Nutritional status is an indicator of a distinct individual's health condition by the influence of intake and utilization of nutrients. Adequate nutrition may be a prerequisite for attaining good health, quality of life, and national proficiency. Although problems related to poor nutrition affect the entire population, women and children are especially vulnerable due to their unique physiology and socioeconomic characteristics 1. According to the World Health Organization (WHO) adolescence is the period in human growth and development that occurs after childhood and before adulthood, from ages 10 to19 2. Future adolescence is divided into early adolescence (10-14 years) and late adolescence (15-19 years). It is informed that the adolescence stage of lifespan is one of the key stages of physical growth and development. Growth occurs in the skeleton, in the muscle, and almost every system and organ of the body in adolescence except the brain and the head 3. Rapid growth during adolescence places increased demand on energy, protein, and other nutrients. The tempo of growth during adolescence is slower in undernourished populations 4. Protein deficiency has been shown to reduce growth during adolescence 5. In most developing countries the adolescent’s nutritional needs are very essential and critical but also neglecting adolescents than other groups of people like children and women. Fulfillment of nutrition demands of adolescents could be an important step towards breaking the cycle of intergenerational malnutrition, chronic diseases, and poverty as well 6.

In Bangladesh, adolescents were more than one-fifth (23 percent) of the entire population, which is 36 million 7. Besides, a large number of adolescent girls suffer from various degrees of nutritional disorders. Poor nutritional status during adolescence is an important determining factor of health outcomes at a later stage of life. Few studies have been done in the last couple of years to identify the extent and consequence of malnutrition in rural and urban adolescent school girls, and adolescent female workers of Bangladesh 689101112. The results of these studies particularly confirmed the higher prevalence of anemia and iron deficiency along with some other micronutrient deficiencies. Their health and nutritional status have a great impact on the quality of the next generation and consequently the prospect of the country. Therefore, attention should be conferred to adolescent health and nutrition. The aimed of these present study to investigate the nutritional status and nutrition-related knowledge among urban adolescent girls in Bangladesh.

The sociodemographic characteristics of the study subjects are shown in Table 1. A total number of 288 early adolescents and 212 late-adolescent girls were included in the study. The ages of their ^{yrs (Mean ± SD)} were 12±1 and 17±1 respectively. A majority (84%) were obtained from the nuclear family. Based on education, the study subjects 91% were under class 8 in early adolescence and 50% study of class 11-12 in late-adolescent girls. 

(Table 2) shows the distribution of the study subjects according to different BMI categories (adapted from WHO guideline - 2004). Mean (±SD) BMI in the early adolescent girls was 21.12±4.32 and in late adolescent girls was 22.10±3.89 respectively. Mean BMI was significantly (p= 0.009) higher in late adolescent girls compared with early adolescent girls. (Mean (±SD) WHR was 0.80±0.10 in the early adolescent girls and late adolescent girls were 0.78±0.09 respectively. Mean WHR was significantly higher in early adolescent girls compare to late-adolescent girls (p=0.037). Mean (±SD) MUAC was 23.10±3.37 in the early adolescent girls and late adolescent girls were 23.65±3.07. Mean MUAC was significantly higher in late adolescent girls compere to early adolescent girls (p=0.065).

(Figure 1) shows the early adolescent girls’ nutritional knowledge score about 62% moderate, 87% showed a positive attitude, and 73% had good practices in daily life. Besides, among the late adolescent girls, the nutritional knowledge score shows about 57% moderate, 90% showed a positive attitude, and 61% had good practices in daily life. Table 3 shows the relationship between knowledge with their attitude and practices among the study subjects. Among the early adolescent girls showed a significant association of nutritional knowledge with attitude and practices (p=<0.001, p=0.005). Nevertheless, in late adolescent girls showed a significant association of nutritional knowledge with attitude (p=0.002).

Mean (±SD) total Calorie (kcal/day) intake was 1447.53±285.07 in the early adolescent girls and late adolescent girls were 1550.33±326.35 respectively. Mean total Calorie (kcal/day) intake was significantly higher in late adolescent girls compere to early adolescent girls (p=<0.001). Mean (±SD) Carbohydrate (g/day) intake was 202.67±54.19 in the early adolescent girls and late adolescent girls were 227.29±66.36. Mean Carbohydrate (g/day) intake was significantly higher in late adolescent girls compared with early adolescent girls (p=<0.001). Mean (±SD) Protein (g/day) intake was 58.63±19.67 in the early adolescent girls and late adolescent girls were 55.05±17.35. Mean Protein (g/day) intake was significant higher in early adolescent girls compared with late-adolescent girls (p=<0.035). Mean (±SD) Fat (g/day) intake was 43.19±12.54 in the early adolescent girls and late adolescent girls was 45.06±12.91. Mean Fat (g/day) intake did not show any statistically significant difference between the two groups (Table 4).

There was a mean deficit of daily energy intake of total kcal (Table 5). Protein and Carbohydrate intake of the adolescent girls was 57 g/day & 213 g/day which 129.80% & 57.72% of RDA. The intake of fat by the adolescent girls was high in the RDA.

Most of the study subjects were consumed rice 2-3 times per day. They also consumed different snacks and beverages in a day but the data showed they preferred fuska to other food items. About 21% of late adolescent girls were consumed fuska 1 time in a day, whereas 55.6% of early adolescent girls were consumed 1-2 times per week. The consumption of chicken was higher than beef in both groups. They preferred big fish to small fish. About 41% of early adolescent girls and 23.6% of late adolescent girls consumed egg 1 time in a day. While only 21% of early adolescent girls and 10.8% of late adolescent girls consumed milk 1 time in a day. The consumption of vegetables was so low in both groups. They chose sour fruits over sweet fruits (Table 6).

Adolescence is an important stage of growth and development that requires increased nutrition and adolescent anthropometry varies significantly worldwide 22. Growth and development are closely associated to the diet received during childhood and adolescence. Undernutrition among adolescent girls is a serious public health problem internationally, especially in developing countries 23.

The present study shows that 31% of early adolescent girls were underweight according to different BMI categories (adapted from WHO guidelines-2004) 14. Early adolescents are at higher risk of undernutrition than late adolescents. Similar to this study's findings, two studies among adolescent girls also stated that nutritional status improves with age and education status. 924. According to BDHS-2014, 31% of the age 15-19 was undernourished (BMI <18.5) 1. Mean BMI and MUAC were significantly higher in late adolescent girls compare to early adolescent girls (p=0.009; p=0.065). Mean WHR was significantly higher in early adolescent girls compere to late-adolescent girls (p=0.037).

In the present study, it is encouraging to note that the majority of respondents had basic nutrition knowledge. According to the scoring system of knowledge, attitude, and practices (KAP). Among the early adolescent girls was showed a significant association of nutritional knowledge with attitude and practices (p=<0.001, p=0.005). Nevertheless, in late adolescent girls, there was a significant association of nutritional knowledge and attitude (p=0.002). No other study according to literature has addressed the scoring system of knowledge, attitude, and practices (KAP) regarding nutrition among adolescent girls in our country.

The present study represents the dietary intakes during a 24-h period preceding the interview, which only included school/college days. The intake on school/college days may differ from that on weekends and other holidays; this is also taken into account by the use of the food frequency questionnaire. The dietary pattern of many adolescent girls exposes them to the risk of specific nutrient problems. Food consumption data revealed that the daily energy intake by the adolescent girls of the present study almost conformed to the studies by Kabir et al 10 and Ahmed et al 11. The energy intake was not sufficient; fulfilled only 76% of RDA, much lower than the energy intake of the rural areas. 25.

For the proper fulfillment of the daily requirement, it is necessary to consume 55 g/day protein and 63.80 g/day protein consumption was reported in national data 26. Protein intake of the adolescent girls was 57 g/day that was 129.80% of RDA, indicating adequate intake of protein. Meat and eggs, which are rich sources of protein, are the preferred food items of adolescent girls. Although protein (g/day) intake was significantly higher in early adolescent girls compere to late-adolescent girls (p=<0.035). Accordingly, a high intake of protein by adolescent girls of the present study was expected and quite rational.

The intake of carbohydrates by the participants was 213 g/day, representing about 57.72% of RDA. Nevertheless, the mean (±SD) Carbohydrate (g/day) intake of the early adolescent girls and late adolescent girls was 202.67±54.19; 227.29±66.36 respectively which is lower Carbohydrate intake in urban adolescent school girls of Bangladesh 11, and urban adolescent college girls of Bangladesh 10. Although urban adolescent girls were deficient in Carbohydrate intake, it provided the highest percentage of energy (60-70%) of the total. The intake of fat by the adolescent girls was high in the RDA due to preference for fast food and consumption of cooking oil that is the major contributor to fat intake.

The seven-day food frequency questionnaire revealed very wide differences in the pattern of foods taken by the adolescent girls, to the extent that it would be difficult to characterize a representative diet 11. Consumption of staple food (rice or wheat) in the last seven days was universal with no difference. Nonetheless, consumptions of non-staple food items, such as meat, eggs, dal (lentils), fruits, and leafy vegetables, were not frequent among the adolescent girls. Eggs, milk, meat, and fish were the major sources of protein, calcium, and preformed vitamin A. Although the consumption of chicken was higher than beef in both groups. They preferred big fish compared to small fish. As well as providing provitamin A, dark green leafy vegetables and fruits are major sources of vitamin C and minerals, especially iron. Although, it was also observed that considerable proportions of the adolescent girls did not consume vegetables in both groups. They chose sour fruits over sweet fruits. Adequate micronutrients are essential for growth and development during adolescence.

More than 50% of adolescent girls were preferred to consume fast food 1-2 times per week. Research also showed that those who ate fast food at home and those students who attended school close to fast-food restaurants were more probable to be overweight 27 and leading to malnutrition and many common teenage problems. These include acne, obesity, mental and behavioral problems. Addressing proper nutrition for girls is equally essential to the special needs of pregnant women and children, and because they also experience a high burden of malnutrition. However, there are financial, sociocultural, and infrastructural challenges to modifying adolescent diets, and identification of bottlenecks is required.

The nutritional status of Bangladeshi adolescent girls was found inadequate in terms of dietary intake. Although the study subjects were mostly from the higher class of urban dwellers, their dietary intake was not balanced as evidenced by the daily intake of the diversity of food indicating a lack of awareness regarding a healthy diet. Repeated reinforcement of nutrition-related education and strong motivation is bound to bring about positive changes in dietary patterns concerning good health. Further studies need to be elucidated by considering a follow-up study with larger sample size.

FRB: contributed her intellectual ability to conception and design of the research, analysis and interpretation of data; drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. JLB: contributed his intellectual skill in the revision of the manuscript. KAK: Revision of manuscript for important intellectual content. All of the above authors read and approved the final manuscript.

We highly acknowledge to respected Dr Khaleda Islam, Professor, Institute of Nutrition and Food Science (INFS), Dhaka University, and Mr Mahfuz Ali, Ex- Senior colleague of Bangladesh Institute of Research and Training on Applied Nutrition (BIRTAN), for their guidance during conduct the research. We also thank to the adolescent girls who participated in the study.