Adolescents' dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya's urban slums.

Abstract Background The double burden of malnutrition (DBM) during adolescence is associated with growth and developmentalimpairment and risk of non-communicable diseases. There is limited evidence on adolescent’s dietary patterns(DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPsof adolescents, their drivers and association with DBM in Kenya’s urban slums.Methods Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional surveyof 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal componentanalysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmentalfactors and DBM. Results Two DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioningDP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks).Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI1.85–6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97–9.32), while longer residencyin the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25–0.90) with transitioning DP. The transitioningDP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16–6.71). The DPswere not associated with thinness or stunting. Conclusion The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by culturalbackground, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescentsto the risks of overweight/obesity in the long-term.