1. The Impact Of Dietary Habits On Nutritional Status Of Children In India Dr. B. Sesikeran, MD, FAMS Director National Institute of Nutrition (Indian Council of Medical Research) Hyderabad – 500 604 E-mail: sesikeran@gmail.com

2. 2 Infant Mortality Rate (Per 1000 Live Births) in India and South-east Asian Countries Source : WHO/SEARO 2000 58 * * SRS, Registrar General of India, 2004 *

3. 3 Prevalence of Low Birth Weight in India and South-east Asian Countries Source : WHO/SEARO 2000 23 (NFHS 2) * * Increase in Institutional Deliveries

4. 4 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

5. 5 Average Daily Food Intake (% RDA) among 1-3 Year Children : By Gender Percent RDA

6. 6 Median Intake of Nutrients (as % RDA) Among 1-3 year children : By gender Percent of RDA

7. 7 Average Daily Food Intake (% RDA) among 4-6 Year Children : By Gender Percent RDA

8. 8 Median Intake of Nutrients (as % RDA) Among 4-6 year children : By gender Percent of RDA

9. 9

10. 10 Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD): By Gender Percent

11. 11 Prevalence of Undernutrition among <5 years children according to Weight for Age (IAP classification) Faulty BFFaulty Complemen tary feeding

12. 12 INFANT AND YOUNG CHILD FEEDING PRACTICES (NFHS 3)

13. 13 MICRO-NUTRIENT DEFICIENCIES

14. 14 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%

15. 15 Prevalence (%) of Bitot Spots among 1 - <5 yrs. Children * WHO cut-off level (0.5%) of Public Health significance

16. 16 Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20  G/dL, Median Dietary Intake of Vit. A (as % RDA) and Extent of Coverage for Suppl. of Massive Dose Vit. A – By State STATES Blood Vitamin A < 20  g/dL Dietary Intake of Vitamin A < 50% of RDA Receipt of Massive Dose Vitamin A 1 or 2 Doses No. of Doses OneTwo Kerala79.491.838.528.410.1 Tamil Nadu48.881.950.620.230.4 Karnataka52.190.456.642.114.5 AP61.592.949.314.235.1 Maharashtra54.788.852.129.422.7 MP88.087.452.319.133.2 Orissa57.777.580.038.841.2 West Bengal61.280.650.646.8 3.8 Pooled61.886.355.430.325.1 Source: NNMB-MND Survey : 8 States, 2003

17. 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 1968. Definition of Anemia

18. 18 IRON DEFICIENCY DIETARY FACTORS LOW INTAKE OF DIETARY IRON INFECTIONS & INFESTATIONS  Malaria  Hook Worm  Schistosomiasis HAEMORRHAGIC CONDITIONS ABSORPTION DIETARY FACTORS  Promoters  Inhibitors HOST FACTORS  Iron Status  Health Status HAEMOLYTIC DISORDERS  Sickle Cell Disease  Thalassemia AETIOLOGY OF IDA IRON DEFICIENCY ANAEMIA PHYSIOLOGICAL CONDITIONS  Menarche  Pregnancies with Lack of adequate interval

19. 19 10.2 0.03 11.2 0.03 11.0 0.03 9.9 0.03 10.6 0.03 Mean ±SE Prevalence (%) of Anaemia by Age, Gender & Physiological Groups > 6 months < 6 months 10.7 1.99 12.6 2.09

20. 20 Computed from NNMB data, rural survey, 2001

21. 21 Computed from NNMB data, rural survey, 2001

22. 22 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

23. 23 PREVALENCE (%) OF IDD AMONG CHILDREN (≤12 years old)

24. 24 Percent of Households consuming salt having adequate Amount (≥15 ppm) of Iodine * By spot test

25. 25 Distribution (%) of Children by Undernutrition and Period of Survey Percent UNDERNUTRITION (< Median - 2SD)

26. 26 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

27. 27 0 5 10 15 20 25 30 35 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

28. 28 AuthorYearAge groups (yr) Number of subjects Prevalence (%) OverweightObesity Mohan B 200411- 17246711.62.6 Khadilkar Y 200410 – 15122819.95.7 Chatwal J 20049 – 15200814.211.1 Subramaniam V 200310 – 1570710.06.0 Laxmaiah A et al 200412 - 17120804.61.6 Chatterji P 20024 – 18500029.06.0 Kapil U 200210 – 1687024.77.4 Ramchandran A 200213 – 18470016.83.1 Pandey S & Vaidya R 20013 - 17243915.115.3 PREVALENCE (%) OVERWEIGHT AND OBESITY AMONG CHILDREN: VARIOUS STUDIES

29. 29 CategoryN Overweight/ Obese P value TV viewing (hrs/day) None1435.6 a b P < 0.05 < 3 hrs/day7304.9 a b  3hrs/day 3359.3 b Participation in outdoor games (hrs/week) None5268.4 a P < 0.004 < 6 hrs2286.6 a  6hrs 4165.1 b Participation in HH activities (hours/day) None22118.6 a P < 0.001 < 3 hrs2334.7 b  3hrs 7163.9 b Prevalence of Overweight/Obesity and Physical Activity (NIN Study)

30. 30 VariableSub-variable Overweight subjects Normal subjects Outdoor games & sports Participation54.566.7 Av. duration (hrs/wk)2.33.7 Physical exercise Participation46.245.3 Av. duration (hrs/wk)3.54.1 Household chores Participation70.477.2 Av. duration (hrs/day)3648 TV watching Participation86.688.0 Av. duration (hrs/day)1.41.2 Nap during a day Participation14.39.9 Av. duration (min/day)126 Various practices among overweight and non-overweight urban Adolescents in Andhra Pradesh NIN-WHO Technical Report 2007

31. 31 Variable Overweight/ Obese Adolescents Normal Adolescents P value Consumption of Soft drinks 21.016.0 p < 0.05 Consumption of soft drinks  300 ml/day 16.79.0 p < 0.05 Prevalence of Hypertension (JNC VII) 8.33.7P < 0.05 Overweight/Obesity Vs Lifestyle practices (n:941) Laxmaiah et al 2007

32. 32 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.  The coverage for vitamin A and IFA tablets supplementation was poor

33. 33  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..)

34. Thank you