title: Prevalence of Thinness in Adolescent Girls in Low- and Middle-Income Countries and Associations With Wealth, Food Security, and Inequality.
abstract: OBJECTIVE
  Adequate nutrition during adolescence is important for optimal physical and cognitive development and for pregnancy either during adolescence or later life. Thinness among adolescent girls in low- and middle-income countries has been little studied.
  
  
  METHODS
  We used body mass index data from 40 countries from the Global School Health Survey to estimate the prevalence of moderate and severe thinness in 12- to 18-year-olds using the World Health Organization 2007 growth reference. Self-report data on going to bed hungry were used as a proxy for household food insecurity. We used multilevel models to assess whether national wealth (gross domestic product), income inequality (Gini index), national gender inequality (Gender Inequality Index), and food security (Global Food Security Index) were associated with undernutrition.
  
  
  RESULTS
  Prevalence rates of moderate and severe thinness across 61,603 girls from 40 countries were 6.30% (95% confidence interval [CI]: 5.71-6.95) and 1.34% (1.12-1.59), respectively, with higher rates in Asia. Combined moderate/severe thinness was more common among early (12-14 years) than later adolescents (15-18 years). Going to bed hungry sometimes was associated with increased risk of moderate/severe thinness (odds ratio [OR]: 1.102; 95% CI: 1.007-1.206). A significant inverse relationship was found between thinness and gross domestic product (OR: .94; 95% CI: .88-.99) and Global Food Security Index (OR: .96; 95% CI: .93-.99) but not Gini or Gender Inequality Index.
  
  
  CONCLUSIONS
  Thinness remains prevalent in adolescent schoolgirls in low- and middle-income countries and poses a significant threat to their health and that of the next generation. Further research is needed to assess potential interventions for this group.
authors.affiliation: UCL Institute of Child Health, London, United Kingdom.
authors.forename: Toby
authors.initials: T
authors.lastname: Candler
authors.affiliation: UCL Institute of Child Health, London, United Kingdom.
authors.forename: Silvia
authors.initials: S
authors.lastname: Costa
authors.affiliation: UCL Institute of Child Health, London, United Kingdom; UCL Institute of Global Health, London, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Heys
authors.affiliation: UCL Institute of Global Health, London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: UCL Institute of Child Health, London, United Kingdom. Electronic address: r.viner@ucl.ac.uk.
authors.forename: Russell M
authors.initials: RM
authors.lastname: Viner
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D017677:Age Distribution; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005523:Food Supply / Q000191:economics* / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D006815:Hunger; D044342:Malnutrition / Q000150:complications* / Q000191:economics* / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000209:etiology*; D015995:Prevalence; D012572:School Health Services / Q000191:economics / Q000706:statistics & numerical data; D013851:Thinness / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D013995:Time
keywords: Adolescent; Female; Food security; Global; Nutrition; Thinness