Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, New Delhi, IN

Abstract

Dual nutrition burden in India is a challenge to the nutrition sector but this can also be considered as an opportunity for the health and nutrition services to show their mettle. The decline in under nutrition rates can be accelerated through the effective implementation of the Food Security Act, ongoing food supplementation of the vulnerable groups and improved access to health care for infections. Over nutrition (BMI>25) rates were less than 5% in the seventies and eighties. Over the last 15 years there has been a progressive but slow rise in over nutrition rates both in women and men. However over nutrition rates in India is still less than 15%. India has two major advantages in combating rising over nutrition rates. Unlike many developing countries economic growth in India was not associated with increased energy intake. Steep reduction in physical activity is the major factor responsible for the rise in over nutrition. The population is becoming aware that moderate physical activity is essential for optimal nutrition and health. If energetic steps are taken to promote discretionary physical activity in all segments of population it will be possible to prevent the projected rise in over nutrition. At present over half of the Indians are normally nourished. With the efforts to reduce under nutrition and steps to prevent escalation of over nutrition, it is possible that majority of Indians may remain normally nourished and not incur the health hazards associated with under and/or over nutrition.

Keywords

National Programmes, Food Security, Nutritional Status, Food Security Mission, Horticultural Mission, National Health Mission, ICDS, Midday Meal Programme.

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Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, New Delhi, IN

Abstract

India with 2.5% of the global land mass is the home of one sixth of the global population. India has always considered population as the major resource for national development. The country accorded high priority to development of human resources through investments in education, nutrition and health. The national Five Year Plans, enunciated the policies, laid down strategies, outlined programmes to improve health and nutritional status of the population, laid the goals to be achieved in specified time frame and provided the needed funds to implement the interventions. The National Health Policy set ambitious goals for health, population and nutrition sectors to be achieved by 2000 AD. Over years there has been substantial progress but given the vast country and varied problems in different states and various constraints, the progress towards these goals was uneven and the country could not achieve many of the goals set for 2000 AD.

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Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, New Delhi - 110 016, IN

Abstract

From time immemorial it has been recognized that women-especially pregnant and lactating women-form one of the most vulnerable segments of the population from nutritional point of view. Numerous studies in India and elsewhere have shown that in chronically undernourished women subsisting on unchanged low dietary intake, pregnancy and lactation have an adverse effect on maternal nutritional status. Maternal under nutrition is associated with low birth weight and all its attendant adverse consequences. Epidemiological studies from India documented the magnitude and adverse consequences of Chronic Energy Deficiency (CED) on the mother child dyad and paved way for intervention programmes to address under-nutrition during pregnancy and lactation.

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R. V. Lakshmi ¹, M. Sylvia Subapriya ², K. Kalaivani ¹, Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, C-13, Qutab Institutional Area, IN
2 Department of Food Science and Nutrition, Avinshilingam Institute for Home Science and Higher Education for Women, Coimbatore, IN

Abstract

Respiratory infection, diarrhea and fever are three common infections in underfive children; there are substantial differences in the reported prevalence and ranking of these three morbidities between studies and surveys. Seasonal and year to year variation in prevalence of morbidity and impact of health care on the duration and severity of infection has not been explored. A large scale mixed longitudinal study of under-five children from urban low income households was carried out to document year to year and seasonal variations in the prevalence and type of morbidity and utilization of health care for morbidity and their impact on duration and severity of morbidity. Between January 2012 and Dec 2015 a total of 3888 pre-school children were investigated and 74636 observations were made; prevalence of morbidity was 10.3% (range 7.2%-11.6%). Prevalence of morbidity was higher between July and October. Respiratory infection was the most common and diarrhea was the least common illness in children. Over years there was a rise in the respiratory illness because of increase in construction activity in the study area. There was a fall in diarrhoeal diseases after construction of water supply and drainage system. Majority of the households accessed health care; as a result duration of illness was short and severe morbidity was rare. Improvement in environmental hygiene can result in reduction in morbidity. Access to health care reduces duration and severity of infection.

Keywords

Pre-School Children, Morbidity, Seasonal Changes, Health Care, Environmental Hygiene.

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R. V. Lakshmi ¹, M. Sylvia Subapriya ², Kalaivani Krishnamurthy ¹, Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, New Delhi - 110 016, IN
2 Department of Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore - 641 043), IN

Abstract

India is currently the home of the largest number of under-nourished and over-nourished children in the world. Data from longitudinal studies in India indicate that both under nutrition and over-nutrition in childhood is associated with higher risk of over-nutrition and noncommunicable diseases in adult life. A community based mixed longitudinal study of underfive children from urban low income families was taken up to assess their nutritional status. Weight was taken every month in all; length was measured every month in infants and height was measured once in three months in 1-5 year children. BMI was computed in all. Nutritional status was assessed using the WHO anthro software package. Between 2012 and 2015, 3888 pre-school children were enrolled (49.4% boys and 50.6% girls); mean age of these children at enrolment was 22.5±16.17 months. The mean Z scores for height for age was - 1.79; weight for age was - 1.41 and -0.47 for BMI for age. Prevalence of stunting was 43.4%; underweight was 31.9%, wasting was 12% and over-nutrition was between 3-5%. The reduction in wasting rate between 0-3 years was mainly due to the increase in prevalence of stunting. With universal screening for early detection of wasting and over-nutrition and effective management of these, it will be possible to achieve the WHA targets of reducing and maintaining wasting below 5% and preventing increase in over-nutrition in this population. This may reduce the risk of over-nutrition and non-communicable diseases in these children during their adult life.

Keywords

Under-Five Children, Nutritional Status, Stunting, Underweight, Wasting, Over-Nutrition.

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Prema Ramachandran ¹, Amrita Pramanik ¹, K. Kalaivani ¹

Affiliations
1 Nutrition Foundation of India, South Delhi, New Delhi-110 016, IN

Abstract

In India prevalence of anaemia and vitamin D deficiency in pregnancy are widespread. National programmes recommend that two tablets of iron and folic acid (IFA) and two tablets of calcium and vitamin D (Ca & Vit D) to be given every day from second trimester till delivery. To minimize the side effects and increase compliance, it is advised that each tablet should be taken after a meal. Most households follow a three meal pattern. A study was taken up to find out how IFA and Ca & Vit D supplementations can be fitted into the habitual three meal pattern. A short term crossover supplementation study was carried out on 38 pregnant women to assess side effects following consumption after lunch of one or two tablets containing 500mg elemental calcium (as calcium carbonate) and 250 IU vitamin D or 60 mg of elemental iron as ferrous sulphate. Prevalence of side effects was higher in women who received iron supplements as compared to Ca & Vit D supplements. Taking two tablets of Ca & Vit D together after meal was associated with significantly higher prevalence of side effects as compared to taking one tablet after meal. Taking two tablets of iron together after meal was not associated with any significant increase in prevalence of side effects as compared to one tablet. Giving two tablets of iron together after one meal and giving one tablet of calcium and vitamin after two meals is feasible option for providing two tablets each of iron and Ca & Vit D to pregnant women who habitually follow a three meal pattern.

Keywords

Iron Folic Acid Supplementation, Calcium and Vitamin D Supplementation, Pregnancy, Side Effects Following Supplementation.

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Kamini Prabhakar ¹, K. Kalaivani ¹, S. Kowsalya ², Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, C-13, Qutab Institutional Area, New Delhi - 110 016, IN
2 Department of Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore - 641 043, IN

Abstract

For the last four decades India had invested in interventions for improving household food security, supplementary feeding programmes and health care to pre-school children. However under-nutrition rates in under-five children continue to be high. Poor infant and young child feeding and caring practices had been identified as the major modifiable factors associated with under-nutrition especially in the critical first two years. Mother Child Protection Card (MCPC) was introduced as the critical intervention tool for combating these two factors and improving nutritional status of the children. A community based mixed longitudinal study was taken up in urban low middle income group mothers with under-three children to assess feasibility and impact of using MCPC as a supportive tool for nutrition and health education regarding infant and young child feeding and care during illness. Mothers readily accepted MCPC, kept it safely and produced it when requested. MCPC with authentic pictorial messages was used by all health and nutrition front line workers and research team; this practice ensured uniformity in nutrition and health education messages. Over 90% of infants at 2 months and over 2/3^rd at 5 months were solely breast-fed. By 8^th month almost all infants received semi-solid food. Almost all families accessed health care during illness and followed the advice regarding feeding during illness and convalescence. As a result the mean z scores for weight-for-age did not show any deterioration in the first year. MCPC is a useful tool in providing nutrition and health education and improving infant feeding practices.

Keywords

Mother Child Protection Card, Under-Three Children, Infant Feeding, Morbidity, Nutritional Status.

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Anshi Goel ¹, A. Thirumani Devi ², K. Kalaivani ¹, Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, New Delhi - 110 016, IN
2 Department of Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore - 641 043, IN

Abstract

 Currently India is experiencing dual nutrition burden. Prevalence of both under and over nutrition is reported to be higher in women as compared to men. Over nutrition rates in Delhi are among the highest in India. A mixed longitudinal study was undertaken to assess nutritional status of urban women from low middle income families. Between January 2015 and December 2017, 4155 non-pregnant non-lactating women were enrolled for this observational study. These women belonged to food secure low middle income families. They were living in highly congested urban localities in one or two room tenements and had no access to public spaces where they could go for walk or discretionary physical activities. In all women, height was measured at enrolment. Efforts were made to measure weight, mid upper arm, waist and hip circumferences once in three months. Prevalence of under nutrition (BMI < 18.5) in the 18-29 years age group was 12.1%, but 33.9% had BMI of ≥25. There was a progressive increase in over-nutrition, high waist and hip circumferences with increasing age; 68.4% of women aged 50 years and above were over-nourished. None of the undernourished women had waist circumference ≥ 80 cm; among the normally nourished 8.5% and in the over-nourished women 3/4th had waist circumference above 80cm. Hip circumference showed a similar trend but prevalence of ≥ 102 cm was lower. Prevalence of over nutrition, truncal and abdominal adiposity was high in women from Delhi low middle income families.

Keywords

Dual Nutrition Burden, Over Nutrition, Non-Pregnant Women, Bmi, Anthropometric Measurement.

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Anshi Goel ¹, Thirumani Devi A. ², Kalaivani K. ¹, Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, C-13, Qutab Institutional Area, New Delhi - 110 016, IN
2 Department of Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore-641 043, Tamil Nadu, IN

Abstract

In India breast feeding is universal. Studies carried out in the 1980s have shown that in women from low income families, lactation during the first six months was associated with weight loss. Over time there has been substantial reduction in under-nutrition across all groups including lactating women and over-nutrition has emerged as a public health problem. A study was taken up to assess the impact of universal and prolonged lactation on nutritional status and adiposity in 2240 women from urban low middle income group; 83.5% were 18-29 years of age and 16.5% were 30 years or older. As lactating women had to meet the energy cost of milk production, they weighed less and had lower mean BMI, MUAC, HC and WC as compared to non-lactating women. Prevalence of under-nutrition was higher and over-nutrition was lower in lactating women as compared to non-lactating women. In this community, prevalence of under-nutrition was low and lactation was not associated with persistent deterioration in nutritional status in either of the age groups; identifying lactating women who are under-nourished, providing them with nutrition education and take home rations continuously and monitoring their improvement may result in steep reduction in under-nutrition rates. Prevalence of over-nutrition in lactating women especially in ≥ 30 year age group was high; over-nutrition rates increased with waning lactation. Nutrition and health education on importance of increasing physical activity and interventions to promote discretionary physical activity are urgently required to halt the rise in over-nutrition and risk of non-communicable diseases in these women.

Keywords

Adiposity, Abdominal Adiposity, Duration Of Lactation, Low Middle Income Families, Over Nutrition, Under-Nutrition, Urban Women.

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Kamini Prabhakar ¹, S. Kowsalya ², K. Kalaivani ¹, Prema Ramachandran ¹

Affiliations
1 Nutrition Foundation of India, C-13, Qutab Institutional Area, New Delhi - 110 016, IN
2 Department of Food Science and Nutrition, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore - 641 043, Tamil Nadu, IN

Abstract

Right from its inception, ICDS programme envisaged monthly weighing and monitoring of growth in under-three children for early detection of under-nutrition. Currently accurate portable digital balances are available in anganwadi and Mother Child Production Card (MCPC) with child growth charts has been provided to children. A community based mixed longitudinal study was taken up in under-three children from urban low middle income families to assess feasibility and impact of growth monitoring and appropriate nutrition education using MCPC. Monthly weighing of children and plotting the weight-for-age in the MCPC was carried out by the research staff. A total of 5708 children were enrolled and followed up over 32879 visits between 2015 and 2019. Plotting the weight-for-age of the child in growth chart enabled identification of underweight children at the time of the visit so that appropriate nutrition and health education and care can be provided. Monthly weighing and plotting weight-for-age in growth chart enabled identification of small children growing along their own trajectory and prevented them from being mislabelled as under-nourished. Children showing deterioration in Weight for age Z score (WAZ) as compared to earlier visit(s) were readily identified and given needed advice. Personalised nutrition and health education provided at each visit taking into account current nutritional status, morbidity and Infant and Young Child Feeding Practices (IYCF) helped in preventing rise in underweight rates in the first 18 months and brought about some improvement in nutritional status of moderate and severely underweight children. It is feasible to operationalize growth monitoring as envisaged in Poshan Abhiyaan and accelerate the pace of reduction in under-nutrition in under three children.

Keywords

Urban, Under-Three Children, Low Middle Income Families, Growth Monitoring, Mother Child Protection Card, Nutritional Status.

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