Role of Nutritionists in Strengthening the Nutritional Scenario @ Base of Pyramid


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Role of Nutritionists in Strengthening the Nutritional Scenario @ Base of Pyramid

  1. 1. Role of Nutritionists in Strengthening the Nutritional Scenario @ Base of Pyramid Rekha Sharma R.D. President Indian Dietetic Association, Director, Nutrition and Dietetics, Diabetes Foundation (INDIA) Former Chief Dietician, All India Institute of Medical Sciences, New Delhi.
  2. 2. Nutritional Challenges at BOP <ul><li>Increased birth rate </li></ul><ul><li>Less of education </li></ul><ul><li>Increased death rate - Increased IMR </li></ul><ul><li>Less medical care </li></ul><ul><li>Less finances </li></ul><ul><li>Less nutritious foods </li></ul><ul><li>Nutritional Deficiencies </li></ul><ul><li>Infectious diseases </li></ul><ul><li>Chronic diseases </li></ul><ul><li>Poor maternal and child health </li></ul>
  3. 3. Nutritional challenges <ul><li>India faces a double burden </li></ul><ul><li>Under nutrition and poor maternal health </li></ul><ul><li>Increase in over weight and obesity </li></ul><ul><li>(Under privileged migrant population </li></ul><ul><li>from rural areas to urban slums) </li></ul><ul><li>Nutritionists role is mandatory in both </li></ul>
  4. 5. Nutritional challenges on Migration to cities(urban slums) <ul><li>loss of traditional diet, </li></ul><ul><li>Irregular ,faulty eating </li></ul><ul><li>High stress –work </li></ul><ul><li>Family deprivation </li></ul><ul><li>Lack of physical activity </li></ul><ul><li>Smoking , tobacco chewing, alcohol </li></ul><ul><li>Over weight and obesity </li></ul><ul><li>Coronary Heart disease </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Metabolic syndrome </li></ul><ul><li>Stroke </li></ul><ul><li>Hypercholesterolemia </li></ul><ul><li>Hypertriglyceridemia </li></ul>
  5. 6. Incidence of obesity& related disorders – Migrant population <ul><li>Young Women (18 – 25 years) = 13.2% </li></ul><ul><li>Delhi, DST Trial (2000) </li></ul><ul><li>Urban slum ( 35 years) = 40.2% </li></ul><ul><li>European Journal of Clinical Nutrition (2001 ) </li></ul><ul><li>Urban Slum (30-60 years) = 28.2% </li></ul><ul><li>Delhi, (2002) DST Trial </li></ul><ul><li>Women migrant study </li></ul><ul><li>4,621( >35 years) overweight urban areas = 64 % </li></ul><ul><li>rural areas = 36 % </li></ul><ul><li>Hypertension >140/90 mm Hg = 50% </li></ul><ul><li>Hyperlipidaemia Cholesterol > 200 mg = 25% </li></ul><ul><li>Diabetes Blood sugar >126 mg% = 3 - 14 % </li></ul><ul><li>DST trial (2009) </li></ul>
  6. 8. Coronary Risk Factors in Urban Underprivileged New Delhi, India Misra et al., Eur J Clin Nutr, 2001 Misra et al., Int J Obesity, 2001 Misra et al., Diab Res Clin Pract, 2002 High W-HR High BMI High body fat Hypertension Diabetes
  7. 9. Transition in Dietary Habits <ul><li>Carbohydrates from whole grains were being replaced by refined products </li></ul><ul><li>Carbohydrates were also being replaced by unhealthy fats specially by SFA and TFA </li></ul><ul><li>Fibre content of diets reduced </li></ul><ul><li>Traditional foods replaced by modern refined foods </li></ul><ul><li>Diet :Low in MUFA ,n3 ,fiber, high in refined Carbohydrates ,SFA,TFA ,n6 </li></ul>
  8. 10. Other side
  9. 11. Other side : Macro and Micronutrient deficiency <ul><li>Deficiency of vitamin minerals often occurs in conjunction with PEM </li></ul><ul><li>One third of the World’s people do not fulfill their physical and intellectual potential because of unrecognized deficiencies of vitamins and minerals- Vitamin A, Iron ,Iodine, folate etc. </li></ul>
  10. 12. Malnutrition affects : <ul><li>Survival </li></ul><ul><li>Development </li></ul><ul><li>Growth </li></ul><ul><li>Health </li></ul><ul><li>Productivity </li></ul><ul><li>Economic Growth </li></ul>
  11. 13. Most Vulnerable Groups are . . . <ul><li>0-6 year children </li></ul><ul><li>Pregnant Women </li></ul><ul><li>Lactating Mothers </li></ul><ul><li>Adolescent Girls </li></ul><ul><li>Aged </li></ul>
  12. 14. India has unacceptably high level of malnutrition (NFHS-III ) 45.9% Underweight Children (Under 3 years) 22.0% Low Birth Weight Babies ( for whom birth weight reported) 33.0% Women with Chronic Energy Deficiencies (30% in Men) 70.0% Children (6-59 months) with anaemia 55.0% , 24.0% Women and Men respectively were anaemic Vitamin A deficiency & Iodine Deficiency Disorders continue to be public health problems
  13. 15. The picture (as per UNICEF and MI VM global progress report) Iodine deficiency Estimated to have lowered the Intellectual capacity by 10-15 percentage points Iron deficiency in 6-24 m olds Mental development impaired by 40-60% Vitamin A deficiency Impaired the immune system leading to an estimated one million children not reaching their 5 th birthday Iodine deficiency in mothers 18 million babies being born mentally impaired
  14. 16. The picture [as per UNICEF and MI VM global progress report Folate deficiency Approximately 200,000 babies with severe birth defects and 1in 10 deaths from heart disease in adults Severe Iron deficiency Causes loss of life more than 60,000 young women in pregnancy and child birth and loss of 2% GDP. This is high economic cost on virtually every developing nation---world bank
  15. 17. Nutritional Challenges <ul><li>UNICEF (2009) data shows infant mortality to be declining steadily, but is still 1726 thousand deaths for children below the age of 5 against 26787 thousand births . </li></ul><ul><li>40% of children below the age of 5 are under weight. </li></ul><ul><li>Despite the country's growing economy and an ambitious rural health initiative </li></ul><ul><ul><li>Over 100,000 women die from pregnancy-related causes each year – highest in the world </li></ul></ul>
  16. 18. Nutritional Challenges <ul><li>While breastfeeding is nearly universal in India, less than half of children (46%) are fed only breast milk for the first 6 months, as recommended </li></ul><ul><li>Only 23.4% of children are breastfed within one hour of birth and the prevalence is significantly lower among the non-educated mothers and in rural areas. </li></ul><ul><li>Only 55.8% of children aged 6-9 months receive solid or semisolid food and breast milk ,making complementary feeding a high-priority to be addressed </li></ul><ul><li>The higher the education of the mother, the better the nutrition status of themselves and their child. </li></ul><ul><li>National Family Health Survey (NFHS-3) </li></ul>
  17. 19. Way Forward <ul><li>Prevention and cure for Anemia: </li></ul><ul><li>Increasing the iron content of food through dietary intake </li></ul><ul><li>Increasing the iron content of food through fortification </li></ul><ul><li>Increasing iron intake through supplementation </li></ul><ul><li>Reducing blood loss by treating for parasites </li></ul><ul><li>Reducing blood loss from hemorrhage by improving birthing or abortion practices and post-abortion care </li></ul><ul><li>PM's National Council on India’s Nutrition Challenges - Iron fortified Iodized Salt to be promoted to battle malnutrition for prevention and cure of Anemia </li></ul><ul><li>One cost effective way of increasing the intake of iron, is fortification of salt with iron in addition to iodine </li></ul>
  18. 20. Nutrition Programmes <ul><li>Improving mothers' feeding and caring behaviour with emphasis on infant and young child feeding and maternal nutrition , during pregnancy and lactation.   </li></ul><ul><li>Improving household water and sanitation.   </li></ul><ul><li>Strengthening the referral to the health system, with emphasis on prevention and control of common child diseases including acute malnutrition.   </li></ul><ul><li>Providing micronutrients. </li></ul><ul><li>Actual implementation follow ups. </li></ul>
  19. 21. Programme recommendations: <ul><li>Supplementary feeding activities need to be better targeted towards those who need it most ,with clear criteria set for quality assurance and accountability.   </li></ul><ul><li>Growth-monitoring activities need to be performed with greater regularity, with an emphasis on using this process to help parents understand how to improve their children's health and nutrition.   </li></ul><ul><li>Involving communities in the implementation and monitoring of programmes and anganwadi centers ,to improve the quality of service delivery and increase accountability in the system. </li></ul>
  20. 22. <ul><li>0-6 months is critical, 6-12 is next </li></ul><ul><li>We allow child under nutrition to set in - with poor feeding ( Breast feeding and complementary feeding) </li></ul><ul><li>Neonatal infections, Diarrhea and pneumonia give 2/3 rd mortality in 1 st year </li></ul><ul><li>According to WHO, other 2/3 rd mortality is related to poor feeding practices </li></ul>Exclusive breastfeeding prevents child malnutrition
  21. 23. Way Forward <ul><li>Prevention and cure for under nutrition in children </li></ul><ul><li>There are ten proven, high-impact interventions ,that can help in bringing, child under nutrition , figures down: </li></ul><ul><ul><li>Timely initiation of breastfeeding within one hour of birth. </li></ul></ul><ul><ul><li>  Exclusive breastfeeding in the first six months of life </li></ul></ul><ul><ul><li>  Timely introduction of complementary foods at six months </li></ul></ul><ul><ul><li>Age-appropriate foods for children six months to two years </li></ul></ul><ul><ul><li>  Safe and hygienic complementary feeding practices </li></ul></ul>
  22. 24. Way Forward <ul><ul><li>6 . Full immunization and bi-annual vitamin A supplementation with deworming </li></ul></ul><ul><ul><li>7. Appropriate feeding for children during and after illness </li></ul></ul><ul><ul><li>8.  Therapeutic feeding for children with severe acute malnutrition </li></ul></ul><ul><ul><li>9.  Adequate nutrition and anemia control for adolescent girls </li></ul></ul><ul><ul><li>10. Adequate nutrition and anemia control for pregnant and breastfeeding mothers </li></ul></ul><ul><li>UNICEF </li></ul>
  23. 25. <ul><li>Fortification </li></ul><ul><li>Supplementation </li></ul><ul><li>Dietary diversification </li></ul><ul><li>Nutrition and health Education </li></ul>Nutrition Interventions to combat Micronutrient Malnutrtition
  24. 26. <ul><li>Horticulture interventions: Promote the Nutritious crops by providing incentive to the farmers </li></ul><ul><li>Nutrition and Health Education to promote healthy eating patterns – LONG TERM SUSTAINABLE intervention – BEHAVIOUR CHANGE </li></ul><ul><li>Promotion of correct Infant and Young child Feeding Norms </li></ul><ul><li>Promotion of low cost locally available nutritious food – by providing them recipes/ or demonstration of the recipes </li></ul><ul><li>Promotion of seasonal fruits and vegetables </li></ul><ul><li>Use of Hygiene and sanitary practices </li></ul><ul><li>Use of Safe Drinking water </li></ul><ul><li>Use of Mass media to promote healthy Food ,Safe , Sanitary and hygiene Practices </li></ul>DIETARY DIVERSIFICATION to combat Micronutrient Malnutrition
  25. 27. Fortification and supplementation <ul><li>Recipes suitable for infants and children </li></ul><ul><li>Recipes which can be prepared daily specifically for the infant </li></ul><ul><li>Adult food modified to suit children’s needs </li></ul><ul><li>Protein-rich supplements that may be added to the family diets </li></ul><ul><li>Ready-to-use infant weaning foods can be prepared </li></ul><ul><li>Recipes suitable for preschool children </li></ul><ul><li>Nutritious snacks for infants and preschool children </li></ul>
  26. 28. Nutrition Education <ul><li>Breast feeding practices </li></ul><ul><li>Weaning foods at proper age </li></ul><ul><li>Easy recipes with supplementation </li></ul><ul><li>Cereal + Pulse mixes </li></ul><ul><li>Use of kitchen garden fresh foods and leafy vegetables </li></ul><ul><li>Use of millets , whole grains vs refined foods </li></ul><ul><li>Hygiene and clean water </li></ul>
  27. 29. Conclusion <ul><li>Nutrition Education to mothers </li></ul><ul><li>Breast feeding practices </li></ul><ul><li>Weaning food practices </li></ul><ul><li>Recipes – easy to prepare and economical </li></ul><ul><li>Modification of family meal </li></ul><ul><li>Supplementation of foods </li></ul><ul><li>Migrant population - on food selection guidance –use whole grains and good quality fats. </li></ul>
  28. 30. Thank you