Adolescent girls in aquaculture ecozones at risk of nutrient deficiency in Bangladesh development and validation of an integrated metric

Eleanor Grieve* (Corresponding Author), Abdullah-Al Mamun, Baukje de Roos, Benoy K. Barman, Gulshan Ara, Nanna Roos, Alexandra Pounds, Alan A. Sneddon, Francis Murray, Tahmeed Ahmed, David C. Little

*Corresponding author for this work

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This study developed and validated an integrated metric that enhances understanding of linkages between agro-ecological and socio-economic factors that are important for explaining nutritional wellbeing in relation to fish consumption; especially among adolescent girls who are at risk of nutritional deficiency in Bangladesh. Currently, there is no metric that takes account of environmental, cultural and economic contexts when considering fish consumption and dietary health from a policy perspective.

The study was designed as a bi-seasonal survey, repeated in the same population of adolescent girls recruited during the dry and wet seasons. Sampling was stratified by five settings (four aqua-agroecological zones and one processing plant community), with 60 girls recruited in each. Associations between candidate predictors (salinity, diet diversity, religion, socio-economic status and women’s autonomy score) and dependent variables representing nutritional outcomes (anthropometry, omega-3 index and micronutrient levels) were explored in multivariable regressions. The fitted model with its predictors was validated, and a risk score derived from responses to a few short questions on religion, salinity zone, female autonomy, diet diversity and tilapia consumption.

The omega-3 index showed the clearest distinction between seasons, by salinity and religion. Higher female autonomy, religion (being Hindu rather than Muslim), geographical location (living in a high or mid-saline area), and a higher dietary diversity were the strongest predictors of whole blood omega-3 index. The c-index for the prognostic model was 0.83 and 0.76 in the wet and dry season respectively, indicating good predictive accuracy. There appeared to be a clear trend in risk scores differentiating between those ‘chronically at risk’ and those ‘never at risk’.

Observational data on different aquaculture-ecozones defined by salinity enabled us to establish linkages between seasonal fish intake, religion, diet diversity, female autonomy and nutritional wellbeing. The purpose of the metric is to reveal these specific linkages in practice. This tool should improve targeting of timely, preventative and cost-effective nutritional interventions to adolescent girls most at-risk from low omega-3 levels in communities where seafood is produced.
Original languageEnglish
Article number405
Number of pages13
JournalBMC Public Health
Issue number1
Early online date28 Feb 2023
Publication statusPublished - 28 Feb 2023

Bibliographical note

We wish to acknowledge funding from the Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA) to undertake this research. We acknowledge the Nutritional Analytical Service, University of Stirling, United Kingdom for laboratory analyses. The work of BdR and AAS is funded by the Scottish Government Rural & Environment Science & Analytical Services.

This work is funded through the Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA) programme. IMMANA Phase 1 is funded with UK Aid from the UK government, led by the London School of Hygiene and Tropical Medicine (LSHTM).


  • Adolescent girls
  • Nutritional status
  • Anthropometry
  • Agrosystems
  • Aquaculture
  • Sustainable livelihoods
  • Nutrient deficiency
  • Omega-3 index
  • Female autonomy


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