Comparison of the Nutrition Transition Among Adolescents in New Versus Established Urban Centers in South India
Authors: Shaikh Nida I , Raj Rebecca K. , Patil Shailaja S. , Narayan K.M. Venkat , Cunningham Solveig A. 
Published: November 2023

BackgroundEmerging research suggests changes in dietary patterns among adolescents during the global nutrition transition, but little is known about the nature of the nutrition transition among adolescents residing in regions that are in different stages of exposure to global markets.ObjectivesTo describe and compare the nutrition transition among adolescents in new versus established urban centers in South India.MethodsResponses to the validated Nutrition Transition‐Food Frequency Questionnaire by adolescents ages 13–18 years in two regions in South India were used to assess and compare their diets with a focus on evidence of transitioning diet patterns. The dietary data were drawn from a representative sample of adolescents from the new urban region (population > 5,000) of Vijayapura (n=198) and from a convenience sample of adolescents from the established urban city (population >100,000) of Bengaluru (n=192) in Karnataka, South India. The validated Nutrition Transition‐Diet score (range 0–10), an index of nutrition transition developed in our previous work, was used to evaluate and compare the nutrition transition among adolescents in the new versus established urban centers. Characteristics and diets of adolescents in the highest quartile (≥75 percentile) of the Nutrition Transition‐Diet Score, indicating more transitioned diets, were compared with those of adolescents with less transitioned diets using chi‐sq tests and Students t tests.ResultsThe mean Nutrition Transition‐Diet Score (range 0–10) of adolescents was 6.1 ± 1.2 (range 2–9) in Bengaluru (urban region) and 5.6 ± 1.2 (range 1–8) in Vijayapura (urbanizing region); it was significantly higher among those in highest quartile versus lower quartile groups in both cities (Bangalore 7.3 ± 0.5 vs, 5.4 ± 0.8, p ≤0.001; Vijayapura 7.1 ± 0.3 versus 5.1 ± 0.9, p ≤0.001). The Nutrition Transition‐Diet Score was higher among non‐vegetarians than vegetarians (6.1 ± 1.1 versus. 5.4 ± 1.1, p ≤ 0.05) and among private school pupils than public school pupils (6.4 ± 1.0 versus. 5.8 ± 1.2, p ≤ 0.01) in Bengaluru. A higher proportion of adolescents in the established urban center as compared to the new urban center consumed processed foods and fried foods daily (intake ≥ 30 g/d; processed foods 74.5% vs. 43.9% and fried foods 91.7% versus 83.3%). On the contrary, a higher proportion of adolescents in the new urban center than the established urban center consumed bread and bread products (intake ≥ 30 g/d; 47.5% versus 30.7%). Adolescents in both cities had saturated fat intake ≥ 10% of total calories (100% vs. 99.5%) but total fat intake was < 30% of total calories.ConclusionThe nutrition transition among adolescents is more advanced in the established urban center than the new urban center in South India.Support or Funding InformationNida I. Shaikh was supported by the award number 1‐R25 TW009337‐01 funded by the Fogarty International Center at National Institutes of Health
Proportion of adolescents across each component of the pre‐defined Nutrition Transition‐Diet Score in new versus established urban center in South India

Nutrition Transition‐Diet Score
Bengaluru (established urban center)n=192
Vijayapura (new urban center)n=198

Components
Criteria for score 11
Criteria for score 02
Score 13
Score 03
Score 13
Score 03

1. Processed foods
≥ 30 g/d
< 30 g/d
74.5
25.5
43.9
56.1

2. Fried foods
≥ 30 g/d
< 30 g/d
91.7
8.3
83.3
16.7

3. Sugar‐sweetened beverages
> 0 ml/d
0 ml/d
96.9
3.1
94.9
5.1

4. Dairy
≥ 500 ml/d
< 500 ml/d
4.7
95.3
7.1
92.9

5. Fruits and vegetables
≤ 400 g/d
> 400 g/d
86.5
13.5
88.9
11.1

6. Breads
≥ 30 g/d
< 30 g/d
25.5
74.5
47.5
52.5

7. Added sugar
≥ 30 g/d
< 30 g/d
32.3
67.7
1.0
99.0

8. Fat, total
≥ 30% of total calories
< 30% of total calories
0
100.0
0
100.0

9. Saturated fat
≥ 10% of total calories
< 10% of total calories
100.0
0
99.5
0.5

10. Sodium
≥ 2300 mg/d
< 2300 mg/d
93.8
6.2
91.9
8.1

Score 1 indicates presence of the Nutrition Transition dietary behavior.
Score 0 indicates absence of the Nutrition Transition dietary behavior.
All values are percentages. Dietary Guidelines of India and the literature on the nutrition transition used to develop the predefined Nutrition Transition‐Diet Score.

Differences in food intake according to the highest vs. lower pre‐defined Nutrition Transition‐Diet Score among adolescents in new versus established urban centers in South India.

Fond group (g/d)1
Bengaluru (established urban center)
Vijayapura (new urban center)

Overalln=l92
Highest quartile2n=63
Lower quartilen=129
Overalln=198
Highest quartilen=47
Lower quartilen=15l

Energy‐dense foods
Bread3
22.3 (22.1)
35.4 (24.1)
14.7 (16.9)***
37.0 (38.4)
76.6 (40.2)
24.6 (28.2)***

Global foods, unhealthy4
45.6 (48.5)
45.7 (40.8)
45.6 (52.5)
28.4 (39.7)
54.3 (52.2)
19.4 (29.7)***

Global foods, healthy5
17.8 (34.9)
27.2 (45.7)
12.4 (25.5)**
1.3 (6.1)
2.4 (10.0)
0.9 (3.9)

Processed foods6
60.0 (36.4)
72.6 (31.3)
52.3 (37.2)**
33.7 (28.8)
62.5 (25.4)
23.7 (22.5)***

Snacks, non‐fried7
18.1 (17.6)
23.8 (20.9)
14.8 (14.5)**
38.1 (36.6)
48.8 (44.1)
34.4 (33.0)*

Snacks, fried8
93.1 (73.2)
99.6 (58.5)
89.3 (80.5)
79.5 (78.9)
137.4 (103.3)
59.4 (56.3)***

Fried traditional food9
24.8 (26.7)
28.7 (28.1)
22.5 (25.8)
23.7 (19.7)
35.1 (25.2)
19.7 (15.6)***

Sweets & desserts
62.9 (44.6)
72.1 (45.5)
57.7 (43.4)*
66.7 (55.7)
98.6 (59.0)
55.6 (50.2)***

Animal‐source foods
Red meat
22.7 (44.9)
21.1 (39.4)
23.4 (47.9)
4.5 (6.7)
6.1 (11.1)
4.0 (9.8)

Lean meat
40.6 (43.7)
47.6 (49.2)
36.6 (39.8)
12.1 (24.7)
18.6 (35.6)
9.9 (19.2)

Eggs
21.6 (20.4)
22.1 (17.1)
21.4 (22.2)
18.0 (25.6)
27.8 (37.2)
14.6 (19.1)*

Dairy
209.7 (147.8)
261.0 (162.3)
180.2 (130.3)**
175.5 (176.9)
249.9 (194.6)
149.7 (163.3)**

Beverages
Soda & energy drinks
23.0 (30.8)
25.4 (25.9)
21.7 (33.3)
17.3 (31.0)
35.1 (42.2)
11.2 (23.1)**

Fruit juice
38.7 (41.7)
50.7 (49.7)
31.9 (34.8)**
62.1 (67.1)
102.0 (79.8)
48.2 (56.1)***

Tea & coffee
84.0 (97.5)
95.9 (108.4)
76.4 (90.4)
158.9 (113.8)
72.7 (40.7)
149.4 (109.9)*

Traditional foods
Fruits
130.2 (85.0)
146.7 (81.7)
120.7 (85.8)*
109.6 (83.5)
126.5 (76.8)
103.8 (85.2)

Vegetables
112.4 (82.0)
104.9 (57.4)
116.7 (93.2)
115.1 (104.3)
139.0 (137.1)
106.8 (89.2)

Pulse & nuts
226.1 (145.6)
233.7 (163.5)
221.6 (134.9)
264.7 (140.9)
301.1 (132.3)
251.7 (141.9)*

Grains
492.3 (241.8)
487.8 (232.9)
494.8 (247.6)
552.0 (267.5)
588.6 (256.3)
504.6 (255.5)***

Added sugar
24.7 (19.8)
35.6 (21.8)
18.5 (15.5)***
4.5 (6.7)
5.9 (7.9)
4.0 (6.2)

Ghee
1.9 (3.8)
1.8 (3.3)
2.0 (4.0)
1.3 (2.7)
1.7 (3.7)
1.2 (2.2)

Dietary data were collected in Vijayapura in November 2013–January 2014 and in Bengaluru in November 2014–January 2015.
p<0.05,
p<0.05,
p<0.001.
T‐tests for differences in food group intake among adolescents with high and low Nutrition Transition Diet Scores in Vijayapura and Bengaluru.
Values are mean (SD) of food group intake in grams/day.
For the predefined Nutrition Transition Diet Score, the ‘highest’ group indicates participants in the lop quartile (≥75th percentile) and ‘lower’ group indicates those in the remaining quartilcs. Dietary data were from adolescents' responses to the validated Nutrition Transition‐FFQ in Vijayapura and Bengaluru in Karnataka. India.
Breads include white bread, brown bread, and paav/bun.
Unhealthy global foods include vegetarian burger, non‐vegetarian burger, vegetarian pizza, chicken pizza, vegetarian puff, egg puff, pancake, and pasta.
Healthy global foods include oats, multigrain biscuit, and breakfast cereal.
Processed foods include Toffee (candy), chocolate, instant noodles, and cream and non‐cream biscuits.
Non‐fried snacks include popcorn, pav bhaji, chooda, and khaari/rusk/butter.
Fried snacks include Potato chips, packaged, finger chips, frozen paratha, frozen cutlet, samosa, wada pav, dahi wada, medhu wada, sago (sabudana) wada, chaats, bhajji, potato bonda, and kachori.
Fried traditional foods include puri, paratha, puranpoli, and papad.