Diet Quality and Affordability of Healthy Diets among Workers of Selected Garments Industries in Bangladesh

Abstract

Background: The ready-made garment (RMG) sector is key to Bangladesh's economy, significantly contributing to Gross Domestic Product (GDP) and foreign exchange earnings. However, RMG workers, predominantly women, face critical challenges related to health, nutrition, and productivity. Despite their socio-economic importance, research on diet quality and the affordability of nutritious diets by RMG workers remains limited. This study aimed to evaluate the diet quality as well as the affordability of healthy diets among RMG workers of selected garment industries in Bangladesh. Methods: This study used baseline survey data from the “Strengthening Workers' Access to Pertinent Nutrition Opportunities” (SWAPNO) project, funded by the Global Alliance for Improved Nutrition (GAIN). A secondary analysis was conducted on cross-sectional data collected from 801 RMG workers (333 males and 468 females) employed in two apparel industries in Dhaka and Mymensingh. Participants were selected using convenience sampling. Data on socio-demographic characteristics, dietary intake (assessed using the 24-hour recall method), nutrient adequacy, and micronutrient intake expressed as a percentage of the Estimated Average Requirement (EAR) were evaluated, along with anthropometric measurements. Nutritional status was assessed using body mass index (BMI) classified according to both World Health Organization and Asian-specific criteria. The affordability of a healthy diet was evaluated, and statistical analyses were performed to examine associations between diet quality, nutritional status, mean probability of adequacy (MPA), and relevant socioeconomic factors. Results: Among the 801 RMG workers studied, 58.4% were female, and 90.3% were aged 18 to 34 years. Female workers generally had lower educational attainment and income levels compared to males. The dietary analysis showed a heavy reliance on calorie-dense foods, particularly rice, with a low intake of fruits, vegetables, and pulses. Macronutrient distribution indicated excessive carbohydrate intake (67.0% of total energy), while fat intake was often below ideal levels in 43.4% of participants (less than 15% of total energy). Calcium consumption among RMG workers was alarmingly low, with most consuming less than 50% of the Estimated Average Requirement (EAR). Similarly, intakes of iron, zinc, riboflavin, and vitamin A are at or below the EAR, viii indicating a high risk of inadequacies. While niacin and folate exceeded the EAR, vitamin C intake was highly variable. A dual burden of malnutrition was observed, with 7.4% of workers underweight and 21.5% overweight or obese based on Global WHO BMI standards, while it was 44% overweight or obese based on WHO Asian BMI standards. The logistic regression analysis showed that the mean probability of adequacy (MPA) for micronutrients was significantly higher among RMG workers in Mymensingh (AOR 1.68, p = 0.004) and among those aged 25 to 34 years (AOR 1.40, p = 0.049), while other socio-economic factors had no significant effect. Regarding the affordability of healthy diet, this study found that most workers could afford energy-sufficient diets; however, 68% of the workers were unable to afford a healthy diet due to economic constraints. Logistic regression analysis further showed that higher income (BDT > 13,000), smaller household size, and the presence of multiple earning members were significantly associated with better affordability of a healthy diet. Conclusion: This study highlights significant nutritional challenges among RMG workers in Bangladesh, marked by widespread micronutrient inadequacy and a dual burden of malnutrition, particularly among female workers. Economic barriers remain a critical impediment to accessing healthy diets. These findings underscore the urgent need for targeted interventions to improve diet quality, address micronutrient inadequacies, and promote balanced macronutrient intake while addressing affordability constraints.