Investigator(s)
| Submitter |
Prem Kumar Neopanay Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan. Currently pursuing Master of Science in Epidemiology, Prince of Songkhla University, Thailand. Prem Kumar Neopanay 
|
| Principal Investigator |
Prem Kumar Neopanay Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan. Currently pursuing Master of Science in Epidemiology, Prince of Songkhla University, Thailand. Prem Kumar Neopanay
|
| Co-Investigator(s) |
Kasemsak Jandee Prince of Songkhla University, Thailand Kasemsak Jandee
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| Co-Investigator(s) |
Tippawan Liabsuetrakul Prince of Songkhla University, Thailand Tippawan Liabsuetrakul
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| Co-Investigator(s) |
Chanchira Phosat Mahidol University, Thailand Chanchira Phosat
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Title(s) and abstract
| Scientific title | Assessment of Dietary Diversity, Nutrient Intake, Plate Waste, Anemia, and Nutritional Status among Bhutanese Adolescents Residing in Boarding Schools |
| Public title | Assessment of Dietary Diversity, Nutrient Intake, Plate Waste, Anemia, and Nutritional Status among Bhutanese Adolescents Residing in Boarding Schools |
| Background | Background Anemia and malnutrition remain major public health challenges among adolescents, particularly in low- and middle-income countries. Iron deficiency anemia affects over two billion people globally and is associated with impaired cognitive development, reduced physical capacity, weakened immunity, poor academic performance, and adverse reproductive outcomes. In Bhutan, the prevalence of anemia among adolescent girls increased from 31.3% in 2015 to 36.5% in 2023, highlighting a growing nutritional concern. Beyond anemia, adolescents are increasingly affected by multiple forms of malnutrition, including undernutrition, micronutrient deficiencies, overweight, and obesity. Adolescence is a period of rapid physical growth and psychosocial development that requires increased energy and nutrient intake. Dietary diversity, defined as the consumption of foods from a variety of food groups, is a well-established indicator of diet quality and micronutrient adequacy. In Bhutan, national surveys have reported cereal-based diets with inadequate consumption of fruits, vegetables, and other nutrient-rich foods, potentially contributing to poor nutritional status and micronutrient deficiencies. Boarding school feeding programs provide a unique opportunity to improve adolescent nutrition, as school meals constitute a substantial proportion of students' daily food intake. However, the nutritional impact of these programs depends not only on the quality of meals provided but also on actual food consumption, as plate waste may substantially reduce nutrient intake and compromise program effectiveness. Despite Bhutan's long-standing school feeding program, evidence linking dietary diversity, nutrient intake, school meal consumption, plate waste, anemia, and nutritional status among adolescents remains scarce. Therefore, this study aims to assess dietary diversity, nutrient intake, plate waste, anemia, and anthropometric nutritional status among adolescents in boarding schools in Bhutan to generate evidence that will inform policies and strengthen school feeding interventions. |
| Objectives | General objectives To assess the dietary diversity and nutritional status of Bhutanese adolescents residing in boarding schools and examine the associations between dietary diversity, nutritional status, plate waste, and anemia. Specific objectives - To determine the prevalence and severity of anemia among Bhutanese adolescents residing in boarding schools. - To assess dietary diversity, nutritional status (anthropometric indicators), plate waste, and nutrient intake among Bhutanese adolescents residing in boarding schools. - To examine the associations between dietary diversity, nutritional status, plate waste, and anemia among Bhutanese adolescents while accounting for sociodemographic and lifestyle factors and school food environment characteristics. |
| Study Methods | Study Methods This study will employ a school-based cross-sectional descriptive design to assess dietary diversity, nutrient intake, food waste, anemia, and nutritional status among Bhutanese adolescents residing in boarding schools in Thimphu, Paro, Punakha, and Wangdue Phodrang districts. These schools operate under a common school feeding program and provide comparable socio-cultural and dietary environments. A multistage sampling technique will be used. Eligible boarding schools will first be selected from the four study districts. Within each selected school, students will be stratified by grade (Grades 8–12), and one section from each grade will be randomly selected. Additional sections will be included through simple random sampling where necessary to achieve the required sample size. Adolescents who provide assent and whose parents or guardians provide informed consent will be enrolled. Data will be collected using a structured questionnaire to obtain information on socio-demographic characteristics, dietary practices, lifestyle factors, and the school food environment. Dietary diversity will be assessed using repeated 24-hour dietary recalls conducted over three consecutive days. Nutrient intake will be evaluated in a subsample of 130 participants using repeated 24-hour dietary recalls and a 30-day Food Frequency Questionnaire. Anthropometric measurements (weight, height, and waist circumference) will be obtained using standardized procedures, while hemoglobin concentration will be measured using a portable HemoCue device to determine anemia prevalence. Food waste will be assessed using the selective aggregate weighing method, and plate waste will be evaluated using a validated six-point visual estimation scale. Data will be analyzed using descriptive and inferential statistics. Multivariable regression models will examine associations between dietary diversity, nutrient intake, food waste, nutritional status, and anemia after adjusting for potential confounding variables. |
| Expected outcomes and use of results | Expected Outcomes This study is expected to generate comprehensive epidemiological evidence on dietary diversity, nutrient intake, plate waste, anemia, and nutritional status among Bhutanese adolescents residing in boarding schools. The findings will provide reliable estimates of the prevalence and severity of anemia, as well as the magnitude of undernutrition, overweight, and obesity among adolescents in selected districts of western and central Bhutan. The study will also document dietary diversity patterns, nutrient intake levels, and the extent of plate waste within the school feeding system. These data will fill an important evidence gap, as nationally representative information on adolescent nutrition in Bhutan remains limited, particularly among boarding school students and adolescent boys. The study is further expected to identify key factors associated with anemia and nutritional status, including dietary diversity, nutrient intake, plate waste, socio-demographic characteristics, lifestyle factors, and school food environment characteristics. Understanding these relationships will help identify modifiable determinants of adolescent nutritional health and provide insights into how school food environments influence dietary intake and nutritional outcomes. The findings will provide context-specific evidence to support the design and strengthening of nutrition-sensitive interventions within Bhutan’s school feeding programme. Evidence on nutrient intake and plate waste will help policymakers and school administrators improve menu planning, food quality, meal acceptability, and resource utilization. The results may also inform nutrition education initiatives aimed at promoting healthy dietary practices and reducing behaviors that contribute to anemia and malnutrition. Ultimately, this study will contribute to strengthening adolescent nutrition policies and school health programmes in Bhutan. By generating evidence on multiple dimensions of adolescent nutrition simultaneously, the study aims in supporting to address anemia and micronutrient deficiencies |
| Keywords | Adolescents, Anemia, Dietary Diversity, Nutritional Status, Nutrient Intake, Food Waste, School Feeding Programme, Boarding Schools |
Research Details
| Student research | Yes |
| Institution: Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Hat Yai, Songkhla, Thailand | |
| Academic degree: Master | |
| Supervisor of the student(s) | |
| Full Name and title: Dr. Kasemsak Jandee, PhD. Assistant Professor, Department of Epidemiology | |
| Email: kasemsak.j@psu.ac.th | |
| Start Date | 01-Aug-2026 |
| End Date | 31-Oct-2026 |
| Key Implementing Institution | Prince of Songkla University |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Nutrition |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Approved |