Abstract

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Background 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 rela‐ tion to fsh consumption; especially among adolescent girls who are at risk of nutritional defciency in Bangladesh. Currently, there is no metric that takes account of environmental, cultural and economic contexts when considering fsh consumption and dietary health from a policy perspective. Methods 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 stratifed by fve 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 rep‐ resenting nutritional outcomes (anthropometry, omega-3 index and micronutrient levels) were explored in multivari‐ able regressions. The ftted 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. Results 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 diferentiating between those ‘chronically at risk’ and those ‘never at risk’. Conclusions Observational data on diferent aquaculture-ecozones defned by salinity enabled us to establish link‐ ages between seasonal fsh intake, religion, diet diversity, female autonomy and nutritional wellbeing. The purpose of the metric is to reveal these specifc linkages in practice. This tool should improve targeting of timely, preventative and cost-efective nutritional interventions to adolescent girls most at-risk from low omega-3 levels in communities where seafood is produced.