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Beware of double burden of malnutrition in India

Sunday, Dec 29, 2019 13:30 [IST]

Last Update: Sunday, Dec 29, 2019 07:57 [IST]

Beware of double burden of malnutrition in India

Dr DEBAPRIYA MUKHERJEE
India that covers 2.4 percent of the global land mass supports more than one-sixth of the world’s population.  Since Indian independence, policy makers have given emphasis on the socioeconomic development with a focus on human resource development. India is still facing the problems of poverty, under-nutrition and communicable diseases.
Article 47 of the Constitution of India states that "the State shall regard raising the level of nutrition and standard of living of its people and improvement in public health among its primary duties". Many policies and multi-sectoral strategies have been framed to prevent nutrition-related public health problems and improve the nutritional and health status of the population as optimal nutrition and health are prerequisites for human development. Still under-nutrition remains a leading cause of childhood morbidity and mortality in India and in many parts of the world. Death of children in Muzaffarpur due to Acute EncephalitisSyndrome was attributed to consumption of litchi but this problem was mainly aggravated on account of under nutrition.
Interestingly, at present large proportion of low-income and middle-income countries (LMICs) facing the double burden of malnutrition (DBM) that indicates the coexistence of under nutrition and overweight. About 2?28 billion children and adults worldwide are estimated to be overweight and more than 150 million children are stunted affecting countries, households, and individuals. Obesity among adults is nearly as big a problem in the country as under-nutrition. Even as under-nutrition continues to remain extraordinarily high in the poorer parts of the country, obesity has reached endemic levels in some of the richer parts of the country. Individuals who have a body mass index, or BMI, of 25 or more are considered overweight while those with a BMI less than 18.5 are considered underweight. Women seem to be affected more by both forms of malnutrition compared to men.
 Now the DBM  is the major public health problems, as both are linked with increased risk of morbidity and mortality among women of reproductive age and children  particularly in low-income and middle-income countries. Overweight and obesity lead to chronic illness, including increased risk of cardiovascular and metabolic diseases. Under nutrition, on the other hand, increases the risk of anaemia and adverse maternal and child outcomes (e.g. neonatal death, stillbirths and low birth weight). South Asia had the highest prevalence of global underweight with 24% women being undernourished in 2014. Now reverse trend is clearly evident because stunting and wasting, and thinness in many people are declining while overweight is increasing in most age groups. The negative impact of being underweight, overweight, or obese on the health and development of children and adolescents can also extend into adulthood, increasing the risk of chronic non-communicable diseases and disability. An enormous epidemic of lifestyle diseases, including obesity, are now among the biggest problems of modern medicine. Obesity places great physiological strain on the human body – and that strain takes a toll on many systems including on nutritional status. Morbid obesity is associated with deficiency of vitamins, A, E, C, D, selenium, folate and carotenoids.
According to the most recent surveys, a severe DBM is defined as wasting in more than 15% and stunting in more than 30% of children aged 0–4 years, thinness in women (body-mass index <18?5 mg/kg²) in more than20% of females aged 15–49 years, and adult or child overweight, was found in 48 countries using the 20% overweight prevalence threshold, 35 countries using the30% overweight prevalence threshold, and ten countries using the 40% overweight prevalence threshold of all LMICs. In India, nearly one in two women are underweight in Purulia (West Bengal) and Malkangiri (Odisha) districts.  These districts are among the poorest in the country. Four out of every 10 women are overweight in Kolkata and Hyderabad. Delhi and Mumbai also figure in the top quartile of districts with high levels of obesity but the proportion of obese people in these cities are lower compared to Kolkata and Hyderabad. Kerala and Tamil Nadu, Andhra Pradesh has among the highest levels of obesity in the country.
Increases in overweight are the result of economic change that  has been crucial to the reductions in wasting, stunting, and thinness.  Introduction of modern technology in market economic work, home production (eg, rice cookers, refrigerators, air conditioner, floor cleaner, washing machine, stoves),and transportation systems  has declined the physical activity of the people  that is also the major cause of overweight. Also major shifts in the food system that have resulted in an increase in consumption of ultra-processed foods that make less nutritious food cheaper and more accessible.  Very rapid changes in the diets and the food systems in energy imbalance cause weight gain. For example, drinking a 355 mL bottle of sugar-sweetened beverage requires to undertake a 1?5 mile walk or run for at least 15 min. During visit to many houses both in rural and urban area, it was observed that sugary beverages and ultra processed foods have become the food items for regular consumption even in many low income families. Despite consumption of these foods, they do not think of doing any physical  activity to maintain  the energy balance. India and China are two of the top five markets for sugary beverage manufacturers and sugary beverages in the next decade. The speed of change is particularly important in understanding how this nutrition reality is shifting to weight gain. Another major bottleneck in maintaining energy balance on consuming these packaged foods  is the engagement of children of age 6-18 years in coaching center particularly after school hour to secure good score in the examination.  Moreover many children make themselves busy in playing game in mobile.
Upon policy liberalization, the control of the entire food chain in many countries by agribusinesses, food retailers, food manufacturers, and food service private companies practically forced the people to increase their consumption of ultra-processed, packaged foods (often ready to use), rich in refined carbohydrates, fat, sugar, and salt. These changes include disappearing fresh food markets, increasing numbers of supermarkets, and the control of the food chain by supermarkets and global food, catering and agriculture companies in many countries. This new nutrition reality is particularly important to acknowledge, because diet is an important driver of the DBM. The roles of income growth and the increase in the number of women working outside the home and the value of their time in work demand the food that is ready to eat or ready to heat and reduce  the consumption of traditional crops (e.g. millet, green vegetables, maize, pulses etc.).
Obviously population growth leads to overcrowding, poverty, under nutrition, environmental deterioration, poor quality of life and increase in disease burden. But at the same time population growth can also be a major resource for economic growth. If India successfully faces the challenge of providing its younger, better-educated, skilled, well-nourished and healthy workforce with appropriate employment and adequate remuneration, the economic status of both the people and the country can improve rapidly. With the increase of economic growth, if we can improve the access  to dietary diversification and increase the  consumption of pulses, vegetables, fruits and dairy products, the majority of the population have a balanced diet  to achieve nutrition security. High-quality diet must contains lots of fruits and vegetables; wholegrains, fibre, nuts, and seeds; modest amounts of animal source foods, minimal amounts of processed meats beverages high in energy and added sugar, saturated fat, trans fat and salt. High-quality diets reduce the risk of malnutrition by encouraging healthy growth, development, and the body's protection against diseases throughout life.
If awareness about the health and nutrition needs is created among 15 to 59 years age group, massive improvement in nutrition and health status can be made. Appropriate counselling will enable people to adopt life styles and diets that prevent the escalation of over nutrition and the attendant non-communicable disease risk. Additionally, addressing all forms of malnutrition will require new ways of designing, targeting, and implementing programs and policies to accelerate progress in improving nutrition globally.
E-mail: dpmcpcb@yahoo.com

Sikkim at a Glance

  • Area: 7096 Sq Kms
  • Capital: Gangtok
  • Altitude: 5,840 ft
  • Population: 6.10 Lakhs
  • Topography: Hilly terrain elevation from 600 to over 28,509 ft above sea level
  • Climate:
  • Summer: Min- 13°C - Max 21°C
  • Winter: Min- 0.48°C - Max 13°C
  • Rainfall: 325 cms per annum
  • Language Spoken: Nepali, Bhutia, Lepcha, Tibetan, English, Hindi