The document discusses common nutrition problems in India. It identifies groups most at risk like pregnant women, lactating women, infants, preschool children, and adolescent girls. The common problems are listed as poor weight gain and low birth weight in women, and growth faltering, protein energy malnutrition (PEM), and micronutrient deficiencies in children. It provides data on malnutrition indicators like prevalence of low birth weight, infant and child mortality rates, anemia in pregnant women and adolescent girls, and goiter rates. Determinants of malnutrition are identified as maternal malnutrition, faulty childfeeding practices, dietary inadequacy, frequent infections, large families, and high female illiteracy. Current interventions to address the problems are also outlined

1. COMMON NUTRITION PROBLEMS
IN INDIA
Dr. K.VIJAYARAGHAVAN
DIRECTOR – RESEARCH,
SHARE INDIA (MEDICITI INSTITUTION)
&
Sr. Dy. Director, NIN (Retd)
<drk.vijayaraghavan@gmail.com>

2. MOTHER AND CHILD
SURVIVAL
MMR
407/100,000 live births
IMR*
Child Mortality
Rate(1-4 years)
58/1000 live births
19.5/1000 Children
*Gujarat 53
Vijayaraghavan

3. NUTRITION PROBLEMS IN
INDIA
WHO IS AT RISK??
PREGNANT WOMEN
LACTATING WOMEN
INFANTS
.
PRESCHOOL CHILDREN
ADOLESCENT GIRLS
ELDERLY
SOCIALLY DEPRIVED
(SC & ST Communities)
Vijayaraghavan

4. NUTRITION PROBLEMS IN
INDIA
WHAT ARE THE COMMON PROBLEMS?
WOMEN
CHILDREN
• POOR WT. GAIN
LOW BIRTH WEIGHT
• GROWTH
DURING
PREGNANCY
FALTERING
• CED
• PEM
• MICRONUTRIENT
• MICRONUTRIENT
DEFICIENCIES
DEFICIENCIES
 FLUOROSIS, LATHYRISM
 DIET RELATED CHRONIC DISEASES
OBESITY, CARDIOVASCULAR
DISEASES, DIABETES
Vijayaraghavan

5. nm
ar
do
ne
si
a
Th
ai
la
nd
In
B
hu
ta
n
10
7.
2
11
16
18
20
20
Sr
iL
an
ka
23
25
M
al
di
ve
s
M
ya
30
33
35
In
di
a
N
ep
al
PER CENT
PREVALENCE OF LBW IN S.E ASIAN COUNTRIES
30
15
5
0
Vijayaraghavan

6. FACTORS MODIFYING PREVALENCE OF
LBW
• % INSTITUTIONAL DELIVERIES
• # ANCs (Minimum: >5)
• QUALITY OF ANC
Includes:
No.of ANCs, TT, Weight, BP,
Examination of Blood,
Examination of Urine

7. INFANT MORTALITY AND BIRTH WEIGHT
1200
IMR /1000 Live-births
1000
1000
800
615
600
400
238
200
59
21
18
0
<1
1-1.5
1.5-2
2-2.5
2.5-3
>3
BIRTH WEIGHT (KG)
S
Source: Shanti Ghosh et al, 1978

8. IFA SUPPLENTATION AND LBW
35
30
PER CENT
25
30.8
20
30.2
15
15.5
10
5
0
CONTROL
IRON
GROUPS
Source: Leela Iyengar & Apte, S,V.,1970
FOLIC ACID

9. SUPPLENTATION OF IRON / FOLIC ACID
AND BIRTH WEIGHT
3000
BIRTH WEIGHT (g)
2900
2800
2700
2890
2600
2500
2567
2650
2400
CONTROL
IRON
GROUPS
Source: Leela Raman & Rajalakshmi,1974
FOLIC ACID

10. NUTRITIONAL DISORDERS IN CHILDREN
• PROTEIN ENERGY MALNUTRITION (PEM)
. CLINICAL FORMS
. SUBCLINICAL UNDERNUTRITION
• MICRONUTRIENT DEFICIENCIES
Vijayaraghavan

11. CLINCAL FORMS of PEM
KWASHIORKOR
•
•
•
•
OEDEMA+
IRRITABILITY+
GROWTH FAILURE+
DISCOLOURED HAIR+
Vijayaraghavan

12. CLINCAL FORMS of PEM
MARASMUS
EXTREME WASTING
“SKIN AND BONES”
MONKEY/OLD MAN
FACIES
Vijayaraghavan

13. SUB-CLINICAL FORMS OF PEM
UNDERNUTRITION
WASTING
STUNTING
 WEIGHT FOR AGE
 WEIGHT FOR
HEIGHT
HEIGHT FOR AGE
Vijayaraghavan

14. UNDERNUTRITION IN INDIA
ADULTS (Females)
PRESCHOOL CHILDREN
6.2
40.6
44.3
NORMAL
GRADE I
5
8.9
GRADE II
46.5
48.5
GRADE III
CED
Based on NCHS weight for age
NORMAL
OBESE
Based on BMI
Vijayaraghavan

15. TIME TRENDS IN ANTHROPOMETRIC PARAMETERS (<Median-2SD)
NNMB
80
70
78.6
76.5
60
PER CENT
62.3
57.7
50
1975-79
1996-97
40
30
20
18.1
10
18.5
0
Height
Weight
Weight for Height
VIJAY’00

16. DISTRIBUTION WEIGHT FOR AGE – IAP
Gujarat
40
35
PER CENT
30
32.5
37.9
25
20
21
15
10
5
7.2
0
Normal
Gr. I
Gr. II
Gr. III
GRADES OF UNDERNUTRITION
1.4
Gr. IV

17. WEIGHT FOR AGE–
SD CLASSIFICATION - GUJARAT
40
35
30
25
% 20
Boys
Girls
Pooled
15
10
5
an
>M
ed
i
an
-1
-M
ed
i
SD
-1
--2
SD
-2
--3
<3
SD
0

18. VITAMIN A DEFICIENCY

19. KERATOMALACIA
BITOT SPOT
V
A
D
BILATERAL BLINDNESS
Vijayaraghavan

20. WHO Criteria for Public Health Significance
- VAD
Minimum Prevalence (%) in children <6 yrs
•
•
•
•
•
BITOT SPOTS
NIGHT BLINDNESS
CORNEAL LESIONS
CORNEAL SCARS
Serum Retinol <10 µg/l
0.5
1.0
0.01
0.05
5.0
Vijayaraghavan

21. VITAMIN A DEFICIENCY (%) IN
INDIA
AGE GROUP
CHILDREN
PREGNANT
WOMEN
X1B
XN*
ICMR, 2001
PRESCHOO
L
SOURCE
0.7
1.03
NNMB
0.7
-
NIN- SURVEYS
2.1
-
ICMR, 2001
-
2.8
* 24-71 MONTHS
Vijayaraghavan

22. VITAMIN A DEFICIENCY
Districts(%) with X1B >0.5%
Average prevalence (%)
2.1
No VAD
55
VAD
45
Based on surveys in 126 Dts.
by NIN and NNMB
Vijayaraghavan

23. NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN
6
5.7
PER CEN T
5
5.7
PEM
X1B
RIBO. DEF.
4
3
2
1
1.7
2.1
1.8
0.7 0.7
0.2
0.7
0
1975-79
1988-90
1996-97
PERIOD OF SURVEY
Vijayaraghavan

24. DISTRIBUTION OF MICRONUTRIENT INTAKES IN
CHILDREN - %RDI
%
100
50
0
<70
70-90
90-100
>100
Vitam in A
86.3
3.2
1.4
9.1
Iron
82.5
8.6
2.1
6.8
Riboflavin
71.4
15.9
4.1
8.6
% RDI
Vijayaraghavan

25. ANAEMIA

26. PREVALENCE OF ANAEMIA IN PREGNANT WOMEN
100
90
96.8
80
94.9
84.6
70
91.4
%
60
87.2
84.1
50
82.5
79.4
40
61
30
20
H.P.
M.P.
A.P.
BIHAR
MAHA.
ASSAM
RAJ.
J&K
POOLED
Vijayaraghavan

27. PREVALENCE OF ANAEMIA
-ADOLESCENT GIRLS
100
98
96
94
92
%
93.9
90
99.3
92
92.2
88
91.8
86
84
91.9
87.7
87.1
82
80
MAHA.
H.P.
A.P.
BIHAR
M.P.
ASSAM
J&K
POOLED
Source: ICMR, 1999

28. ANAEMIA IN FEMALES
• PREVALENCE OF
ANAEMIA IS VERY
HIGH IN BOTH THE
GROUPS
95
90
85
• NO CHANGE
NOTICED OVER
TIME IN THE
PREVALENCE
Percent
80
75
92
84.6
70
65
60
55
50
Pregnant
Women
Adolescent
girls
Vijayaraghavan

29. IODINE DEFICIENCY DISORDERS

30. IODINE DEFICIENCY DISORDERS
GOITRE+
239 OF 282 DTs. SURVEYED –
ENDEMIC
167 millions AT RISK ?

31. PREVALENCE OF GOITRE IN
6-12 Yr CHILDREN - Gujarat
16
14
12
10
Surat
Valsad
8
6
4
2
0
Gr. I
Gr. II
Total

32. DIETARY INTAKES

33. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
90
92
Protein (g)
Rural
Tribal
Urban Slums
85
Energy (Kcal)
79
Calcium (mg)
87
91
131
98
118
51
48
Iron (mg)
0
20
40
60
78
80
PER CENT
100
120
140
VIJAY’00

34. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
51
Vitamin A (µg)
46
63
Rural
Tribal
Thaimin (mg)
87
Riboflavin (mg)
55
Urban Slums
71
64
102
Vitamin C (mg)
Folic acid (µg)
104
100
105
120
156
164
0
0
50
100
PER CENT
150
200

35. NUTRIENT INTAKES AMONG INDIAN WOMEN
NUTRIENTS
NPNL
PREGNANT
WOMEN
LACTATIN
G WOMEN
Protein (g)
49.9
47.2
56.5
Energy (kcal)
1983
1994
224.3
Total Fat (g)
24.5
21.5
373
Calcium (mg)
382
339
12.4
Iron (mg)
11.3
11.0
162
Vitamin A (µg)
Thiamin (mg)
148
142
1.1
0.9
0.9
1.1
Riboflavin (mg)
0.8
0.8
0.9
Vitamin C (mg)
32.0
28.4
29.4
Folic Acid (µg)
86
84
106
Source: NNMB, 2000

36. NUTRIENT INTAKES IN PREGNANT WOMEN
% RDI
% RDI
Energy
Protein
Vitamin A
Iron
Riboflavin
Total Fat
<30
0
0
52.4
53.7
1.2
22
30-40
1.2
0
8.5
22
20.7
6.1
40-50
3.7
2.4
11
9.8
13.4
6.1
50-60
9.8
11
9.8
7.3
12.2
7.3
60-70
8.5
17.1
0
0
18.3
8.5
70-80
23.2
11
3.7
1.2
4.9
7.3
80-90
9.8
9.8
2.4
1.2
4.9
4.9
90-100
7.3
8.5
2.4
2.4
7.3
4.9
≥100
36.5
40.2
9.8
2.4
17.1
32.9
Source: NNMB,2000

37. NUTRIENT INTAKES (per day) IN CHILDREN
Age in Years
Nutrients
Mean
Protien (g)
22.4
Tot fat (g)
13.5
Energy (Kcal)
867
Calcium (mg)
250
Iron (mg)
5.50
Vit A (ug)
145
Thiamin (mg)
0.44
Ribo. (mg)
0.44
Niacin (mg)
4.97
Vit C (mg)
16.5
Folic acid (mg) 45
1-3
Median
20.4
10.1
815
168
4.30
72
0.40
0.40
4.5
9.9
36.6
NNMB, 2000
4-6
Mean Median
31.4
29.40
17.6
13.90
1215
1154
300
224
8.4
6.90
205
96
0.69
0.60
0.56
0.50
7.37
6.60
24.9
17.5
65
55.1
Vijayaraghavan

38. DETERMINANTS OF MALNUTRITION
MATERNAL MALNUTRITION
START WITH A HANDICAP(LBW)
FAULTY CHILDFEEDING PRACTICES
DIETARY INADEQUACY
FREQUENT INFECTIONS
LOW PURCHASING POWER
LARGE FAMILIES
HIGH FEMALE ILLITERACY
TABOOS AND SUPERSTITIONS

39. Factors Affecting Nutritional Status
High illiteracy
Unemployment/
Underemployment
Large families
Ignorance
Low Procurement
of foods
Low production
of foodgrains
Poor environment
Low purchasing power
High dependence rate
False food beliefs
Inadequate intakes
Poor PDS
High cost
Low availability of foods
Reduced work
Malnutrition
output
Morbidity
Poor utilization of services
Absorption of nutrients
Low Appetite
poor coverage of immunization
Improper health services
poor infrastructure
Lack of resources

40. INTERVENTIONS IN
OPERATION
DIRECT
•CONVERGENCE OF SERVICES (RCH)
•INTEGRATED CHILD DEVELOPMENT SERVICES
•IRON AND FOLIC ACID DISTRIBUTION
•MASSIVE DOSE VITAMIN A PROGRAMME
•PRIMARY HEALTH CARE PROGRAMME
•HEALTH AND NUTRITION EDUCATION
INDIRECT
•POVERTY ALLEVIATION PROGRAMMES
•ENVIRONMENTAL SANITATION
•PROTECTED WATER SUPPLY
•LITERACY PROGRAMME