How much is right: Nutrition manual for Indians

By Syed Akbar
A majority of Indians are malnourished. Even those who consume sufficient 
quantity of food suffer from malnutrition because they don not get well-
balanced food. Nationwide surveys by Central government agencies over the 
years reveal that Indians, including those living in urban areas, suffer from 
common nutrition problems like protein energy malnutrition and 
micronutrient deficiencies (vitamin A, iron, iodine and vitamin B-complex).
Keeping this in view, the Hyderabad-based National Institute of Nutrition has 
come out with a Nutrition Manual containing dietary guidelines for Indians, 
particularly adolescent girls and pregnant women. The guidelines give a 
broad perspective on the present nutritional scenario in the country, besides 
suggesting the type of food one should take for healthy, long and happy life. 
The nutrition quota differs from person to person depending on the amount 
and type of work he or she undertakes. It also varies depending on age and 
sex.
The nutrition guidelines assume importance in the backdrop of the poor 
health scenario in several parts of the country. About one-third of infants 
born are low in weight i.e. less than 2.5 kgs. This is as against less than 10 
per cent of low birth weights recorded in developed countries including small 
nations like Israel. It was also noticed that two per cent of nursery school 
children in the country suffer from severe and florid forms of protein energy 
malnutrition leading to health problems like Kwashiorkor and marasmus.
Health surveys reveal that children below five years suffer from sub-clinical 
under-nutrition resulting in low weight for age. This is less than 75 per cent 
of median weight for age as fixed by the National Centre for Health 
Statistics. About 65 per cent of these children are stunted (low height for 
age). Under-nutrition if continued throughout the growing phase of 
childhood leads to short stature in adults. Half of the adults in the country 
have body mass index  below 18.5, which in other words means chronic 
energy deficiency.
The dietary goals as envisaged by the NIN include maintenance of a state of 
positive health and optimal performance in populations at large, ensuring 
adequate nutritional status for pregnant women and lactating mothers, 
improving birth weights and promoting growth of infants, children and 
adolescents to achieve their full genetic potential and preventing chronic diet-
related disorders.
The dietary guidelines are: consuming nutritionally adequate diet through a 
wise choice from a variety of foods; additional food and extra care during 
pregnancy and lactation; food supplements for infants by four to six months; 
consumption of green leafy vegetables, other vegetables and fruits in large 
quantities; moderate use of oils, sugar and salt; avoidance of processed and 
ready-to-eat foods; and adequate amounts of water.
According to NIN, a balanced diet should provide around 60 to 70 per cent of 
total calories from carbohydrates, preferably starch, about 10-12 per cent 
from proteins and 20-25 per cent from fat.
Nutrient dense low fat foods are recommended for old people for being 
physically active and healthy. Nutritionally adequate diet with extra food for 
child bearing/rearing women for maintenance of health productivity and 
prevention of diet-related disease and to support pregnancy/lactation.
Body-building and protective foods are recommended for adolescents for 
growth spurt, maturation and bone development. For children's growth, 
development and to fight infections, energy, body-building and protective 
food (milk, vegetables and fruits) are recommended. And for infants, breast 
milk and energy rich foods (fats and sugar) are needed for growth and 
appropriate milestones.
The balanced diet recommended for an adult man (sedentary) per day is: 20 
grams of oil/fats; 25 grams of sugar, 300 grams of milk and milk products, 60 
grams of pulses (for vegetarians), 30 grams of pulses, egg/meat/chicken/fish 
(for non vegetarians), 400 grams of vegetables, 100 grams of fruits and 420 
grams of cereals and millets. Elderly people may reduce 90 grams of cereals 
and millets and add an extra serving of fruit.
In case of women, 300 grams of vegetables, 300 grams of cereals and millets 
and 20 grams of sugar, besides the other dosage recommended for men.
Half of the people suffer from nutritional anaemia and this is more 
pronounced in women as 70 to 90 per cent of them are found to be anaemic. 
Health statistics indicate that anaemia caused due to malnutrition kills over a 
lakh pregnant women. Coming to iodine deficiency, about 300 million people 
live in areas where iodine is in short supply. Iodine deficiency leads to 
problems like goitre, neonatal hypothyroidism, mental retardation, delayed 
motor development, stunting, deaf-mutism and neuromuscular disorders. 
Around one lakh still-birth and neonatal deaths occur every year because of 
deficiency of iodine in mothers.
Studies by the National Nutrition Monitoring Bureau show that the daily 
intake of most foods, except cereals and millets (470 grams) is much below 
the recommended dietary allowances. The diets provide negligible amounts 
of protective foods like pulses (29 grams) and vegetables.
Consumption of green leafy vegetables and other vegetables (70-80 grams), 
which are rich sources of micronutrients like beta-carotene, folate, calcium, 
riboflavin and iron, is woefully inadequate. Intake of visible fat is less than 
60 per cent of the RDA.
"The proportion of households with energy inadequacy is 48 per cent while 
that with protein inadequacy is 20 per cent. Thus, in the cereal/millet-based 
Indian dietaries, the primary bottleneck is energy and not protein, as was 
earlier believed. This dietary energy gap can be easily overcome by 
increasing the quantities of habitually eaten foods by the poor," the study 
points out.

Food served in government residential schools is not nutritious, lacks in vital minerals

Syed Akbar
Hyderabad: The food served to students in many government
residential schools in the State is anything but nutritious and the
inmates mostly end up anaemic.

A detailed analysis of food served in select government residential
schools under Andhra Pradesh Social Welfare Residential Educational
Institutions Society revealed that the diet falls short of the
Recommended Dietary Allowance by almost 50 per cent. The students thus
consume just half of the daily nutritional requirement for a healthy
growth of body and mind.

Teams from the micronutrient research group of the biophysics
division, and the division of community studies, of the National
Institute of Nutrition collected samples of food served in lunch from
government residential school hostels. Since iron is linked to body
energy and better performance, both physical and mental, the NIN teams
studied the content of iron in the menu served. They also studied the
haemoglobin content in the blood of the students. A majority of boys
and girls showed high incidence of anaemia, which could be linked to
low dietary intake of iron.

The researchers included D Roy Choudhury, MS Radhika, GNV Brahmam and
K Madhavan Nair. The students were adolescents, in the age group 13 to
15 years. It is the rapid growth period with physiological and
psychological modulation and the children need extra nutritional
requirement.

The Recommended Dietary Allowance for Indian adolescent boys and girls
is 32 mg and 27 mg respectively, and when it is calculated for 1000
kcal, it comes to 12 mg. The NIN scientists found that the iron
density of prescribed diet was 5.55 mg/1000 kcal, which is 50 per cent
lower than the RDA of 12 mg/1000 kcal.

The iron density in the individual intake was also found to be lower
at 5 mg per 1000 kcal than the corresponding RDA. To corroborate these
findings, the researchers took the overall prevalence of anaemia,
which was found to be 66 per cent in girls and 75 per cent in boys.

“The deficit in iron density of diets and concomitant prevalence of
anaemia among adolescent in government residential schools are of
concern and calls for implementation of focused strategies for dietary
diversification and food fortification concurrently to improve and
maintain the macronutrient status of adolescents,” the NIN teams
observed in their study.

Indian children are capable of registering a high growth rate

Syed Akbar
Hyderabad: Indian children are capable of registering a high growth rate provided they get a well-balanced nutritional diet during the schooling years.
A study conducted by the city-based National Institute of Nutrition showed micronutrient-rich supplement would increase tissue growth and skeletal shell in apparently normal children. School-children who received micronutrient-rich food recorded growths up to three cm in height and four kgs in weight during the 14 months of study as compared with children fed with regular normal diet.
The NIN carried out the study among residential school-children, between six and 16 years of age, in Hyderabad. As many as 268 children were selected randomly from two classes of each grade (1 to 9) and were provided a micronutrient-enriched beverage. While 146 got the micronutrient-rich beverage, 122 children received a placebo drink.
Bone parametres and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study.
After 14 months, increments for height, weight, fat-free mass, percentage of fat, whole-body bone mineral content, whole-body bone area and bone mass density at the neck of the femur were significantly greater in the supplemented group than in the placebo group.
NIN deputy director Veena Shatrugna, who conducted the research study, told this correspondent that diets in the boarding school provided 745 mg/d of calcium, including the calcium from milk used to reconstitute the respective supplements.
This is the first time that data on bone parametres in children between the ages six and 16 years is reported from India. The baseline values appear to correspond to reported values from the West. In addition, the beneficial effects of an additional calcium intake of 224 mg with other micronutrients in the supplemented group compared with the placebo group have been demonstrated, she pointed out.
The children in this study belonged to middle-income group from the semi-urban areas of Hyderabad with apparent adequate intake of energy and protein, but intakes of vitamin A, iron, folate, thiamin, and niacin were less than 60 per cent of recommended dietary allowance and calcium intakes were only 700 mg/d which is much below the Western RDAs.

Indian children capable of registering high growth rate

By Syed Akbar
Hyderabad: Indian children are capable of registering a high growth rate provided they get a well-balanced nutritional diet during the schooling years.
A study conducted by the city-based National Institute of Nutrition showed micronutrient-rich supplement would increase tissue growth and skeletal shell in apparently normal children. School-children who received micronutrient-rich food recorded growths up to three cm in height and four kgs in weight during the 14 months of study as compared with children fed with regular normal diet.
The NIN carried out the study among residential school-children, between six and 16 years of age, in Hyderabad. As many as 268 children were selected randomly from two classes of each grade (1 to 9) and were provided a micronutrient-enriched beverage. While 146 got the micronutrient-rich beverage, 122 children received a placebo drink.
Bone parametres and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study.
After 14 months, increments for height, weight, fat-free mass, percentage of fat, whole-body bone mineral content, whole-body bone area and bone mass density at the neck of the femur were significantly greater in the supplemented group than in the placebo group.
NIN deputy director Veena Shatrugna, who conducted the research study, told this correspondent that diets in the boarding school provided 745 mg/d of calcium, including the calcium from milk used to reconstitute the respective supplements.
This is the first time that data on bone parametres in children between the ages six and 16 years is reported from India. The baseline values appear to correspond to reported values from the West. In addition, the beneficial effects of an additional calcium intake of 224 mg with other micronutrients in the supplemented group compared with the placebo group have been demonstrated, she pointed out.
The children in this study belonged to middle-income group from the semi-urban areas of Hyderabad with apparent adequate intake of energy and protein, but intakes of vitamin A, iron, folate, thiamin, and niacin were less than 60 per cent of recommended dietary allowance and calcium intakes were only 700 mg/d which is much below the Western RDAs.

People in Andhra Pradesh are nutritionally "backward"

2005
By Syed Akbar
Hyderabad, July 15: People in Andhra Pradesh are "starved" nutritionally when compared with those living in many States in the country.
According to a research study carried out by Andhra Pradesh Social Watch (Report 2005), chronic energy deficiency is observed in 37.4 per cent of men and 42 per cent of women living in villages. The scenario, however, is slightly better in towns and cities.
The average protein intake of both rural and urban Andhraites is just 62 (gm/cu/day) as against the all-India figure of 71.50. They also lag behind in fat intake. The State's average fat consumption is 50.7 gm/cu/day as compared with the all-India intake of 60.70 gm/cu/day.
Consumption of pulses in the State is 860 grams per head per month as against the all-India average of 960 grams.
The study points out that the per capita consumption of food items in the State is largely below the Indian Council of Medical Research norms. Even in urban areas, out of 10 food items examined during the survey, not a single food item is consumed according to the ICMR norms.
As many as 10.5 per cent of children in the State are severely undernourished and 28.2 per cent are moderately undernourished. The incidence of moderate malnutrition implies that the affected children may not reach their full physical and mental potential while severe malnutrition indicates that they may be functionally impaired.
No wonder then that Andhra Pradesh ranks 13 among 16 top States in the country in terms of food availability situation.
The per capita consumption of milk in the State is 3.96 litres per month as compared with 4.59 litres national average. Fish consumption is just 0.08 kgs per month in the State while the all-India average is 0.22 kgs. Break-up of other food items in the State with national average in brackets is: edible oil 0.60 kgs (0.72 kgs), vegetables 2.93 kgs (3.02 kgs), fruits 0.97 kgs (1.06 kg) and sugar 0.67 kgs (1.00 kg). Only in the case of cereals, the State is slightly ahead with just 42 grams per month. The State's per capita monthly consumption of cereals is 10.94 kgs (10.42 kgs all India).
Even in the case of production too, the State lags behind. Production of cereals in the State is only 363.35 grams per capita while ICMR norms stipulate 420 grams per head per day. The all-India average is 430.33 grams. About 40 grams of pulses are needed per head per day while the actual net production in the State is just 22.68 grams (all-India average is 31.94 grams).
"Consumption of food too provides important information about the food security status. In Andhra pradesh there's deficit in production over consumption of cereals. While net production of cereals is 381.90 grams per day the actual consumption is 442.33 grams," the report points out.
Though the Rural Food Insecurity Atlas (prepared by Dr MS Swaminathan Foundation and World Food Programme) has shown surplus net production of milk, edible oil, sugar and fruits in Andhra Pradesh, the same is not reflected in the per capita consumption in urban areas. In the case of cereals, 87 per cent of the ICMR norm is fulfilled but when it comes to pulses it is only 73 per cent. It is as low as 24 per cent in the case of eggs.
Stating that food consumption pattern across classes of consumers too demonstrates the food insecurity situation, the report points out that per capita monthly consumption for cereals is 10.94 kgs for all classes while it is only 9.67 kgs for the lowest 10 per cent.
This difference is viewed in the consumption of other food items as well. The per capita monthly consumption of pulses for all classes is 0.86 kgs but it is as low as 0.46 kgs for the lowest 10 per cent of the population.