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Our Nutrition

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Nutrition is a very confusing topic for most people these days. If you pick up a woman’s magazine or watch any morning television programme you are likely to find that an article or presentation about …

Nutrition is a very confusing topic for most people these days. If you pick up a woman’s magazine or watch any morning television programme you are likely to find that an article or presentation about nutrition is trying to convince you that a particular fad diet, or a particular group of nutrients, will be the one secret that positively changes your life forever. Yet, the more you read magazine articles or watch television shows, the more you are likely to be in the dark as to which advice to follow, because many of them are contradictory.

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  • 1. OUR NUTRITION Dr.Sujnanendra Mishra
  • 2. IT IS REAL EVEN TODAY
  • 3. The main meal of the day
  • 4. Women Power
  • 5. Collection of firewood Women Power
  • 6. Burden of large family
  • 7. She also pulls the burden of family Perhaps the only woman in the male bastion, Sabitri Das (45) of Sasang village in Orissa's Balasore district has been pulling trolley for the last five years.
  • 8.  
  • 9. MOTHER AND CHILD SURVIVAL MMR 407/100,000 live births IMR* 58/1000 live births Child Mortality 19.5/1000 Children Rate(1-4 years)
  • 10. An Old Chinese Proverb
    • REGARDLESS OF WHO THE FATHER OF A DISEASE IS
    • SURELY ITS MOTHER IS
    • IMPROPER DIET
  • 11. NUTRITION PROBLEMS IN INDIA WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY SOCIALLY DEPRIVED (SC & ST Communities) .
  • 12.
    • WOMEN
    • • POOR WT. GAIN
    • DURING PREGNANCY
    • CED
    • MICRONUTRIENT DEFICIENCIES
    • CHILDREN
    • LOW BIRTH WEIGHT
    • GROWTH FALTERING
    • PEM
    • MICRONUTRIENT DEFICIENCIES
    NUTRITION PROBLEMS IN INDIA WHAT ARE THE COMMON PROBLEMS?
    • FLUOROSIS, LATHYRISM
    • DIET RELATED CHRONIC DISEASES
    • OBESITY, CARDIOVASCULAR
    • DISEASES, DIABETES
  • 13. Body Mass Index (BMI)
    • The BMI is defined as weight in kilograms divided by height in metres squared (kg/m2).
    • A cut-off point of 18.5 is used to define thinness or acute undernutrition and a BMI of 25 or above indicates overweight or obesity. A BMI of 17.0-18.4 refers to mildly thin and <17.0, refers to moderately/severely thin. A BMI of over 30.0 refers to obesity.
    • The BMI data discussed excludes women who were pregnant at the time of the survey and women who gave birth during the two months preceding the survey.
  • 14. PREVALENCE OF LBW IN S.E ASIAN COUNTRIES
  • 15. 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
  • 16. NUTRITIONAL DISORDERS IN CHILDREN
    • PROTEIN ENERGY MALNUTRITION (PEM)
    • . CLINICAL FORMS
    • . SUBCLINICAL UNDERNUTRITION
    • MICRONUTRIENT DEFICIENCIES
  • 17. CLINCAL FORMS of PEM
    • KWASHIORKOR
    • OEDEMA+
    • IRRITABILITY+
    • GROWTH FAILURE+
    • DISCOLOURED HAIR+
  • 18. CLINCAL FORMS of PEM
    • MARASMUS
    EXTREME WASTING “ SKIN AND BONES” MONKEY/OLD MAN FACIES
  • 19. SUB-CLINICAL FORMS OF PEM UNDERNUTRITION  WEIGHT FOR AGE WASTING  WEIGHT FOR HEIGHT STUNTING HEIGHT FOR AGE
  • 20. UNDERNUTRITION IN INDIA PRESCHOOL CHILDREN ADULTS (Females) Based on BMI Based on NCHS weight for age
  • 21.  
  • 22. DISTRIBUTION WEIGHT FOR AGE – IAP Gujarat Normal Gr. I Gr. II Gr. III Gr. IV
  • 23. WEIGHT FOR AGE– SD CLASSIFICATION - GUJARAT
  • 24. VITAMIN A DEFICIENCY
  • 25. BITOT SPOT KERATOMALACIA BILATERAL BLINDNESS V A D
  • 26. WHO Criteria for Public Health Significance - VAD
    • Minimum Prevalence (%) in children <6 yrs
    • BITOT SPOTS 0.5
    • NIGHT BLINDNESS 1.0
    • CORNEAL LESIONS 0.01
    • CORNEAL SCARS 0.05
    • Serum Retinol <10  g/l 5.0
    Vijayaraghavan
  • 27. VITAMIN A DEFICIENCY (%) IN INDIA * 24-71 MONTHS AGE GROUP SOURCE X1B XN* PRESCHOOL CHILDREN ICMR, 2001 0.7 1.03 NNMB 0.7 - NIN- SURVEYS 2.1 - PREGNANT WOMEN ICMR, 2001 - 2.8
  • 28. VITAMIN A DEFICIENCY Districts(%) with X1B >0.5% Average prevalence (%) 2.1 Based on surveys in 126 Dts. by NIN and NNMB No VAD VAD
  • 29. NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN
  • 30.  
  • 31. ANAEMIA
  • 32.  
  • 33. PREVALENCE OF ANAEMIA -ADOLESCENT GIRLS
  • 34. ANAEMIA IN FEMALES
    • PREVALENCE OF ANAEMIA IS VERY HIGH IN BOTH THE GROUPS
    • NO CHANGE NOTICED OVER TIME IN THE PREVALENCE
    Pregnant Women Adolescent girls
  • 35. IODINE DEFICIENCY DISORDERS
  • 36. 239 OF 282 DTs. SURVEYED – ENDEMIC 167 millions AT RISK ? IODINE DEFICIENCY DISORDERS GOITRE+
  • 37. PREVALENCE OF GOITRE IN 6-12 Yr CHILDREN - Gujarat
  • 38. DIETARY INTAKES
  • 39. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
  • 40. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
  • 41. NUTRIENT INTAKES AMONG INDIAN WOMEN Source: NNMB, 2000 NUTRIENTS NPNL PREGNANT WOMEN LACTATING 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 (  g) 148 142 1.1 Thiamin (mg) 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 (  g) 86 84 106
  • 42. NUTRIENT INTAKES IN PREGNANT WOMEN % RDI Source: NNMB,2000 % 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
  • 43. NUTRIENT INTAKES (per day) IN CHILDREN
            • NNMB, 2000
    Vijayaraghavan
  • 44. 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
  • 45. Factors Affecting Nutritional Status High illiteracy Unemployment/ Underemployment Large families Low purchasing power Ignorance High dependence rate False food beliefs Inadequate intakes Low Procurement of foods Poor PDS High cost Low availability of foods Low production Reduced work Malnutrition of foodgrains output Poor environment Morbidity Absorption of nutrients Low Appetite Poor utilization of services poor coverage of immunization Improper health services poor infrastructure Lack of resources
  • 46. 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
  • 47. 2005-06 National Family Health Survey (NFHS-3) Adult Nutrition
  • 48.
    • The percentage of ever-married women age 15-49 who are overweight or obese increased from 11 percent in NFHS-2 to 15 percent in NFHS-3
    • This is a growing problem in India. Women suffer from a dual burden of malnutrition with nearly half of them being either too thin or overweight
    • As undernutrition decreases, overnutrition increases by about the same amount
    Dual Nutritional Burden More than a third (36%) of women have a BMI below 18.5, indicating a high prevalence of nutritional deficiency. Among women who are thin, 44% are moderately or severely thin.
  • 49. Prevalence of Undernutrition and Overweight/Obesity among Adults by Residence NFHS-3, 2005-06 Undernutrition ( % abnormally thin) % Overweight/ obese Undernutrition is more prevalent in rural areas. Overweight and obesity are more than three times higher in urban than in rural areas. Undernutrition and overweight/ obesity are both higher for women than men
  • 50. Undernutrtion and Overweight/Obese Women by Age Age in years Malnutrition levels are higher among young girls. Almost half of the girls in age 15-19 are undernourished. Undernutrition declines and overnutrition increases with age of women
  • 51. Underweight and Overweight/Obese Women by Education The prevalence of undernutrition is nearly two times higher among women with no education than among those with 12 or more years of schooling. The prevalence of overweight and obesity is three times higher among women with 12 or more years of schooling than those with no education.
  • 52. Underweight and Overweight/ Obesity among Women by Wealth More than half of women in the highest income quintile are underweight. In contrast, almost one-third of women in the highest income quintile are overweight or obese .
  • 53. The percentage of women who are too thin is particularly high in Bihar (45%), Chhattisgarh, and Jharkhand (43% each). Malnutrition levels are lowest in Delhi, Punjab, and several of the small northeastern states. The percentage of women who are overweight or obese is highest in Punjab (30%), followed by Kerala (28%) and Delhi (26%) State Variations in Malnutrition
  • 54. Underweight and Overweight/Obese Men Similar variations are seen by state in the percentage of men who are thin and the percentage of men who are overweight and obese. The prevalence of underweight and overweight among men shows similar variations by age, education and wealth index.
  • 55. Contents
    • Malnutrition
    • Anaemia
    • Micronutrient intake
  • 56. Trends in Anaemia Prevalence among Women The anaemia situation has worsened over time for women 10.0-10.9g/dl 7.0-9.9g/dl <7.0g/dl
  • 57. Anaemia Prevalence among Women and Men by Residence NFHS-3, 2005-06 The anaemia prevalence levels are more than two times higher among women than men with almost half of them with moderate to severe anaemia. The prevalence of anaemia is marginally higher in rural than urban areas but anaemia is a common problem in both urban and rural areas. More than 50 percent of women in urban areas are anaemic, with almost a third of them with moderate to severe anemia. Women Men
  • 58. Anaemia Prevalence among Pregnant Women NFHS-3, 2005-06 The prevalence of anaemia among pregnant women is higher than among non-pregnant women. The prevalence of moderate anaemia is greater among pregnant women women
    • Compared with non-pregnant women:
    • The prevalence of anaemia among pregnant women is higher.
    • The prevalence of moderate to severe anaemia is higher among pregnant women.
  • 59.  
  • 60. Contents
    • Malnutrition
    • Anaemia
    • Micronutrient intake
  • 61. Percentage of Household Using Iodized Salt By Residence Only about half of the households in India use cooking salt which is adequately iodized More than two-thirds of urban households used adequately idolized cooking salt compared with just 41 percent in rural areas.
  • 62. Food Consumption
    • NFHS-3 asked women and men about the frequency of consuming food from different food groups:
    • Milk or curd, pulses, fruits, dark green leafy
      • vegetables, eggs, chicken or meat, and fish
    • 33 percent of women and 24 percent of men are vegetarians
    • Consumption of fruits at least once a week is less common. Sixty percent of women do not consume fruits even once a week
    • The pattern of food consumption by men is similar to that of women, but men are more likely than women to consume milk or curd regularly
  • 63. Contd…
    • Food consumption shows variation by residence, education, religion, caste/tribe, and the wealth index
    • The frequent consumption of milk and curd is most common in the Northern and Southern regions, as well as in Sikkim and Gujarat
    • Egg, fish, and meat consumption is more common in the southern states (except for Karnataka), Northeastern states, Goa, West Bengal, and Jammu and Kashmir
  • 64. Key Findings
    • Indian women suffer a very high burden of nutritional deficiency; but the prevalence of overweight and obesity are also on the rise
    • This is a dual burden of malnutrition, with nearly half being either too thin or overweight
    • The prevalence of overweight or obesity among women is highest in Punjab, followed by Kerala and Delhi (the low fertility states)
  • 65.
    • The prevalence of overweight and obesity are on the rise among women in urban areas, women who are well educated, women in households in the highest wealth quintile, and Sikh women
    • The anaemia situation has worsened over time for women
    • Anaemia increases with the number of children ever born and decreases with education and the household’s wealth