

2

3

4

5 6 7

8

9

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

7

8

9

10

11

1

2

4

5

6 7 8

9

11

1

2

3

4

5

6 7 8

9

10

11




<25% 25–50% 51–75% >75%

Jammu &

Kashmir 1

2

3

4

5 6 7

8

9

10

11

1

2

3

4 5

6

7

8

9

10

11

Karnataka Kerala

4

4

Jharkhand 1

2

3

4

5

6

7

8

9

10

11

1

2

3

4 5

6

8

9

10

11

7

1

2 3

4

5

6 7

8

9

10

11

1

2 3

4

5

6 7 8

9

10

11

1

2

3

5

6

7

8

9

10

11

1

2

3

5

6

7

8

9

10

11




<25% 25–50% 51–75% >75%

Madhya

Pradesh

10

7

Manipur 1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7 8

9

10

11

Meghalaya 1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Maharastra 1

2

3

4

5

6

7

8

9

11

1

2

3

4

5

6

8

9

10 1

1

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11




<25% 25–50% 51–75% >75%

Mizoram 1 2 3

4 5

6

7

8

9

10

11

1 2 3

4

5

6

7

8

9 10

11

Nagaland 1

2

3

4

5

6 7

8

9

10

11

1

2

3

4

5 6 7 8

9

10

11

Odisha 1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

8

9

10

11

7

3

6

1011

Punjab

6 5

1

2

4

5 7

8

9

1

2

3

4

7 8

9

10 1

1




<25% 25–50% 51–75% >75%

Rajasthan

10

10

11

11

1

2

3

4

5 6 7

8

9

1

2

3

4 5 6 7

8

9

Tamil Nadu

4

Telangana

4

4

5

5

6

6

Sikkim 1

2

3

4

5

6 7

8

9 10

11 1

2

3

4

5 6 7 8

9 10

11

1

2

3

4

5

6 7 8

9 10

11

1

2

3

5

6

7 8

9

10

11

1

2

3

7

8

9 10

11

1

2

3

7

8

9

10

11




<25% 25–50% 51–75% >75%

Tripura 1

2

3

4

5

6

7

8

9

10

11

7

Uttarakhand 1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

West Bangal 1

2

3

4

5

6

7 8

9

10

11

1

2

3

4

5

6

7 8

9

10

11

Uttar

Pradesh

10 1

2

3

4

5

6

8

9

10

11

1

2 3

4

5

6 7

8

9

11

1

2

3

4

5 6 7

8

9

10

11


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94

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4.4

44

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Trip

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.15

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4.6

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Ka

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56

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90

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62

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92

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25

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75%

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5%


Foods to be avoided (daily consumption)

Among girls, in early adolescence, daily

consumption of fried foods varied from <1%

(Chhattisgarh) to 13% (Kerala). In late adolescence

it varies from <1% (Rajasthan) to 13% (Goa). Daily

junk food consumption varies from 0 (Karnataka,

Rajasthan) to 13% (Manipur) in early adolescence

and from 0 (Andhra Pradesh, Bihar, Chhattisgarh,

Jammu and Kashmir) to 8% (Manipur) in late

adolescence. Daily intake of sweets ranged from 0

(Bihar) to 11% (Tamil Nadu) in early adolescence

and from 0 (Punjab) to 10% (Karnataka). Daily

intake of aerated drinks ranges from 0 (Bihar,

Jharkhand, Kerala, Maharashtra, Tripura) to 5%

(Arunachal Pradesh) in early adolescence and

from 0 (Haryana, Karnataka, Kerala, Tripura) to 7%

(Himachal Pradesh) in late adolescence.

As in girls, among boys in early adolescence,

the lowest proportion of daily consumers of fried

foods is in Chhattisgarh (<1%) and highest in

Kerala (11%). In late adolescence, it ranges from

<1% (Haryana) to 15% (Odisha). Daily junk food

consumption varies from 0 (Karnataka, Telangana)

to 7% (Meghalaya) in early adolescence and

from 0 (Jharkhand, Madhya Pradesh, Tripura)

to 8% (Nagaland) in late adolescence. Daily

intake of sweets ranged from <1% (Goa) to 7%

(West Bengal) in early adolescence and from

0 (Haryana) to 10% (Tamil Nadu). Daily intake

of aerated drinks ranges from 0 (Assam, Kerala,

Maharashtra, Telanga, Tripura) to 6% (Nagaland)

in early adolesence and from 0 (Tripura) to 14%

(Nagaland) in late adolesence.

Figure 26: Consumption of Fried food by Adolescents aged 10-14 years (3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

5.6

4.0

4.2

4.6

2.1

6.5 10

.3

7.4 10

.3

3.4

1.4

9.9

8.9

3.8 7.

1 8.7

7.4

12.2

1.0

1.7

1.4 5

.3

5.2

1.4 3

.7

3.8 5.4

5.4

4.0 7.

1 8.5

3.7

4.6

5.2 2

.1

2.7

3.9

7.9 7.4 3

.5

3.6 0

.4

6.2

1.4

3.7

5.2 2

.1

3.9

7.7 3

.5 2.2 1.

3

2.3 2.0

2.6

7.8 6.1

1.2

4.5

4.6

5.4 4.2

Boys Girls

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

4.1

1.9

1.5

2.1 2.8

0.4

8.3

5.8

5.4

2.9

0.8 4

.1

2.1

1.2

11.3

2.7 3.5

9.2

5.9

1.6

1.5

10.7

7.0

1.5 2.6

1.2 4

.1

2.9 5

.3

4.1 4.7

4.2 2

.6

2.2 1.9

3.2 0

.5

6.0 4.2

9.3

2.3

5.0

1.2

2.5 1.5

13.3

2.2

3.9

7.5

10.5

1.2

1.9 1.1

3.0 0

.8

10.0

5.8

2.1 1.4

5.2 3.8

3.9

Boys Girls

Figure 25: Daily Consumption of Fried food by Adolescents aged 10-14 years (%)


Boys Girls

Figure 28: Consumption of Junk food by Adolescents aged 10-14 years (3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.5

0.2 2

.7

0.4

0.9

0.8 4

.7

2.7 5

.0

0.4 3

.3

2.4

2.0

1.5

1.5

1.6

7.7

2.0

6.7

12.6

3.9

3.0

0.0

0.2

0.2 2

.6

1.6

1.4

1.9 3.3

1.1

1.3

0.4

4.8

1.4

0.4

0.6

3.9 0

.2

0.9

0.3

6.7

0.3

0.0

1.1

1.1

2.2

6.8

1.0

9.4

3.3

4.8 0

.9 1.1

5.32

.5 1.0

0.6

1.7

2.1

1.6

1.7

Boys Girls

Figure 27: Daily Consumption of Junk food by Adolescents aged 10-14 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

0.9

0.6

0.6

0.1

0.3

0.1 0.9

0.4 2

.9

0.5 2.1

0.2

0.2

0.0

0.1 1.2 2.9 3.9 6

.8

1.7 4

.6

4.1

2.0

0.6

0.6

1.0

0.0 0.9

1.1 3

.5

0.6

0.8

0.5

2.4 0

.4 0.1

0.2

0.9

1.6

1.2

0.3

0.8 0.1

0.4

0.0

0.7

1.3

2.6

12.8 9

.9

4.3 1.

8 0.4

0.0

3.31.

5 0.1

1.1

1.9

1.3

2.6 0

.6

Boys Girls

Figure 29: Daily Consumption of Sweets by Adolescents aged 10-14 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.7

2.2 3.4

0.5

0.5

0.7 1.5

0.1 1.

7

0.5 3

.7

0.4 1.7

7.2

0.5 1.6

1.6

0.7

6.4

5.5

1.0 1.7 6

.3

0.3 1.3

1.4 4

.3

0.6

0.2 2

.3

7.3

1.6

1.5

3.0 1.

0

0.0

0.7 1.1

0.4

1.5

1.6

2.3 0.5

1.9

7.8

0.4

1.2

3.3 2.2

4.7

5.1 0

.7

0.9 0.2

4.02.9

10.9

2.9 0

.4

1.2

1.5

1.0


Boys Girls

Figure 30: Consumption of Sweets by Adolescents aged 10-14 years (3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.9

1.4

2.1

0.3

0.4 2.1

1.9 2.9

2.3

0.6

7.9

0.1

4.5

3.8

1.5

1.4 4

.7

2.5

1.0

0.1

4.4

2.1

7.6

0.4

0.8 3

.8

3.6

0.7

1.0

0.9 3

.4

1.9 0.5

4.1 1.

5

0.2

2.6

4.4 0

.8

0.8 0.1

4.7 0

.2

2.5

8.2

1.5

1.7

6.0

2.1

2.1 0.5

2.5 0.9 1.0

0.2

1.6

5.2 3.7 2.8 1.

3

1.0

6.1

Boys Girls

Figure 32: Consumption of Aerated Drinks by Adolescents aged 10-14 years (3 times a

week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.6

0.9 2

.9

0.2

0.1

0.4 3

.5 7.1

6.8

0.2

12.0

0.4 1.9

0.8

0.2 2.0

1.1

0.3 0.9

0.5

10.7

0.3 1.

7

0.1 1.4 2.4 4

.4

1.2

1.5

1.4

0.7

0.8

0.5

5.1 0

.9 0.6

0.0

4.9 1.

8

1.3 0.1

3.0 0

.0

0.0

0.0

0.0

3.4 1.

4

6.2

1.6

0.6

4.5

0.0

0.3

3.00

.1

3.1 1.6

1.6

0.3

2.8 0

.3

Boys Girls

Figure 31: Daily Consumption of Aerated Drinks by Adolescents aged 10-14 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.4

0.7

5.1

0.0

0.6

0.7 1.6

0.7 4

.3

0.5 3

.7

0.1

0.2

0.3

0.0 3

.1

0.0 1.0 2.1

0.4

5.6

0.6

5.3

0.4

0.6 2

.8

0.0

0.0 2

.2 3.3

0.4

0.8

0.8

4.9

0.2

0.0

0.1

3.1 1.

3 1.1

0.7

2.2 0.4

0.0

0.3

0.4

0.0 2

.5

0.0 1.3

0.5

0.6 0

.3

0.2

0.2

4.3

2.6 1.

7

0.0

1.0

0.3

0.4


Boys Girls

Figure 35: Daily Consumption of Junk food by Adolescents aged 15-19 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.0

1.0 2.6

0.2 1.0

0.2 0.8

0.9 2

.6

1.5

0.5

0.2

0.0

0.5

0.2

0.0 2

.2 4.4

4.9

3.5

7.7

2.9

0.62.2

0.8

4.8

0.5

0.0 1.

7 4.5

0.5

0.6

0.0

3.7 0

.4

0.0

0.0

3.0

2.3

2.2 0

.3

2.2 0

.0

1.1

0.4

0.2

1.4

3.8

8.2 7.

2

6.3

2.5 0.7 0.1

6.7

0.7

0.4

0.3

0.5

0.3

2.8 0

.7

Boys Girls

Figure 34: Consumption of Fried food by Adolescents aged 15-19 years (3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

7.1

5.6

2.4

2.7 6

.9 8.7

8.9 12

.2

2.2

0.7

5.5

10.4

4.1 4.9

16.5

8.9

9.2

2.3

1.0

0.6

7.2 8.5

5.6

4.0

2.8 6

.9

5.3 8

.1

6.4

6.8

4.8

4.9

5.2 2

.7

3.7

3.4 0

.9

7.8 4

.0 2.6

5.3 4.6 3.3

3.3

6.3 4.8

8.2

2.3

2.2 1.5

9.0

0.8

0.9

3.4

8.4 5

.8 3.3

7.6

6.9

7.5 3

.3

5.8

Boys Girls

Figure 33: Daily Consumption of Fried food by Adolescents aged 15-19 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

5.7

2.7

1.5 3.3 4.2

2.6

7.0

4.9

4.2

0.6 2.1

6.8

2.9

12.2

5.2

3.8 5.2

4.7

1.6

1.5

14.1

15.4

12.6

3.8

4.2

3.4

3.3

7.3

5.5 9

.0

9.3

4.1 2.5 3.9

1.6

3.6

1.0

9.7

12.8

3.5

0.9

5.7 1.

0 0.9

11.5

1.1

1.5

5.4

6.9 1.

8

2.7

4.9 1.

1

0.2

3.2

8.0 6

.2 0.9 2.4

6.1 5.5

5.1


Boys Girls

Figure 36: Consumption of Junk food by Adolescents aged 15-19 years

(3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

2.1

1.8 4

.5

0.6

0.6 2.2

2.5 4.3

4.5

0.3 1.6

1.8

0.6 1.0

1.2 2.7 5

.8

3.0

9.5

3.3 6

.1

5.9

2.1

1.9

0.8 4

.3

2.3

2.5

1.7

1.9 4

.3

1.3

0.4

5.6

0.1

0.5

0.6

4.1 0

.6

2.4 0

.0

4.2

1.0

1.5

1.5

0.9

2.4

8.4

0.7

6.7 3

.9

5.3

8.2

1.2

2.9

2.5 0.9 0.0

2.6 1.

1

3.9 0

.8

Boys Girls

Figure 38: Consumption of Sweets by Adolescents aged 15-19 years (3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

2.6

1.9

2.2

2.3

1.9

1.9 3.4

8.3

1.6

0.7

5.2

1.5

7.4

3.7

0.7 2

.9

7.0

1.9 3.4

0.7 4

.0

3.8 7.

3

2.1

1.2

0.6 2.1 3.4

1.3

2.1

2.6

1.1

0.3

3.0 1.

3

0.3

0.2

2.6 0

.4

1.1

0.5

2.7 0

.3

2.6

2.3 0.8

1.7

4.7 0

.3

2.0 0.3

1.7

0.0

0.5

3.1

3.0

3.4

3.5

3.5 0

.7

1.5

1.3

Boys Girls

Figure 37: Daily Consumption of Sweets by Adolescents aged 15-19 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

2.2

1.3

1.1

0.3

0.8 1.9

1.1

1.0

1.4

0.0 1.1 2.1

0.3

4.9

0.1

0.6 1.9

1.1 2.6

1.5

1.1

1.3

10.1

0.6 3

.1

2.5

2.1

0.9 3

.2

1.9 4

.1

1.8

1.2

4.6 0

.5

0.5

0.1

1.1

1.8 0.2

0.4

0.5

0.8

1.8

9.5

0.7 0.1

2.7 1.

3

1.2

7.0

0.3

0.0 0.1

1.3

2.2

9.2

3.5 0

.4

1.6

1.6

3.3


Boys Girls

Figure 40: Consumption of Aerated Drinks by Adolescents aged 15-19 years

(3 times a week) (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

3.0

2.1 2.9

1.8

1.5

0.0

7.5

6.2

6.0

0.0

15.4

0.2 2

.2 4.4

0.2

4.9

0.6 4

.6

1.5

1.3

11.2

1.0

6.8

2.0

1.3 2.2 4

.9

1.6 2.5

2.3 3.5

1.1

0.2

2.0

2.4 0.9 0.0

2.6

2.4

2.6 0

.2

3.9 0

.4

0.2

0.0

0.0

2.6 1.

4

1.8

0.9

1.3

4.8

0.0

0.3

4.8

0.0

2.9 0

.3

2.1 1.3

2.1 0.6

Boys Girls

Figure 39: Daily Consumption of Aerated Drinks by Adolescents aged 15-19 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

2.5 4

.9 7.4

0.4

0.3

0.2 3

.9

1.1

10.5

0.3

6.0

1.1

0.4 1.6

0.3 2

.2

0.3 1.7

0.4

0.6

13.9

0.6

9.0

1.5

1.3 4

.0 4.7

0.0 2

.9

1.8

1.5

0.8

0.5

1.9 0.3 0.1

0.2

2.4

3.2 0

.1

0.0

6.8

0.4

1.3

0.0

0.0

0.8 0.5

1.9 0.3

0.3

5.0

1.0 0.1

1.1

0.4

3.1 1.

1

0.0

0.4

1.0

0.3

3.4.3 Comparison of

Diets of Malnourished

AdolescentsWhen the proportion complying to frequency

of food intake among those not short, not thin,

not overweight/obese, not moderately/severely

anemic (standard) is compared with those having

visible forms of malnutrition or anemia, very

consistent patterns emerge across early and late

adolescence and among girls and boys.

Milk and milk products

Compliance to daily milk / milk products intake

is lower than standard among those anemic,

thin and short for both boys and girls and both

age groups. It is higher than standard for those

overweight/obese

Pulses/beans

Like milk, a consistent pattern is noted, where

in those thin or short comply lesser with daily

pulses/bean intake compared with standard.

Among those overweight/obese, compliance is

similar to the standard.


Dark green leafy vegetables

Those who are anemic, thin or short are less

compliant to daily intake of dark green leafy

vegetables compared with standard. Among

those overweight/obese, compliance is similar to

the standard.

Fruits


compliant to daily intake of fruits compared

with standard. Compliance is lowest among

those short. Among those overweight/obese,

compliance is similar to the standard.

Eggs


compliant to recommended intake of eggs

compared with standard. Compliance is lowest

among those anemic. Among those overweight/

obese, compliance is similar to the standard.

Fish/chicken

Compliance to recommended intake of fi sh/

chicken is lower among those thin, while it is

comparable among those short or anemic and

the standard. It is higher than standard for those

overweight/obese.

Figure 41: Consumption of Specifi c Food Groups by Adolescent Girls aged 10-14 years (%)

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Normal Anemic Thin Short Overweight/Obese


Egg


Fruits

Pulses or Beans

Fish/chicken/meat

Pe

rce

nta

ge

(%

)

Figure 42: Consumption of Specifi c Food Groups by Adolescent Boys aged 10-14 years (%)

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0Normal Anemic Thin Short Overweight/Obese


Egg


Fruits

Pulses or Beans

Fish/chicken/meat

Pe

rce

nta

ge

(%

)


Figure 44: Consumption of Specifi c Food Groups by Adolescent Girls aged 15-19 years (%)


Normal Anemic Thin Short Overweight

Obese

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Figure 43: Consumption of Specifi c Food Groups by Adolescent Boys aged 15-19 years (%)


Normal Anemic Thin Short Overweight

Obese

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Pe

rce

nta

ge

(%

)P

erc

en

tag

e (

%)


Figure 45: Consumption of Specifi c Food Groups by Adolescents Girls aged 10-14

years with or without Micronutrient Defi ciencies (%)


None >=1 >=2 >=3 >=4

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Figure 46: Consumption of Specifi c Food Groups by Adolescents Boys aged 10-14

years with or without Micronutrient Defi ciencies (%)


None >=1 >=2 >=3 >=4

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

60.0

50.0

40.0

30.0

20.0

10.0

0.0

3.4.4 Comparison of Diets of

Adolescents with or without


When diets of girls and boys with no

micronutrient defi ciencies (that we included in

our analysis) is compared with those who have

one or more defi ciency a very consistent pattern

on compliance to eating recommended foods

emerges:

1. Compliance to all foods except milk is higher

among those with no micronutrient defi ciency

than those with one or more micronutrient

defi ciencies. These include foods like eggs,

fi sh/chicken, dark green leafy vegetables,

pulses/beans and fruits, which are rich sources

of micronutrients.

Pe

rce

nta

ge

(%

)P

erc

en

tag

e (

%)




2. Compliance to consumption of foods as per

recommended frequency among those with

one, two, three, four or more micronutrient

defi ciencies does not fl uctuate much. Those

who are defi cient in one or more micronutrients

have similar foods missing from the food

plate as those with four or more micronutrient

defi ciencies.

Figure 47: Consumption of Specifi c Food Groups by Adolescents Girls aged

15-19 years with or without Micronutrient Defi ciencies (%)


None >=1 >=2 >=3 >=4

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Figure 48: Consumption of Specifi c Food Groups by Adolescents Girls aged

15-19 years with or without Micronutrient Defi ciencies (%)


None >=1 >=2 >=3 >=4

Fish/chicken/meat


Fruits

Pulses or Beans

Eggs

60.0

50.0

40.0

30.0

20.0

10.0

0.0



Pe

rce

nta

ge

(%

)P

erc

en

tag

e (

%)


3.4.5 Comparison of Diets of

Adolescents at risk of Non-

Communicable Diseases

Unlike healthy foods, when unhealthy food

consumption was analysed, consistent patterns

did not emerge across age groups as well by

gender.

Figure 49: Daily Consumption of Foods to be Avoided by Adolescent Girls aged 10-14 years (%)

None

None

Overweight/

Obese

Overweight/

Obese

Risk of

diabetes

Risk of

diabetes

Low HDL

Cholesterol

Low HDL

Cholesterol

High LDL

Cholesterol

High LDL

Cholesterol

High

Triglycerides

High

Triglycerides

Hypertensive

Hypertensive

Fried Foods Junk Foods Sweets Aerated Drinks

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Figure 50: Daily Consumption of Foods to be Avoided by Adolescent Boys aged 10-14 years (%)


6.0

5.0

4.0

3.0

2.0

1.0

0.0

Among girls, in early adolescence, of the six

risks analysed, daily consumption of sweets and

aerated drinks is higher for four risks, followed

by fried foods which is higher for three risks as

compared with those who do not have any of

the risks considered. Daily junk food is higher

among those pre-diabetic (risk of diabetes). In

late adolescence, daily consumption of aerated

drinks is higher for four risks, followed by fried

Pe

rce

nta

ge

(%

)P

erc

en

tag

e (

%)

Risks of Non-Communicable Diseases



Figure 51: Daily Consumption of Food to be Avoided Adolescent Girls aged 15-19 years (%)


6.0

5.0

4.0

3.0

2.0

1.0

0.0

Figure 52: Daily Consumption of Food to be Avoided Adolescent Boys aged 15-19 years (%)


6.0

5.0

4.0

3.0

2.0

1.0

0.0

foods and sweets, which are higher for three risks

as compared with those who do not have any

of the risks considered. Daily junk food intake is

marginally higher among those with high levels of

triglycerides.

Among boys, in early adolescence, daily

consumption of aerated drinks is higher for

four risks, followed by fried foods which is

higher for three risks and sweets for two risks as

compared with those who do not have any of

the risks considered. Daily junk food intake is

marginally higher among those with high levels of

triglycerides. Almost similar pattern is noted in late

adolescence, among boys.

Pe

rce

nta

ge

(%

)P

erc

en

tag

e (

%)

None

None

Overweight/

Obese

Overweight/

Obese

Risk of

diabetes

Risk of

diabetes

Low HDL

Cholesterol

Low HDL

Cholesterol

High LDL

Cholesterol

High LDL

Cholesterol

High

Triglycerides

High

Triglycerides

Hypertensive

Hypertensive




3.5 What are the physical activity patterns among

adolescents?

Key messages

1. Both girls and boys comply with recommendations on <120 minutes (<2 hours) screen time

per day but fail to meet requirements of 60 minutes (1 hour) vigorous physical activity.

2. Among girls, vigorous activity time is lower than boys and reduces from early to late

adolescence.

Physical activity among adolescents has

immediate and long-term benefi ts. Regular 60

minutes of outdoor sports or exercise helps in

building strong bones and muscles, controlling

weight, improving cardiovascular fi tness and

reducing symptoms of anxiety and depression.

In the long term, it protects from chronic diseases

like heart diseases, type 2 diabetes and some

cancers. Adolescents who follow recommended

physical activity pattern are less likely to be

overweight/obese.


On an average, girls spend 3 hours sitting and

travelling to school. Their average screen time is

about 1 hour 20 minutes and they spend same

Recommended time per day (minutes) Actual average time spent (minutes)

10 to 14 years 15 to 19 years

Girls Boys Girls Boys

Screen time (<120) 80 70 90 90

Vigorous exercise (60) 25 40 10 50

0

1

1

1

1

1

1

1

2

2

Outdoor sports/exercise/physical

activity at school

Screen time


Travel to school

Sitting time

Girls Boys

Figure 53: Average time (in hours) spent per day in specifi c domains of physical activity by

adolescents aged 10-14 years (%)


amount of time in leisure physical activity. They

spend about 25 minutes playing outdoor sports,

which may classify as vigorous activity.

Boys spend on an average 2 hours 40 minutes

sitting and travelling to school. Their average screen

time is about 1 hour 10 minutes and they spend

almost equal time in leisure physical activities. They

spend about 40 minutes playing outdoor sports,

which may classify as vigorous activity.


Sitting and traveling to school time increases

for girls in this age group compared to early

adolescence (3 hours 20 minutes). Leisure

time physical activity also increases to 3 hours

30 minutes. So does screen time (1 hour 30

minutes). However, time spent in vigorous activity

reduces to about 10 minutes.

Among boys, sitting time and travel to school time

increase compared with early adolescents (3

hours 20 minutes). Their average screen time is

about 1 hour 30 minutes and they spend almost

same time in leisure physical activity. Vigorous

activity time on an average is about 50 minutes.

3.5.1 Physical activity patterns

at each completed age from 10

to 19 years

Among girls, mean sitting time increases and

outdoor sports or exercise time (vigorous activity)

decreases consistently with age. There are no

distinct peaks for these two activities, with girls

spending most time in vigorous activity at the age

of 10 years and most time sitting at the age of 19

years. Based on mean time, at no age, girls meet

the 60 minutes recommended vigorous activity

time. Screen time too increases along with sitting

time, with a steep increase from ages 16 to 19

years. Leisure time peaks at 15 years.

Among boys, mean sitting time increases from 10

to 17 years but dives steeply to reach lowest mean

time spent sitting at 19 years. Based on mean

time, boys meet the recommended 60 minutes

vigorous activity at 17 years and almost maintain

that level the following year.

Girls Boys

Figure 54: Average time (in hours) spent per day in specifi c domains of physical activity by

Adolescents aged 15-19 years (%)

0

2

2

1

1

3

1

1

2

3

Outdoor sports/exercise/physical

activity at school

Screen time


Travel to school

Sitting time


Figure 55: Average time (in hours) spent in different domains of physical activity by

Adolescent Girls (%)

Travel TimeScreen Time

Sitting Time Leisure Time Outdoor Physical Acitivity Time

Figure 56: Average time (in hours) spent in different domains of physical activity by

Adolescent Boys (%)

Travel TimeScreen Time

Sitting Time Leisure Time Outdoor Physical Acitivity Time

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0.0

10 11 12 13 14 15 16 17 18 19

Tim

e (

in h

ou

rs)

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0.0

10 11 12 13 14 15 16 17 18 19

Tim

e (

in h

ou

rs)

Age (in years)

Age (in years)


Single age and state-wise

differences for screen time and

vigorous activity (actual hours

spent)

State-wide comparisons:

Screen time

Among girls, data on screen time is available for

23 states and mean screen time ranges from

1 hour (Nagaland) to a little less than 2 hours

in Meghalaya in early adolescence. In late

adolescence it ranges from 0 (Madhya Pradesh)

to almost 4 hours in Delhi. While none of the

states exceed screen time limit on 2 hours in early

adolescence, in late adolescence mean screen

time is almost double the recommendation in

Delhi. It is also higher than the two hour cut-off in

Goa (2.3 hours).

Among the 26 states for which data is available

for boys in early adolescence, mean screen

time ranges from 20 minutes (Bihar) to over

2.5 hours (Mizoram) in early adolescence. In

late adolescence the range is from 0 (Andhra

Pradesh) to over 2.5 hours (Delhi). Three states-

Assam, Mizoram, Uttar Pradesh, exceed the

recommended time limit of two hours for screen

time in early adolescence, but in late adolescence

it is higher than recommendation for Delhi and

Jammu Kashmir.

Vigorous activity time

Among girls, mean vigorous activity time ranges

from less than 20 minutes (Assam) to almost 2.5

hours (Sikkim) in early adolescence and from

less than 10 minutes (Bihar) to more than 4.5

hours (Jammu and Kashmir) in late adolescence.

Based on means, in early adolescence, girls in

only 11 of 30 states, meet the minimum required

vigorous activity time of 60 minutes. These states

are Chhattisgarh, Karnataka, Kerala, Jammu

and Kashmir, Manipur, Punjab, Sikkim, Tamil

Nadu, Tripura, Uttarakhand and West Bengal. In

late adolescence, girls in eight states meet the

minimum required vigorous activity time of 60

minutes. In addition to Arunachal Pradesh, these

include all of the above states, except- Karnataka,

Punjab, Tripura and Uttarakhand.

Among boys, mean vigorous activity time ranges

from 30 minutes (Bihar) to almost 3.5 hours

(Tamil Nadu) in early adolescence and from less

than 10 minutes (Punjab) to 5 hours (Karnataka)

in late adolescence. Based on mean time, boys

in 19 states meet the minimum required vigorous

activity time in early adolescence and in 16 states

in late adolescence.


Figure 57: Time spent in hours (screen time) 10–14 years aged 10-14 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

1.2

1.3 1.

1

1.6

1.2 1.

1

1.3

1.0

1.7

1.1

1.6

1.6

1.2

1.2

1.8

0.4

0.1

0.9

1.6

1.3

1.5

1.1

1.5

1.2

1.2

1.0

1.5

2.2

0.4

1.1

1.1

1.0 1.

1

0.7

1.4

1.4 1.

5

0.4

1.2

1.0

1.3

2.7

1.1

1.4 1.5

1.4

0.5

1.4

2.6

1.2

1.0

BoysGirls

0.7

0.4

0.5

0.2

0.3

1.0

0.3

0.5

0.5 0.4

0.5

1.2

0.3

1.1

1.8

0.6 0

.4

1.0

0.7

0.2

0.3

0.8

1.0

0.2

2.4

1.3

0.5

2.0

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2.3

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1.5

0.8

0.6

2.0

3.3

0.7

2.1

3.4

1.4

0.7

1.5

3.0

Figure 58: Time spent in hours (outdoor sports/exercise/physical activity at school)

10–14 years (%)

Ind

ia

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BoysGirls


Figure 59: Time spent in hours (screen time) 15–19 years (%)

Ind

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1.6 1.7

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1.6 1.7 1.8

0.9

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Figure 60: Time spent in hours (outdoor sports/exercise/physical activity at school)

15–19 years (%)

0.8

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BoysGirls

BoysGirls


3.6 What are the decision making patterns in

adolescent girls?

3.7.1 State-wide variations in

decision making on life choices

How long she studies?

Decision making on length of schooling ranges

from 39% (Odisha) to 89% (Punjab) among 10

to 14 years aged girls. In Andhra Pradesh, Manipur

and Odisha less than half the girls reported not

having a say on duration of their schooling.

Among 15 to 19 years aged girls, it ranges from

45% (Odisha) to 89% (Goa). Odisha is the only

state where less than half the girls are involved in

this decision.

Goes to market

Girls involvement in market purchases ranges from

15% (Odisha) to 80% (Mizoram) in the 10 to 14

years age-group. In 19 states, less than half the

girls can go to market to make their own purchases

Among 15 to 19 years aged girls, 29% (Odisha)

to 90% (Mizoram) reported going to market to

make their own purchases. In six states- Madhya

Pradesh, Manipur, Odisha, Rajasthan, Uttar

Pradesh and West Bengal less than half were

involved in market purchases.

Whom to marry?

In early adolescence fewer girls reported being

involved in decision on whom to marry ranging

from 7% (Punjab) to 80% (Mizoram). Less than

1 in 10 reported being involved in this decision in

Key messages

1. Girls are most involved in decisions related to the duration of their schooling and least

involved on marriage related decisions. The fact that they are not involved in decision on age

of marriage, nullifi es any positives around their role in decisions about length of schooling.

2. Girls especially in 10 to 14 years have little say on market purchases; programs to promote

healthy diets and nutrition status should involve parents as well.

3. Odisha emerges as a state where girls have little to no say in their life choices and Mizoram

as the state where almost all girls make their own life choices.

A girl’s decision making ability in addition to her

education and health can impact social and

economic indicators of a country. One of the

key decisions is around duration and completion

of education. Girls who complete secondary

education are less likely to marry in adolescence

than those who don’t.

How long she studies?

An equal proportion of girls aged 10 to 14 years

and 15 to 19 years (70%) reported being involved

in decision on how long she will study?

Going to market

About 2 in 5 girls aged 10 to 14 years and half

of those aged 15 to 19 years reported going to

market to make their own purchases

Who to marry?

Girls appear to have little say in whom they

marry? 1 in 4 reported having a say on the matter

in both age groups (25% -10 to 14 years, 29% -

15 to 19 years).

When to marry?

They also are less involved in deciding on the age

of marriage with about 1 in 3 reporting to have a

say in the matter (30% -10 to 14 years, 36% - 15

to 19 years).


eight states- Delhi, Madhya Pradesh, Manipur,

Odisha, Punjab, Rajasthan, Sikkim and Tamil Nadu.

In late adolescence the proportion improves

ranging from 17% (Madhya Pradesh) to 89%

(Mizoram). However, less than 1 in 5 reported

being involved in this decision in Punjab, Madhya

Pradesh and Uttar Pradesh.

When to marry?

Among 10 to 14 years aged girls 15% (Odisha) to

82% (Mizoram) reported being involved in decision

on age of marriage. In late adolescence this

proportion ranged from 23% (Madhya Pradesh) to

89% (Mizoram). In 21 states, less than half the girls

are involved in decisions on age of marriage.

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Figure 61: How long you attend school (10-14 years) (%)

Figure 62: Go to the market (10-14 years) (%)

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Figure 63: Who you marry (10-14 years) (%)

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Figure 64: When you marry (10-14 years) (%)

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Figure 65: How long you attend school (15-19 years) (%)

Figure 66: Go to the market (15-19 years) (%)

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Figure 67: Who you marry (15-19 years) (%)

Figure 68: When you marry (15-19 years) (%)

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51


3.7 What is the co-coverage of school-based nutrition

services?

Adolescents spend up to 7 hours of their waking

time in schools making it an ideal platform for

health and nutrition services provision. Under

the Rashtriya Bal Swasthya Karyakram school

going adolescents are entitled to at least

annual screening of defi ciencies, diseases and

development delays (including disabilities).

These services are aimed at early detection and

timely intervention for any treatable/ manageable

nutritional defi ciencies and health condition/

disabilities. At the same time, considering

Key messages

1. Amongst school-going adolescents, coverage of IFA supplementation is the lowest: 13% girls

and 11% boys aged 10-14 years receive iron and folic acid supplements. The coverage drops

to 11% and 6% respectively for girls and boys in 15-19 years age group.

2. More than two-third adolescents in 10-14 years (67% girls and 61% boys) receive mid-day

meals in schools.

3. Amongst adolescents aged 10-14 years, 41% girls and 34% boys reported being dewormed

in the last six months. The coverage reduced in case of late adolescents.

4. Forty two percent girls and 31% boys aged 10-14 years attended bi-annual health check-up

camps in the last one year. The attendance was lower in case of adolescents aged 15-19

years.

5. Nearly 25% percent girls and boys do not receive any of the above services.

the high burden of anemia, Government of

India has a universal prophylactic weekly IFA

supplementation and biannual deworming

program for all adolescent in schools and girls not

in school. Finally, all school going adolescents

upto class eight (14 years) and in some states

even beyond are entitled to hot cooked meal for

200 school days. The meal composition is aimed

at meeting a third of the daily energy and protein

requirements with inclusion of pulses, vegetables

and oils in addition to cereals.

IFA supplementation

Late adolescence (15 to 19 years)Early adolescence (10 to 14 years)

About 1 in 10 girls

(13%) received IFA

supplement in the week

previous to the survey

About 1 in 10 girls

(11%) received IFA



Similar to girls, only

11% boys received IFA



Only 6% boys received

IFA supplement in the

week previous to the

survey


Girls Boys

Figure 69: Adolescents aged 10-14 years with access to services in school (%)

0 10 20 30 40 50 60 70 80

42

37

41

34

67

61

Mid-day Meal

13

11

IFA consumption in last one week

Biannual helth check up in last one year

Deworming tablets provided in the last

six months

Deworming

Biannual health check up

Mid-day meals


2 in 5 girls (41%) reported being dewormed

in the last six months

1 in 5 girls and boys

(23% and 20%) reported being

dewormed in the last six months

1 in 3 boys (34%) reported being dewormed



2 in 5 girls (41%)

reported health check up


More than 1 in 4 girls (29%) and almost

the same proportion of boys (24%) reported

health check up in last six months

1 in 3 boys (34%)

reported health check up


Early adolescence (10 to 14 years)Early adolescence (10 to 14 years) Late adolescence (15 to 19 years)

More than two-thirds girls (67%)

and boys (61%) reported receiving

mid-day meal.

Only 1 in 4 girls (27%) and

2 in 4 boys (47%) reported receiving

mid-day meal.


Girls Boys


0 10 20 30 40 50

11

6IFA consumption in last one week

29

24Biannual helth check up in last one year

23

20

Deworming tablets provided in the last

six months

3.7.1 School going students

receiving none, 1, 2, or 3

services


1 in 5 girls and 1 in 4 boys receive none of the four

services

Among girls, 25% received one service, 27% two

services and 22% three services

Among boys a higher proportion than girls

receive one service (30%), but lower proportion

receive two and three services (24% and 17%,

respectively)


1 in 4 girls received no service; almost half the

boys (45%) received no service

Among girls, 22% received one service, 36% two

services and 13% three services

Among boys an equal proportion to girls receive

one service (22%), but lower proportion receive

two and three services (26% and 5%, respectively)

Girls Boys


0 5

22

17

27

24

25

30

21

25

10 15 20 25 30

Any 3 Services

Any 2 Services

Any 1 Services

No Services


Girls Boys


0 5 10 15 20 25 30

22

17Any 3 Services

27

24Any 2 Services

25

30Any 1 Services

21

25No Services

3.7.2 Variations in receipt of

services across states

IFA supplementation


Among girls, receipt of weekly IFA

supplementation ranges from 1% (Nagaland) to

49% (Sikkim). In 14 states - Arunachal Pradesh,

Assam, Bihar, Haryana, Jammu and Kashmir,

Jharkhand, Manipur, Meghalaya, Mizoram,

Nagaland, Rajasthan, Telangana, Tripura and Uttar

Pradesh, 1 in 10 or fewer girls receive weekly IFA

supplement.

Among boys, receipt of weekly IFA

supplementation ranges from almost none

(Nagaland) to 36% (Goa). In 12 states-

Arunachal Pradesh, Assam, Bihar, Jammu and

Kashmir, Jharkhand, Manipur, Meghalaya,

Mizoram, Nagaland, Telangana, Tripura and Uttar

Pradesh 1 in 10 or fewer boys receive weekly IFA

supplement.


Among girls, receipt of weekly IFA


32% (Sikkim). In half the states 1 in 10 or fewer

girls are reached.

Among boys, receipt of weekly IFA


37% (Manipur). In 23 states, 1 in 10 or fewer boys

are reached

Deworming


Deworming among girls ranges from 7%

(Assam) to 83% (Karnataka). In 12 states -

Andhra Pradesh, Assam, Delhi, Gujarat, Jammu

and Kashmir, Jharkhand, Madhya Pradesh,

Maharashtra, Odisha, Rajasthan, Uttar Pradesh

and West Bengal, less than half the girls are

dewormed biannually.

Deworming among boys ranges from 8% (Uttar

Pradesh) to 82% (Sikkim). In half the states, less

than half the boys are dewormed.


Deworming among girls ranges from 4% (Uttar

Pradesh) to 65% (Tripura). In 25 states, less than

half the girls are dewormed.

Deworming among boys ranges from 4% (Uttar

Pradesh) to 69% (Sikkim). As among girls, in 25

states less than half the girls are dewormed.


Biannual health check up


Biannual school health check-ups services

among girls range from 13% (Uttar Pradesh) to

89% (Goa). In 17 states, less than half the girls

are covered.


among boys range from 11% (Uttar Pradesh) to

89% (Goa). In 20 states, less than half the boys

are covered.



among girls range from 11% (Manipur) to 65%

(Chhattisgarh). In 25 states, less than half the

girls are covered.


among boys range from 7% (Bihar) to 64%

(Goa). In 26 states, less than half the boys are

covered.

Mid-day meal


Coverage of mid-day meal among girls is 18%

(Manipur) to 90% (Goa). In 11 states, more than

75% of the girls are covered.

Coverage of mid-day meal among boys is 15%

(Manipur) to 91% (Goa). In 22 states, more than

half the boys are covered; among these in eight

states 75% boys are covered.


Figure 73: Deworming tablets provided to adolescents aged 10-14 years (%)

State Variation in receipt of Services in Adolescents aged 10-14 years

Figure 74: Biannual health check up in last 1 year for adolescents aged 10-14 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

34

44

58

33

13

74

41

72

44

31

67

20

43

73 76

36

18

55 6

1

54

49 5

4

70

39

82

72

56

80

49

17

8

41

39

63

7

51

43

78

75

35

58

67

49

28

83 80

23

46

57

64

53 5

1 48

72

36

79 76

55

83

54

24

12

BoysGirls

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

37

33

57

33

19

61

37

89

79

35

49

50

18

12

66

61 6

5

17

31

64

55

30

22

64

39 4

2

37

11

44

41

41

42

34

54

22

31

58

30

89

81

38

53

44

43

80

58

67

12

52

30

19

56

43

27

52

69

39

39

12

43

28

59

BoysGirls


Figure 75: Adolescents aged 10-14 years receiving Mid-day Meal (%)

Figure 76: IFA consumption by adolescents aged 10-14 years in last one week (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al P

rad

esh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

46

61

67

58 5

4

80

89

75

63

90

77

50

62

41

82 80

70

75

83

71

51

38

80

59

61

76

58

50

84

27

53

89

18

55

76 75 76

51

91

66

56

47

56

62

75

72 74

15

31

51

50

67

53

53

85

36

43

86

73

48

78

41

BoysGirls

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

11 11

6

1 1

13 12

36

29

12

24

6

3

14

20

14

12

3

8 9

0

21

20

13

34

12

4

9

3

11

24

13

11

6

4 3

16

20

40

45

22

3

7

18 19

15

13

7

1010

8

1

23 2

0

10

49

17

5

10

4

15

34

BoysGirls


Figure 77: Adolescents aged 10-14 years receiving None of the Services (%)

Figure 78: Adolescents aged 10-14 years receiving Any 1 of the Services (%)

Co-coverage of Services in Adolescents aged 10-14 yearsIn

dia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

25

22

17

16

23

9

27

1

7

33

6

25

30

10

1

19

16

38

14

22

29

7

25

35

4

10

25

5

54

31

12

21

25

16

19

8 8

24

0

5

26

13

27

11

6

1

16

9

34

13

16

22

11

17

30

6

9

26

3

28

60

9

BoysGirls

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

30

25

36

26

28

25

61

58

36

25

1617

27

25

67

23

16

28

24

27

23

38

41

26

26

189

1419

37

24

1917

46

43

25

22

31

41

48

51

20

18

20

22

21

28

1314

24

21

30

25

1314

35

28

1918

36

30

BoysGirls




Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

24 2

6

31

15

26

22

28

20

32

21

41

32 33

27

36

23

33

12

34

29

20

32

20 21

38

29 3

1

47

9

26

32

27

29

33

17

42

21

32

20

25 24 2

0

17

34

19

42

30

34

20

30 2

8

22

27 2

3 20

22

27 25

49

10

24

42

BoysGirls

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

17

11

24

9

15

46

17

52

28

16

19

4

12

35

45

17

27

4

22

18

3

33

19

17

29

29

13

32

2

20

17

22

18

26

6

24

44

18

45

34

21

27

14

28

54

31

19

32

2

31

13

5

35

28

18

28

38

21

30

2

25

16

BoysGirls


Figure 81: Deworming tablets provided to adolescents aged 15-19 years (%)

Figure 82: Biannual health check up in last 1 year for adolescents aged 15-19 years (%)

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

20

23 18

36

4

22

64

37

64

19

36

43

33

49

50

14

10

22

41

46

35

41

45

23

63

48

27

4

65

39

8

25

14

44

9 11

61

36

32

21

37

12

25

46 4

9

6

20

40

18

52

46

39

37

25

69

25

3

64

32

11

45

55

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

29

20

45

36

18

12

65

57

61

25 24 22

47

54

35

37

44

11

32 30 2

7

28

39

27

47

51

34

18

13

42

20

12

24

49

22

7

55

36

64

51

31

41

31

20

43

26

22

39

21

38

25

17

34

25

22

56

44

15

32

7

33

12

State Variation in receipt of Services in Adolescents aged 15-19 years

BoysGirls

BoysGirls


Figure 84: Adolescents aged 15-19 years receiving none of the Services (%)

Figure 83: IFA consumption by adolescents aged 15-19 years in last one week (%)

Co-coverage of Services in Adolescents aged 15-19 years

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jas

tha

n

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

7611

3 5 3

6

13

17

29

21

10

6

24

4

14

5

19

9

4

8

14

2

12 14

9

32

13

5

8

5

16

26

3

9

4 4

13 15

22

11

8

24

5 3 3

9 8 6

2

5

8

2

5 6 4

37

7

3 2

6

21

BoysGirls

9.3

Ind

ia

An

dh

ra P

rad

esh

Aru

na

ch

al

Pra

de

sh

Ass

am

Bih

ar

Ch

ha

ttis

ga

rh

De

lhi

Go

a

Gu

jara

t

Ha

rya

na

Him

ac

ha

l P

rad

esh

Jam

mu

& K

ash

mir

Jha

rkh

an

d

Ka

rna

tak

a

Ke

rala

Ma

dh

ya

Pra

de

sh

Ma

ha

rash

tra

Ma

nip

ur

Me

gh

ala

ya

Miz

ora

m

Na

ga

lan

d

Od

ish

a

Pu

nja

b

Ra

jasth

an

Sik

kim

Ta

mil

Na

du

Te

lan

ga

na

Tri

pu

ra

Utt

ar

Pra

de

sh

Utt

ara

kh

an

d

We

st

Be

ng

al

45

34

.4

35

.6

19.1

17.

6

27

28

.9

51.

3

54

.6 41

27.

3

15.7

33

.2

22

.3

51.

2

38

40

41

40

.4

16.5

14.9

14.9

16.1

20

.9

22

.3

54

.2

25

.1

24

.8

33

.6

50

.8

31.

9

48

38

50

32

19

0

4

0 0

22

.2 28

.8

48

.7

47.

1

43

56

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52

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60

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16.7

6.4

16.3

19.2

26

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22

.8

36

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31.

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36

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36

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33

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52

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BoysGirls




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Figure 87: Adolescents aged 15-19 years receiving Any 3 of the Services (%) 10

22

0 0

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4 Opportunities

The second decade of life is the second

opportunity to make up for missed chances on

better nutrition earlier in life. It is a much wider

window than available in the fi rst 1000 days

from conception till child is two years. Another

advantage is that adolescents are capable of

making informed choices or infl uencing decisions

about their own health and nutrition if equipped

with correct and easily understood information.

Their decision-making being dependent on the

level of autonomy they have in the household.

Our analysis reveals what can be and should be

done to maximize long term health and nutrition

benefi ts in this bigger and infl uential second

window of opportunity in the life-course. There are

implications for policy in the ongoing POSHAN

Abhiyaan, bolstering ongoing programs for

adolescent health and nutrition and new research

to better the design of programs for adolescents.

Four opportunities emerge. First, there is a need

for a dedicated policy on adolescent health

and nutrition under the Poshan Abhiyan for

planning and managing services spread across

departments of education, health and woman

and child development. This has been attempted

earlier under the weekly IFA supplementation

program through joint commitment letters

from the three departments to ensure fund

allocation, supply and logistics, capacity building

of teachers, behaviour change promotion and

other actions from the department of health

go hand in hand with service delivery at point

of use (class room, village anganwadi)24. Our

analysis reveals huge gaps in compliance to both

diets and physical activity recommendations

among adolescents both of which have not been

addressed in any earlier program on adolescent

health and nutrition program. An adolescent

health and nutrition policy for the country must

include guidance on this.

Second, the Poshan Abhiyan targets for

undernutrition and anemia have resulted in

fast pacing actions to meet these targets for

women, girls and children albeit progress varies

across states25. The problem of overweight/

obesity and related non-communicable

diseases risks has been missed in design. The

problem is growing and still ignored in policy

and programs. Considering the very early onset

of these conditions in the Indian population,

policy on assessment and management of these

conditions in early adolescence is needed. There

are 12 states in India where over 10% of the

adolescents are overweight/obese; states of Goa,

Gujarat, Haryana and most states in north-east

have high burden of diabetes and cardiovascular

risks. State-specifi c action plans need to follow a

national policy on managing overweight/obesity

among adolescents. State with diets skewed to

carbohydrates, animal fats, avoidable foods (fried

foods, junk foods, sweets and aerated drinks)

need policies on restricting sale of such food

within and in vicinity of the schools.

Thirdly, with the CNNS data, new dimensions on

adolescent nutritional status especially related

to the high burden of multiple micronutrient

defi ciencies have emerged. India does not

have a policy to address vitamin B12

, vitamin D

and zinc defi ciency which have high burden

among adolescents in addition to iron and folic

acid defi ciency. An expert review of evidence is

needed to inform policy gap here.


The analysis of current receipt of public health

service use by adolescents has implications

for reviewing the ongoing adolescent health

and nutrition programs. A bottleneck analysis

to understand root causes of challenges in

implementation of Anemia Mukt Bharat and

Rashtriya Bal Swasthya Karyakram is much

needed considering that a captive set of girls

and boys in schools is missed out from these

services. Both iron and folic acid defi ciency

continue to be highly prevalent in most states of

India. This review should include fi nancing, supply

and logistics, human resource availability and

capacity and support system to deliver services

related to weekly IFA supplementation.

Secondly, each state should have an adolescent

score card for girls and boys that captures the

progress on service use every six months. Anemia

Mukt Bharat portal provides monitoring data on

IFA and deworming for this age-group which

needs to be part of state level health and nutrition

program reviews26. Similarly, data on biannual

health check-ups and quarterly adolescent health

days needs to be made available in the public

domain.

Thirdly, there is a need to build on the ongoing

efforts in schools for promoting healthy habits

and diets like those under Food Safety and

Standards Authority of India and Anemia Mukt

Bharat. Special nutrition and diet promotion

campaign focusing on problem foods (fruits,

eggs, fi sh/chicken, dark green leafy vegetables,

pulses and milk) and adolescent health and

nutrition services need to be designed, tested and

popularised.

Research on adolescent health and nutrition in

India is limited. Current efforts while still weak are

focussed on schools. But the food plate is mostly

decided at home and not much is known about

translation of health and nutrition promotion in

schools to food plate at home. Mothers and/

or fathers remain key decision makers on what

is purchased from the market and campaigns

to reach them with correct information on food

choices for adolescents and understanding their

health needs have not been tested. Finally, in a

food system where avoidable foods are much

cheaper than healthier options more research and

development on nutritious products that appeal to

adolescents is needed.


Uttar Pradesh

22.3

Punjab

19.0

Arunachal Pradesh

6.5

Sikkim

10.3

Bihar

16.1

Jharkhand

28.2

Odisha

19.9

Assam

21.1

Telangana

23.4

Andhra

Pradesh

20.7

Kerala

20.0

Karnataka

25.0

Maharashtra

23.2

Gujarat

26.3 Madhya Pradesh

29.7

Rajasthan

29.8

NCT of Delhi

26.1

Haryana

23.1Uttarakhand

18.1

Himachal Pradesh

38.4

Jammu and

Kashmir

16.6

Puducherry

Manipur

6.3

Nagaland

11.8

Mizoram

7.3Tripura

18.1

Meghalaya

6.3

Chhattisgarh

13.9

Lakshadweep

Andaman and

Nicobar Islands

Dadra and

Nagar Haveli

Goa

16.4

West Bengal

27.3

Tamil Nadu

16.2

Better Performing States

Manipur (6.3%)

Meghalaya (6.3%)

Arunachal Pradesh (6.5%)

Mizoram (7.3%)

Sikkim (10.3%)

States with most challenges

Himachal Pradesh (38.4%)

Rajasthan (29.8%)

Madhya Pradesh (29.7%)

Jharkhand (28.2%)

West Bengal (27.3%)

India (22.9%)

10-14 years (Girls)

(BMI-for-age z-score<-2SD)

<20% : Low public health

signifi cance

20–39.9% : High public

health signifi cance

>40% : Very high public

health signifi cance

No Data

THIN

Uttar Pradesh

10.9

Punjab

17.3

Sikkim

1.0

Bihar

17.3

Jharkhand

17.2

Odisha

11.8

Assam

9.1

West

Bengal

11.9

Telangana

22.8

Andhra

Pradesh

9.4

Tamil

Nadu

13.4Kerala

9.5

Karnataka

15.5

Maharashtra

12.1

Gujarat

22.3 Madhya Pradesh

21.2

Rajasthan

15.2

NCT of Delhi

14.1

Haryana

13.4

Uttarakhand

8.1

Himachal Pradesh

21.7

Jammu and

Kashmir

4.6

Puducherry

Manipur

4.2

Nagaland

2.7

Mizoram

2.9Tripura

10.5

Meghalaya

1.1

Ch

ha

ttis

ga

rh11

.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

22.7

Arunachal Pradesh

1.9


Sikkim (1.0%)

Meghalaya (1.1%)


Nagaland (2.7%)

Mizoram (2.9%)


Telangana (22.8%)

Goa (22.7%)

Gujarat (22.3%)



India (14.2%)

15-19 years (Girls)

Prevalence of Visible Forms of Malnutrition in Adolescent Girls, CNNS 2016-18


Uttar Pradesh

28.9

Punjab

18.7 Arunachal Pradesh

25.8

Sikkim

19.2

Bihar

36.4

Jharkhand

39.2

Odisha

30.6

Assam42.9

Telangana

16.6

Andhra

Pradesh

24.1

Tamil Nadu

17.1Kerala

11.0

Karnataka

28.5

Maharashtra

27.7

Gujarat

30.6 Madhya Pradesh

33.5

Rajasthan

20.8

NCT of Delhi

22.6

Haryana

17.1

Uttarakhand

28.9

Himachal Pradesh

24.4

Jammu and

Kashmir

18.6

Puducherry

Manipur

20.3

Nagaland

41.3

Mizoram

29.4Tripura

34.8

Meghalaya

37.4

Chhattisgarh

22.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

13.7

West

Bengal

18.3


Kerala (11.0%)

Goa (13.7%)

Telangana (16.6%)

Tamil Nadu (17.1%)

Haryana (17.1%)


Assam (42.9%)

Nagaland (41.3%)

Jharkhand (39.2%)

Meghalaya (37.4%)

Bihar (36.4%)

India (27.8%)

10-14 years (Girls)

20-30%

<10%

10–20%

>30%

No Data

SHORT

Uttar Pradesh

34.9

Punjab

8.7

Sikkim

25.9

Bihar

35.0

Jharkhand

46.7

Odisha

29.3

Assam

30.0

West

Bengal

43.8

Telangana

29.7

Andhra

Pradesh

30.7

Tamil Nadu

19.9Kerala

14.7

Karnataka

27.8

Maharashtra

27.0

Gujarat

29.2 Madhya Pradesh

26.5

Rajasthan

16.7

NCT of Delhi

30.7

Haryana

17.9

Uttarakhand

19.8

Himachal Pradesh

22.4

Jammu and

Kashmir

17.7

Puducherry

Manipur

23.5

Nagaland

20.3

Mizoram

22.5Tripura

36.7

Meghalaya

52.0

Chhattisgarh

29.3

Lakshadweep

Andaman and Nicobar

Islands

Dadra and Nagar

Haveli

Goa

22.0

Arunachal Pradesh

39.3


Punjab (8.7%)

Kerala (14.7%)

Rajasthan (16.7%)

Jammu And Kashmir (17.7%)

Haryana (17.9%)


Meghalaya (52.0%)

Jharkhand (46.7%)

West Bengal (43.8%)


Tripura (36.7%)

India (30.2%)

15-19 years (Girls)

(Height-for-age z-score<-2SD)


Uttar Pradesh

3.3

Punjab

6.9

Arunachal Pradesh

14.6

Sikkim

10.6

Bihar

1.3

Jharkhand

2.0

Odisha

7.7

Assam

7.6

Telangana

5.8

Andhra

Pradesh

11.0

Tamil

Nadu

16.5Kerala

11.4

Karnataka

6.4

Maharashtra

4.9

Gujarat

9.7 Madhya Pradesh

1.6

Rajasthan

4.7

NCT of Delhi

13.4

Haryana

3.1

Uttarakhand

6.0

Himachal Pradesh

3.8

Jammu and

Kashmir

8.1

Puducherry

Manipur

10.8

Nagaland

13.4

Mizoram

9.4Tripura

11.2

Meghalaya

5.0

Chhattisgarh

3.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

19.9

West

Bengal

8.1


Bihar (1.3%)


Jharkhand (2.0%)

Haryana (3.1%)

Uttar Pradesh (3.3%)


Goa (19.9%)

Tamil Nadu (16.5%)


Nagaland (13.4%)

Delhi (13.4%)

India (5.3%)

10-14 years (Girls)

9-14%

<5%

5–9%

>14%

NA

OVERWEIGHT/OBESE

15-19 years (Girls )

Uttar

Pradesh

2.7

Sikkim

13.2

Bihar

2.3

Jharkhand

1.4

Odisha

4.9

Telangana

7.0

Andhra

Pradesh

9.9

Tamil

Nadu

9.4

Karnataka

10.7

Maharashtra

6.0

Madhya Pradesh

1.7

NCT of Delhi

6.7

Uttarakhand

4.4

Himachal Pradesh

2.2

Puducherry

Ch

ha

ttis

ga

rh3

.7

Punjab

6.3

Assam

2.6

West

Bengal

3.6

Kerala

9.2

Gujarat

6.2

Rajasthan

1.5

Haryana

3.9

Jammu and

Kashmir

9.3

Manipur

7.1

Nagaland

4.1

Mizoram

6.5Tripura

6.0

Meghalaya

4.3

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

9.3

Arunachal Pradesh

10.8


Jharkhand (1.4%)

Rajasthan (1.5%)



Bihar (2.3%)


Sikkim (13.2%)


Karnataka (10.7%)

Andhra Pradesh (9.9%)

Tamil Nadu (9.4%)

India (4.1%)

(BMI-for-age z-score>+1SD)



Kerala (6.4%)

Manipur (8.1%)

Nagaland (9.0%)

Tamil Nadu (11.4%)



West Bengal (56.0%)

Jharkhand (50.2%)

Gujarat (44.2%)

Chhattisgarh (42.1%)

Tripura (41.3%)

India (32.1%)

20-39.9% : Moderate public

health problem

<5% : Public health problem

5–19.9% Mild public health

problem

>=40% : Severe health public

health problem

NA

Uttar Pradesh

39.9

Punjab

24.1

Arunachal Pradesh

22.3Sikkim

30.7

Bihar

23.0

Jharkhand

50.2

Odisha

31.1

Assam

35.2

Telangana

37.8

Andhra

Pradesh

28.0

Tamil Nadu

11.4Kerala

6.4

Karnataka

16.5

Maharashtra

27.6

Gujarat

44.2Madhya Pradesh

23.3

Rajasthan

31.1

NCT of Delhi

32.0

Haryana

29.6

Uttarakhand

17.0

Himachal

Pradesh

12.1

Jammu and

Kashmir

15.6

Puducherry

Manipur

8.1

Nagaland

9.0

Mizoram

16.0Tripura

41.3

Meghalaya

32.1

Chhattisgarh

42.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

14.2

West

Bengal

56.0

10-14 years (Girls)

15-19 years (Girls)

ANEMIC

Uttar Pradesh

49.2

Punjab

46.9

Sikkim

45.5

Bihar

46.0

Jharkhand

53.7

Odisha

50.2

Assam

53.4

West

Bengal

67.6

Telangana

55.2

Andhra

Pradesh

39.4

Tamil

Nadu

40.2Kerala

21.4

Karnataka

34.9

Maharashtra

47.5

Gujarat

47.8Madhya Pradesh

34.1

Rajasthan

50.3

NCT of Delhi

56.5

Haryana

54.2

Uttarakhand

23.7

Himachal Pradesh

28.0

Jammu and

Kashmir

31.9

Puducherry

Manipur

14.9

Nagaland

6.0

Mizoram

35.7Tripura

67.1

Meghalaya

60.1

Ch

ha

ttis

ga

rh4

1.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

32.1

Arunachal Pradesh

48.2


Nagaland (6.0%)

Manipur (14.9%)

Kerala (21.4%)

Uttarakhand (23.7%)



West Bengal (67.6%)

Tripura (67.1%)

Meghalaya (60.1%)

Delhi (56.5%)

Telangana (55.2%)

India (47.5%)

Prevalence of Anemia in Adolescent Girls, CNNS 2016-18

(Hemoglobin levels <11.5 g/dl for 10–11 years, <12.0 g/dl for 12–14 years and <12.0 g/dl for 15–19 years)


Uttar Pradesh

14.8

Punjab

50.0 Arunachal Pradesh

23.2

Sikkim

22.0

Bihar

9.8

Jharkhand

5.7

Odisha

25.9

Assam

10.5

Telangana

33.1

Andhra

Pradesh

15.9

Kerala

27.4

Karnataka

36.6

Maharashtra

53.4

Gujarat

42.9 Madhya Pradesh

11.9

Rajasthan

37.6

NCT of Delhi

21.0

Haryana

34.7

Uttarakhand

27.5

Himachal Pradesh

10.7

Jammu and

Kashmir

30.7

Puducherry

Manipur

12.4

Nagaland

20.4

Mizoram

11.8Tripura

20.6

Meghalaya

24.6

Chhattisgarh

35.3

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

NagarHaveli

Goa

17.6

West

Bengal

25.8

Tamil Nadu

37.0


Jharkhand (5.7%)

Bihar (9.8%)

Assam (10.5%)


Mizoram (11.8%)


Maharashtra (53.4%)

Punjab (50.0%)

Gujarat (42.9%)

Rajasthan (37.6%)

Tamil Nadu (37.0%)

India (24.1%)

10-14 years (Girls)

20-30%

<10%

10–20%

>30%

No Data

IRON DEFICIENCY

Uttar Pradesh

35.3

Punjab

65.0

Arunachal Pradesh

40.7Sikkim

39.6

Bihar

21.6

Jharkhand

26.6

Odisha

39.8

Assam40.6

Telangana

40.0

Andhra

Pradesh

37.7

Tamil Nadu

44.1

Kerala

48.7

Karnataka

40.6

Maharashtra

51.5

Gujarat

47.4 Madhya Pradesh

48.9

Rajasthan

69.2

NCT of Delhi

41.2

Haryana

42.6

Uttarakhand

34.9

Himachal Pradesh

41.8

Jammu and

Kashmir

42.2

Puducherry

Manipur

27.6

Nagaland

5.5

Mizoram

23.4Tripura

19.1

Meghalaya

31.1

Ch

ha

ttis

ga

rh5

1.4

Lakshadweep

Andaman and Nicobar Islands

Dadra & Nagar

Haveli

Goa

32.8

West Bengal

32.9

15-19 years (Girls)


Nagaland (5.5%)

Tripura (19.1%)

Bihar (21.6%)

Mizoram (23%)

Jharkhand (26.6%)


Rajasthan (69.2%)

Punjab (65%)

Maharashtra (51.5%)

Chattisgarh (51.4%)


India (39.0%)

Prevalence of Micronutrient Defi ciencies in Adolescent Girls, CNNS 2016-18

(Serum ferritin levels <15 �g/l; excluding cases with C-reactive protein > 5 mg/L)


Uttar Pradesh

39.5

Punjab

46.9

Arunachal Pradesh

7.0

Sikkim

7.5

Bihar

16.9

Jharkhand

18.9

Odisha

11.4

Assam

10.2

Telangana

25.2

Andhra

Pradesh

20.1

Tamil Nadu

12.5Kerala

3.3

Karnataka

32.8

Maharashtra

26.6

Gujarat

40.0 Madhya Pradesh

37.6

Rajasthan

47.4

NCT of Delhi

21.9

Haryana

22.3

Uttarakhand

16.2

Himachal Pradesh

22.5

Jammu and

Kashmir

14.5

Puducherry

Manipur

5.4

Nagaland

4.9

Mizoram

8.4Tripura

3.4

Meghalaya

8.2

Chhatt

isgarh

40.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and Nagar

Haveli

Goa

11.7

West

Bengal

1.1

10-14 years (Girls)


West Bengal (1.1%)

Kerala (3.3%)

Tripura (3.4%)

Nagaland (4.9%)

Manipur (5.4%)


Rajasthan (47.4%)

Punjab (46.9%)


Gujarat (40.0%)


India (25.6%)

<10%

10–20%

>30%

20–30%

No Data

VITAMIN B12

DEFICIENCY

Uttar Pradesh

30.8

Punjab

45.9

Arunachal Pradesh

5.4

Sikkim

15.6

Bihar

25.6

Jharkhand

17.5

Odisha

20.5

Assam

8.3

Telangana

23.2

Andhra

Pradesh

13.6

Tamil Nadu

18.2Kerala

0

Karnataka

54.7

Maharashtra

30.0

Gujarat

50.4 Madhya Pradesh

36.7

Rajasthan

45.4

NCT of Delhi

33.7

Haryana

38.5Uttarakhand

24.6

Himachal Pradesh

33.0

Jammu and

Kashmir

22.8

Puducherry

Manipur

11.1

Nagaland

2.2

Mizoram

3.5Tripura

10.4

Meghalaya

3.5

Chhattisgarh

49.2

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

12.2

West

Bengal

2.5


Kerala (0)

Nagaland (2.2%)

West Bengal (2.5%)

Meghalaya (3.5%)

Mizoram (3.5%)


Karnataka (54.7%)

Gujarat (50.4%)

Chattisgarh (49.2%)

Punjab (45.9%)

Rajasthan(45.4%)

India (28.1%)

15-19 years (Girls)

(Serum vitamin B12

< 203 pg/ml )


Uttar Pradesh

3.8

Punjab

16.3

Arunachal Pradesh

50.0

Sikkim

2.2

Bihar

14.4

Jharkhand

19.5

Odisha

65.2

Assam

73.9

Telangana

58.6

Andhra

Pradesh

89.3

Kerala

48.5

Karnataka

72.2

Maharashtra

75.6

Gujarat

58.3 Madhya Pradesh

68.6

Rajasthan

48.8

NCT of Delhi

0.6

Haryana

37.2Uttarakhand

22.2

Himachal Pradesh

9.2

Jammu and

Kashmir

9.5

Puducherry

Manipur

7.0

Nagaland

73.6

Mizoram

21.1Tripura

5.5

Meghalaya

78.3

Chhattisgarh

71.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

44.5

West

Bengal

0

Tamil Nadu

74.8

10-14 years (Girls)


West Bengal (0%)

Delhi (0.6%)

Sikkim (2.2%)


Tripura (5.5%)



Meghalaya (78.3%)

Maharashtra (75.6%)

Tamil Nadu (74.8%)

Assam (73.9%)

India (36.1%)

40-60%

<20%

20–40%

>60%

No Data

FOLATE DEFICIENCY

15-19 years (Girls)

Uttar Pradesh

4.9

Punjab

23.9

Arunachal Pradesh

36.8

Sikkim

0

Bihar

8.8

Jharkhand

23.7

Odisha

73.4

Assam

66.4

Telangana

72.5

Andhra

Pradesh

81.3

Tamil Nadu

67.9

Kerala

53.3

Karnataka

71.9

Maharashtra

60.9

Gujarat

55.2 Madhya Pradesh

64.5

Rajasthan

46.3

NCT of Delhi

3.8

Haryana

24.7

Uttarakhand

21.0

Himachal Pradesh

0.5

Jammu and

Kashmir

3.1

Puducherry

Manipur

3.5

Nagaland

88.4

Mizoram

25.8Tripura

3.4

Meghalaya

52.5

Ch

ha

ttis

ga

rh6

2.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra &

Nagar Haveli

Goa

51.9

West

Bengal

0.1


Sikkim (0)

West Bengal (0.1%)


Jammu and Kashmir (3.1%)

Tripura (3.4%)


Nagaland (88.4%)


Odhisa (73.4%)

Telangana (72.5%)

Karnataka (71.9%)

India (32.0%)

(Serum erythrocyte folate < 151 ng/ml)


Uttar Pradesh

24.9

Punjab

26.9

Arunachal Pradesh

13.0

Sikkim

4.3

Bihar

25.7

Jharkhand

43.5

Odisha

24.4

Assam

9.9

Telangana

26.9

Andhra

Pradesh

12.4

Tamil Nadu

7.7Kerala

14.9

Karnataka

15.4

Maharashtra

7.4

Gujarat

7.7 Madhya Pradesh

16.7

Rajasthan

0

NCT of Delhi

15.1

Haryana

7.4Uttarakhand

22.5

Himachal Pradesh

2.6

Jammu and

Kashmir

6.0

Puducherry

Manipur

10.6

Nagaland

3.6

Mizoram

19.5Tripura

13.1

Meghalaya

15.9

Chhatt

isgarh

42.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

1.8

West

Bengal

4.4

10-14 years (Girls)

VITAMIN A DEFICIENCY

<2% : No public health

problem

2–9.9% : Mild public health

problem

>=20% : Severe health

public health problem

10–19.9% : Moderate public

health problem

No Data


Rajasthan (0%)

Goa (1.8%)


Nagaland (3.6%)

Sikkim (4.3%)


Jharkhand (43.5%)


Punjab (26.9%)

Telangana (26.9%)

Bihar (25.7%)

India (18.7%)

Uttar Pradesh

11.9

Punjab

9.4

Arunachal Pradesh

9.6Sikkim

6.5

Bihar

16.9

Jharkhand

26.9

Odisha

13.0

Assam

14.3

Telangana

17.4

Andhra

Pradesh

16.3

Tamil

Nadu

6.2Kerala

17.1

Karnataka

1.6

Maharashtra

10.4

Gujarat

25.7 Madhya Pradesh

19.5

Rajasthan

6.3

NCT of Delhi

13.6

Haryana

12.5

Uttarakhand

12.3

Himachal Pradesh

4.5

Jammu and

Kashmir

9.7

Puducherry

Manipur

11.4

Nagaland

5.6

Mizoram

7.9Tripura

20.3

Meghalaya

1.3

Ch

ha

ttis

ga

rh2

2.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra &

Nagar Haveli

Goa

7.9

West

Bengal

1.5


Meghalaya (1.3%)

West Bengal (1.5%)

Karnataka (1.6%)


Nagaland (5.6%)


Jharkhand (26.9%)

Gujarat (25.7%)

Chattishgrah (22.4%)

Tripura (20.3%)


India (12.2%)

15-19 years (Girls)

(Serum retinol concentration <20 μg/dL; excluding cases with C-reactive protein > 5 mg/L)


10-14 years(Girls)

VITAMIN D DEFICIENCY

Uttar

Pradesh

32.1

Punjab

80.7

Arunachal Pradesh

35.2

Sikkim

26.5

Bihar

55.4

Jharkhand

32.6

Odisha

25.6

Assam

15.1

Telangana

10.9

Andhra

Pradesh

22.0

Tamil

Nadu

11.0Kerala

42.0

Karnataka

26.8

Maharashtra

33.1

Gujarat

46.7Madhya Pradesh

37.2

Rajasthan

38.8

NCT of Delhi

60.0

Haryana

64.2

Uttarakhand

74.7

Himachal Pradesh

33.4

Jammu and

Kashmir

69.4

Puducherry

Manipur

75.3

Nagaland

15.2

Mizoram

24.4Tripura

43.0

Meghalaya

13.1

Chhatt

isgarh

37.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

26.0

West Bengal

30.9


Telangana (10.9%)

Tamil Nadu (11.0%)

Meghalaya (13.1%)

Assam (15.1%)

Nagaland (15.2%)


Punjab (80.7%)

Manipur (75.3%)

Uttarakhand (74.7%)

Jammu & Kashmir (69.4%)

Haryana (64.2%)

India (35%)

<10%

10-30%

30-40%

>40%

No Data

15-19 years (Girls)

Uttar

Pradesh

31.2

Punjab

75.6

Arunachal Pradesh

27.0

Sikkim

23.2

Bihar

48.5

Jharkhand

43.9

Odisha

25.6

Assam

9.1

West

Bengal

28.9

Telangana

17.4

Andhra

Pradesh

20.1

Tamil Nadu

11.0

Kerala

44.6

Karnataka

24.0

Maharashtra

30.5

Gujarat

39.4

Madhya

Pradesh

29.1

Rajasthan

29.4

NCT of Delhi

68.1

Haryana

76.7

Uttarakhand

77.1

Himachal Pradesh

16.4

Jammu and

Kashmir

80.5

Puducherry

Manipur

72.3

Nagaland

7.7

Mizoram

21.4Tripura

39.6

Meghalaya

7.0

Chhatt

isgarh

25.7

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

30.0


Meghalaya (7.0%)

Nagaland (7.7%)

Assam (9.1%)

Tamil Nadu (11.0%)




Uttarakhand (77.1%)

Haryana (76.7%)

Punjab (75.6%)

Manipur (72.3%)

India (33.6%)

(Serum 25(OH)D concentration <12ng/mL)


Uttar

Pradesh

18.7

Punjab

54.2

Arunachal Pradesh

23.6

Sikkim

32.0

Bihar

15.3

Jharkhand

38.7

Odisha

43.0

Assam

34.0

Telangana

23.7

Andhra

Pradesh

22.2

Tamil

Nadu

30.7Kerala

18.8

Karnataka

35.0

Maharashtra

24.7

Gujarat

37.7 Madhya Pradesh

21.9

Rajasthan

30.5

NCT of Delhi

42.8

Haryana

22.8Uttarakhand

32.1

Himachal Pradesh

51.0

Jammu and

Kashmir

33.0

Puducherry

Manipur

47.2

Nagaland

0

Mizoram

2.8Tripura

33.9

Meghalaya

51.8

Chhattisgarh

19.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

24.9

West

Bengal

25.8


Nagaland (0%)

Mizoram (2.8%)

Bihar (15.3%)


Kerala (18.8%)


Punjab (54.2%)

Meghalaya (51.8%)


Manipur (47.2%)

Odisha (43.0%)

India (26.6%)

10-14 years(Girls)

ZINC DEFICIENCY

<10%

10-20%

20-30%

>30%

No Data

Uttar

Pradesh

21.5

Punjab

41.8

Arunachal Pradesh

13.5

Sikkim

39.1

Bihar

25.3

Jharkhand

27.7

Odisha

43.4

Assam

27.2

West

Bengal

29.7

Telangana

30.1

Andhra

Pradesh

19.3

Tamil Nadu

58.3Kerala

23.3

Karnataka

48.2

Maharashtra

24.5

Gujarat

55.8Madhya Pradesh

9.5

Rajasthan

18.4

NCT of Delhi

47.8

Haryana

10.5

Uttarakhand

26.6

Himachal Pradesh

44.7

Jammu and

Kashmir

33.9

Puducherry

Manipur

49.7

Nagaland

9.9

Mizoram

15.4Tripura

43.0

Meghalaya

30.9

Chhatt

isgarh

44.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

24.0



Nagaland (9.9%)

Haryana (10.5%)


Mizoram (15.4%)


Tamil Nadu (58.3%)

Gujarat (55.8%)

Manipur (49.7%)

Karnataka (48.2%)

Delhi (47.8%)

India (30.2%)

15-19 years15-19 years(Girls)

(Serum Zinc concentration < 70 μg/dl (morning fasting) and < 66 μg/dl (morning non-fasting) in non-pregnant females)


10-14 years (Boys)

15-19 years (Boys)

Uttar Pradesh

32.2

Punjab

21.4

Arunachal Pradesh

12.0

Sikkim

14.6

Bihar

30.0

Jharkhand

37.1

Odisha

22.8

Assam

27.1

West

Bengal

35.2

Telangana

33.2

Andhra

Pradesh

24.0

Tamil Nadu

28.4Kerala

20.7

Karnataka

35.0

Maharashtra

33.0

Gujarat

37.5Madhya Pradesh

40.9

Rajasthan

36.6

NCT of Delhi

21.3

Haryana

22.5

Uttarakhand

21.9

Himachal Pradesh

30.1

Jammu and

Kashmir

19.1

Puducherry

Manipur

6.9

Nagaland

14.6

Mizoram

9.1Tripura

22.6

Meghalaya

6.2

Chhatt

isgarh

28.8

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

20.3

<20 %: Low Public health

signif icance

20-39.9%: High Public health

signif icance

>40%: Very public health

problem

No data


Meghalaya (6.2%)

Manipur (6.9%)

Mizoram (9.1%)


Sikkim (14.6%)



Gujarat (37.5%)

Jharkhand (37.1%)

Rajasthan (36.6%)

West Bengal (35.2%)

India (31.8%)

THIN

Uttar Pradesh

23.7

Punjab

13.0

Sikkim

14.2

Bihar

29.5

Jharkhand

26.6

Odisha

17.4

Assam

17.2

West

Bengal

24.9

Telangana

35.5

Andhra

Pradesh

21.7

Tamil

Nadu

26.0Kerala

30.1

Karnataka

32.4

Maharashtra

26.2

Gujarat

33.3Madhya Pradesh

34.5

Rajasthan

32.9

NCT of Delhi

22.8

Haryana

21.9

Uttarakhand

10.2

Jammu and

Kashmir

11.0

Puducherry

Manipur

6.7

Nagaland

8.3

Mizoram

5.3Tripura

12.8

Meghalaya

12.1

Ch

hatt

isg

arh

18.7

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

28.8

Arunachal Pradesh

9.4


Mizoram (5.3%)

Manipur (6.7%)

Nagaland (8.3%)


Uttarakhand (10.2%)


Telangana (35.5%)


Gujarat (33.3%)

Rajasthan (32.9%)


India (26.3%)

Himachal Pradesh

32.7

Prevalence of Visible Forms of Malnutrition in Adolescent Boys, CNNS 2016-18

(BMI-for-age z-score<-2SD)


10-14 years (Boys)

SHORT

Uttar Pradesh

22.5

Punjab

16.5

Arunachal Pradesh

19.9

Sikkim

19.1

Bihar

28.7

Jharkhand

20.6

Odisha

23.4

Assam34.1

West Bengal

26.4

Telangana

18.7

Andhra

Pradesh

21.6

Tamil Nadu

17.1

Kerala

16.7

Karnataka

25.4

Maharashtra

29.2

Gujarat

21.1Madhya Pradesh

24.5

Rajasthan

17.6

NCT of Delhi

15.3

Haryana

13.1

Uttarakhand

16.1

Himachal Pradesh

19.4

Jammu and

Kashmir

14.2

Puducherry

Manipur

26.0

Nagaland

41.3

Mizoram

30.7Tripura

36.6

Meghalaya

45.4

Chhattisgarh

24.2

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

13.6


Haryana (13.1%)

Goa (13.6%)


Delhi (15.3%)

Uttarakhand (16.1%)


Meghalaya (45.4%)

Nagaland (41.3%)

Tripura (36.6%)

Assam (34.1%)

Mizoram (30.7%)

India (23.2%)

<10%

10-20%

20-30%

>30%

No data

15-19 years(Boys)

Uttar Pradesh

26.5

Punjab

19.7

Sikkim

33.9

Bihar

27.0

Jharkhand

32.8

Odisha

27.8

Assam

56.1

West

Bengal

33.8

Telangana

18.7

Andhra

Pradesh

27.2

Tamil

Nadu

22.4Kerala

14.9

Karnataka

29.6

Maharashtra

40.3

Gujarat

21.2 Madhya Pradesh

37.1

Rajasthan

15.9

NCT of Delhi

17.2

Haryana

17.0

Jammu and

Kashmir

24.4

Puducherry

Manipur

40.0

Nagaland

64.9

Mizoram

33Tripura

52.1

Meghalaya

50.5

Ch

hatt

isgarh

28

.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

20.6

Arunachal Pradesh

41.5



Kerala (14.9%)

Rajasthan (15.9%)

Haryana (17.0%)

Delhi (17.2%)


Nagaland (64.9%)

Assam (56.1%)

Tripura (52.1%)

Meghalaya (50.5%)


India (28.3%)

Uttarakhand

19.0

Himachal Pradesh

13.6

(Height-for-age z-score<-2SD)


10-14 years (Boys)

OVERWEIGHT/OBESE

Uttar Pradesh

0.8

Punjab

12.3

Arunachal Pradesh

12.5

Sikkim

9.6

Bihar

1.9

Jharkhand

2.3

Odisha

11.3

Assam

4.2

West

Bengal

9.1

Telangana

5.6

Andhra

Pradesh

8.0

Tamil Nadu

16.7Kerala

8.8

Karnataka

6.8

Maharashtra

10.0

Gujarat

7.3 Madhya Pradesh

1.5

Rajasthant

2.8

NCT of Delhi

17.4

Haryana

6.1

Uttarakhand

6.2

Himachal Pradesh

12.0

Jammu and

Kashmir

12.2

Puducherry

Manipur

10.2

Nagaland

12.9

Mizoram

10.7Tripura

12.2

Meghalaya

4.2

Chhatti

sgarh

5.2

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

17.3




Bihar (1.9%)

Jharkhand (2.3%)

Rajasthan (2.8%)


Delhi (17.4%)

Goa (17.3%)

Tamil Nadu(16.7%)

Nagaland (12.9%)


India (5.3%)

<5%

5-9%

9-14%

>14%

No Data

15-19 years (Boys)

Uttar

Pradesh

1.7

Punjab

10.1

Sikkim

2.1

Bihar

2.7

Jharkhand

1.8

Odisha

6.3

Assam

1.2

West

Bengal

9.2

Telangana

4.8

Andhra

Pradesh

7.1

Tamil Nadu

6.2Kerala

10.0

Karnataka

6.1

Maharashtra

6.3

Gujarat

8.9 Madhya Pradesh

1.9

Rajasthan

2.2

NCT of Delhi

9.7

Haryana

4.5

Uttarakhand

3.7

Himachal Pradesh

3.6

Jammu and

Kashmir

4.4

Puducherry

Manipur

5.7

Nagaland

3.6

Mizoram

3.9Tripura

7.6

Meghalaya

0.2

Chhatt

isgarh

4.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

9.2

Arunachal Pradesh

5.6


Meghalaya (0.2%)

Assam (1.2%)


Jharkhand (1.8%)



Punjab (10.1%)

Kerala (10.0%)

Delhi (9.7%)

West Bengal (9.2%)

Goa (9.2%)

India (4.4%)

(BMI-for-age z-score>+1SD)


10-14 years (Boys)

ANEMIC

Uttar Pradesh

17.9

Punjab

16.5

Arunachal Pradesh

20.5Sikkim

17.8

Bihar

20.4

Jharkhand

17.6

Odisha

18.2

Assam24.9

Telangana

16.7

Andhra

Pradesh

9.8

Tamil Nadu9.2

Kerala

2.9

Karnataka

4.8

Maharashtra

21.2

Gujarat

21.6 Madhya Pradesh

12.1

Rajasthan

6.0

NCT of Delhi

12.5

Haryana

23.2

Uttarakhand

7.0

Himachal Pradesh

4.4

Jammu and

Kashmir

6.7

Puducherry

Manipur

7.3

Nagaland

15.5

Mizoram

13.0Tripura

25.7

Meghalaya

23.8

Chhattisgarh

21.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

5.8

West

Bengal

31.2


Kerala (2.9%)


Karnataka (4.8%)

Goa (5.8%)



West Bengal (31.2%)

Meghalaya (23.8%)

Tripura (25.7%)

Assam (24.9%)

Haryana (23.2%)

India (17.1%)

<5%: No public health

problem

5-19.9%: Mild public

health problem

20-39.9%:Moderate public

health problem

>40%:Severe public

health problem

N/A

15-19 years (Boys)

Uttar Pradesh

16.9

Punjab

13.7

Sikkim

10.5

Bihar

16.4

Jharkhand

15.0

Odisha

17.5

Assam

39.1

West

Bengal

28.0

Telangana

20.3

Andhra Pradesh

13.3

Tamil Nadu

5.3Kerala

5.2

Karnataka

12.7

Maharashtra

20.3

Gujarat

21.6Madhya Pradesh

19.8

Rajasthan

17.1

NCT of Delhi

18.8

Haryana

20.5

Uttarakhand

15.9

Himachal Pradesh

21.1

Jammu and

Kashmir

5.6

Puducherry

Manipur

12.5

Nagaland

0

Mizoram

9.0Tripura

33.0

Meghalaya

20.5

Chhatt

isgarh

21.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

6.2

Arunachal Pradesh

17.8


Nagaland (0.0)

Kerala (5.2%)

Tamil Nadu (5.3%)


Goa (6.2%)


Assam (39.1%)

Tripura (33.0%)

West Bengal (28.0%)



India (18.1%)

Prevalence of Anemia in Adolescent Boys, CNNS 2016-18

(Hemoglobin levels <11.5 g/dl for 10–11 years, <12.0 g/dl for 12–14 years and <13.0 g/dl for 15–19 years)


10-14 years (Boys)

IRON DEFICIENCY

Uttar Pradesh

9.9

Punjab

45.6

Arunachal Pradesh

3.7

Sikkim

11.3

Bihar

9.8

Jharkhand

6.8

Odisha

7.5

Assam

2.5

West

Bengal

6.8

Telangana

13.9

Andhra

Pradesh

5.7

Tamil Nadu

16.6Kerala

13.6

Karnataka

26.3

Maharashtra

17.0

Gujarat

31.4 Madhya Pradesh

23.0

Rajasthan

15.6

NCT of Delhi

8.7

Haryana

24.7Uttarakhand

14.9

Himachal Pradesh 7.3

Jammu and

Kashmir

25.7

Puducherry

Manipur

4.4

Nagaland

0

Mizoram

4.4Tripura

3.3

Meghalaya

2.8

Chhattisgarh

22.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

5.2


Nagaland (0.0%)

Assam (2.5%)

Meghalaya (2.8%)

Tripura (3.3%)



Punjab (45.6%)

Gujarat (31.4%)

Karnataka (26.3%)


Haryana (24.7%)

India (14.0%)

<10%

10-20%

20-30%

>30%

No data

15-19 years (Boys)

Uttar Pradesh

4.1

Punjab

16.5

Sikkim

10.0

Bihar

5.1

Jharkhand

2.8

Odisha

5.8

Assam

4.0

West

Bengal

2.7

Telangana

16.7

Andhra

Pradesh

4.8

Tamil

Nadu

4.4Kerala

4.2

Karnataka

17.8

Maharashtra

13.7

Gujarat

20.5Madhya Pradesh

6.2

Rajasthan

20.0

NCT of Delhi

3.8

Haryana

17.1

Uttarakhand

6.5

Himachal Pradesh

27.9

Jammu and

Kashmir

18.8

Puducherry

Manipur

4.2

Nagaland

0

Mizoram

0Tripura

3.9

Meghalaya

2.9

Ch

ha

ttis

ga

rh14

.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

0

Arunachal Pradesh

7.9


Goa (0.0%)

Mizoram (0.0%)

Nagaland (0.0%)

West Bengal (2.7%)

Jharkhand (2.8%)



Gujarat (20.5%)

Rajasthan (20.0%)


Karnataka (17.8%)

India (8.5%)

Prevalence of Micronutrient Defi ciencies in Adolescent Boys, CNNS 2016-18

(Serum ferritin levels <15 μg/l; excluding cases with C-reactive protein > 5 mg/L)


10-14 years (Boys)

VITAMIN B12

DEFICIENCY

Uttar Pradesh

50.8

Punjab

44.4

Arunachal Pradesh

10.2

Sikkim

14.9

Bihar

27.3

Jharkhand

20.8

Odisha

11.4

Assam

5.0

West

Bengal

5.5

Telangana

30.7

Andhra

Pradesh

15.4

Tamil Nadu

10.9Kerala

1.6

Karnataka

32.6

Maharashtra

30.0

Gujarat

37.7 Madhya Pradesh

37.4

Rajasthan

45.6

NCT of Delhi

25.3

Haryana

33.1

Uttarakhand

24.3

Himachal Pradesh

31.6

Jammu and

Kashmir

32.9

Puducherry

Manipur

9.3

Nagaland

0.6

Mizoram

13.3Tripura

7.9

Meghalaya

11.4

Chhattisgarh

41.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

14.2


Nagaland (0.6%)

Kerala (1.6%)

Assam (5.0%)

West Bengal (5.5%)

Tripura (7.9%)



Rajasthan (45.6%)

Punjab (44.4%)


Gujarat (37.7%)

India (30.4%)

<10%

10-20%

20-30%

>30%

No data

15-19 years (Boys)

Uttar Pradesh

49.7

Punjab

49.1

Sikkim

27.1

Bihar

29.6

Jharkhand

33.5

Odisha

18.6

Assam

16.1

West

Bengal

5.4

Telangana

37.6

Andhra

Pradesh

30.7

Tamil Nadu

33.3Kerala

5.4

Karnataka

59.9

Maharashtra

58.3

Gujarat

60.7

Madhya Pradesh

56.8

Rajasthan

50.9

NCT of Delhi

42.5

Haryana

42.7

Uttarakhand

43.2

Himachal Pradesh

46.9

Jammu and

Kashmir

34.9

Puducherry

Manipur

20.0

Nagaland

5.6

Mizoram

16.3Tripura

16.6

Meghalaya

14.3

Chhatt

isgarh

58.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

17.1

Arunachal Pradesh

29.1


Nagaland (5.6%)

Kerala (5.4%)

West Bengal (5.4%)

Meghalaya (14.3%)

Assam (16.1%)


Gujarat (60.7%)

Karnataka (59.9%)

Maharashtra (58.3%)



India (40.5%)

(Serum vitamin B12

< 203 pg/ml )


10-14 years (Boys)

FOLATE DEFICIENCY

Uttar Pradesh

43.9

Punjab

1.1

Arunachal Pradesh

37.0

Sikkim

58.9

Bihar

17.2

Jharkhand

23.4

Odisha

0

Assam

6.5

West

Bengal

53.7

Telangana

80.5

Andhra

Pradesh

1.9

Tamil Nadu

68.7Kerala

0

Karnataka

64.6

Maharashtra

71.4

Gujarat

62.8 Madhya Pradesh

50.6

Rajasthan

35.5

NCT of Delhi

55.7

Haryana

77.4

Uttarakhand

59.7

Himachal Pradesh

4.1

Jammu and

Kashmir

8.8

Puducherry

Manipur

6.7

Nagaland

93.2

Mizoram

23.5 Tripura

65.8

Meghalaya

59.0

Chhattisgarh

18.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

4.2


Kerala (0.0%)

Odisha (0.0%)

Punjab (1.1%)




Nagaland (93.2%)

Telangana (80.5%)

Haryana (77.4%)

Maharashtra (71.4%)

Tamil Nadu (68.7%)

India (35.6%)

<20%

20-40%

40-60%

>60%

No data

15-19 years (Boys)

Uttar Pradesh

8.8

Punjab

15.7

Sikkim

0.7

Bihar

16.4

Jharkhand

30.7

Odisha

72.0

Assam

80.5

Telangana

71.1

Andhra

Pradesh

81.1

Tamil

Nadu

80.0Kerala

68.1

Karnataka

71.4

Maharashtra

79.7

Gujarat

65.2Madhya Pradesh

84.8

Rajasthan

60.6

NCT of Delhi

8.0

Haryana

33.7

Uttarakhand

28.9

Himachal Pradesh

5.3

Jammu and

Kashmir

3.8

Puducherry

Manipur

10.1

Nagaland

96.4

Mizoram

19.2Tripura

5.5

Meghalaya

53.2

Ch

hatt

isgarh

76.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

59.2

West

Bengal

0

Arunachal Pradesh

52.7


West Bengal (0.0%)

Sikkim (0.7%)



Tripura (5.5%


Nagaland (96.4%)



Assam (80.5%)

Tamil nadu (80.0%)

India (43.7%)

(Serum erythrocyte folate < 151 ng/ml)


10-14 years (Boys)

VITAMIN A DEFICIENCY

Uttar Pradesh

14.5

Punjab

23.3

Arunachal Pradesh

15.2

Sikkim

19.3

Bihar

7.1

Jharkhand

22.3

Odisha

7.7

Assam

5.1

West

Bengal

21.7

Telangana

22.2

Andhra

Pradesh

17.0

Tamil Nadu

10.4Kerala

9.1

Karnataka

21.8

Maharashtra

17.6

Gujarat

23.5 Madhya Pradesh

12.4

Rajasthan

4.7

NCT of Delhi

0

Haryana

9.0

Uttarakhand

3.1

Himachal Pradesh

23.4

Jammu and

Kashmir

26.6

Puducherry

Manipur

18.3

Nagaland

14.8

Mizoram

43.7Tripura

5.8

Meghalaya

3.7

Chhattisgarh

10.8

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

24.2


Delhi (0.0%)

Uttarakhand (3.1%)

Meghalaya (3.7%)

Rajasthan (4.7%)

Assam (5.1%)


Mizoram (43.7%)


Goa (24.2%)

Gujarat (23.5%)


India (17.8%)

<2%: No public health

problem

2-9.9%: Mild public health

problem

10-19.9%:Moderate public

health problem

>=20%:Severe public health

problem

No data

15-19 years (Boys)

Uttar Pradesh

13.8

Punjab

6.1

Sikkim

0

Bihar

17.4

Jharkhand

27.3

Odisha

17.1

Assam

15.2

West

Bengal

4.4

Telangana

12.9

Andhra

Pradesh

2.7

Tamil Nadu

38.6Kerala

4.5

Karnataka

9.9

Maharashtra

4.6

Gujarat

11.7Madhya Pradesh

6.2

Rajasthan

0

NCT of Delhi

4.3

Haryana

3.7

Uttarakhand

6.8

Himachal Pradesh

1.0

Jammu and

Kashmir

3.6

Puducherry

Manipur

9.8

Nagaland

0

Mizoram

16.4Tripura

19.4

Meghalaya

2.0

Chhatt

isgarh

11.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

0.8

Arunachal Pradesh

1.9


Nagaland (0.0%)

Rajasthan (0.0%)

Sikkim (0.0%)

Goa (0.8%)



Tamil Nadu (38.6%)

Jharkhand (27.3%)

Tripura (19.4%)

Bihar (17.4%)

Odisha (17.1%)

India (13.0%)

(Serum retinol concentration <20 μg/dL; excluding cases with C-reactive protein > 5 mg/L)


10-14 years (Boys)

VITAMIN D DEFICIENCY

Uttar Pradesh

8.6

Punjab

63.5

Arunachal Pradesh

16.5

Sikkim

13.1

Bihar

19.8

Jharkhand

22.5

Odisha

13.5

Assam

2.5

West Bengal

14.3

Telangana

4.3

Andhra

Pradesh

11.2

Tamil Nadu

3.9

Kerala

15.4

Karnataka

4.3

Maharashtra

13.6

Gujarat

33.2Madhya Pradesh

16.8

Rajasthan

18.8

NCT of Delhi

28.3

Haryana

42.3

Uttarakhand

58.9

Himachal Pradesh

9.8

Jammu and

Kashmir

23.9

Puducherry

Manipur

48.9

Nagaland

5.8

Mizoram

4.2Tripura

20.3

Meghalaya

2.3

Chhattisgarh

10.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

18.6


Meghalaya (2.3%)

Assam (2.5%)

Tamil Nadu (3.9%)

Mizoram (4.2%)

Karnataka (4.3%)


Punjab (63.5%)

Uttarakhand (58.9%)

Manipur (48.9%)

Haryana (42.3%)

Gujarat (33.2%)

India (15.6%)

<10%

10-30%

30-40%

>40%

No data

15-19 years (Boys)

Uttar Pradesh

2.8

Punjab

52.5

Sikkim

11.3

Bihar

10.8

Jharkhand

21.7

Odisha

6.1

Assam

1.8

Telangana

2.9

Andhra

Pradesh

12.6

Tamil

Nadu

0.7Kerala

22.5

Karnataka

6.9

Maharashtra

15.9

Gujarat

24.6

Madhya Pradesh

13.3

Rajasthan

15.2

NCT of Delhi

35.8

Haryana

38.3

Uttarakhand

46.3

Himachal Pradesh

5.1

Jammu and

Kashmir

24.6

Puducherry

Manipur

40.3

Nagaland

7.4

Mizoram

3.9Tripura

15.4

Meghalaya

6.4

Ch

hatt

isgarh

9.8

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

13.4

West

Bengal

4.4

Arunachal Pradesh

9.5


Tamil Nadu (0.7%)

Assam (1.8%)


Telangana (2.9%)

Mizoram (3.9%)


Punjab (52.5%)

Uttarakhand (46.3%)

Manipur (40.3%)

Haryana (38.3%)

Delhi (35.8%)

India (11.6%)

(Serum 25(OH)D concentration <12ng/mL)ȁ


10-14 years (Boys)

ZINC DEFICIENCY

Uttar Pradesh

35.0

Punjab

56.4

Arunachal Pradesh

35.1

Sikkim

41.0

Bihar

29.5

Jharkhand

67.0

Odisha

39.2

Assam

33.0

West Bengal

29.8

Telangana

29.1

Andhra

Pradesh

18.2

Tamil Nadu

44.6Kerala

13.8

Karnataka

46.3

Maharashtra

24.2

Gujarat

66.0 Madhya Pradesh

23.9

Rajasthan

10.6

NCT of Delhi

43.1

Haryana

25.4

Uttarakhand

41.5

Himachal Pradesh

63.9

Jammu and

Kashmir

45.3

Puducherry

Manipur

64.3

Nagaland

3.5

Mizoram

1.0Tripura

42.1

Meghalaya

44.0

Ch

hatt

isg

arh

37.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar

Haveli

Goa

33.5


Mizoram (1.0%)

Nagaland (3.5%)

Rajasthan (10.6%)

Kerala (13.8%)



Jharkhand (67.0%)

Gujarat (66.0%)

Manipur (64.3%)


Punjab (56.4%)

India (36.08%)

<10%

10-20%

20-30%

>30%

No data

15-19 years (Boys)

Uttar Pradesh

32.3

Punjab

55.8

Sikkim

33.9

Bihar

24.5

Jharkhand

57.8

Odisha

44.8

Assam

40

West

Bengal

19.9

Telangana

29.4

Andhra

Pradesh

20.6

Tamil

Nadu

33.0Kerala

11.4

Karnataka

56.7

Maharashtra

27.6

Gujarat

59.1

Madhya

Pradesh

23.3

Rajasthan

33.5

NCT of Delhi

37.1

Haryana

17.9

Uttarakhand

17.8

Himachal Pradesh

48.2

Jammu and

Kashmir

42.0

Puducherry

Manipur

49.2

Nagaland

1.9

Mizoram

10.9Tripura

37.9

Meghalaya

63.4

Ch

ha

ttis

ga

rh4

6.0

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

21.6

Arunachal Pradesh

7.8


Nagaland (1.9%)


Mizoram (10.9%)

Kerala (11.4%)

Uttarakhand (17.8%)


Meghalaya (63.4%)

Gujarat (59.9%)

Jharkhand (57.8%)

Karnataka (56.7%)

Punjab (55.8%)

India (34.2%)

(Serum zinc concentration < 74 μg/dl (morning fasting) and < 70 μg/dl (morning non-fasting) in males)



RISK OF DIABETES

Uttar Pradesh

2.5

Punjab

8.1

Arunachal Pradesh

8.1

Sikkim

1.3

Bihar

2.3

Jharkhand

14.7

Odisha

8.6

Assam

10.8

Telangana

15.5

Andhra

Pradesh

9.6

Tamil Nadu

7.7Kerala

3.7

Karnataka

5.6

Maharashtra

5.4

Gujarat

25.3 Madhya Pradesh

13.6

Rajasthan

11.2

NCT of Delhi

3.1

Haryana

27.3Uttarakhand

7.3

Himachal Pradesh

2.4

Jammu and

Kashmir

7.5

Puducherry

Manipur

16.3

Nagaland

3.5

Mizoram

3.1Tripura

10.6

Meghalaya

3.8

Chhatt

isgarh

16.5

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

28.4

West

Bengal

3.6


Sikkim (1.3%)

Bihar (2.3%)



Delhi (3.1%)


Goa (28.4%)

Haryana (27.3%)

Gujarat (25.3%)


Manipur(16.3%)

India (7.9%)

<5%

5–10.9%

>21%

11–20.9%

No Data


Assam (0.0%)

Nagaland (0.0%)

Sikkim (0.1%)


Tripura (1.8%)


Haryana (17.0%)

Karnataka (16.6%)

Goa (16.4%)

Odisha (15.5%)

Kerala (13.5%)

India (7.4%)

Uttar Pradesh

5.7

Punjab

11.0

Sikkim

0.1

Bihar

2.6

Jharkhand

8.8

Odisha

15.5

Assam

0.0

West

Bengal

4.5

Telangana

9.9

Andhra

Pradesh

12.4

Tamil

Nadu

11.2Kerala

13.5

Karnataka

16.6

Maharashtra

10.1

Gujarat

11.6Madhya Pradesh

1.8

Rajasthan

8.5

NCT of Delhi

3.2

Haryana

17.0

Uttarakhand

7.0

Himachal Pradesh

2.0

Jammu and

Kashmir

9.2

Puducherry

Manipur

7.3

Nagaland

0.0

Mizoram

6.8Tripura

1.8

Meghalaya

7.8

Ch

ha

ttis

ga

rh12

.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

16.4

Arunachal Pradesh

4.515-19 years (Girls)

Prevalence of Risk Factors for Non-Communicable Diseases in Adolescent

Girls, CNNS 2016-18

(Glycosylated Haemoglobin (HbA1c) level >5.6% & 6.4%)


Uttar Pradesh

1.4

Punjab

2.3

Arunachal Pradesh

3.0

Sikkim

11.2

Bihar

0.0

Jharkhand

3.7

Odisha

3.7

Assam

1.3

Telangana

2.6

Andhra

Pradesh

1.2

Kerala

18.6

Karnataka

3.8

Maharashtra

1.6

Gujarat

5.6 Madhya Pradesh

1.5

Rajasthan

4.8

NCT of Delhi

3.1

Haryana

0.0Uttarakhand

1.0

Himachal Pradesh

6.4

Jammu and

Kashmir

1.7

Puducherry

Manipur

9.1

Nagaland

0.0

Mizoram

0.9Tripura

0.0

Meghalaya

0.3

Chhattisgarh

0.7

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

17.7

West

Bengal

13.6

Tamil Nadu

16.2

10-14 years (Girls)

HIGH LDL (“BAD”) CHOLESTEROL


Bihar (0.0%)

Nagaland (0.0%)

Tripura (0.0%)

Haryana (0.0%)

Meghalaya (0.33%)


Kerala (18.6%)

Goa (17.7%)

Tamil Nadu (16.2%)

West Bengal (13.6%)

Sikkim (11.2%)

India (4.1%)

5–7.9%

<2%

2–4.9%

>=8%

No Data

15-19 years (Girls)

Uttar Pradesh

1.2

Punjab

5.2

Arunachal Pradesh

1.4

Sikkim

11.1

Bihar

0.7

Jharkhand

1.8

Odisha

4.4

Assam

1.5

Telangana

0.0

Andhra

Pradesh

4.3

Kerala

19.7

Karnataka

2.6

Maharashtra

6.2

Gujarat

1.8 Madhya Pradesh

2.9

Rajasthan

2.8

NCT of Delhi

1

Haryana

4.6Uttarakhand

1.8

Himachal Pradesh

6.6

Jammu and

Kashmir

2.1

Puducherry

Manipur

11.6

Nagaland

0.0

Mizoram

0.0Tripura

11.3

Meghalaya

2.2

Chhattisgarh

1.7

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

28.6

West

Bengal

18.0

Tamil Nadu

16.3


Nagaland (0.0%)

Mizoram (0.0%)

Telangana (0.0%)

Bihar (0.7%)



Goa (28.6%)

Kerala (19.7%)

West Bengal (18.0%)

Tamil Nadu (16.3%)

Manipur (11.6%)

India (4.3%)

(High LDL or “Bad” cholesterol 130 mg/dl)


10-14 years(Girls)

LOW HDL (“GOOD”) CHOLESTEROL

Uttar Pradesh

33.8

Punjab

14.3

Arunachal Pradesh

40.9

Sikkim

13.5

Bihar

36.8

Jharkhand

25.3

Odisha

31.5

Assam

24.4

Telangana

19.6

Andhra

Pradesh

15.0

Tamil Nadu

19.9Kerala

24.6

Karnataka

28.4

Maharashtra

24.8

Gujarat

26.2 Madhya Pradesh

17.8

Rajasthan

14.1

NCT of Delhi

31.1

Haryana

10.7Uttarakhand

16.5

Himachal Pradesh

31.6

Jammu and

Kashmir

11.2

Puducherry

Manipur

24.1

Nagaland

19.2

Mizoram

9.0Tripura

26.9

Meghalaya

52.9

Chhatt

isgarh

41.

2

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

17.3

West

Bengal

16.6


Mizoram (9.0%)

Haryana (10.7%)


Sikkim (13.5%)

Rajasthan (14.1%)


Meghalaya (52.9%)



Bihar (36.8%)


India (26.0%)

<10%

10–20.9%

>=31%

21–30.9%

No Data

Uttar Pradesh

32.5

Punjab

6.8

Arunachal Pradesh

37.7

Sikkim

2.8

Bihar

30.3

Jharkhand

14.8

Odisha

22.8

Assam

15.0

Telangana

19.5

Andhra

Pradesh

7.1

Tamil Nadu

16.0Kerala

11.3

Karnataka

41.1

Maharashtra

23.0

Gujarat

18.1 Madhya Pradesh

15.0

Rajasthan

22.6

NCT of Delhi

30.6

Haryana

10.9Uttarakhand

16.9

Himachal Pradesh

29.9

Jammu and

Kashmir

12.3

Puducherry

Manipur

21.6

Nagaland

8.8

Mizoram

31.0Tripura

18.6

Meghalaya

34.8

Chhatt

isgarh

43.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

5.2

West

Bengal

10.4


Sikkim (2.8%)

Goa (5.2%)

Punjab (6.8%)


Nagaland (8.78%)



Karnataka (41.1%)


Meghalaya (34.8%)


India (23.8%)


(Low HDL or “Good” cholesterol < 40 mg/dl)


Uttar Pradesh

19.8

Punjab

10.0

Arunachal Pradesh

22.9

Sikkim

41.2

Bihar

19.8

Jharkhand

28.2

Odisha

10.9

Assam

41.8

Telangana

17.6

Andhra

Pradesh

19.6

Tamil Nadu

15.2Kerala

10.1

Karnataka

16.1

Maharashtra

11.8

Gujarat

17.8 Madhya Pradesh

19.9

Rajasthan

6.7

NCT of Delhi

29.6

Haryana

7.9Uttarakhand

21.9

Himachal Pradesh

32.9

Jammu and

Kashmir

23.1

Puducherry

Manipur

41.6

Nagaland

39.5

Mizoram

37.1Tripura

36.3

Meghalaya

27.5

Chhattisgarh

14.0

Lakshadweep

Andaman and

Nicobar Islands

Dadra and

Nagar Haveli

Goa

14.2

West Bengal

43.7

Jharkhand

26.2

10-14 years (Girls)

HIGH TRIGLYCERIDES


Rajasthan (6.7%)

Haryana (7.9%)

Punjab (10.0%)

Kerala (10.1%)

Odisha (10.9%)


West Bengal (43.7%)

Assam (41.8%)

Manipur (41.6%)

Sikkim (41.2%)

Nagaland (39.5%)

India (20.3%)

<10%

10–20.9%

21–30.9%

>=31%

No Data


Maharashtra (2.1%)

Kerala (5.0%)

Haryana (5.4%)

Telangana (5.8%)

Punjab (7.3%)


West Bengal (43.8%)

Nagaland (41.4%)

Manipur (36.8%)

Sikkim (35.9%)

Mizoram (35.4%)

India (15.8%)

Uttar Pradesh

17.5

Punjab

7.3

Arunachal Pradesh

19.6

Sikkim

35.9

Bihar

15.1

Jharkhand

28.2

Odisha

9.9

Assam

23.6

Telangana

5.8

Andhra

Pradesh

10.9

Kerala

5.0

Karnataka

9.3

Maharashtra

2.1

Gujarat

12.5 Madhya Pradesh

13.8

Rajasthan

10.3

NCT of Delhi

11.2

Haryana

5.4Uttarakhand

18.8

Himachal Pradesh

14.8

Jammu and

Kashmir

13.1

Puducherry

Manipur

36.8

Nagaland

41.4

Mizoram

35.4Tripura

30.2

Meghalaya

19.2

Chhattisgarh

9.7

Lakshadweep

Andaman and

Nicobar Islands

Dadra and

Nagar Haveli

Goa

13.0

West Bengal

43.8

Jharkhand

27.2

Tamil Nadu

7.3


(High Triglycerides 130 mg/dl)



HYPERTENSIVE

Uttar Pradesh

6.4

Punjab

0.0

Arunachal Pradesh

2.0Sikkim

0.8

Bihar

5.3

Jharkhand

0.0

Odisha

6.0

Assam

4.4

Telangana

8.3

Andhra

Pradesh

7.1

Tamil Nadu

9.8Kerala

0.0

Karnataka

2.9

Maharashtra

5.4

Gujarat

2.2Madhya Pradesh

6.7

Rajasthan

1.1

NCT of Delhi

9.5

Haryana

0.0

Uttarakhand

0.0

Himachal

Pradesh

5.1

Jammu and

Kashmir

2.0

Puducherry

Manipur

4.3

Nagaland

3.7

Mizoram

NATripura

1.5

Meghalaya

2.7

Chhattisgarh

5.1

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

4.6

West

Bengal

1.4


Haryana (0.0%)

Jharkhand (0.0%)

Kerala (0.0%)

Punjab (0.0%)

Uttarakhand (0.0%)


Tamil Nadu (9.8%)

Delhi (9.5%)

Telangana (8.3%)



India (5.0%)

5-7.9%

<2%

2–4.9%

>=8%

No Data

15-19 years (Girls)


Haryana (0.0%)


Nagaland (0.0%)

Punjab (0.0%)

Telangana (0.0%)


Odisha (13.3%)



Delhi (9.4%)

Bihar (8.3%)

India (5.0%)

Uttar Pradesh

11.0

Punjab

0.0

Arunachal Pradesh

6.0Sikkim

2.0

Bihar

8.3

Jharkhand

3.2

Odisha

13.3

Assam

4.4

Telangana

0.0

Andhra

Pradesh

2.3

Tamil Nadu

5.6Kerala

0.0

Karnataka

1.9

Maharashtra

3.2

Gujarat

5.1Madhya Pradesh

10.4

Rajasthan

1.7

NCT of Delhi

9.4

Haryana

0.0

Uttarakhand

6.2

Himachal

Pradesh

0.0

Jammu and

Kashmir

3.7

Puducherry

Manipur

7.8

Nagaland

0.0

Mizoram

4.4Tripura

0.5

Meghalaya

7.8

Chhattisgarh

1.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

1.3

West

Bengal

0.0

Assam

15.0

(systolic blood pressure level 140 mmHg, or diastolic blood pressure level 90 mmHg)


10-14 years (Boys )

RISK OF DIABETES


Nagaland (0.7%)

Kerala (4.5%)


Sikkim (5.0%)

Bihar (6.9%)


Goa (33.9%)

Haryana (29.1%)

Gujarat (21.0%)

Karnataka (19.6%)


India (11.7%)

Uttar Pradesh

4.5

Punjab

19.3

Arunachal Pradesh

11.8

Sikkim

5.0

Bihar

6.9

Jharkhand

15.4

Odisha

15.2

Assam

13.1

West

Bengal

7.7

Telangana

13.5

Andhra

Pradesh

19.4

Tamil Nadu

7.2 Kerala

4.5

Karnataka

19.6

Maharashtra

10.9

Gujarat

21.0

Madhya Pradesh

19.0

Rajasthan

15.0

NCT of Delhi

14.1

Haryana

29.1

Uttarakhand

9.7

Himachal Pradesh

10.4

Jammu and

Kashmir

10.8

Puducherry

Manipur

19.1

Nagaland

0.7

Mizoram

14.8 Tripura

16.2

Meghalaya

17.2

Chhattisgarh

10.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

33.9

<5%

5-10.9%

11-20.9%

>21%

No data

Uttar Pradesh

5.5

Punjab

17.0

Sikkim

4.1

Bihar

1.4

Jharkhand

10.1

Odisha

11.1

Assam

23.6

West

Bengal

9.5

Telangana

21.6

Andhra

Pradesh

11.5

Tamil Nadu

7.7Kerala

6.6

Karnataka

22.3

Maharashtra

8.0

Gujarat

19.1Madhya Pradesh

15.8

Rajasthan

15.8

NCT of Delhi

7.5

Haryana

24.0

Uttarakhand

4.0

Himachal Pradesh

6.0

Jammu and

Kashmir

5.2

Puducherry

Manipur

16.9

Nagaland

4.6

Mizoram

6.2Tripura

19.4

Meghalaya

1.9

Chhatt

isgarh

13.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

19.7

Arunachal Pradesh

6.0


Bihar (1.4%)

Meghalaya (1.9%)

Uttarakhand (4.0%)

Sikkim (4.1%)

Nagaland (4.6%)


Haryana (24.0%)

Assam (23.6%)

Karnataka (22.3%)

Telangana (21.6%)

Goa (19.7%)

India (10.9%)

15-19 years (Boys)

Prevalence of Risk Factors for Non-Communicable Diseases in Adolescent

Boys, CNNS 2016-18

(Glycosylated Haemoglobin (HbA1c) level >5.6% & 6.4%)


10-14 years (Boys)

HIGH LDL (“BAD”) CHOLESTEROL



Assam (0.0%)

Bihar (0.0%)

Jharkhand (0.0%)

Nagaland (0.0%)


Tamil Nadu (21.0%)

Sikkim (13.5%)

Kerala (13.4%)

Karnataka (8.6%)

Gujarat (8.0%)

India (3.8%)

Uttar Pradesh

1.9

Punjab

2.4

Arunachal Pradesh

0.0

Sikkim

13.5

Bihar

0.0

Jharkhand

0.0

Odisha

2.4

Assam

0.0

West

Bengal

7.1

Telangana

3.1

Andhra

Pradesh

4.0

Tamil Nadu

21.0Kerala

13.4

Karnataka

8.6

Maharashtra

2.5

Gujarat

8.0

Madhya Pradesh

1.7

Rajasthan

2.0

NCT of Delhi

1.0

Haryana

2.4

Uttarakhand

2.1

Himachal Pradesh

7.4

Jammu and

Kashmir

0.9

Puducherry

Manipur

4.8

Nagaland

0.0

Mizoram

1.3Tripura

4.4

Chhattisgarh

0.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

5.5

<2%

2-4.9%

5-7.9%

>=9%

No data

15-19 years (Boys)

Uttar Pradesh

1.7

Punjab

3.2

Sikkim

18.4

Bihar

1.1

Jharkhand

0.0

Odisha

7.7

Assam

0.3

West

Bengal

11.0

Telangana

0.7

Andhra Pradesh

3.2

Tamil Nadu

3.2Kerala

5.1

Karnataka

1.9

Maharashtra

1.3

Gujarat

8.7Madhya Pradesh

0.6

Rajasthan

1.0

NCT of Delhi

1.2

Haryana

3.5

Uttarakhand

7.0

Himachal Pradesh

3.2

Jammu and

Kashmir

4.1

Puducherry

Manipur

17.6

Nagaland

0.0

Mizoram

0.8Tripura

6.6

Meghalaya

0.0

Chhatt

isgarh

1.8

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

10.3

Arunachal Pradesh

1.0


Jharkhand(0.0%)

Meghalaya(0.0%)

Nagaland(0.0%)

Assam(0.3%)

Madhya Pradesh(0.6%)


Sikkim(18.4%)

Manipur(17.6%)

West Bengal(11.0%)

Goa(10.3%)

Gujarat(8.7%)

India (3.0%)

(High LDL or “Bad” cholesterol 130 mg/dl)


10-14 years (Boys)

LOW HDL (“GOOD”) CHOLESTEROL


Nagaland (2.5%)

West Bengal (5.8%)

Punjab (7.9%)

Tamil Nadu (7.9%)

Sikkim (8.6%)


Meghalaya (50.3%)




Bihar (33.1%)

India (25.6%)

Uttar Pradesh

40.3

Punjab

7.9

Arunachal Pradesh

34.8

Sikkim

8.6

Bihar

33.1

Jharkhand

32.6

Odisha

16.8

Assam

22.6

West

Bengal

5.8

Telangana

15.7

Andhra

Pradesh

18.0

Tamil Nadu

7.9Kerala

14.4

Karnataka

28.7

Maharashtra

13.6

Gujarat

27.0

Madhya Pradesh

32.3

Rajasthan

14.5

NCT of Delhi

31.4

Haryana

10.2

Uttarakhand

18.7

Himachal Pradesh 11.6

Jammu and

Kashmir

16.9

Puducherry

Manipur

26.7

Nagaland

2.5

Mizoram

17.9Tripura

13.9

Meghalaya

50.350.3

Chhattisgarh

46.6

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

17.4

<10%

10-20.9%

21-30.9%

>=31%

No data

15-19 years (Boys)

Uttar Pradesh

53.9

Punjab

18.5

Sikkim

14.9

Bihar

48.4

Jharkhand

16.3

Odisha

35.5

Assam

35.7

West

Bengal

14.6

Telangana

46.3

Andhra Pradesh

11.5

Tamil Nadu

36.7Kerala

36.4

Karnataka

55.4

Maharashtra

36.1

Gujarat

30.2Madhya Pradesh

38.5

Rajasthan

23.2

NCT of Delhi

64.5

Haryana

18.2

Uttarakhand

31.5

Himachal Pradesh

35.5

Jammu and

Kashmir

26.4

Puducherry

Manipur

26.9

Nagaland

7.9

Mizoram

20.3Tripura

29.7

Meghalaya

60.6

Chhatt

isgarh

56.5

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

27.0

Arunachal Pradesh

47.6


Nagaland (7.9%)

West Bengal (14.6%)

Sikkim (14.9%)

Jharkhand (16.3%)

Haryana (18.2%)


Delhi (64.5%)

Meghalaya (60.6%)


Karnataka (55.4%)


India (38.6%)

(Low HDL or “Good” cholesterol < 40 mg/dl)


10-14 years (Boys)

HIGH TRIGLYCERIDES


Kerala (4.3%)

Rajasthan (5.3%)


Odisha (6.0%)

Chhattisgarh (6.7%)


Sikkim (40.9%)

West Bengal (38.3%)

Manipur (34.6%)

Tripura (28.5%)


India (12.9%)

Uttar Pradesh

12.8

Punjab

8.3

Arunachal Pradesh

9.4

Sikkim

40.9

Bihar

10.4

Jharkhand

7.6

Odisha

6.0

Assam

18.0

West

Bengal

38.3

Telangana

6.7

Andhra

Pradesh

9.6

Tamil Nadu

11.2Kerala

4.3

Karnataka

15.0

Maharashtra

8.5

Gujarat

18.7

Madhya Pradesh

5.4

Rajasthan

5.3

NCT of Delhi

16.0

Haryana

8.9

Uttarakhand

14.7

Himachal Pradesh

14.4

Jammu and

Kashmir

20.2

Puducherry

Manipur

34.6

Nagaland

18.1

Mizoram

19.5Tripura

28.5

Meghalaya

15.515.5

Chhattisgarh

6.7

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

9.3

<10%

10-20.9%

21-30.9%

>=31%

No data

15-19 years (Boys)

Uttar Pradesh

13.7

Punjab

13.9

Sikkim

40.7

Bihar

11.9

Jharkhand

14.6

Odisha

9.9

Assam

44.7

West

Bengal

44.5

Telangana

19.1

Andhra Pradesh

20.5

Tamil Nadu

9.7Kerala

13.1

Karnataka

9.5

Maharashtra

3.6

Gujarat

19.6Madhya Pradesh

4.2

Rajasthan

8.6

NCT of Delhi

8.5

Haryana

23.9

Uttarakhand

22.5

Himachal Pradesh

18.9

Jammu and

Kashmir

25.0

Puducherry

Manipur

39.4

Nagaland

12.7

Mizoram

19.6Tripura

21.4

Meghalaya

19.0

Chhatt

isgarh

2.4

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

15.0

Arunachal Pradesh

15.8


Chhattisgarh (2.4%)

Maharashtra (3.6%)


Delhi (8.5%)

Rajasthan (8.6%)


Assam (44.7%)

West Bengal (44.5%)

Sikkim (40.7%)

Manipur (39.4%)


India (15.5%)

(High Triglycerides 130 mg/dl)


10-14 years (Boys)

HYPERTENSIVE


Haryana (0.0%)


Kerala (0.0%)

Punjab (0.0%)

Sikkim (0.0%)



Delhi (9.8%)

Manipur (9.5%)

Odisha (7.6%)

Uttarakhand (6.3%)

India (4.8%)

Uttar Pradesh

12.7

Punjab

0.0

Arunachal Pradesh

3.7

Sikkim

0.5

Bihar

1.8

Jharkhand

6.3

Odisha

7.6

Assam

6.3

West

Bengal

0.8

Telangana

5.8

Andhra

Pradesh

5.3

Tamil Nadu

6.0Kerala

0.0

Karnataka

5.3

Maharashtra

5.7

Gujarat

4.0

Madhya Pradesh

2.3

Rajasthan

1.0

NCT of Delhi

9.8

Haryana

0.0

Uttarakhand

6.3

Himachal Pradesh

3.8

Jammu and

Kashmir

0.0

Puducherry

Manipur

9.5

Nagaland

0.6

Mizoram

NATripura

5.1

Meghalaya

4.44.4

Chhattisgarh

5.5

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

5.5

<2%

2-4.9%

5-7.9%

>=8%

No data

Uttar Pradesh

3.6

Punjab

0.6

Sikkim

3.1

Bihar

6.7

Jharkhand

0.0

Odisha

4.7

Assam

7.4

West

Bengal

0.4

Telangana

6.9

Andhra Pradesh

4.9

Tamil Nadu

1.4Kerala

0.8

Karnataka

2.2

Maharashtra

1.7

Gujarat

7.8Madhya Pradesh

12.7

Rajasthan

6.0

NCT of Delhi

11.3

Haryana

0.0

Uttarakhand

2.5

Himachal Pradesh

2.2

Jammu and

Kashmir

2.6

Puducherry

Manipur

12.1

Nagaland

4.9

Mizoram

0.0Tripura

9.4

Chhatt

isgarh

4.9

Lakshadweep

Andaman and Nicobar

Islands

Dadra and

Nagar Haveli

Goa

12.8

Arunachal Pradesh

2.7


Haryana (0.0%)

Jharkhand (0.0%)

Mizoram (0.0%)

West Bengal (0.44%)

Punjab (0.58%)


Goa (12.8%)


Manipur (12.1%)

Meghalaya (11.8%)

Delhi (11.3%)

India (4.6%)

15-19 years (Boys)

Meghalaya

11.8%

(systolic blood pressure level 140 mmHg, or diastolic blood pressure level 90 mmHg)


Annexure 1: Sociodemographic characteristics of

analytical sample based on which fi ndings are

presented in this report

Sociodemographic

characteristics (%)

Age group

10-14 years 15-19 years

Overall Girls Boys Overall Girls Boys

Schooling Status

Currently in School 86 85 87 63 59 67

Not in School 14 15 13 37 41 33

Residence

Urban 24 24 24 26 25 27

Rural 76 76 76 74 75 73

Religion

Hindu 80 79 81 80 79 82

Muslim 15 16 15 15 16 14

Christian 2 2 2 2 2 2

Sikh 1 1 1 1 1 1

Others 1 1 1 1 1 1

Caste/Tribe

Scheduled Caste 22 22 23 23 23 23

Schedulef Tribe 11 10 12 11 12 10

Other Backward Class 41 42 40 42 42 43

Other 26 26 25 24 23 25

Wealth Index

Poorest 22 21 22 18 20 16

Poor 21 21 21 19 19 19

Middle 19 19 19 21 20 21

Rich 19 20 18 21 21 22

Richest 19 18 20 21 20 21

Mother's Education

No schooling 50 51 49 56 58 54

<5 years completed 7 7 7 7 6 7

(Continued)


Sociodemographic

characteristics (%)

Age group

10-14 years 15-19 years

Overall Girls Boys Overall Girls Boys

5-7 years completed 14 14 14 13 13 13

8-9 years completed 12 13 12 11 11 12

10-11 years completed 8 8 9 7 6 8

12 or more years completed 8 8 8 6 6 7

Mother's Occupation

Unemployed 61 62 60 64 64 64

Employed 38 37 39 34 34 34

Father's Occupation

Unemployed 2 3 2 4 4 4

Working in Agricultural Sector 33 32 34 36 35 36

Working in non-agricultural sector 64 65 64 60 60 59

(Continued)


Richest householdsPoorest households

Bihar

Jharkhand

Madhya Pradesh

Uttar Pradesh

Odisha

West Bengal

Rajasthan

Chhattisgarh

Assam

Manipur

Tripura

Andhra Pradesh

Nagaland

Meghalaya

Arunachal Pradesh

Gujarat

Maharashtra

Telangana

Jammu & Kashmir

Mizoram

Karnataka

Uttarakhand

Haryana

Tamil Nadu

Sikkim

Kerala

Himachal Pradesh

Punjab

Delhi

Goa

0 10 20 30 40 50 60 70

Annexure 2: Where do the poorest adolescents live in

India (%)


Annexure 3: Nutrient rich sources (Top 10) and

consequences of defi ciency/excess among adolescents

Nutrients Consequences of defi ciency/excess Food items (Top 10) Nutritive Value

(per 100 g)

Iron Low blood hemoglobin concentration

(Iron defi ciency anemia)

Impaired motor and neural

development, and cognitive function

Limits growth spurt

Impaired immune function and

reduced resistance to infection

Produces fatigue and reduces physical

endurance

Adversely affects learning and

scholastic performance, and

diminished work productivity later in

life

Produces behavior alteration

Negatively affect bone mass (bone

protective effects)

Affects reproductive physiology

Poultry, chicken, liver

Bengal gram whole

Horse gram whole

Amaranth leaves, red

Raisins

Bajra

Fenugreek leaves

Ragi

Lotus root

Egg, whole, raw

9.9mg

9.5 mg

8.8mg

7.3mg

6.8mg

6.4mg

5.7mg

4.6mg

3.3mg

1.8mg

Folate Causes megaloblastic anemia

Elevates plasma homo-cysteine

levels which increases susceptibility to

cardiovascular diseases

May cause peripheral neuropathy,

mental confusion and depression

Catla fi sh

Moth beans

Rajma

Soybean

Spinach

Field beans (tender, lean)

Field beans (tender, broad)

Mustard leaves

Beetroot

Mango, ripe, Himsagar

1926μg

349μg

316μg

297μg

142μg

127μg

123μg

110μg

97.4μg

90.9μg

Vitamin B12

Impairs utilization of folate, causing

increase in homo-cysteine levels.

Hence, may lead to development of

cardiovascular symptoms

Megaloblastic anemia

Irreversible poor memory and cognitive

function, leading to neurological

problems

Clams (steamed)

Mussels (steamed)

Mackerel (Atlantic, cooked, dry-heat)

Crab (Alaska king, steamed)

Salmon (chinook, cooked, dry-heat)

Rockfi sh (cooked, dry-heat)

Milk (skim)

Brie (cheese)

Egg (poached)

Chicken (light, cooked, roasted)

84.1μg

20.4μg

16.1μg

9.8μg

6.9μg

2.4μg

1.0μg

0.8μg

0.5μg

0.4μg



(per 100 g)

Vitamin A Adverse effects on bone growth and

sexual maturation

Increases risk for infectious diseases

Increased risk to visual implications.

Severe vitamin A defi ciency leads

to xerophthalmia (specially among

children)

Goat liver

Drumstick leaves

Fenugreek leaves

Carrot, orange

Sweet potato

Egg poultry, whole raw

Tomato

Muskmelon

Papaya

Milk whole, cow

15655mcg

2193mcg

1156mcg

678mcg

672mcg

198mcg

189mcg

96mcg

87mcg

60mcg

Vitamin D Linked with non-skeletal disorders

including autoimmune disorders

(Crohn’s disease, multiple sclerosis,

rheumatoid arthritis, and type 1

diabetes), infections, and risk of

developing cancers of the breast,

colon, prostate and ovaries

Failure of bone mineralization leading

to rickets and bowed limbs

Prevent the attainment of peak bone

mass and fi nal height

Oyster mushroom dried

Gingelly seeds, brown

Soybean, white

Walnut

Maize tender local

Ragi

Corn, baby

Wood apple

Amaranth leaves, green

Milk, whole, cow

109μg

76.51μg

69.9μg

46.31μg

42.34μg

41.46μg

31.20μg

28.71μg

16.01μg

1.22μg

Zinc Impaired behavioural and brain

development

Delayed sexual maturation

Increased bone loss and reduced bone

formation

Defects in immune system

Impaired taste acuity

Dermatitis

Oyster mushroom dried

Gingelly seeds, white

Poppy seeds

Soyabean, brown

Bengal gram dal

Egg, whole boiled

Wheat fl our, whole

Bajra

Khoa


8.67mg

7.7mg

6.38mg

4.01mg

3.65mg

3.59mg

2.85mg

2.76mg

2.74mg

1.57mg

Iodine Goitre and cretinism (short stature)

and hypothyroidism

Brain damage

Mental retardation (low IQ)

Psychomotor defects

Hearing and speech impairment

Seaweed

Milk (cow's)

Cod

Salt (iodized)

Potato with peel, baked

Shrimp

Fish sticks

Turkey breast, baked

Navy beans, cooked

Tuna, canned in oil

Egg, boiled

4500μg

99μg

99μg

77μg

60μg

35μg

35μg

34μg

32μg

17μg

12μg



(per 100 g)

Vitamin C Weakness

Bleeding, swollen gums

Defective bone growth

Inadequate iron absorption

Follicular hyperkeratosis

Perifollicular hemorrhages

Delayed wound healing

Increased risk of developing secondary

infections

Gooseberry

Guava

Agathi leaves

Green mango, raw

Amaranth leaves, red

Green gram whole sprouts

Drumstick

Lime sweet

Lemon

Orange

252mg

222mg

121mg

90mg

86mg

80mg

72mg

50mg

48mg

43mg

Calcium Affects bone mineralization leading to

a increased risk of bone fracture and

osteoporosis in adulthood

May lead to memory loss, tingling,

confusion, depression or hallucinations

Muscle spasms and muscle cramps

Poppy seeds

Gingelly seeds, white

Paneer

Khol-Khol leaves

Ragi


Horse gram, whole

Phalsa

Milk, whole, cow

Cluster beans

1372mg

1174mg

476mg

368mg

364mg

330mg

269mg

153mg

121mg

121mg

Energy Inappropriate energy intake may

cause malnutrition (obesity or

undernutrition)

Delayed puberty and hormonal

alterations

Nutritional growth retardation

Increased risk to non-communicable

diseases

Cooking oil

Walnut

Sugar

Wheat fl our, whole

Maize, dry

Soyabean

Khoa

Chicken, hen, thigh with skin

Egg, whole, raw

Milk, whole, buffalo

900 kcal

671 kcal

400 kcal

352 kcal

348 kcal

377 kcal

316 kcal

188 kcal

168 kcal

107 kcal

Protein Inadequate intake leads to retardation

of linear growth and sexual maturation

Nutritional growth-development

retardation (protein energy

malnutrition)

Reduction in fat free body mass and

muscle mass

Reduction in immune functions and

organ functions; and if reaches to

advanced stage it may even cause

death

Soyabean, white

Tuna fi sh

Lentil, dal

Groundnut

Chicken, hen, breast with skin

Paneer

Egg, whole, raw

Bajra

Wheat fl our

Milk, whole, cow

37.8 g

24.5 g

24.4 g

23.7 g

22.1 g

18.9 g

13.1 g

11.0 g

10.6 g

3.3 g



(per 100 g)

Carbohydrates Excess intake causes increased risk of

non-communicable diseases (obesity,

diabetes, cardiovascular diseases and

colon cancer)

Sugar

Jaggery, cane

Rice, raw, milled

Wheat fl our, refi ned

Horse gram, whole

Red gram, dal

Mushroom, oyster, dried

Banana

Sweet potato


100 g

83 g

78 g

74 g

87 g

55 g

33 g

25 g

24 g

9 g

Fat Hinders protein sparing action

Reduced absorption of fat-soluble

vitamins (vitamins A, D, E and K) and

Negatively affect growth development

in children

Excess intake causes increased risk of

non-communicable diseases

Cooking oil/ghee

Butter

Walnut

Coconut, dry

Sunfl ower seeds

Khoa

Pork ham

Egg, whole raw

Chicken hen, thigh with skin


100 g

83 g

64.3 g

53.3 g

51.8 g

20.6 g

18.6 g

13 g

12.8 g

6.6 g

Dietary Fibre Constipation and diverticular disease

High risk for development of non-

communicable diseases (CVDs, type 2

diabetes mellitus, metabolic disorders

and various types of cancers)

Obesity

Bengal gram, whole

Red gram, whole

Barley

Maize, dry

Sapota

Guava

Drumstick leaves

Jackfruit

Drumstick

Lotus root

25.2 g

22.8 g

15.6 g

12.2 g

9.6 g

8.6 g

8.2 g

7.7 g

6.8 g

4.7 g

Vitamin K Hinders the process of blood clotting Drumstick leaves

Drumstick

Gingelly seeds, brown

Broad beans

Red gram, whole

Egg whole, raw

Custard apple

Soyabean white

Lotus root

Jowar

479mg

358mg

113mg

93.2mg

91.8mg

64mg

58mg

46.2mg

44.5mg

43.8mg



(per 100 g)

Ribofl avin Endocrine abnormalities

Skin disorders

Hyperemia (excess blood)

Edema (mouth and throat)

Angular stomatitis (lesions at the

corner of mouth)

Cheilosis (swollen, cracked lips)

Hair loss

Reproductive problems

Sore throat

Itchy and red eyes

Degeneration of liver and nervous

system

Amaranth leaves

Drumstick leaves

Goat liver

Green gram, whole

Fenugreek leaves

Bajra

Milk, whole, cow

Brinjal

Papaya, ripe

Khoa

0.51 mg

0.45 mg

0.37 mg

0.27 mg

0.22 mg

0.20 mg

0.13 mg

0.11 mg

0.11 mg

0.11 mg

Thiamine Wet beri-beri (neurologic symptoms,

cardiovascular manifestations, rapid

heart rate, enlargement of heart,

edema, diffi culty in breathing and

congestive heart failure)

Dry beri-beri (neuropathy, abnormal,

refl exes, diminished sensation,

weakness in the legs and arms, muscle

pain and tenderness)

Cerebral beri-beri (Wernicke's

encephalopathy, Korsakoff's

psychosis)

Gastro-intestinal beri-beri (nausea,

vomiting and severe abdominal pain)

Low plasma concentration and high

renal clearance (diabetic patients)

Impairment of endocrine functions

Hyperglycemia

Thiamine responsive megaloblastic

anemia

Poppy seeds

Red gram, whole

Soyabean, brown

Wheat, whole

Ragi

Jowar

Apricot, processed

Spinach

Broad beans

Mustard leaves

0.87 mg

0.74 mg

0.59mg

0.46 mg

0.37 mg

0.35 mg

0.25 mg

0.16 mg

0.12 mg

0.08 mg

Pyridoxine Immune dysfunction

Neurological symptoms (irritability,

depression, confusion)

Infl ammation of tongue

Sores or ulcers of mouth

Ulcers of skin at corners of mouth

Rohu, fi sh

Sunfl ower seeds

Drumsticks leaves

Walnut

Black gram, whole

Banana ripe

Lentil, whole, yellow

French beans, hybrid

Fenugreek leaves

Rice, raw, brown

240 mg

0.94 mg

0.87 mg

0.80 mg

0.53 mg

0.51 mg

0.47 mg

0.44 mg

0.38 mg

0.37 mg



(per 100 g)

Naicin Pellagra (D's: Dermatitis, Diarrhoea,

Dementia, and Death, if left untreated)

Infl ammation of mouth and tongue

Vomiting

Constipation

Abdominal pain

Gastro-intestinal disorders

Neurological symptoms (headache,

apathy, fatigue, depression,

disorientation, memory loss)

Goat liver

Groundnut

Chicken, poultry, breast

Tuna fi sh

Brown rice

Wheat whole

Peas, dry

Dates, dry, pale brown

Potato, brown skin

Drumstick leaves

12.9 mg

11.4 mg

8.1 mg

5.0 mg

3.4 mg

2.7 mg

2.7 mg

1.5 mg

1.4 mg

1.8 mg

Vitamin E Neurologic symptoms (impaired

balance and coordination)

Injury to the sensory nerves

(peripheral neuropathy)

Muscle weakness (myopathy)

Damage to the retina of the eye

(retinopathy)

Saffl ower seeds

Almonds

Coconut dry

Egg, whole, raw

Catla fi sh

Bengal gram, whole

Spinach

Phalsa

Pumpkin, green

Mustard leaves

35.09 mg

25.86 mg

6.06 mg

2.97 mg

2.35 mg

1.72 mg

1.29 mg

0.93 mg

0.87 mg

0.57 mg


Acknowledgements

Conceptualization, data analysis and writing

Dr. Vani Sethi UNICEF India Country Offi ce, New Delhi

Anwesha Lahiri Indian Institute of Technology Bombay

Arti Bhanot National Centre of Excellence and Advanced Research on Diets, Lady Irwin

College, New Delhi

Dr. Mansi Chopra National Centre of Excellence and Advanced Research on Diets, Lady Irwin

College, New Delhi

Abhishek Kumar Institute of Economic Growth, New Delhi

Data analysis support

Dr. Rahul Mishra Institute of Economic Growth, New Delhi

Review and advisory support

Arjan de Wagt UNICEF India Country Offi ce, New Delhi

Dr. Ruby Alambusha Institute of Economic Growth, New Delhi

Robert Johnston UNICEF India Country Offi ce, New Delhi

Dr. Praween K Agrawal UNICEF India Country Offi ce, New Delhi

Pavithra Rangan UNICEF India Country Offi ce

Additional technical information support (on Diets)

National Centre of Excellence and Advanced Research on Diets, Lady Irwin College, New Delhi

Tashi Choedon, Naman Kaur, Priyanshu Rastogi, Dr. Anjani Bakshi, Dr. Neha Bakshi and

Akanksha Srivastava

Design, layout and pre-press production

Fountainhead Solutions (Pvt) Limited, New Delhi, Design agency

Funding

Aditya and Megha Mittal


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adolescents, diets and nutrition

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