1 Diet and Nutrition Situation and Time Trends in India Dr. B. Sesikeran, MD, FAMS Director National Institute of Nutrition, I.C.M.R. Hyderabad –

2

3 Infant Mortality Rate (Per 1000 Live Births) in India and South-east Asian Countries Source : WHO/SEARO * * SRS, Registrar General of India, 2004 *

4 Prevalence of Low Birth Weight in India and South-east Asian Countries Source : WHO/SEARO (NFHS 2) * * Increase in Institutional Deliveries

5 Andhra Pradesh Madhya Pradesh Maharashtra Karnataka KeralaTamilnadu Orissa West Bengal Uttar Pradesh Gujarat NATIONAL NUTRITION MONITORING BUREAU (Estd: 1972) Objectives of NNMB 1.Assessment of Nutritional status of various communities by adopting standardized procedures and techniques 2.Periodical evaluation of National Nutrition programs operation in India

6 Average Daily Food Intake (% RDA) among 1-3 Year Children : By Gender Percent RDA

7 Median Intake of Nutrients (as % RDA) Among 1-3 year children : By gender Percent of RDA

8 Average Daily Food Intake (% RDA) among 4-6 Year Children : By Gender Percent RDA

9 Median Intake of Nutrients (as % RDA) Among 4-6 year children : By gender Percent of RDA

10

11 Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD): By Gender Percent

12 Prevalence of Undernutrition among <5 years children according to Weight for Age (IAP classification) Faulty BFFaulty Complemen tary feeding

13 INFANT AND YOUNG CHILD FEEDING PRACTICES (NFHS 3)

14 MICRO-NUTRIENT DEFICIENCIES

15 Pooled: 0.7% < 0.5 %  0.5 % Kerala 0 Tamil Nadu 0.5 Karnataka 0.7 Andhra Pradesh 1.2 Maharashtra 1.3 Madhya Pradesh 1.4 Orissa 0.3 West Bengal 0.6 Prevalence (%) of Bitot spots among 1 - <5 year children Boys: 0.9% Girls 0.6%

16 Prevalence (%) of Bitot Spots among 1 - <5 yrs. Children * WHO cut-off level (0.5%) of Public Health significance

17 AGE / PHYSIOLOGICAL GROUP Gender Hb (g/dl) 6 months – 6 Years Boys & Girls<11 6 – 14 Years Boys & Girls<12  14 Years Men<13 Women<12 Pregnant Women <11 WHO, Nutritional Anemia - TRS No. 405, Geneva Definition of Anemia

Mean ±SE Prevalence (%) of Anaemia by Age, Gender & Physiological Groups > 6 months < 6 months

19 Pooled: 3.9 < 5 % > 5 % Kerala 0.6 Tamil Nadu 0 Karnataka 1.9 Andhra Pradesh 3.8 Maharashtra 12.2 Madhya Pradesh 4.3 Orissa 0.1 West Bengal 9.0 Prevalence (%) of IDD among 6 – 11 Year Children Source: MND-NNMB, Tech Rep 22, 2003

20 PREVALENCE (%) OF IDD AMONG CHILDREN (≤12 years old)

21 Percent of Households consuming salt having adequate Amount (≥15 ppm) of Iodine * By spot test

22 Time Trends

23 Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey Percent

24 Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey (contd.) Percent

25 Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey Percent

26 Percent Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey (Contd.)

27 Distribution (%) of Children by Undernutrition and Period of Survey Percent UNDERNUTRITION (< Median - 2SD)

28 Trends in poverty line estimates and Prevalence of Undernutrition among 1-5 yr. Children (According to SD Classification Using NCHS Standards) Source :- BPL : Economic survey and NNMB Surveys

Worldwide Americas Europe Near/middle East Asia-Pacific Sub-Sahara Africa Prevalence (%) overweight obese Prevalence of overweight and obesity among school-age boys aged 5-17 years by global region

30 AuthorYearAge groups (yr) Number of subjects Prevalence (%) OverweightObesity Mohan B Khadilkar Y – Chatwal J – Subramaniam V – Laxmaiah A et al Chatterji P – Kapil U – Ramchandran A – Pandey S & Vaidya R PREVALENCE (%) OVERWEIGHT AND OBESITY AMONG CHILDREN: VARIOUS STUDIES

31 CategoryN Overweight/ Obese P value TV viewing (hrs/day) None a b P < 0.05 < 3 hrs/day a b  3hrs/day b Participation in outdoor games (hrs/week) None a P < < 6 hrs a  6hrs b Participation in HH activities (hours/day) None a P < < 3 hrs b  3hrs b Prevalence of Overweight/Obesity and Physical Activity (NIN Study)

32 Variable Overweight/ Obese Adolescents Normal Adolescents P value Consumption of Soft drinks p < 0.05 Consumption of soft drinks  300 ml/day p < 0.05 Prevalence of Hypertension (JNC VII) P < 0.05 Overweight/Obesity Vs Lifestyle practices (n:941) Laxmaiah et al 2007

33 Prevalence of Overweight in relation to activity score. l Prevalence of Overweight was higher in lower tertile of physical activity. Trend  2 = 45.6, P < Tertiles of activity score % Overweight Ramachandran et al 2002

34 Conclusion  Despite rapid progress in the area of food production, the intake of food and nutrients continues to be deficient, both in terms of quantity and quality  Prevalence of LBW is about 30%, and about 55% of preschool children are underweight and 50% are stunted.  Even though, the prevalence of undernutrition is significantly declining over a period of 3 decades, still the current prevalence is exceptionally high.  MNDs such as IDA VAD and IDD continues to be of public health problem.

35  The prevalence of overweight and obesity is significantly increasing over a period of 3 decades even among rural population, which is the major independent risk factor for metabolic syndrome.  Prevalence of overweight and obesity is considerably high, especially when Asian cut of levels were used (≥23 BMI).  India is passing through a critical phase i.e. ‘double burden of disease’.  One fourth of our rural adults are suffering from hypertension About 5-6% of the adults have IGT/DM. Conclusion (Contd..)

36