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. Nutritional Challenges at BOP
 Increased birth rate
 Less of education
 Increased death rate - Increased IMR
 Less medical care
 Less finances
 Less nutritious foods
 Nutritional Deficiencies
 Infectious diseases
 Chronic diseases
 Poor maternal and child health

3. Nutritional challenges
India faces a double burden
 Under nutrition and poor maternal health
 Increase in over weight and obesity
(Under privileged migrant population
from rural areas to urban slums)
Nutritionists role is mandatory in both

4. Picture 2

5. Nutritional challenges on
Migration to cities(urban slums)
 loss of traditional diet,  Over weight and
obesity
 Irregular ,faulty eating
 Coronary Heart disease
 High stress –work  Diabetes
 Family deprivation  Hypertension
 Lack of physical activity  Metabolic syndrome
 Smoking , tobacco  Stroke
chewing, alcohol  Hypercholesterolemia
 Hypertriglyceridemia

6. 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)

8. Coronary Risk Factors in Urban Underprivileged
New Delhi, India
60
High W-HR
45
Hypertension
High body fat
Percentage
30
15
High BMI Diabetes
0
Misra et al., Eur J Clin Nutr, 2001
Misra et al., Int J Obesity, 2001
Misra et al., Diab Res Clin Pract,

9. 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

10. Other side

11. 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.

12. Malnutrition affects:
• Survival
• Development
• Growth
• Health
• Productivity
• Economic Growth

13. Most Vulnerable Groups are . . .
• 0-6 year children
• Pregnant Women
• Lactating Mothers
• Adolescent Girls
• Aged

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

15. The picture (as per UNICEF and MI VM global progress
report)
Iodine Estimated to have lowered the
deficiency Intellectual capacity by 10-15 percentage
points
Iron Mental development impaired by 40-60%
deficiency in
6-24 m olds
Vitamin A Impaired the immune system leading to
deficiency an estimated one million children not
reaching their 5th birthday
Iodine 18 million babies being born mentally
deficiency in impaired
mothers

16. The picture [as per UNICEF and MI VM
global progress report
Folate Approximately 200,000 babies with
deficiency severe birth defects and 1in 10 deaths
from heart disease in adults
Severe Iron Causes loss of life more than 60,000
deficiency young women in pregnancy and child
birth and loss of 2% GDP.
This is high economic cost on virtually
every developing nation---world bank

17. Nutritional Challenges
 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

18. Nutritional Challenges
 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)

19. Way Forward
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

20. Nutrition Programmes
 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.
 Providing micronutrients.
 Actual implementation follow ups.

21. Programme recommendations:
 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.

22. Exclusive breastfeeding prevents
child malnutrition
 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 2/3rd mortality in 1st year
 According to WHO, other 2/3rd mortality is
related to poor feeding practices

23. Way Forward
Prevention and cure for under nutrition in children
 There are ten proven, high-impact interventions ,that can
help in bringing, child under nutrition , figures down:
q Timely initiation of breastfeeding within one hour of
birth.
q Exclusive breastfeeding in the first six months of life
q Timely introduction of complementary foods at six
months
q Age-appropriate foods for children six months to two
years
q Safe and hygienic complementary feeding practices

24. Way Forward
6. Full immunization and bi-annual vitamin A supplementation
with deworming
7. Appropriate feeding for children during and after illness
8. Therapeutic feeding for children with severe acute
malnutrition
9. Adequate nutrition and anemia control for adolescent girls
10. Adequate nutrition and anemia control for pregnant and
breastfeeding mothers
UNICEF

25. Nutrition Interventions to combat
Micronutrient Malnutrtition
• Fortification
• Supplementation
• Dietary diversification
• Nutrition and health Education

26. DIETARY DIVERSIFICATION to combat
Micronutrient Malnutrition
• Horticulture interventions: Promote the Nutritious crops by
providing incentive to the farmers
• Nutrition and Health Education to promote healthy eating patterns –
LONG TERM SUSTAINABLE intervention – BEHAVIOUR CHANGE
• Promotion of correct Infant and Young child Feeding Norms
• Promotion of low cost locally available nutritious food – by
providing them recipes/ or demonstration of the recipes
• Promotion of seasonal fruits and vegetables
• Use of Hygiene and sanitary practices
• Use of Safe Drinking water
• Use of Mass media to promote healthy Food ,Safe , Sanitary and
hygiene Practices

27. Fortification and supplementation
 Recipes suitable for infants and children
 Recipes which can be prepared daily specifically for
the infant
 Adult food modified to suit children’s needs
 Protein-rich supplements that may be added to the
family diets
 Ready-to-use infant weaning foods can be prepared
 Recipes suitable for preschool children
 Nutritious snacks for infants and preschool children

28. Nutrition Education
 Breast feeding practices
 Weaning foods at proper age
 Easy recipes with supplementation
Cereal + Pulse mixes
 Use of kitchen garden fresh foods and
leafy vegetables
 Use of millets , whole grains vs refined
foods
 Hygiene and clean water

29. Conclusion
 Nutrition Education to mothers
 Breast feeding practices
 Weaning food practices
 Recipes – easy to prepare and economical
 Modification of family meal
 Supplementation of foods
 Migrant population - on food selection
guidance –use whole grains and good
quality fats.

30. Thank you