New Delhi: ‘A balanced diet is essential for every individual’, this is a globally recognised fact, yet malnutrition is considered as the number one risk to health worldwide, as per the World Health Organisation (WHO). In a bid to highlight the importance of a balanced diet to ensure the proper intake of nutrients, the government of India is conducting a month-long campaign called Rashtriya Poshan Maah or the National Nutrition Month from September 1 to September 30. To understand the various aspects of nutrition and the imbalance of it, NDTV interviewed Dr. Charu Dua, Chief Clinical Nutritionist at Max Super Speciality Hospital Patparganj in East Delhi. Dr. Dua is also a member of the Indian Dietetic Association.
Here are the excerpts from the interview:
Question: What is malnutrition? How big is the problem of malnutrition in India?
Dr. Dua: Malnutrition is the deficiencies, excesses and imbalances of nutrients in the human body, as per the World Health Organisation. In India, malnutrition problem pose dual burden – first, undernutrition and second, overnutrition. Undernutrition further includes stunting or low-height-for-age, wasting or low-weight-for-height and underweight caused by long-term insufficient nutrient intake. While undernutrition hampers the growth of a child and decreases immunity, overnutrition leads to non-communicable diseases like diabetes, fatty liver, and high cholesterol.
There is also another fight when it comes to malnutrition which is lack of proper micronutrients such as vitamins and minerals because various micronutrient deficiencies lead to various diseases like anaemia. So we actually have three malnutrition situations to combat.
The problem of malnutrition is very big in our country. It is heart-breaking but true that over half of the deaths among children is due to malnutrition in India. As per the fourth and the latest National Family and Health Survey (NFHS-4), 38.4 per cent of children in the country die due to stunting and 46 per cent children die due to abnormally low weight.
Question: What are the symptoms of malnutrition? How can malnutrition affect children and women?
Dr. Dua: The first symptom of malnutrition is the abnormal Body Mass Index (BMI). BMI is the first parameter that is evaluated for nutrition screening in a person. It is calculated using a person’s height and weight. The healthy range of BMI is 18.5 to 24.9. A BMI of 25.0 or more is overweight and a BMI less than 18.5 is underweight.
Other symptoms include the loss of appetite, muscles, and hair. The person would experience fatigue, mental confusion, poor eye-sight and poor wound-healing. Swollen stomach among children is also a sign of malnutrition among children. While children and adults both can be affected by malnutrition, the numbers are alarming when it comes to malnutrition among children.
Addressing malnutrition among women is very important because a healthy mother means a healthy family and healthy families make a healthy country.
Question: The government has recently announced the target of eradicating malnutrition by 2022. How can India become malnutrition free by 2022? What are the critical steps that need to be adopted to meet this target?
Dr. Dua: If the country aims to become malnutrition free by 2022, it will happen only through awareness and through government support. The affluent population need to be made aware about the right kind of food they should consume for meeting the nutrient needs of the body and the economically poor sections of the society need to be provided with financial aid to get basic food items, education and guidance in terms of affordable recipes.
For building awareness and extending nutrition education among people the government needs to partner with hospitals, nutrition institutes, NGOs and health foot-workers providers like ANMs (Auxiliary Nurse Midwife) and Anganwadi Workers. The foot-workers can prove to be very significant in the fight against malnutrition as they are closest to the people, pregnant women and children. So they must be given special training focusing on nutrition especially for women and children. Regular health camps must be organised for people from affluent communities to address over-nutrition and obesity.
Another critical step is that food needs to be made more accessible to the people who are fighting and working hard to meet basic needs of themselves and their families. We need to reach the people that are below poverty line (BPL) which means that they have income below Rs. 32 per day in rural areas and Rs. 47 in urban areas, as per the new BPL estimated by an expert committee set up by the government in 2015. Most of the times, people below poverty line do not spend on buying even basic food items like vegetables, fruits, milk, gram flour, and sometimes even rice. It is the responsibility of the government to provide the basic food items to these people so that they can eat, and fight malnutrition. I understand this is a huge task as India has high poverty but we all need to join hands to eradicate malnutrition from the country.
Question: What is a balanced diet? How can people with no means have a nutritious diet?
Dr. Dua: A balanced diet is a diet which has food items from all the major food groups – carbohydrates, fats, fiber, minerals, protein, vitamins, and water. The mantra is to have a rainbow diet that is to add as many colours of food as possible. This is because each colour adds a different nutrient, for example, red foods like tomatoes, beets, radish, apples are rich in vitamin C and antioxidants; greens like broccoli, cabbage, sprouts, spinach are rich in iron and folic acid.
Nutritionists and dietician must work on developing innovative recipes that are affordable for people with lower means and these can be popularised through awareness programmes and training. For example, a simple ‘wheat flour and spinach crepe’ is very rich in iron, carbohydrates and is easily affordable. Another example is laddoo made from wheat flour, and Jaggery with a little bit of ghee is affordable and high in energy and iron.
It is a general perception that over-nutrition is found among people from affluent households and those people who have a sedentary lifestyle. However, in recent years, we have seen cases where people from the labour community or those who are involved in high physical work also suffer from over-nutrition and obesity especially in metropolitan cities. These cases are on a rise. We found that it is mainly because of the improper diet intake among them. Affordable high-calorie food like ‘Chole-kulche’, ‘parathe’ and ‘pav-bhaji’ are easily available on the streets and most of the time, the people from labour community eat such high-calories food just to fill the stomach and gain energy to work. Proper nutrition is not a consideration for them.
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Question: In terms of nutrition what are the factors to keep in mind for new mothers and children? What is the role of the first 1000 days in combating malnutrition among mothers and children?
Dr. Dua: Malnutrition can set in the mother’s womb itself. Thus, the first 1000 days which include the nine-month period of gestation and the first two years after birth are extremely crucial for mother as well as the child. If the mother is not healthy and her Body Mass Index which is one of the indicators of health is not more than 18.5, then there are extremely high chances that the child will suffer from malnutrition. In this case, we need to work on the mother first as malnutrition in the early pregnancy are linked with premature birth and low birth weight.
For the women who are between BMI 18.5 and 24.9, we just need to add 300 calories to her diet during pregnancy. The diet of a pregnant woman must include iron which is found in green leafy vegetables and foods rich in Vitamin C such as tomatoes. It must have folic acid, zinc, calcium, vitamin D, and fatty acids which are found in whole-grain cereal, milk, seafood, lentils and nuts.
For babies after birth, it is highly recommended that breastfeeding is initiated within the first hour of birth. Exclusive breastfeeding in the first six months is extremely important for the healthy growth of the child.