Prema Ramachandran

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INDIAS NUTRITIONAL CHALLENGES
Prema Ramachandran
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• 2007-India in transition
• India is undergoing rapid socio-economic,
  demographic, nutrition, health transition.
  
• India in 2007 is a country of paradoxes.
• Fast growing economy, but high poverty levels
• Self sufficient in food production, large food
  subsidy and food supplementation programmes
• But under-nutrition levels in children continue
  to be very high higher than Sub-Saharan Africa
• Over-nutrition in children is rising especially
  among affluent and urban children

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• Major nutrition-related public health problems
• Chronic energy deficiency and undernutrition
• Micro-nutrient deficiencies
• Anaemia due to iron and folate deficiency
• Vitamin A deficiency
• Iodine Deficiency Disorders
• Chronic energy excess and overnutrition

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Indias GDP growth was over 8 in the last three
years projected growth rate for the next five
years is 10. Accelerated economic growth has
not translated into accelerated decline in
poverty. Income disparities are widening as
growth has not been inclusive .
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Growth of agriculture sector is low. Half the
population depends on agriculture for livelihood
and low growth will adversely affect their
nutrition. To meet nutritional needs of the
growing population, we have to produce an extra
five million tonnes of food grains annually and
increase the production of livestock, fish and
horticultural products. This has to be achieved
in the face of shrinking arable land and farm
size, low productivity, growing regional
disparities in productivity and depletion of the
natural resource base
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The mutually reinforcing vicious cycle of
poverty and under-nutrition is well recognised.
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The eighties and early nineties witnessed a
relatively slow decline in poverty but a sharper
decline in undernutrition in children- due to
improved access to health care rather than
improved increase in dietary intake. Reduction
in undernutrition in children the last decade is
slow .
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• Nutritional status in childhood will
• affect their growth, development and health
  status during childhood and adolescence
• influence their nutrition and health status
  through out their life span
• Under-nutrition in early childhood may render
  them more susceptible to over-nutrition and non
  communicable disease risk in adult life
• Does the ongoing economic and nutrition
  transition represent a major challenge or does it
  provide an opportunity window to achieve rapid
  improvement in nutritional status?

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Breast feeding in India is nearly universal but
majority of urban and rural women do not
exclusively breast feed their infants up to six
months or introduce complementary feeds at 6
months. Poor infant feeding practices result in
rise in undernutrition rates
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• Low birth-weight rate in India is 30
• Prevalence of under-weight in first three months
  is 30 - exclusive breast-feeding prevents
  further deterioration in nutritional status in
  the first three months .
• After 3 months underweight rate rises due to
  introduction of milk supplements infections.
• Between 6 and 11 months underweight rate further
  rises to 45 - due to inadequate complementary
  feeding infections.

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• Progressive increase in the underweight rates in
  12 to 24 months of age mainly attributable to
  inadequate intake of family food due to poor
  child feeding practices. Need for nutrition
  education to correct these faulty habits.
• Further rise in under-nutrition rates is mainly
  due to poor intra-family distribution of food
  parents have to understand that children have
  small stomach capacity and have to be fed 5-6
  times a day to fully get adequate food intake.
• Under-nutrition in early life may predispose to
  over-nutrition and non-communicable diseases in
  adult life.

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Reduction in poverty is not associated with
increase in energy intake among poor . Poor
continue to be in negative energy balance so
undernutrition rates are not declining . But
reduction in physical activity has resulted in
increase in overnutrition rates
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Under-nutrition in adults is a major problem in
all states. Over-nutrition is emerging as a major
problem in some states.
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• Indians have a greater amount of fat and less
  amount of fat free mass as compared to their
  western counterparts.
• If over and above this, they become over weight
  (due to accumulation of body fat) they are at
  higher risk of diabetes and CVD.
• Exercise holds the key to improving muscle mass,
  reducing fat and reducing the risk of NCD.

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Anaemia is a major problem right from childhood
it worsens during adolescence in girls.
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Vitamin A deficiency
Blindness due to Vitamin A deficiency has been
eliminated. Prevalence of Bitots spots has
declined. However prevalence of biochemical
vitamin A deficiency is quite high.
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Coverage Under Massive dose of Vitamin A
Coverage under massive dose only 20 (NFHS-3)
Coverage can be improved -Orissa, UP
experience Coverage can be scaled up through
convergence between ICDS and NRHM
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Many coastal, salt manufacturing states with good
health indices have low iodised salt use and high
goitre rates.
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There was a decline in household access to
iodised salt when ban on sale of non-iodised salt
was lifted. Ban has been re-imposed in 2006.
Several states are supplying iodised salt through
PDS we can reach the goal of universal access to
iodised salt by 2010.
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Thank You