{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T09:01:10Z","timestamp":1785315670426,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Adolescents in low- and middle-income countries face a disproportionate burden of dietary inadequacy, yet evidence on the determinants of overall diet quality remains scarce. This study assessed the prevalence of macro- and micronutrient inadequate intake and identified factors associated with dietary adequacy among adolescents in rural Pakistan. Methods: A cross-sectional survey was conducted among adolescents using multistage cluster sampling. Dietary intake was assessed through a single 24-h dietary recall; nutrient adequacy was determined using age-and sex-specific Dietary Reference Intake (DRI) standards, including Estimated Average Requirements (EARs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Acceptable Macronutrient Distribution Ranges (AMDRs), as appropriate. Overall dietary adequacy was quantified using the Mean Adequacy Ratio (MAR), calculated as the unweighted mean of nutrient adequacy ratios for fourteen nutrients, including protein, fiber, calcium, iron, zinc, thiamin, riboflavin, niacin, vitamins A, B6, C, D, E, and folate, scaled from 0 to 100. Multivariable linear regression incorporating survey weights and clustering was used to identify independent predictors of MAR using STATA. Results: A total of 1132 adolescents were included. Most of the energy was derived from carbohydrates, and a high proportion of adolescents had energy intakes below age- and sex-specific Estimated Energy Requirement (EER) values, while very high levels of inadequacies were observed for protein, fiber, calcium, vitamin D, and vitamin A. The mean MAR score was 54.04 \u00b1 16.51, indicating overall poor dietary adequacy. In multivariable analysis, male sex (\u03b2 = 3.26; 95% CI: 1.76, 4.75), belonging to the richest wealth quintile (\u03b2 = 5.81; 95% CI: 1.76, 9.86), always eating between meals (\u03b2 = 6.70; 95% CI: 3.93, 9.47), and use of bar soap for handwashing (\u03b2 = 4.97; 95% CI: 2.00, 7.94) were significantly associated with higher dietary adequacy. Adolescents who were underweight (\u03b2 = \u22122.40; 95% CI: \u22124.81, \u22120.11) and those with moderate physical activity levels (\u03b2 = \u22123.96; 95% CI: \u22127.62, \u22120.29) had significantly lower dietary adequacy scores. Conclusions: Dietary inadequacy among rural adolescents in Pakistan was highly prevalent and was associated with socioeconomic, behavioral, and nutritional factors. These findings highlight the need for interventions that address food insecurity, promote equitable food distribution, and strengthen nutrition education to support adolescent health and nutrition. However, these findings should be interpreted in light of the cross-sectional design and the use of a single 24-h dietary recall, which may not reflect habitual dietary intake.<\/jats:p>","DOI":"10.3390\/nu18152438","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:49:27Z","timestamp":1785131367000},"page":"2438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary Adequacy and Its Associated Factors Among Adolescents in a Rural District of Sindh"],"prefix":"10.3390","volume":"18","author":[{"given":"Tansheet","family":"Jawad","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2070-8878","authenticated-orcid":false,"given":"Naureen","family":"Rehman","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0090-4880","authenticated-orcid":false,"given":"Muzna","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4553-8130","authenticated-orcid":false,"given":"Arjumand","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-7565","authenticated-orcid":false,"given":"Zahra Ali","family":"Padhani","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleema","family":"Gulzar","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery (SoNaM), Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hira","family":"Farooq","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasool","family":"Bux","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7425-3113","authenticated-orcid":false,"given":"Imran Ahmed","family":"Chauhadry","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"},{"name":"Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2966-7162","authenticated-orcid":false,"given":"Jai K.","family":"Das","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan"},{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, July 11). 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