The Impact Of Dietary Habits On Nutritional Status Of Children In India

Dr. B. Sesikeran, MD, FAMS

Director National Institute of Nutrition (Indian Council of Medical Research)Hyderabad – 500 604E-mail: sesikeran@gmail.com

2

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

Source : WHO/SEARO 2000

0

20

40

60

80

10085

7772 69

5954

17 12

IMR

58 *

* SRS, Registrar General of India, 2004

*

3

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

Source : WHO/SEARO 200023 (NFHS 2) *

* Increase in Institutional Deliveries

4

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

5

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

Percent RDA

6

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

Percent of RDA

7

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

Percent RDA

8

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

Percent of RDA

9

10

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

Per

cen

t

11

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

(IAP classification)

Faulty BF Faulty Complementary feeding

12

INFANT AND YOUNG CHILD FEEDING PRACTICES (NFHS 3)

13

MICRO-NUTRIENT DEFICIENCIES

14

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%

15

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

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

16

Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20 G/dL, Median Dietary Intake of Vit. A (as % RDA) and

Extent of Coverage for Suppl. of Massive Dose Vit. A – By State

STATESBlood

Vitamin A < 20 g/dL

Dietary Intake of Vitamin A < 50% of RDA

Receipt of Massive Dose Vitamin A

1 or 2

Doses

No. of Doses

One Two

Kerala 79.4 91.8 38.5 28.4 10.1

Tamil Nadu 48.8 81.9 50.6 20.2 30.4

Karnataka 52.1 90.4 56.6 42.1 14.5

AP 61.5 92.9 49.3 14.2 35.1

Maharashtra 54.7 88.8 52.1 29.4 22.7

MP 88.0 87.4 52.3 19.1 33.2

Orissa 57.7 77.5 80.0 38.8 41.2

West Bengal 61.2 80.6 50.6 46.8 3.8

Pooled 61.8 86.3 55.4 30.3 25.1

Source: NNMB-MND Survey : 8 States, 2003

17

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

18

IRON DEFICIENCY

DIETARY FACTORS

LOW INTAKE OF DIETARY IRON

INFECTIONS & INFESTATIONS

Malaria Hook Worm Schistosomiasis

HAEMORRHAGIC CONDITIONS

ABSORPTIONDIETARY FACTORS Promoters Inhibitors

HOST FACTORS Iron Status Health Status

HAEMOLYTIC DISORDERS Sickle Cell Disease Thalassemia

AETIOLOGY OF IDA

IRON DEFICIENCY ANAEMIA

PHYSIOLOGICAL CONDITIONS

Menarche Pregnancies with Lack of adequate interval

19

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

20

Computed from NNMB data, rural survey, 2001

21

Computed from NNMB data, rural survey, 2001

22

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

23

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

24

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

25

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

Per

cen

t

UNDERNUTRITION (< Median - 2SD)

26

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

27

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

28

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

29

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)

30

Variable Sub-variableOverweight

subjectsNormal

subjects

Outdoor games & sports

Participation 54.5 66.7

Av. duration (hrs/wk) 2.3 3.7

Physical exerciseParticipation 46.2 45.3

Av. duration (hrs/wk) 3.5 4.1

Household chores

Participation 70.4 77.2

Av. duration (hrs/day) 36 48

TV watchingParticipation 86.6 88.0

Av. duration (hrs/day) 1.4 1.2

Nap during a dayParticipation 14.3 9.9

Av. duration (min/day) 12 6

Various practices among overweight and non-overweight urban Adolescents in Andhra Pradesh

NIN-WHO Technical Report 2007

31

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

32

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. The coverage for vitamin A and IFA tablets

supplementation was poor

33

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..)

Thank you