Fighting malnutritionar

MALNUTRITION IS a condition resulting from the deficiency or excess intake of calories and one or more nutrients. Low income and poverty are the main contributory factors to the wide prevalence of malnutrition. Better nutrition would give people more confidence in the survival of their infants and thus would lead to smaller families and slower population growth. All these are bound to improve the quality of life.

Surveys indicate that malnutrition among the under fives has come down in Tamil Nadu. Moderate cases of malnutrition have decreased from 47 to 45.8 per cent, severe from 12.6 to 4.2 per cent but mild cases have risen from 34.2 to 42 per cent. While part of these statistics indicates improvement, the prevalence of anaemia to the tune of 70 per cent among pregnant women and that of iodine deficiency in certain pockets of the population is alarming. The National Family Health Survey points out that almost half (47 per cent) of children under the age of four years are underweight for their age and 13 per cent are severely underweight. Prevalence of vitamin A deficiency among pregnant women, infants and children, high morbidity rates, infant mortality and maternal mortality rates among certain population groups must receive intervention to wipe out malnutrition completely.

Fast foods

Added to nutritional deficiencies, problems such as traditional beliefs, fads and fallacies aggravate malnutrition. Recently there has been an increase in the sale and consumption of fast foods on the roadside. The growing pressure of population, increase in the number of working women, the breakdown of the joint family system and increase in the cost of living force people to depend on such `ready to eat' foods. These foods have economic, social and nutritional implications. There is an urgent need to insist on minimum quality and safety standards, particularly hygiene, with regard to the street foods.

Adulteration of food is a menace. Adulterants deteriorate not only the quality of food but also lead to deleterious effects. For example, admixture of argemone oil with mustard oil causes epidemic dropsy. While the problems of undernutrition persist among the poor, there is also a simultaneous emergence of malnutrition among the new rich urban class. Their lack of awareness about good nutrition is reflected in an alarming increase in the incidence of obesity, coronary artery disease, hypertension, diabetes and cancer among the youth. The replacement of millets with refined rice or maida leading to decreased fibre consumption, excessive consumption of refined calories and decreased physical activity are also the causative factors for the increasing occurrence of malnutrition.

Malnutrition lowers resistance to diseases, resulting in higher morbidity, apathy, lethargy and reduction of working efficiency. These lead to low income, low standard of living, poverty and infection.

The magnitude and implications of the nutritional problems call for urgent actions. A multi-pronged approach including increased food production, its equitable distribution, nutrition intervention and nutrition education need to be considered as the most important focal points.

The area of food production is the main concern of the agriculturists. The nutritionists can help in analysing the food for nutrients, evolving new food processing and preserving techniques, introducing novel nutritive foods in the dietary patterns and developing new infant weaning foods, and low-cost recipes.

The major ongoing nutrition intervention programmes in Tamil Nadu are: the Integrated Child Development Services (ICDS), Nutritious Meal Programme (NMP), anaemia and vitamin A prophylaxis and goitre control. Each programme has specific objectives and provides supplementary nutrition and other services.

ICDS programme is a major strategy in providing children the basic health and nutrition related services, pre-school education and other supportive services such as water supply and sanitation.

The supplementary nutrition in ICDS provides about 300 calories and 12-15 g of protein per child per day for 300 days in a year. Their mothers receive 80 g of supplementary food per day in the form of a `ready to consume' mixture on take-home basis.

Tamil Nadu has been a pioneer in organising successfully a massive feeding programme for children from the age of 2+ to 14+ years throughout the year.

The best solution in the long run is to impart nutrition knowledge to the people, utilising different methods. The efficiency of different methods, desirable channels for approaching the community and the impact evaluation have been studied by Avinashilingam institutions, Coimbatore. One of their studies showed that as the level of education among mothers increased, the birth rate decreased and the IMR got reduced.

In order to derive maximum benefits from the interventions, the following actions are recommended:

The various types of the ongoing interventions must be evaluated scientifically as part of the programme. Local educational institutions, NGOs, research organisations and medical personnel should be involved in the evaluation of the programmes.

All the interventions should have the built-in component of education.

All the developmental and poverty alleviation programmes should spread the message of nutrition to the beneficiaries.

All the possible channels must be utilised to create public awareness about nutrition.

Wise choice

The following guidelines will help obtain maximum health returns:

A diet consisting of food in proper amounts from different groups - cereals, millets, pulses, vegetables, fruits, milk, oils and nuts, eggs and fleshy foods - provide the required nutrient. Variety in food is essential for healthy food habits. Milk which provides good quality proteins and calcium must be an essential item of the diet for infants, children and women. Oils and nuts are calorie-rich foods, and are useful for increasing the energy density. Vegetables and fruits provide protective components such as vitamins/minerals and fibre.

A balanced diet should provide around 60-70 per cent of total calories from carbohydrates, preferably starch, about 10-12 per cent from proteins and 20-25 per cent from fat.

Pregnancy is physiologically and nutritionally a highly demanding period. Extra food is required to satisfy the needs of the foetus. A lactating mother requires extra food to secrete adequate quantities of milk to the infant and to safeguard her own health. Breast-milk is the most natural and perfect food for normal growth and healthy development of infants. Therefore it should be fed to infants from the moment of birth. Breast-feeding reduces the risk of infections. It can be continued up to two years.

Breast-milk alone is not adequate beyond 4-6 months of age. Food supplements must be given along with breast-feeding. Provision of adequate and appropriate supplements to young children will prevent malnutrition.

A nutritionally adequate diet is essential for optimal growth and development of children. Appropriate diet during childhood will reduce the risk of diet-related diseases.

Micronutrients

Vegetables/fruits are rich sources of micronutrients, such as iron, iodine and vitamin A. Fruits and vegetables provide also several non-nutritional factors like fibre and phytochemicals. Green leafy vegetables, other vegetables (yellow/orange) and fruits help in the prevention of micronutrient malnutrition and certain chronic diseases.

Fats/oils have high energy value and provide satiety. Fats provide essential fatty acids and promote absorption of fat- soluble vitamins. Diets that provide excess of calories, fats and cholesterol elevate blood lipids (cholesterol and triglycerides). Excessive fat in the diet increases the risk of obesity, heart disease, stroke and cancer.

Obesity which is defined as excess accumulation of body fat results from overeating. Obesity leads to several adverse health effects and can even lead to premature death.

Sodium is the major electrolyte in edible salt. It plays an important role in nerve function and fluid balance in the body. Maintenance of sodium balance depends on kidney function. High intake of salt is associated with high blood pressure and stomach cancer. All foods contain sodium. Hence the sodium requirements can be met with moderate salt intake.

Cultural factors play an important role in dietary practices. Faulty food beliefs and faddism affect adversely nutrition and health. Proper cooking renders food palatable and helps in easy digestion.

The elderly have reduced need of calories. The elderly are more prone to diseases due to lowered food intake, physical activity and resistance to infection. The elderly need more calcium, iron, zinc, vitamin A and antioxidants to prevent age-related diseases.

Awakening to the call of good nutrition and practising the basic principles from early childhood can go a long way to help prevent many disorders.

RAJAMMAL P. DEVADAS

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