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Diet and Nutrition Situation and Time Trends in India

Dr. B. Sesikeran, MD, FAMS

Director National Institute of Nutrition, I.C.M.R.

Hyderabad – 500 604E-mail: sesikeran@gmail.com

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3

Infant Mortality Rate (Per 1000 Live Births) in India and South-east Asian Countries

Source : WHO/SEARO 2000

8577

72 69

5954

17 12

0

20

40

60

80

100

IMR

58 *

* SRS, Registrar General of India, 2004

*

4

Prevalence of Low Birth Weight in India and South-east Asian Countries

Source : WHO/SEARO 2000

33 30

25 2523

13

8

10

10

20

30

40

Pe

r c

en

t

IndiaBangladesh

Nepal

Myanm

ar

Bhutan

Maldives

Indnesia

DPR Korea

23 (NFHS 2) *

* Increase in Institutional Deliveries

5

Andhra Pradesh

Madhya Pradesh

Maharashtra

Karnataka

Kerala Tamilnadu

Orissa

West Bengal

Uttar Pradesh

Gujarat

NATIONAL NUTRITION MONITORING BUREAU (Estd: 1972)

Objectives of NNMB

1.Assessment of Nutritional status of various communities by adopting standardized procedures and techniques

2.Periodical evaluation of National Nutrition programs operation in India

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Average Daily Food Intake (% RDA) among 1-3 Year Children : By Gender

31

321918

26

31 232

21987

6917

1435

3680

74

0 50 100 150 200

Sugar & Jaggery

Fats & Oils

Milk & Milk Prod.

Roots & Tubers

Other Veg.

Green Leafy Veg.

Pulses

Cereals BoysGirls

Percent RDA

7

Median Intake of Nutrients (as % RDA) Among 1-3 year children : By gender

6058

3230

6156

4343

67

671414

3835

4040

5754 87

83

0 25 50 75 100 125

F.Folic Acid

Vitamin C

Niacin

Riboflavin

Thiamin

Vitamin A

Iron

Calcium

Energy

Protein BoysGirls

Percent of RDA

8

Average Daily Food Intake (% RDA) among 4-6 Year Children : By Gender

26

2630

3323

27166

181

87

8623

1954

5276

79

0 50 100 150 200

Sugar & Jaggery

Fats & Oils

Milk & Milk Prod.

Roots & Tubers

Other Veg.

Green Leafy Veg.

Pulses

Cereals BoysGirls

Percent RDA

9

Median Intake of Nutrients (as % RDA) Among 4-6 year children : By gender

6466

3637 65

683030

67

6716

173738

4952

5759 87

90

0 25 50 75 100 125

F.F.Acid

Vitamin C

Niacin

Riboflavin

Thiamin

Vitamin A

Iron

Calcium

Energy

Protein BoysGirls

Percent of RDA

10

0

20

40

60

80

100

% R

DI

DISTRIBUTION OF MICRONUTRIENT INTAKES IN CHILDREN - % RDI

Riboflavin 76.1 11.4 2.6

Vitamin A 87.4 3.8 8.8

Iron 71.4 13.4 15.2

F.F.Acid 31.5 24.2 44.3

<50% RDA 50-70% RDA >=70% RDA

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Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD): By Gender

55 5550 52

16 15

0

20

40

60

Underweight Stunting Wasting

Boys

Girls

Per

cen

t

12

Prevalence of Undernutrition among <5 years children according to Weight for Age

(IAP classification)

39.9

56.458.7

57.4

56.8

61.0

20

40

60

80

6 12 24 36 48 60

Age (Months)

Per

Cen

t

Faulty BF Faulty Complementary feeding

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INFANT AND YOUNG CHILD FEEDING PRACTICES (NFHS 3)

22

2923

48

4046

5462

56

0

20

40

60

80

100

Early Initiation of BF

Exclusive BF Upto 6 months

Compl. Feeding among 6- 9

months Children

Rural Urban Pooled

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MICRO-NUTRIENT DEFICIENCIES

15

Pooled: 0.7%

< 0.5 %

0.5 %

Kerala0

Tamil Nadu 0.5

Karnataka0.7

Andhra Pradesh 1.2

Maharashtra1.3

Madhya Pradesh1.4

Orissa0.3 West Bengal

0.6

Prevalence (%) of Bitot spots among1 - <5 year children

Boys: 0.9% Girls 0.6%

16

0.7 0.70.6

0

0.2

0.4

0.6

0.8

1

1.2

MND-NNMB-2003

MND-ICMR-2001

NNMB-2006

Prevalence (%) of Bitot Spots among 1 - <5 yrs. Children

* WHO cut-off level (0.5%) of Public Health significance

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AGE / PHYSIOLOGICAL GROUP Gender

Hb

(g/dl)

6 months – 6 Years Boys & Girls <11

6 – 14 Years Boys & Girls <12

14 Years Men <13

Women <12

Pregnant Women <11

WHO, Nutritional Anemia - TRS No. 405, Geneva 1968.

Definition of Anemia

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32.5 31.4 30.325.7 22.3 24.8

45.2

23.7

47 47.2

24.7

43.3 41.9

45.8

41.7

20.5 20.7

45.5

31.4 30.5

8.42.8 0.63.04.11.81.12.1

1-5 yr B+G 12-14 YrGirls.

15-17 Yr.Girls

Preg. W Lact. W NPNL. W Men

Normal Mild Moderate Severe

10.20.03

11.20.03

11.00.03

9.90.03

10.60.03

Mean ±SE

Prevalence (%) of Anaemia by Age, Gender & Physiological Groups

> 6 months < 6 months

10.71.99

12.62.09

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Pooled: 3.9

< 5 %

> 5 %

Kerala0.6

Tamil Nadu 0

Karnataka1.9

Andhra Pradesh 3.8

Maharashtra12.2

Madhya Pradesh4.3

Orissa0.1

West Bengal

9.0

Prevalence (%) of IDD among 6 – 11 Year

Children

Source: MND-NNMB, Tech Rep 22, 2003

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PREVALENCE (%) OF IDD AMONG CHILDREN (≤12 years old)

3.9

4.8

0

2

4

6

8

10

NNMB-MND, 2003 ICMR-2001

21

54.649.9

29.7 29.425.6 24.4

23.3

10.1

31.3

0

10

20

30

40

50

60

70

80

WB KER AP MR TN KAR ORI MP POOLED

Percent of Households consuming salt having Percent of Households consuming salt having adequateadequate

Amount (≥15 ppm) of IodineAmount (≥15 ppm) of Iodine

* By spot test

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Time Trends

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Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey

82

78

8290

40

3823

20

70

68

80

85

86

98

102110

0 50 100 150

O.Veg.

GLV

Pulses

Cereals

1975-77

1988-90

1996-97

2005-06

Percent

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Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey (contd.)

4770

9777

7060

65

70

55

5761

77

120

8882

112

0 50 100 150

Sug&J ag.

Fats&Oils

Milk&MP

Roots&Tub.

1975-771988-90

1996-972005-06

Percent

25

Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey

5389

97

108

110130

141

152

76

87

94

97

8290

97

103

0 50 100 150

Iron

Calcium

Energy

Protein

1975-791988-901996-972005-06

Percent

26

110100

9398

9279

8992

436464

57100

100108

12543

5047

41

0 50 100 150

Vitamin C

Niacin

Riboflavin

Thiamin

Vitamin A

1975-791988-901996-972005-06

Percent

Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey (Contd.)

27

Distribution (%) of Children by Undernutrition and Period of Survey

64

4955

67

60

52

21 23

15

0

20

40

60

80

Underweight Stunting Wasting

1988-902000-012005-06

Per

cen

t

UNDERNUTRITION (< Median - 2SD)

28

37.437.6

21.8

26.136.0

38.9

51.3

54.9

17.5

21.022.526.6

37.037.0

42

39.1

39.939.539.5

45.1

39.9

31.4

23.523.5

0

10

20

30

40

50

60

1973-74 1977-78 1987-88 1993-94 1999-2000 2005-06

Year

Per

cen

t

Population BPL Severe underweightModerate Underweight Normal

Trends in poverty line estimates and Prevalence of Undernutrition among 1-5 yr. Children

(According to SD Classification Using NCHS Standards)

Source :- BPL : Economic survey and NNMB Surveys

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0

5

10

15

20

25

30

35

World

wide

Amer

icas

Europe

Near/m

iddle

Eas

t

Asia-

Pacifi

c

Sub-Sah

ara

Africa

Pre

vale

nce

(%

)

overweight

obese

Prevalence of overweight and obesity among Prevalence of overweight and obesity among school-age boys aged 5-17 years by global regionschool-age boys aged 5-17 years by global region

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Author Year Age groups

(yr)

Number of

subjects

Prevalence (%)

Overweight

Obesity

Mohan B 2004 11- 17 2467 11.6 2.6

Khadilkar Y 2004 10 – 15 1228 19.9 5.7

Chatwal J 2004 9 – 15 2008 14.2 11.1

Subramaniam V 2003 10 – 15 707 10.0 6.0

Laxmaiah A et al 2004 12 - 17 1208 04.6 1.6

Chatterji P 2002 4 – 18 5000 29.0 6.0

Kapil U 2002 10 – 16 870 24.7 7.4

Ramchandran A 2002 13 – 18 4700 16.8 3.1

Pandey S & Vaidya R

2001 3 - 17 2439 15.1 15.3

PREVALENCE (%) OVERWEIGHT AND OBESITY AMONG CHILDREN: VARIOUS STUDIES

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Category NOverweight/

ObeseP value

TV viewing (hrs/day)

None 143 5.6 a b

P < 0.05

< 3 hrs/day 730 4.9 a b

3hrs/day 335 9.3 b

Participation in outdoor games (hrs/week)

None 526 8.4 a

P < 0.004< 6 hrs 228 6.6 a

6hrs 416 5.1 b

Participation in HH activities (hours/day)

None 221 18.6 a

P < 0.001< 3 hrs 233 4.7 b

3hrs 716 3.9 b

Prevalence of Overweight/Obesity and Physical Activity (NIN Study)

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VariableOverweight/

Obese Adolescents

Normal Adolescents P value

Consumption of Soft drinks

21.0 16.0 p < 0.05

Consumption of soft drinks 300 ml/day

16.7 9.0 p < 0.05

Prevalence of Hypertension

(JNC VII)8.3 3.7 P < 0.05

Overweight/Obesity Vs Lifestyle practices (n:941)

Laxmaiah et al 2007

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Prevalence of Overweight in relation to activity score.

19.7

13.1

10.5

0

5

10

15

20

25

1 2 3

Overweight % Prevalence of Overweight

was higher in lower tertile of physical activity. Trend 2 = 45.6, P <0.001.

Tertiles of activity score

% O

verw

eigh

t

Ramachandran et al 2002

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Conclusion Despite rapid progress in the area of food production,

the intake of food and nutrients continues to be deficient, both in terms of quantity and quality

Prevalence of LBW is about 30%, and about 55% of preschool children are underweight and 50% are stunted.

Even though, the prevalence of undernutrition is significantly declining over a period of 3 decades, still the current prevalence is exceptionally high.

MNDs such as IDA VAD and IDD continues to be of public health problem.

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The prevalence of overweight and obesity is significantly increasing over a period of 3 decades even among rural population, which is the major independent risk factor for metabolic syndrome.

Prevalence of overweight and obesity is considerably high, especially when Asian cut of levels were used (≥23 BMI).

India is passing through a critical phase i.e. ‘double burden of disease’.

One fourth of our rural adults are suffering from hypertension About 5-6% of the adults have IGT/DM.

Conclusion (Contd..)

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