NUTRITIONAL PROBLEMS IN INDIA &

WORLD: WAYS TO COMBAT

DR KALPANA KULSHRESTHA
PROFESSOR& HEAD
DEPARTMENT OF FOODS AND NUTRITION
COLLEGE OF HOME SCIENCE
G.B.P.U.A.&T.
PANTNAGAR- 263 145
UTTARAKHAND
 NUTRITIONAL STATUS
Nutritional status is a measure of the health condition of individual as affected
primarily by the intake of food and utilization of nutrients. Good nutritional
status can only be realized and sustained when individuals within families and
communities are food-secure.

MALNUTRITION
Malnutrition is a broad term that refers to all forms of poor nutrition. It is caused
by a complex array of factors including dietary inadequacy (deficiencies,
excesses or imbalances in energy, protein and micronutrients), infections and
socio-cultural factors. Malnutrition includes undernutrition as well as
overweight and obesity.

HEALTH
Health is not only the absence of disease but a state of complete mental and
physical wellbeing in relation to the productivity and performance of an
individual
THE CHALLENGE OF IMPROVING NUTRITIONAL STATUS IS A
QUINTESSENTIALLY 21ST-CENTURY ENDEAVOR. It’s a
challenge that resonates the world over: nearly every country
in the world experiences a level of malnutrition that
constitutes a serious public health risk. Between 2 and 3 billion
people are malnourished—they experience some form of
undernutrition, are overweight or obese, or have some sort of
micronutrient deficiency.
 CHANGING SCENARIO

GLOBAL AND REGIONAL PREVALENCES OF

STUNTING, UNDERWEIGHT, WASTING &
OVERWEIGHT (WHO STANDARDS FOR
1990, 2000, 2010) BY UN REGION.
FROM UNICEF, WHO & WORLD BANK (2012)
 MICRONUTRIENT MALNUTRITION
Commonly used to refer to vitamin and mineral deficiency disorders. Vitamins
and minerals are referred to as micronutrients because the body needs them in
only small amounts to maintain normal health and functioning. However, lack of
these micronutrients results in serious health repercussions like Vitamin A
deficiency (VAD), iron deficiency anemia (IDA) and iodine deficiency disorders
(IDD).
• A large proportion of people, particularly children under five years of age,
school-age children, and pregnant and lactating women, suffer from problems of
PEM and micronutrient malnutrition disorders.
• Micronutrient deficiencies often occur in conjunction with other nutritional
deficiencies. The concurrent prevalence of chronic malnutrition, IDD and IDA can
reduce the gross domestic product (GDP) by 2-4 percent.
• According to FAO, over 2 billion people in the world suffer from micronutrient
malnutrition
 VITAMIN A DEFICIENCY
• Principally affects pre-school age children.

• VAD can lead to xerophthalmia, night blindness and eventually, total

blindness.

• In all developing countries, an estimated 163 million children have VAD

(by low serum retinol), with a prevalence of about 30%. South central
Asia (which includes India) has the highest prevalence, and along with
central and west Africa has a prevalence of more than 40%. South and
central America and the Caribbean have the lowest prevalence, near
10%. South central Asia has two thirds of the affected children.

• Every year, 250,000 to 500,000 children lose their sight as a result of

VAD: two-thirds of these children are likely to die.
ASSESSMENT
Increasingly, the extent and trends in vitamin A deficiency have
come to be assessed using other methods, of which “the only
biochemical parameter validated and found practical for routine
survey use is serum retinol concentration” (Sommer & Davidson,
2002). One agreed cut-off point is 20 μg/dl, and the criterion for
establishing a public health problem is >15% prevalence. The term
“sub-clinical” has been generally dropped, and low serum retinol
can be referred to as VAD, meaning the state of inadequate
vitamin A nutrition.
VITAMIN A DEFICIENCY (LOW SERUM RETINOL)
PREVALENCE AND SEVERITY
AS A PUBLIC NUTRITION PROBLEM (WHO, 2009 &
UNSCN,2007 ESTIMATES) AND CLASSIFICATION
*N indicates national survey, S indicates subnational survey (fi rst administrative level), blank indicates regression result (WHO, 2009).
 IRON DEFICIENCY ANEMIA
• Caused by insufficient intake and/or inadequate biological utilization of dietary
iron.
• Assessed by measuring haemoglobin levels, rather than by clinical signs.
• Affects mainly young children, pregnant women, lactating women and women
in reproductive age.
 Known to be very extensive, affecting nearly half the women in the developing
world. This contributes to increased maternal mortality risks, ill-health and
debilitation.
 In the general (non-pregnant) female population is assessed as haemoglobin
<12g/dl, and this leads to anaemia in pregnancy, estimated as < 11 g/dl (in part to
take account of increased blood volume in pregnancy and consequent
haemodilution).
 Entering pregnancy anaemic is very difficult to reverse by intervention during
pregnancy, although supplementation is important in preventing further falls in
haemoglobin levels. In turn, low maternal iron availability leads to reduced iron
stores in the newborn infant, a risk factor for childhood anaemia.
ANAEMIA IN NON-PREGNANT WOMEN:
RESULTS FROM REPEATED NATIONAL SURVEYS
Mean prevalence (unweighted) of anaemia calculated by
averaging survey results (N=number of surveys), according to
time of survey and region
 IODINE DEFICIENCY DISORDER

 IDD occur in populations living in areas where iodine in the soil has been washed away by
glaciers and rain, and in areas of frequent flooding.

 Over 2 billion people in the world are at risk of IDD.

 IDD can lead to visible goitre; in pregnancy and early life causes mental retardation,
stunted growth, and other developmental abnormalities, which are largely irreversible. In
later life it reduces intellectual vigor, educational achievement and productivity, which
can be improved with increased iodine intakes.

 Global campaign to iodize the salt supply in almost all countries has now led to an
estimated 68% of households using iodized salt, in both developing and industrialized
countries (UNICEF, 2009).

 Interpreting changes in goitre prevalences : i) needs to take account of the endemic (pre-
iodized-salt) rate, which varies widely by country, and the coverage and length of time of
exposure to iodized salt or ii) estimates are derived from the median urinary iodine (<100
μg/l depicting IDD).
PREVALENCE OF IODINE DEFICIENCY OR EXCESS,
1993–2011
ESTIMATED PREVALENCE OF GOITRE (TOTAL GOITRE RATE),
NUMBERS AFFECTED & IODIZED SALT COVERAGE
 OBESITY
 Obesity reflects energy imbalance. It is an abnormal or excessive fat
accumulation in adipose tissue, to the extent that health is impaired.
 The classification of obesity for epidemiological purposes defines
overweight as BMI >23 kg/m2 and obesity as BMI >25 kg/m2 .
 Overweight and obesity were estimated to afflict nearly 1.5 billion
adults worldwide in 2008.
 Urbanization was a major driving force in global obesity, even
emerging in low and middle income countries. Adverse effects of
dietary change with shifts in energy balance and the entire structure
of the diet have played major concomitant and separate roles.
• Worldwide obesity has doubled since 1980
• In 2008, 35% of adults (>20 years) were overweight, and 11% were obese
• In 2011, more than 40 million children below 5 years of age were obese
• More than 10% of world’s adult population was obese in 2008
 CHANGING SCENARIO

GLOBAL AND REGIONAL PREVALENCES OF

STUNTING, UNDERWEIGHT, WASTING &
OVERWEIGHT (WHO STANDARDS FOR
1990, 2000, 2010) BY UN REGION.
FROM UNICEF, WHO & WORLD BANK (2012)
 COMBATING UNDERNUTRITION: MULTI-
SECTORAL APPROACH

Two complementary approaches to reducing undernutrition—

I. Direct nutrition specific interventions
II. Broader multi-sectoral approach

Action on both is urgent.

Evidence based
direct
interventions to
prevent and treat
undernutrition
 Multi-sectoral approaches can help reduce
undernutrition in 3 ways…..
By accelerating action on determinants of undernutrition like inadequate income,
agricultural production, improved water supply or by improving gender equality and
girls’ education, which are known to have a powerful impact over time in preventing
undernutrition. Deeper underlying determinants such as the quality of governance and
institutions and issues relating to peace and security.

By including specific pro-nutrition actions—in programmes in other sectors e.g. school

curricula should include basic knowledge of good nutrition, family nutrition practices.
The closest links, though, are to food security and agriculture, health and social
protection, which are three sectors in which the international development community
recently launched high priority initiatives.

By increasing “policy coherence” through government-wide attention to unintended

negative consequences on nutrition of policies in other sectors : applies both to donors
and developing countries. What is required is better and timelier analysis of nutritional
consequences and inclusion of nutritional consequences in “all of government”
mechanisms for policy co-ordination.
 CURRENT EFFORTS TO PREVENT AND
CONTROL MALNUTRITION
Efforts in the areas of advocacy, service delivery, institutional
capacity building and community empowerment. Programmes for
improving nutrition have focused on:
• Household Food and Nutrition Security
• Child Survival and Development
• Micronutrient Initiatives (such as backyard gardening, Vitamin A
fortification and salt iodization)
• Nutrition Surveillance and Intervention
• Poverty Alleviation
• Nutrition Education
HOUSEHOLD FOOD AND NUTRITION SECURITY PROGRAMMES
At the household level, food security implies physical and economic
access to foods that are adequate in terms of quantity,
nutritional quality, safety and cultural acceptability to meet each
person's needs.
For household food security household members should have:
• sufficient knowledge and skills to acquire, prepare and consume
food that provides a nutritionally balanced-diet, with special
attention to the needs of young children; and
• access to health services and a healthy environment to ensure
effective biological utilization of foods consumed.
FAO, in collaboration with governments and all actors in civil society, is
working on developing and maintaining up to date, the Food Insecurity
and Vulnerability Information and Mapping System (FIVIMS), which was
launched at the WFS in 1996. Seven general categories of national
information systems relevant to FIVIMS are listed below:
• agricultural information systems;
• health information systems;
• land, water and climatic information systems;
• early warning systems;
• household food security and nutrition information systems;
• market information systems; and
• vulnerability assessment and mapping systems.
Successful innovative efforts to ensure household food
and nutrition security in developing countries
include:
1. Tamil Nadu Integrated Nutrition Project in India;
2. Project COPA C A in Peru;
3. Pilot Food Price Subsidy Scheme in the Philippines;
and
4. Alternative School Nutrition Programme in the
Philippines (ACC/SNC, 1991)
 CHILD SURVIVAL AND DEVELOPMENT
PROGRAMMES
Child malnutrition in developing countries has been largely attributed
to poor breastfeeding practices and inadequacy of complementary
feeding.

WHO recommends that all infants receive only breast milk from birth to
six months of age.

• This requires appropriate policy support from governments to

encourage and assist all women to initiate exclusively breastfeed
their infants for 4-6 months and continue breastfeeding with
adequate complementary feeding up to 2years (WHO/UNICEF, 1989).
 MICRONUTRIENT INITIATIVES
Micronutrient deficiencies continue to exist even among population
groups that have enough food to eat .
Four main strategies to combat micronutrient deficiencies (FAO/ILSI, 1997):
i. Dietary diversification :availability and consumption of micronutrient-
rich foods
ii. Food fortification: addition of nutrients to commonly eaten foods to
maintain or improve the quality of a diet
iii. Vitamin and mineral supplementation programmes and initiatives such
as the Vitamin A Supplementation and the Expanded Programme on
Immunization.
iv. Global public health and disease control measures
 NUTRITION SURVEILLANCE AND INTERVENTION
PROGRAMMES
Nutrition Surveillance: broadest management information systems found in
nutrition programmes.
It entail monitoring the nutrition situation and taking appropriate action.
Indicators commonly used in nutrition surveillance are:
(i) food security information such as food availability and access;
(ii) nutritional status such as anthropometric data which includes
underweight, stunting and wasting;
(iii) specific micronutrient status such as for vitamin A, iron and iodine;
(iv) health information such as birthweight, infant and child mortality rates,
morbidity incidence or prevalence; and
(v) socio-economic variables such as income and selected assets.
 POVERTY ALLEVIATION PROGRAMMES

Objective: to assist communities to meet their basic needs. May include

nutrition programme and development of income generating
activities.
A poverty alleviation plan may include:
1) Rural job creation programme
2) Agricultural production programme:production of nutritious foods
(especially crops used for supplementary feeding of young children).
3) Village development projects: building village fish ponds, creating safe
water sources, poultry raising and others.
4) Provision of basic services: health facilities, clean water supplies, and
literacy and nutrition education programmes.
 NUTRITION EDUCATION PROGRAMMES
Objective: to provide people with adequate information, skills and
motivation to procure and to consume appropriate foods.
Focus on:
• strategies to improve family food supplies
• efficient utilization of available food and
• economic resources to provide well balanced diets and better care for
vulnerable groups
Components of a Nutrition Education Programme:
i) Increasing nutrition knowledge and awareness of the public and
policymakers.
ii) Promoting desirable healthy food choices and nutritional practices.
iii) Increasing diversity and quantity of family food supplies.
 &
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Agriculture plays a central role in increasing food availability and incomes, supporting livelihoods and
contributing to the overall economy (World Bank, 2008), and is thus a key actor in efforts to improve
food and nutrition security.

Sustainable agriculture is important for improving dietary diversity and nutrition outcomes.
Indeed, many of the production practices that are currently being promoted as ways to
improve environmental viability also represent strategies to improve dietary diversity, and vice
versa. Examples include:

• agricultural extension services that offer communities information and improved inputs,
including seed and cultivars for better crop diversity and promotion of biodiversity, e.g.
intercropping cereal crops with drought resistant legumes such as cowpea
• integrated agro-forestry systems that reduce deforestation and promote harvesting of
nutrient-rich forest products
• education and social marketing strategies that strengthen local food systems and promote
cultivation and consumption of local micronutrient-rich foods, e.g. agricultural extension
services that provide nutrition education at the community level
• promotion of aquaculture and small livestock ventures that include indigenous as well as
farmed species
• biofortification via research and development programmes that breed plants (including local
and traditional cultivars) and livestock selectively to enhance nutritional quality, e.g. increasing
protein content of mung bean
• reduction of post-harvest losses via improved handling, preservation, storage, preparation
and processing techniques, e.g. solar drying of fruits and vegetables that are rich in beta-
carotene.
ECONOMIC BENEFITS OF INVESTING IN NUTRITION
 FOOD FOR THOUGHT: CHALLENGES AHEAD…

1. Lack of coherent leadership

2. Malnutrition is not perceived to be an “urgent” issue
3. Developing nations face health inequities and a dual burden
of disease
4. The Nutrition Transition
5. Dearth of private-sector engagement in the nutrition field
6. Uncertainty about best practices in nutrition interventions
7. Lack of clear, enforceable, flexible policies at the state level
THANK YOU .