Examination of national Nutrition Monitoring Bureau (NNMB) data, ICDS (Integrated Child Development Scheme) and other data reveal briefly the following features about nutrition.
Class | Normal | Wasted | Stunted | Acute | N |
Agricultutral Labour | 43.7 | 31.0 | 15.1 | 10.2 | 270 |
Agricultural Labour tied | 45.6 | 28.6 | 14.5 | 11.3 | 103 |
Poor- Middle peasant | 57.6 | 27.9 | 9.3 | 5.2 | 73 |
Middle peasant | 75.4 | 17.1 | 4.9 | 2.0 | 90 |
Big Peasant | 57.3 | 31.1 | 8.3 | 3.3 | 243 |
Landlord | 70.6 | 20.6 | 8.4 | 0.3 | 164 |
Non-Agricultural | -- | -- | -- | -- | -- |
No Activity | 45.2 | 31.4 | 11.8 | 11.6 | 49 |
All | 53.5 | 28.4 | 11.3 | 6.8 | 992 |
* The norms used by the authors for defining "normal", "stunted", etc. are as follows: | ||
Weight for age | ||
over 85% | over 85% | "normal" |
less than 85% | over 85% | "stunted" |
over 85% | less than 85% | "wasted" |
less than 85% | less than 85% | "acute" |
Source : P.H Prased et. al "The Pattern of Poverty in Bihar" (World Employment Programme Research), Working Paper No. 152. |
Calorie Intake Of Schedule Castes as a percent of | Calorie Intake Of Schedule Tribes as a percent of | ||||
States | State Average | State Average | Recommended Daily Allowance (2400) | State Average | Recommended Daily Allowance (2400) |
Karnataka | 2837 | 86.6 | 102.4 | SS | -- |
Andhra Pradesh | 2517 | 96.3 | 101.0 | SS | -- |
Orissa | 2324 | 94.1 | 91.0 | 96.3 | 93.3 |
Tamil Nadu | 2292 | 88.7 | 84.7 | SS | - |
Maharashtra | 2286 | 85.6 | 81.5 | 98.1 | 93.5 |
West Bengal | 2227 | 98.7 | 91.5 | 92.2 | 85.5 |
Gujarat | 2211 | 98.0 | 90.3 | 92.4 | 85.1 |
Madhya Pradesh | 2160 | 92.5 | 83.3 | 89.4 | 80.5 |
Uttar Pradesh | 2123 | 97.2 | 86.0 | SS | - |
Kerala | 1942 | 94.1 | 67.4 | SS | - |
SS : Small Sample Source : Computed from disaggregated NNMB data. |
Nutritional Problems in India
The major nutritional problem in India is therefore PCM or protein calorie malnutrition, especially among most vulnerable groups like children, pregnant women, lower income groups and population living in tribal tracts. The term PCM implies the problem of malnutrition is one of primarily calorie or energy intake deficiency, the protein deficiency being secondary, since in Indian conditions, the dietary sources of proteins and calories are the same, an adequate qota of calories will expectedly take care of an adequate proteinin the diet.
The other major nutritional deficiency diseases are Vitamin A deficiency, goitreand iron deficiency anemia. In certain parts of India fluorosis is also a problem due to the presence of excessive amounts of fluoride in drinking water. Pellagra, caused due to niacin or nicotinic acid deficiency is prevalent in populations whose staple diet is maize. Pellagra has also been reported in jowar caters, although there is no niacin defiency in this millet
Average | Scheduled Castes | Scheduled Tribes | ||||
0-36 months | 0-72 months | 0-36 months | 0-72 months | 0-36 months | 0-72 months | |
Andhra Pradesh | 9.6 | 8.6 | 10.4 | 8.3 | 9.9 | 7.5 |
Bihar | 31.8 | 31.7 | 39.5 | 40.9 | - | - |
Gujarat | 7.3 | 6.2 | 6.0 | 3.9 | 11.7 | - |
Haryana | 4.6 | 3.5 | - | - | - | |
Himachal Pradesh | 5.3 | 4.3 | 7.0 | 9.3 | - | |
Karnataka | 8.8 | 8.3 | 10.1 | 8.5 | 5.0 | 2.5 |
Kerala | 7.7 | 7.8 | 11.0 | 10.2 | 17.5 | 15.6 |
Madhya Pradesh | - | - | - | - | 24.3 | 12.7 |
Maharashtra | 15.8 | 13.3 | 16.7 | 14.8 | 23.7 | 20.7 |
Orissa | 16.7 | 13.0 | 19.0 | 16.8 | - | |
Punjab | 8.6 | 8.2 | 13.9 | 12.3 | - | |
Rajasthan | 8.2 | 8.7 | 17.3 | 12.1 | 8.1 | 7.6 |
Tamil Nadu | 8.1 | 6.4 | 10.1 | 7.1 | - | |
Uttar Pradesh | 13.1 | 10.5 | 17.1 | 13.2 | 16.3 | 13.4 |
West Bengal | 19.9 | 17.3 | 26.5 | 21.3 | 17.0 | 12.1 |
* ICDS authorities follow the Indian Academy of Paediatrics (IAP) classification, as shown below :
Source : Compiled from Child in India. A Statistical Profile, Ministry of Welfare, Government of India |
State | Average | Rural@ | Tribal# | Urban$ |
Andhra Pradesh | 9.6 | 11.0 | 10.8 | 10.3 |
Himachal Pradesh | 5.3 | 8.1 | 12.4 | 26.3 |
Maharashtra | 15.8 | 27.3 | 14.3 | 16.4 |
Uttar Pradesh | 13.1 | 30.8 | 13.9 | 20.8 |
West Bengal | 19.9 | 16.2 | 33.8 | |
Source : Compiled from Child in India. A Statistical Profile. Ministry of Welfare, Government of India. |
Table 9E
Summary Nutritional Status by Age (% Distribution) in Bihar Villages*
Age | Normal | Wasted | Stunted | Acute | N |
6 Months but less than 18 | 22.8 | 42.5 | 22.8 | 11.9 | 41 |
19 Months but less than 54 | 36.7 | 33.1 | 19.3 | 10.9 | 248 |
54 Months but less than 114 | 52.5 | 31.0 | 9.9 | 6.6 | 419 |
114 Months or more | 76.3 | 17.9 | 3.7 | 2.2 | 279 |
All | 53.5 | 28.4 | 11.3 | 6.8 | 992 |
* For definitions of "normal", "wasted", etc., see footnote to Table 9A Source : P.N. Prasad, et al., "The Pattern of Poverty in Bihar" (World Employment Programme Research) Working Paper No. 152. |
Table 9F
Calorie Inadequacy* Among Adult Males and Females
(Perecent of Population)
1975-1979 | 1980 | |||||
States | Males | Females | Males | Females | Males | Females |
Kerala | 60.8 | 50.9 | 60.6 | 54.6 | 81.8 | 58.5 |
Madhya Pradesh | 48.4 | 28.8 | 63.3 | 55.0 | - | - |
West Bengal | 45.7 | 38.4 | 53.1 | 54.6 | 35.3 | 30.4 |
Orissa | 42.6 | 24.0 | 39.6 | 22.1 | 39.3 | 20.3 |
Maharashtra | 40.3 | 27.9 | 44.0 | 36.9 | - | - |
Uttar Pradesh | 36.7 | 32.2 | 28.8 | 29.5 | 38.4 | 25.8 |
Andhra Pradesh | 35.6 | 18.5 | 22.9 | 7.7 | 35.1 | 24.1 |
Gujarat | 35.2 | 27.3 | 24.2 | 17.2 | 29.3 | 20.9 |
Tamil Nadu | 34.8 | 25.4 | 15.7 | 16.7 | 41.4 | 36.1 |
Karnataka | 18.8 | 10.4 | 19.8 | 7.9 | 11.0 | 10.3 |
* Intake two standard deviations or more below the mean Source : NNMB data, as reported in Kamala S. Jaya Rao, "Undernutrition Among Adult Indian Males", NFI Bulletin, July 1984. |
Lathyrism is especially prevalent in MP, Bihar, UP, etc. among landless labourers and poor farm workers , who are usually the victims and who often get Khesari Dal as a form of wages. The pulse itself is rich in protein. Harmful effects of this pulse are produced if a diet in 2-4 months contains more than 40 percent of Khesari Dal. The disease manifests itself in the form of paraplegia with most victims crippled for the rest of their lives. Khesari is often used for adulteration of other pulses, which is one more vested interest to ensure its cultivation. Soaking of Khesari in hot water to detoxify it is not feasible because of fuel shortage. Studies of the University of Dhaka have shown that boiling the seeds withwater five times did not detoxify it. The only solution seems to be banits cultivation in MP, Bihar and West Bengal as has been done in other states.
Also in India there are a host of other mineral and vitamin deficiency diseases, other deficiency anemias, like folic acid, vitamin B12 and B6 deficiency anemias, and problems caused by food toxicants like epidemic dropsy(adulteration of usually mustard oil with argemone seed oil), alfatoxicosis (due to consumption of ground nut flour becoming now common for the school children' diets- that has been contaminated by a paricularly toxic fungal growth in groundnutseeds). An epidemic of Veno-Occlusive disease (VOD) of liver hit Surguja district in Eastern MP in 1973 and again in 1975. VOD is apparently caused contamination of seeds of Crotalaria mana with Gondli millet. Guinea worm infestation of water is also a major problem as also a whole host of problems affecting nutrition that are caused by unclean drinking water, chief of which are diarrhoea and intestinal parasitic infestation (including hookworms) that promote chronic blood loss and in turn aggravate iron deficiency.
Income Group | Middle Class | Slum Dwellers | RCI(Sedentary) | RDI (Moderate) |
Cereals and Millets | 316 | 416 | 460 | 520 |
Pulses | 57 | 33 | 40 | 50 |
Leafy Vegetables | 21 | 11 | 40 | 40 |
Other Vegetables | 113 | 40 | 60 | 70 |
Roots and Tubers | 82 | 70 | 50 | 60 |
Nuts and Oil Seeds | 21 | 9 | -- | -- |
Fruits | 124 | 26 | -- | -- |
Fish | 12 | 10 | -- | -- |
Other Fresh Foods | 19 | 9 | -- | -- |
Milk | 424 | 42 | 150 | 200 |
Fats and Oils | 46 | 13 | 40 | 45 |
Sugar and Jaggery | 434 | 20 | 30 | 55 |
*Grams per consumption unit per day NNMB Reprot on Urban Population (1975-79), published 1984, NIN |
Table 9H
Average Weights and Heights of Adults (20-25 years) in Different Urban Groups
Males | Females | |||
Income Group | Height (cms) | Weight (Kgs) | Height (cms) | Weight (Kgs) |
Middle class | 166.4 | 50.4 | 154.6 | 46.8 |
Slum–dwellers | 161.4 | 46.6 | 150.1 | 41.7 |
Source : NNMB Report on Urban Population (1975-79), published 1984, NIN. |
Dietary Patterns of the Affluent
As Indian populations, move up in social scale, important changes that appear to take place are:
The affluent group of Indians has had prevalence of economy heart disease (CHD) comparable to the affluent in the first world, with prealence of type II diabetes, there to five times that of similar groups in West. Indian who beome affluent appear to be particularly genetically prone to diabetes and CHD, especially when devoid of dietary discipline. Fat intake (in the form of ghee, vanaspati, edible oils) in Indians is particularly bizarre withe the 5% of population consuming 40% of the available fat. Achaya has shown that practically every Indian diet consists of some fat--as 'invisible fat'.2 Using more recent information available on total lipids in food materials, especiallly, rice, wheat and other cereals, and the average rural dietary data for 1980,the intake of invisible fat was shown to be 20 to 50 gms a day, averaging 29.0 gms. Large coconut intakes in Kerala and Tamil Nadu led to high levels of invisible fat in these states. Staples (tapioca being included in this category in Kerala) contributed to the bulk of the invisible fat (31-88%; average 68%) and milk and pulses an average of 11.4% and 2.4% respectively. Total fat intakes, both visible and invisible made an average contribution of 14.7% in 10 states of India.
Millets | |
Bajra (Penniseum typhoideum) | 20.4 g % |
Jower (Sorghum vulgare) | 14.2 g% |
Maize (Zea mays) | 6.8g% |
Ragi (Elensine coracana) | 18.6g% |
Wheat | |
Wholemeal (100%) | 9.6g% |
Refined | 3.0g% |
Rice | |
Raw (brown) | 5 to 8 g% |
Polished | 2.4 g% |
Chemical Nature of Cereal Fibre | |
Non-Celluloid polysaccharide | 48.9 - 61.5% |
Celluloid | 31.8 - 32.7% |
Liguin | 6.7 - 18.4% |
Estimated Total Fibre Contents of Average Indian Cereal-based Dietaries | |
Wheat based | 57.7 g/day/person |
Rice based | 33.2 g/day/person |
Millet based | 90.0 g/day/person |
Source : R.D. Sharma, National Institute of Nutrition, Personal Communication. Quoted in Gopalan, op. cit. |
The upshot of these findings is that even poor Indian diets are reasonably adequate in fat. For the affluent sections, intakes of edible fat of the order observed are wholly unnecessary if not dangerous.
A related point to be noted is that the fashion among the affluent to go in for safflower oil and sunflower oil, based on their reported superiority due to high content of polyunsaturated fatty acids(PUFA), instead of traditioal vegetable oils like groundnut, may actually be misplaced. These never oils contain 70% of linoleic acid (an essential fatty acid) as compared to 30% linoleic acid for groundnut and sesameoils. Excess linoleic acid could lower blood cholesterol--a feature desirable for coronary heart disease pone populations. Excess linolec acid is also suspected to lead to certain types of tumors and suppressionof immune response.
< Dietary Guidelines for the Affluent
Lest dietary guidlines for the affluent be thought of as an irrelevance,one should remember that even at 5% (let us assume only 5% have affluent characteristics described above) of the totalpopulation of India, they constitute about 40 million, which is a big number of people at nutritional risk, not to speak of the economic costs of keeping this 5% healthy.
Dietary guidelines are just that,merely guidelines for nutritional discipline. They may not solve all health problems of the affluent but could certainly help minimise the nutritionally related risk factors in, for instance CHD or diabetes. These guidelines2 should form part of school curricula in especially upper class schools.
Dietary Guidelines for the Poor
The Indian Council for Medical Research (ICMR) makes periodic recommendations on desirable diets for Indian populatuions . Considering the fact that at least one-third of the households in India are not able to afford even the minimum nutritional requirements (these households spend 80% of their income on food), the ICMR felt that its Recommended Diet Intake (RDI) should also have practical suggestions as to how the recommended nutrient allowance could be procured from low-cost diets. The model least cost diets per day that are 'balanced' are shown in Tables 11 and 11B. In rcommending diets for poor Indian Groups, the ICMR has been guided by the following considerations:
In reality as already seen from Table 11A and 11B actual intakes are far lower than RDI.
Adult Men | Adult Women | Children | Boys | Girls | ||||||
Food Items | Sedentary | Moderate Work | Heavy Work | Sedentary | Moderate Work | Heavy Work | 1-3 years | 4-6 years | 10-12 years | 10-12 years |
Cereals | 460 | 520 | 670 | 410 | 440 | 575 | 175 | 270 | 420 | 380 |
Pulses | 40 | 50 | 60 | 40 | 45 | 50 | 35 | 35 | 45 | 45 |
Leafy Vegetables | 40 | 40 | 40 | 100 | 100 | 50 | 40 | 50 | 50 | 50 |
Other Vegetables | 60 | 70 | 80 | 40 | 40 | 100 | 20 | 30 | 50 | 50 |
Roots and tubers | 50 | 60 | 80 | 50 | 50 | 60 | 10 | 20 | 30 | 30 |
Milk | 150 | 200 | 250 | 100 | 150 | 200 | 300 | 250 | 250 | 250 |
Oil and fat | 40 | 45 | 65 | 20 | 25 | 40 | 15 | 25 | 40 | 35 |
Sugar or Jaggery | 30 | 35 | 55 | 20 | 20 | 40 | 30 | 40 | 45 | 45 |
* Grams per day for each category Source : Recommended Dietary Inta kes for Indains, ICMR, 1984 |
Middle Class | Slum-dwellers | Recommended Intake (ICMR-1981) | |
Protein (g) | 73.1 | 53.4 | 55.0 |
Calories (Kcal) | 2603 | 2008 | 2400(sedentary) 2500(moderate) |
Calcium (mg) | 1121 | 492 | 400-500 |
Iron (mg) | 27.3 | 24.9 | 24.0 |
Vitamin A Retinol (?g) | 881 | 248 | 750 |
Thiamine (mg) | 1.47 | 1.27 | 1.20 |
Riboflavin (mg) | 1.52 | 0.81 | 1.40 |
Niacin (mg) | 15.3 | 14.6 | 16.0 |
Vitamin C (mg) | 93 | 40 | 40 |
Source : NNMB Report on Urban Population (1975-79), published 1984, NIN. |
Additional messages that need to be got across with respect to children are:
Food Items | Pregnancy | Calories (K Cal) | Lactation | Calories (K Cal) |
Cereals | 35g | 118 | 60g | 203 |
Pulses | 15g | 52 | 30g | 105 |
Milk | 100g | 83 | 100g | 83 |
Fat | -- | -- | 10g | 90 |
Sugar | 10g | 40 | 10g | 40 |
Total | -- | 293 | -- | 521 |
Source : RDI, ICMR (1981) |
A Good Diet for Pregnancy and Lactation During pregnancy and lactation a woman needs more food and a greeater vcariety of food. More food is the first and most important thing. Diets based on cereals are generally good, but the woman needs more of them. She should eat one-fourth more food than she was eating before she became pregnant (25% extra) Find out how much she was eating before. Divide that into 4 portions. Tell her, or better show her, how much one of these portions is. This is the extra food she should eat, not only in pegnancy, but right through lactation. Pregnant and nursing mothers should eat for two persons A variety of foods will supply most of the nutrients a pregnant woman needs. These are listed below: Source: Guidelines for Training Community Health Workers in Nuttrition. 2nd Edn. WHO.(Geneva,1986). |
Guidelines for other Major Nutritional Problems
There are dietary guidelines that have been formulated for a host of other deficiency problems but the above to be the major ones. Particular guidelines will have to be worked out considering location specific conditions.
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