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Role of Nutritionists in Strengthening the Nutritional Scenario @ Base of PyramidPresentation Transcript
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.
Nutritional challenges on Migration to cities(urban slums)
loss of traditional diet,
Irregular ,faulty eating
High stress –work
Lack of physical activity
Smoking , tobacco chewing, alcohol
Over weight and obesity
Coronary Heart disease
Incidence of obesity& related disorders – Migrant population
Young Women (18 – 25 years) = 13.2%
Delhi, DST Trial (2000)
Urban slum ( 35 years) = 40.2%
European Journal of Clinical Nutrition (2001 )
Urban Slum (30-60 years) = 28.2%
Delhi, (2002) DST Trial
Women migrant study
4,621( >35 years) overweight urban areas = 64 %
rural areas = 36 %
Hypertension >140/90 mm Hg = 50%
Hyperlipidaemia Cholesterol > 200 mg = 25%
Diabetes Blood sugar >126 mg% = 3 - 14 %
DST trial (2009)
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
Transition in Dietary Habits
Carbohydrates from whole grains were being replaced by refined products
Carbohydrates were also being replaced by unhealthy fats specially by SFA and TFA
Fibre content of diets reduced
Traditional foods replaced by modern refined foods
Diet :Low in MUFA ,n3 ,fiber, high in refined Carbohydrates ,SFA,TFA ,n6
Other side : Macro and Micronutrient deficiency
Deficiency of vitamin minerals often occurs in conjunction with PEM
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.
Malnutrition affects :
Most Vulnerable Groups are . . .
0-6 year children
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
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
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
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 .
40% of children below the age of 5 are under weight.
Despite the country's growing economy and an ambitious rural health initiative
Over 100,000 women die from pregnancy-related causes each year – highest in the world
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
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.
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
The higher the education of the mother, the better the nutrition status of themselves and their child.
National Family Health Survey (NFHS-3)
Prevention and cure for Anemia:
Increasing the iron content of food through dietary intake
Increasing the iron content of food through fortification
Increasing iron intake through supplementation
Reducing blood loss by treating for parasites
Reducing blood loss from hemorrhage by improving birthing or abortion practices and post-abortion care
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
One cost effective way of increasing the intake of iron, is fortification of salt with iron in addition to iodine
Improving mothers' feeding and caring behaviour with emphasis on infant and young child feeding and maternal nutrition , during pregnancy and lactation.
Improving household water and sanitation.
Strengthening the referral to the health system, with emphasis on prevention and control of common child diseases including acute malnutrition.
Actual implementation follow ups.
Supplementary feeding activities need to be better targeted towards those who need it most ,with clear criteria set for quality assurance and accountability.
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.
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.
0-6 months is critical, 6-12 is next
We allow child under nutrition to set in - with poor feeding ( Breast feeding and complementary feeding)
Neonatal infections, Diarrhea and pneumonia give 2/3 rd mortality in 1 st year
According to WHO, other 2/3 rd mortality is related to poor feeding practices