Mother’s Nutrition has a lifelong impact on the child’s mental and physical heath. Maternal Malnutrition and Child Under nutrition results in stunting in less than 5 years age children and also Low Birth Weight (LBW). This has long term consequences like poor cognitive skills and susceptibility to infections.

India has a unique challenge which is the double burden of malnutrition. The CNNS (Comprehensive National Nutrition Survey) highlights overweight and obesity is common in Indian children also. A staggering 54% of Indians are anaemic. Hidden Hunger or micronutrient deficiencies are common in both the urban and rural population. Malnutrition in several forms is found in early adolescence and they also fail to meet the requirements of Physical activity. With more screen time and increase in consumption of junk foods there is increase in many micro nutrient deficiencies in both genders.

According to CNNS survey (2016-18) Top 3 Deficiencies in Boys & Girls

India being diverse in culture and food habits and varied socio economic strata it is difficult to tackle the problem of maternal malnutrition and under nutrition. Adhering to local traditional foods, RUTF (ready to use therapeutic foods) and sourcing local crops and produce is one simple and effective way to address local concerns in villages and districts. Communication in local language by the Health and ASHA workers on the importance of Nutrition will slowly bring about a change in the society. Socio Economic environment also contribute to malnutrition such as Gender Bias in the society (girl Child is neglected in some culture) education, sanitation & hygiene and of course poverty.

Key points to emphasize to tackle Malnutrition:

• Adequate Nutrition with Iron and Folic Acid Supplementation for women of Reproductive age and Expectant mothers
• Only Breast Feeding for the initial 6 months
• Infant and Young child feeding Practices to be counseled and its implementation monitored
• Introduction of Right Complementary Foods at 6 months along with Breast feeding
• Prevention of Anemia with Iron and Vitamin C rich foods
• Sanitation & Hygiene
• Prevention of Diarrhea
• Distribution of Fortified foods through ICDS (Integrated Child Development Services) and PDS (Public Distribution System)
• Sourcing locally and encouraging local farming to be self-sustained
• Emphasizing on Dietary Diversity
• Monitoring SAM ( Severe Acute Malnutrition) children in Anganwadis
• Education to school kids on importance of Nutrition

With Covid-19 ravaging most parts of World including India the burden of Protein Energy Malnutrition is also predicted to become worse. Effective Communication in Local languages on the right local foods to consume and ensuring Food Security to all will go a long way in reducing Malnutrition.

Sreemathy Venkatraman
Clinical Nutritionist & Dietician
Brains Hospital
Bangalore

The post Poshan Maa First 1000 days -India’s challenge is malnutrition. appeared first on Health Vision.

New Delhi, 18^st Sept’ 2020: COVID-19 has hardly left anyone unaffected. Recently, UNICEF warned that an additional 6,000 children could die daily from preventable causes over the next six months as the COVID-19 pandemic has weakened the health systems, disrupting routine services. In the Rashtriya Poshan Maah, to discuss Nutrition Security and National Nutrition Programs; the Immunity Conundrum: Lesson learnt, and Ayurveda, Yoga & Naturopathy: Linking ancient wisdom to modern science, ‘Healthcare Advocacy Group’ — HEAL Foundation in association with ICCIDD and name partner Coalition Food & Nutrition Securityorganised ‘India Immunity e-Summit 2020: Science of Balancing Food & Nutrition in Maintaining Optimal Immunity’ followed by ‘Immunity Champions of India Awards’ on September 17.

During COVID-19, the Prime Minister’s overarching scheme for Holistic Nutrition or POSHAN Abhiyaan or National Nutrition Mission, a flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers have been affected badly. This is a multi-ministerial convergence mission with a vision to address malnutrition in a targeted approach. On being asked on the current state of malnutrition amongst the children in India due to COVID-19 and the probable measure to overcome this menace, Mr Arjan De Wagt, Chief of Nutrition, UNICEF, India, while addressing ‘India Immunity e-Summit 2020 said, “As far as malnutrition in India is concerned, Lancet study last year estimated that two-thirds of the 1.04 million deaths in children under five years in India is still attributable to malnutrition. And during COVID-19, it may increase by 10-20%’’.

“COVID-19 has affected the momentum of POSHAN Abhiyan, and induced the nutrition crisis. However, in the ongoing Poshan Maah, we see the momentum is getting back, and I hope to see POSHAN Abhiyan 1.2. The govt. needs to maintain the tempo and get back on track with maximum Coverage, Continuity, Intensity and Quality (CCIQ) to fight back COVID-19. And In my opinion, there should be 12 Poshan Maah and 52 Breastfeeding Weeks in a year rather than one. Parents play the biggest role in feeding the children, so they should be educated about the importance of nutrition in boosting immunity”, added Mr Wagt.

While addressing ‘India Immunity e-Summit 2020, Mr Tarun Vij, Country Director, GAIN, said, “Still, 700 thousand children are stunted. In the COVID-19 pandemic, already vulnerable groups have been affected the most as the food supply chain got disturbed. Considering the malnutrition and stunting in India galore, all development partners should work towards food fortification. This will help make out the nutritional balance because nutrition is the key to life and if one is nutritionally deficient, one is going to die.”

Elaborating on the essence and the need to conduct such discourse on nutrition and immunity, Mr Bishow Parajuli, Representative & Country Director, WFP, India, while addressing ‘India Immunity e-Summit 2020 said, “During the COVID-19 time, some Indian states have faced crisis but at the same time the role of some states have been instrumental in tackling the COVID-19 situation such as Kerala, Orissa and UP have done a fantastic job, indeed. Especially, the UP state has been seen quite proactive in ensuring that the people receive foods even without ration cards. The CM of UP is coming forward and making sure that no one sleeps hungry. To scale up the food supply chain and to combat the food crisis, the UP Govt. is pumping INR 1200 crore.”

“Although, hunger and malnutrition are rising due to COVID-19, yet civil societies, self-help groups are coming forward to rescue the people encountered with hunger. POSHAN Abhiyan in India is fantastic, though it is affected a bit due to COVID. During mass migration, we realised hidden hunger, so we need to customise the nutrition module”,added Mr Bishow Parajuli.

Deliberating on the importance of nutrition and its relevance with optimising immunity, Dr Swadeep Srivastava, Founder HEAL Foundation, said, “Malnutrition has always been a major problem in India with over 38% of Indian children under five being stunted and over 50% of women of reproductive age are anaemic. And this momentum has increased considerably during COVID-19. This pandemic has made us learn the importance of food & nutrition and its pivotal role in maintaining optimal immunity. We need to balance our nutrition because India faces the double burden of undernutrition and obesity: the cases of overweight adults are now almost equal to the number of underweight adults. Nothing but balanced nutrition can only help us maintain the desired level of immunity.”

“The world at large is passing through the abject nutritional crisis in the wake of the COVID-19 pandemic which has resulted in debilitating of immunity. It is very important to make the people aware of the close relationship between nutrition and immunity. In such a scenario, organising ‘India Immunity e-Summit 2020 is indeed a much needed and a welcome step forward”, Dr C S Pandav, Former HoD, Community Medicine, AIIMS, Director- South Asia Region, ICCIDD.

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New Delhi, Sep 1, 2020: Highlighting that the POSHAN Abhiyaan will benefit more than 10 crore people, hon’ble Minister of State for Social Justice and Empowerment Shri Ramdas Athawale today said that the government is addressing malnutrition in a ‘mission-mode’. He was delivering the inaugural keynote address at the Bharat Nutrition Week, organised by the Integrated Health and Wellbeing (IHW) Council, a non-profit social impact institution promoting health for all, on the first day of ‘National Nutrition Month’.

“Since March 2018, our government has initiated POSHAN Abhiyaan that directs the attention and efforts to tackle the problem of malnutrition and address it in a mission-mode. This programme will benefit more than 10 crore people, especially women and children. POSHAN Abhiyaan is an intensely community-based programme that involves family members – husbands, father, mothers-in-law and neighbours – and community health care providers to create awareness on key nutrition behaviours. As a society, it is our responsibility to ensure that everyone gets the required nutrition. The war-footing efforts will ensure people even in the remotest part of India get this necessity,” says Minister of State for Social Justice and Empowerment, Shri Ramdas Athawale.

“There are two Indias in this India comprising the under-nourished and the over-nourished. Both these types are at an increased risk of morbidity and mortality irrespective of sex and across all ages. The issue of malnourishment should be addressed by inculcating healthy habits in children in and outside schools who can influence their peers, teachers, and parents. Besides, people should be made aware of eating habits on three principles: Balance of nutrition; moderation of portion; and variety of food,” says Dr Harshad Thakur, Director, National Institute of Health & Family Welfare, MoHFW.

“Our approach to nutrition is fragmented and approaches mentioned by the Prime Minister, e.g. nutrition cards and nutrition monitors, are very innovative. We need a shift in our approach to nutrition deficiencies: use a lifecycle approach; bringing together all sectors and ministries; move from food security to nutrition security; focus on family-based interventions; and address the spectrum of nourishment which means one who is ‘over-nourished’ with one ingredient may be under-nourished for another,” says Dr Sanjiv Kumar, Chairperson, Indian Academy of Public Health.

“India’s rank in the Global Hunger Index indicates how prevalent malnutrition is in the country. Jan Bhagidari or public participation is the most important part of our battle against malnutrition. Besides, we must also be mindful towards those who are suffering due to improper nourishment – it is critical to induce a behavioural change in them. The ‘Bharat Nutrition Week’ aims our goal of securing and ensuring access to good food for all,” says Mr. Kamal Narayan, CEO, Integrated Health and Wellbeing (IHW) Council.

Aiming to raise the awareness and discussion around nutrition among children, a fact highlighted by honble Prime Minister Narendra Modi during his ‘Mann ki Baat’ broadcast, the event will have a special segment titled ‘Bharat Nutrition Quiz Show with School Kids’, where students from all over India will participate. Panel discussions with around 100 speakers including government officials of various ministries and institutions; policy experts of WHO and UNICEF; industry leaders, researchers, and medical practitioners will deliberate for over 60 hours on the pressing issues related to availability and access to nutrition. Discussion forums involving leading dieticians, nutritionists, food entrepreneurs and influencers will be held under ‘Good Food Talk Show’ while ‘Healthy Khayega India’, a special live session, will host celebrity chefs.

‘Bharat Nutrition Week’ is being hosted with support from Asian Research and Training Institute for Skill Transfer (ARTIST), WWW Foundation, World of Wellbeing (WOW), and Federation of Obstetric and Gynaecological Societies of India (FOGSI). The event will culminate on 7th September with Bharat Nutrition Awards 2020, honouring organizations, institutions and individuals for their contribution in developing innovative products, conducting new research, grassroot-level initiatives for women, children and elderly people, and spreading awareness and educational programs.

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The world has witnessed a rapid rise in nutrition-related disorders. Scientists at EON believe that a bad diet is another form of malnutrition where the over consumption of saturated fats and refined sugar has a detrimental effect on the immune system. Our age, sex, infection history, genetics can affect our immune system and make us more prone to disease. Sadly the world has been witnessing a trend in the consumption of high fats, sugars and salts which have now led to the suppression of the immune system.

Leading to the inability of the immune system to mount an effective attack increases the risk of disease and the ability of the body to recover over chronic exposures. The immune system is designed to detect and destroy foreign invaders inside the body like bacteria and viruses. When working optimally, the immune system can prevent sickness when we’re exposed to germs. Several factors like sleep, diet, stress and hygiene can affect the immune system’s performance, and any offsets in these behaviours can cause havoc on immune function.

Factors leading to a suppressed immune system: 

Often the impact of these factors go unnoticed, but if you tend to get sick after a big project at work or during finals at school, it’s likely because your immune system has suffered due to stress, lack of sleep, binge eating or unhygienic behaviours. Overall there may be two factors leading to a suppressed immune system and today we are facing a dual burden because of the same. One is malnutrition which may be clearly due to reduced availability of food across the certain lower socio-economic strata or any underlying disease condition. Reduced food also translates to lower proteins and micronutrients –directly proportionate to increased infections and lowered immunity.

The second factor is mall nutrition where once there is an energy abundance due high fat, sugar, salt food the body is still very depleted in micronutrients which creates the entire concept of hidden hunger where despite having extra calories, there is a significant shortfall of proteins, micronutrients like zinc, selenium, iron, Magnesium which would fight infections and increase immunity. Comprehensive research reflects diet high in refined sugar, salt, high fat and refined carbohydrates could lead to an unusual activation of T cells. T cells as we all know have a direct impact on our immune system .Higher the fat in the body the lesser the T cells production and obesity is directly related to lower immune responses.

In an Indian scenario, 73% of population is protein deficient –thereby leading to sarcopenic which means we have lesser muscles or lean body mass. Most Indians consume around 60 to 70 % carbohydrates in their diet and only 8 to 12 % of protein and 20 to 25 % of fat. This ratio needs to change because our dependence on carbohydrates is extremely high and protein intake is skimmed. The low Skeletal muscle mass is directly proportionate to reduced immunity and higher rates of infections.

It may be prudent to change the portion of protein to at least 15-20% of total energy. This can be achieved easily by  incorporating additional serves of  pulses, curd, nuts, dairy, lean meats like fish and chicken whilst reduction of refined carbohydrates. Impactful correlations as reflected by Body Impedance analysis studies increase in physical activity and resistant endurance exercises also elevate. Increasing fibre and increasing the colour from various fruits and vegetables basically “Eat Your Rainbow” as we often say increases the natural nutrients and antioxidants in the diet.

The Mediterranean diet was also found to be a perfect example of how to use fruits, vegetables, nuts and healthier fats like olive oil and fish to reduce the inflammation.  High Saturated fats and trans fats can be switched healthier fats like omega 3 is important. Sources of omega 3 fats would include nuts, fish and oil seeds which should be included on a daily in the diet thereby positively reducing inflammation.

Around 70% of our immune system is located in our gut. Gut bacteria also crowd out pathogenic bacteria, prevent them from adhering to the gut lining and gaining entry, as well as producing lactic acid which helps stop harmful bacteria growing. To encourage good bacteria, eat plenty of fibrous and pre-biotic foods such as bananas, oats, brown rice, millets, flax seeds, walnuts are particularly good.

Improving gut health:

Some other studies are based on improving gut health and increasing the pre-biotic and pro-biotic composition. Typically when one is looking at pre-biotic composition the moment one increases the intake of fruits and whole cereals, millets, nuts like walnuts, seeds like flaxseeds and pumpkin seeds. Enhancing your pre-biotic levels which create a base for the probiotic bacteria to grow thereby helping in improving gut health. Scientific studies indicate a change in dietary habit  from highly refined carbohydrates, high saturated fat and trans fats to a plant-based diet which is high in fibre, whole foods, pulses, millets, nuts, oilseeds, fruits and vegetables can  initiate a positive change the environment of the gut in as less as 5-7 days.

Increase intake of trans fats is another trend that is being witnessed today due a lot of consumption of refined foods especially bakery products, street foods, order-in menus owing to which a lot of trans fats creep into ones diet and this creates a lot of inflammation which is directly linked to heart disease to diabetes and other chronic conditions. Trans fats typically contribute to a lot of insulin resistance which increases the risk of developing type 2 diabetes even small amounts of trans fats can harm one’s health. Every two 2 calories from trans fats daily can increase the risk of heart disease and significantly impact inflammation so it is advisable to avoid trans fats.

Coming to saturated fats some amount of saturated fats less than 10% of the total calories consumed is allowed. However one should be careful while consuming trans fats from meat products specially marbling of the meat and skin of the chicken as all of these are completely harmful and should be deleted from the diet. In conclusion, the two major studies narrowed down to showing that just replacing saturated fat with polyunsaturated fats like the vegetable fats is healthy. In an Indian scenario we could consider rice bran oil, ground nut oil and if a family is used to mustard oil or til oil they should continue to use the same this would help in reducing risk of disease along with the reduction of highly processed carbohydrates.

To counter a wrong diet EON looked at nutrition-based solutions where it found that a plant-based diet is highly anti-inflammatory. Studies show vitamins C, A, E, B6 and B12 and minerals like iron and zinc are important for the maintenance of immune function.

Maximise immune supportive nutrients:

1. Vitamin C enhances white blood cells response, increases interferon levels and improves the integrity of the mucous membranes.

2. Vitamin A plays an essential role in the health of the skin and mucosal barriers as well as enhancing white blood cell function, antibody response and thymus function.

3. Vitamin E is vital for both cell-mediated and antibody related immunity, and deficiency results in significant impairment of immune function.

4. Deficiency in B6, B12 and folic acid impairs immune function and immune response.

5. Zinc promotes destruction of foreign particles, is required for proper functioning of white blood cells and activates immune enhancing thymus hormone.

In Conclusion, the concept of a wrong diet automatically induces infection. The infection when continued in the body over a long period of time i.e. in a chronic stage along with depleted micro nutrient content in the body eventually leads to a state of inflammation and hence the concept of the DINI Axis is a is a very striking one as it connects all the dots together.

Dr.Naaznin Husein

Principal Coordinator- Nutrition and Dietetics

Esperer Onco Nutrition Private Limited (EON)

The post Malnutrition and mall nutrition suppresses immunity appeared first on Health Vision.

The average weight of a healthy two-year-old should be at least 8kgs; however, Rubina, born in Madhya Pradesh weighs only 6.5kgs. She was not always like this, though. She was born healthy and weighed just right. Over the years, it was observed that she did not grow at a healthy pace, which led the anganwadi worker in her village to declare her as severely malnourished. Such was her condition that doctors whom she was referred to, stated that her malnutrition could stunt her physical growth and cognitive development forever.

While such cases might seem isolated to the general public, reality however, is that India is home to the largest number of the world’s cases of child malnutrition. According to a joint study by ASSOCHAM and EY, about 37 per cent of children under the age of five are underweight, 21 per cent are wasted (low weight for height), 39 per cent are stunted, and eight per cent are acutely malnourished. It was also found, that as compared to urban India, which stood at 29 per cent, malnutrition in rural areas was 38 per cent. And despite statistics, as a country, we have not been able to employ even simple methods to identify such cases. These alarming findings have strongly advocated the need for India to frame healthcare policies with a focus on reducing social and health inequities.

One of the most efficient methods, which is used all over the world, is that of a measuring tape. The Mid-Upper Arm Circumference (MUAC) tape, is a simple and quick method used to determine whether a child is malnourished or not, and works using a three colour system.  A measurement in the green zone indicates a child is properly nourished, while yellow means he is at risk of malnourishment, and red indicates an acute case of the condition. The MUAC can be used on children aged one year and going up to five. This method of identifying cases of malnutrition is not only effective, but also easy to use. All a medical professional or assistant needs to do is simply determine the mid-point between the elbow and the shoulder of the left arm, and place the tape around it and record the measurement.

In a country like India, where majority of the rural population lives below the poverty line, a significant portion of infants are susceptible to malnutrition. And given the magnitude of people who do not have access to basic healthcare, employing the MUAC tape can make all the difference in identifying and treating cases of malnutrition. With the increase of Mobile Medical Units in rural India, these tapes can be used by paramedics as a tool during community outreaches, health camps, and even as part of anganwadis. By using such methods of identifying cases of malnutrition, it can serve as an understanding of the on-ground reality and become an opportunity for providing the Government with vital statistics to work towards providing solutions.

Malnutrition : How a Measuring Tape can be the Key to Progress? For any country, the health of its citizens is central to well-being and happiness and thus is an important contributor to economic progress. This also explains the old adage ‘health before wealth’, by looking at the links between good health boosting labour productivity, thereby reducing poverty. With high incidences of malnutrition, tackling this is key if India is to progress as a nation. In fact, The Global Nutrition Report has called for nutrition to be placed at the heart of efforts to end poverty, raise educational standards, tackle climate change and fight disease. The onus is now on us, to work along with the Government to not only identify cases of malnutrition, but also eradicate it across the country.

Manish Sacheti
Mumbai

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