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Trends and patterns in the triple burden of malnutrition in India

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Abstract

This paper brings together recent evidence on what has come to be referred to as the triple burden of malnutrition—consisting of overnutrition, undernutriton, and micronutrient deficiencies—using various anthropometric, biochemical, and diet quality indicators, and juxtaposing these against changes in relative prices. The evidence points to the rapid emergence of overweight as a public health problem, widespread not only in urban, but also in rural areas; associated noncommunicable diseases are also on the rise. Over time, while most indicators of undernutrition have improved, magnitudes are nonetheless high; a persistent problem is anemia, the prevalence of which remains high and unchanged. As for food, more than quantity, it is its quality that appears to be correlated with malnutrition. Yet improvements in diet quality have not been high, and micronutrient intakes remain low. It has become increasingly difficult for the poor to have a diet rich in vegetables, dairy and meat, as their prices (per unit calorie), relative to cereals, have risen faster than for the rich.

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... Between 1990 and 2016 NCDs as a proportion of the overall disease burden increased from 39% to 67%, whilst deaths attributable to NCDs increased from 38% to 62% (ISDBIC, 2017). In tandem with the epidemiological change, India has been undergoing a dietary transition in which there has been a shift away from traditional cereal-based foods towards a diet containing greater animal-sourced products, saturated fats and sugars in addition to lifestyle changes which are reflected by reduced levels of physical activity (Griffiths & Bentley, 2001;Law, Fraser, & Piracha, 2020;Meenakshi, 2016;Misra, Singhal, & Sivakumar, 2011;Shamsi, Almutairi, & Mashrafi, 2018;Shetty, 2002). This has seen a dramatic increase in the prevalence of overweight/obesity in India: it has doubled during the decade to 2015-16 to now affect nearly 20% of the entire Indian population aged 15-49 years (NFHS-4, 2017). ...
... However, more recent studies reveal that the prevalence of overweight/obesity has started expanding from the more affluent economic cohorts to the less wealthy ones in the urban population, particularly among women but there is evidence of a decreasing gender gap with the prevalence of overweight/obesity rising more rapidly for men (Luhar, Mallinson, Clarke, & Kinra, 2018Sengupta, Angeli, & Syamala, 2015;Shannawaz & Arokiasamy, 2018). Recent work also shows that overweight/obesity is an increasing issue in rural areas (Meenakshi, 2016). This has led to the recognition that the problem of overnutrition in India is no longer considered a 'disease of affluence' nor is it confined to the urban environment (Luhar, Mallinson, Clarke, & Kinra, 2018;Meenakshi, 2016). ...
... Recent work also shows that overweight/obesity is an increasing issue in rural areas (Meenakshi, 2016). This has led to the recognition that the problem of overnutrition in India is no longer considered a 'disease of affluence' nor is it confined to the urban environment (Luhar, Mallinson, Clarke, & Kinra, 2018;Meenakshi, 2016). To date, however, with the exception of Luhar, Mallinson, Clarke, and Kinra (2019) who focuses on a select few states, there has been very limited research analysing obesity transition in India in the context of state-level variations. ...
Article
The dramatic increase in overweight/obesity prevalence in India and the concomitant increase in nutrition-related non-communicable diseases present critical health policy challenges. This paper analyses two successive nationally representative household datasets – the 2015–16 and 2005–06 National Family Health Survey rounds – to discern the extent of shifts in overweight/obesity prevalence underway in India and the implications for informing policy. Unique features of the study are the focus given to analysing overweight/obesity across different sub-populations, based on gender, rurality and socio-economic status, and the diverse pattern of the prevalence across individual states over time. A fixed effects model using state-time interactions is used to analyse state-level variations and time-dependent effects across particular sub-populations. Despite the considerable increase in the prevalence of overweight/obesity over the past decade and a degree of convergence across population cohorts, the results show that this has been accompanied by considerable variation and divergence between states. Our findings reveal that a select few economically advanced states, most noticeably for wealthy urban female cohorts, experienced negative time-dependent effects where the predicted rates of overweight/obesity declined over the decade. However, some less developed and more populous states experienced positive time-dependent effects such that by 2015–16 they had attained overweight/obesity rates that had overtaken those of richer states. Also, interestingly, beyond a particular threshold education exhibits a negative relationship in the likelihood of overweight/obesity for females but not for males. Policymakers need to understand the driving factors underpinning the state-level differences and the changing patterns across cohorts over time, and to formulate regionally–based policies that specifically target these differences rather than pursue a single policy approach. Moreover, India’s health system needs to be re-orientated to manage burgeoning chronic disease conditions and to address the burden placed on the poor given that such health expenditure is mostly privately incurred.
... They have empirically established that food security of the households is one of the major factors in determining nutritional outcomes of the population (Smith and Haddad 2001;Reis, 2012;Naser et al. 2014;Mutisya, et al. 2015). While Sangeetha et al. (2017) emphasized the role of homestead production in improving nutritional outcomes, Little et al. (2016) and Meenakshi (2016) have put forth the importance of household income in achieving nutritional security. Aromolaran (2010) suggests that gender-neutral increase in income is likely to increase the nutrient intake substantially. ...
... Aromolaran (2010) suggests that gender-neutral increase in income is likely to increase the nutrient intake substantially. A number of studies exploring the linkages between agriculture and nutrition have concluded that agriculture interventions can play a promising role in enhancing nutritional status (Gulati et al. 2012;Kadiyala et al. 2012;Kadiyala et al. 2014;Smith and Haddad 2001;Reis 2012;Mutisya et al. 2015;Naser et al. 2014;Das et al. 2014;Bhaskar et al. 2017;Sangeetha et al. 2017;Little et al. 2016;Meenakshi 2016). ...
... Similarly, Little et al. (2016) found a high prevalence of obesity among the affluent society and they also reported upper caste, accessibility to TV and less physical activity were the other major factors which increased obesity among the people. Meenakshi (2016) found that the incidence of over nutrition remains lower in the poorer states than richer states in India. Our analysis is also in line with the Masters et al. (2016) study where they reported that obesity rates shifted up significantly for the higher income level countries but not in poorer countries based on the analysis of more than 100 countries over 30 years of data. ...
Conference Paper
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The Indian economy is one of the fastest-growing economies in the world. While it achieved self-sufficiency in food production, India ironically also harbours the largest population in the world suffering from malnutrition-. This paper examines the food security status across the Indian states, by constructing an index comprising 17 indicators developed by the Economist Intelligence Unit, which represents food availability, affordability and quality, and safety. Information from multiple government sources and research reports were combined to develop a comprehensive food security index for 2015-16. By extracting National Family Health Survey-4 (2015-16) data, body mass index and anaemia-based indicators were analysed to study the nutritional status of children and adults across the states. A multivariate linear regression model was employed to explore the relationship between nutritional outcome and food security of the population. Empirical evidence suggests that increase in food security index by one percent would significantly decline the incidence of stunting and underweight respectively by 0.5 and 0.6 percent among children and about 0.4 percent in case of adults underweight, after controlling for state dummy.
... It is important to note that malnutrition is not concerned only with the sufficiency of food but extends to having the appropriate micronutrients (Meenakshi, 2016). Moreover, evidence suggests that malnutrition coexists with other health conditions (Kulkarni and Gaiha, 2017;Mondal et al., 2015). ...
... The coexistence of undernutrition along with overweight or obesity within individuals, households, and populations and across the life course is what has been referred to as the double burden of malnutrition (DBM) (Davis et al., 2020). However, in recent times, there have been concerns about the coexistence of over nutrition, under nutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM) (Meenakshi, 2016). ...
... The DBM is defined by the coexistence of maternal overweight and obesity along with child undernutrition within the same household level (Emdadul et al., 2018;WHO, 2016). TBM (TBM) refers to the coexistence of overnutrition, undernutrition and micronutrient deficiencies (Meenakshi, 2016). ...
Article
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Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub–Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.
... A leading risk factor for the increasing disease burden is consumption of processed food (8)(9)(10)(11). Since liberalization in the early nineties, there has been a drastic change in food consumption patterns of urban Indians (12)(13)(14) characterized by increased consumption of sugars, fats, oil, and ultra-processed foods (12)(13)(14)(15). Certainly, there has been a notable increase in the purchase of sweet and salty snacks from 2013 to 2017 in India (16). ...
... A leading risk factor for the increasing disease burden is consumption of processed food (8)(9)(10)(11). Since liberalization in the early nineties, there has been a drastic change in food consumption patterns of urban Indians (12)(13)(14) characterized by increased consumption of sugars, fats, oil, and ultra-processed foods (12)(13)(14)(15). Certainly, there has been a notable increase in the purchase of sweet and salty snacks from 2013 to 2017 in India (16). ...
... The entry of many foreign cuisines is a new phenomenon (87) and people are enjoying the novelty and variety of dining options now available. Eating out was a rare treat for the middle class but now with the dinning environment changing (13,48,87) and increased income, eating out frequently has become popular. Ordering food has also become very frequent and is more popular than eating out (88). ...
Article
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One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.
... In this same time period, between 2005 and 2015, overweight incidence doubled in the country (ICMR, 2017;Pingali et al., 2019a;Aiyar et al., 2021). An analysis of the distribution of overweight incidence revealed that there were significant intracountry differences (Meenakshi, 2016;Pingali et al., 2019a). Rural areas, which have been traditionally food insecure, saw the largest increase in overweight incidence. ...
... Intrahousehold disparities in access to income-generating assets leads to men using motorized vehicles more than women (Masamha et al., 2018). These intrahousehold disparities in access to goods and services are known to impact nutritional outcomes of women more adversely (Sengupta et al., 2015;Meenakshi, 2016;Pingali and Rao, Fig. 1. Factors that contribute to within-country differences in overweight prevalence during the nutrition transition. ...
... They found that the SES gradient is downward sloping for urban women living in more developed states in India. More developed states experience obesity at higher rates in the population even among their poor (Griffiths and Bentley, 2001;Meenakshi, 2016). Building on Swinburn et al. (2019), we propose that the NT stage matters in explaining India's within-country differences. ...
Article
Full-text available
India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005–06 and 2015–16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.
... In contrast, there was a 2% increase in children affected by mild anemia from 2005-2006 to 2015-2016. The rates of anemia in women have also increased from 2005-2006 to 2012-2014, with Uttar Pradesh showing a 40% rise in anemia prevalence [17]. In general, the prevalence of anemia is higher in poorer areas, socioeconomically lagging communities (scheduled castes and scheduled tribes) and among children born to uneducated women [16]. ...
... Meanwhile, the share of staple cereal in total calorie intake has witnessed a decrease in the past few years. However, this calorie deficit seems to have been met with an increased consumption of oil and sugar, while the share of fruits and vegetables or livestock has remained unchanged during this period [17]. Lastly, meat consumption in India is at 3.3 kg/capita, which is much lower than the world average of 34.3 kg/capita [34]. ...
... In many cases, this led people to consume more staples to meet their caloric demand and drastically diminished the dietary diversity [48], further enabling iron deficiency [49]. Such ramifications could be attributed, partially, to India's food policy to favor caloric sufficiency over a nutritionally diversified food system [17]. ...
Article
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While rates of malnutrition have declined over the last decade in India due to successful government interventions, the prevalence of anemia remains high. Staple foods provide almost 70% of the daily iron intake. As staple foods are a rich source of phytate, this ingested iron is poorly absorbed. Currently, 59% of children below 3 years of age, 50% of expectant mothers and 53% of women aged 15–19 years are anemic. The most common intervention strategy has been through the use of iron supplements. While the compliance has been low and supplies irregular, such high rates of anemia cannot be explained by iron deficiency alone. This review attempts to fit dietary and cooking practices, field-level diagnostics, cultural beliefs and constraints in implementation of management strategies into a larger picture scenario to offer insights as to why anemia continues to plague India. Since the rural Indian diet is predominantly vegetarian, we also review dietary factors that influence non-heme iron absorption. As a reference point, we also contrast anemia-related trends in India to the USA. Thus, this review is an effort to convey a holistic evaluation while providing approaches to address this public health crisis.
... It is important to note that malnutrition is not concerned only with the sufficiency of food but extends to having the appropriate micronutrients [8]. Moreover, evidence suggests that malnutrition coexists with other health events [9,10]. ...
... The coexistence of undernutrition along with overweight and obesity within individuals, households and populations and across the life course is what has been referred to as the double burden of malnutrition (DBM) [11]. However, in recent times, there have been concerns about the coexistence of overnutrition, undernutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM) [8]. ...
... Few studies have examined the prevalence and associated factors of TBM. Available evidence from elsewhere in Nepal [12] and India [2,8] have found factors such as maternal age, maternal educational status, caesarean section delivery, birth size of baby, household wealth quintile and place of residence to be significantly associated with TBM. Nonetheless, its prevalence and associated factors in the sub-Saharan African context have not been investigated, even though TBM poses a great threat to the health and wellbeing of children. ...
Article
Full-text available
Despite concerns about the coexistence of overnutrition, undernutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM), little is known about the phenomenon in sub-Saharan Africa (SSA). We, therefore, aimed to examine the prevalence and investigate the factors associated with TBM in SSA. This study uses cross-sectional survey data collected through the Demographic and Health Surveys (DHS) Program from 2010 to 2019. Data from 32 countries in SSA were used for the analysis. The prevalence of TBM were presented in tables and maps using percentages. The predictors of TBM were examined by fitting a negative log-log regression to the data. The results were then presented using adjusted odds ratios (aORs) at 95% Confidence Intervals (CIs). Out of the 169,394 children, 734 (1%) suffered from TBM. The highest proportion of children with TBM in the four geographic regions in SSA was found in western Africa (0.75%) and the lowest in central Africa (0.21%). Children aged 1 [aOR = 1.283; 95% CI = 1.215–1.355] and those aged 2 [aOR = 1.133; 95% CI = 1.067–1.204] were more likely to experience TBM compared to those aged 0. TBM was less likely to occur among female children compared to males [aOR = 0.859; 95% CI = 0.824–0.896]. Children whose perceived size at birth was average [aOR = 1.133; 95% CI = 1.076–1.193] and smaller than average [aOR = 1.278; 95% CI = 1.204–1.356] were more likely to suffer from TBM compared to those who were larger than average at birth. Children born to mothers with primary [aOR = 0.922; 95% CI = 0.865–0.984] and secondary [aOR = 0.829; 95% CI = 0.777–0.885] education were less likely to suffer from TBM compared to those born to mothers with no formal education. Children born to mothers who attended antenatal care (ANC) had lower odds of experiencing TBM compared to those born to mothers who did not attend ANC [aOR = 0.969; 95% CI = 0.887–0.998]. Children born to mothers who use clean household cooking fuel were less likely to experience TBM compared to children born to mothers who use unclean household cooking fuel [aOR = 0.724; 95% CI = 0.612–0.857]. Essentially, higher maternal education, ANC attendance and use of clean cooking fuel were protective factors against TBM, whereas higher child age, low size at birth and being a male child increased the risk of TBM. Given the regional variations in the prevalence and risk of TBM, region-specific interventions must be initiated to ensure the likelihood of those interventions being successful at reducing the risk of TBM. Countries in Western Africa in particular would have to strengthen their current policies and programmes on malnutrition to enhance their attainment of the SDGs.
... oils and highly processed food in Indian diets (Meenakshi, 2016, Law et al. 2019, with more apparent changes identified in urban India (Luhar et al. 2018, Baker., 2014Moodie et al. 2013;Thow et al. 2016). With the rapid growth of the modern global food retail sector, the consumption of packaged and processed foods has become more common in much of the world (Popkin, 2014), with biryani being one of the most purchased processed food commodity. ...
... Additionally, energy-dense diets may contribute to insulin resistance by their higher levels of saturated fats, which have been shown to be related to impaired insulin sensitivity (Ledikwe et al. 2006;Jason et al. 2007). In recent decades, researchers have observed an increased intake of sugar, oils and highly processed food in Indian diets (Meenakshi, 2016, Law et al. 2019, with more apparent changes identified in urban India (Luhar et al. 2018, Baker., 2014Moodie et al. 2013;Thow et al. 2016). With the rapid growth of the modern global food retail sector, the consumption of packaged and processed foods has become more common in much of the The biryani samples contained essential amino acids, which the human body cannot synthesize like Leucine, Lysine, Methionine, Phenylalanine, Threonine and Valine in the range of 1.27 ± 0.70 to 3.80 ± 2.28 g/100gms (Table 3). ...
... Despite the recent achievements in food security, malnutrition continues to be a major health concern in many developing countries. Food and nutritional security are not just about having enough food, rather approaching for foods that can help with quality diet, adequate calories, and micronutrients [1]. In fact, malnutrition concerns not only undernutrition but also overnutrition and its related non-communicable diseases (NCDs) [1]. ...
... Food and nutritional security are not just about having enough food, rather approaching for foods that can help with quality diet, adequate calories, and micronutrients [1]. In fact, malnutrition concerns not only undernutrition but also overnutrition and its related non-communicable diseases (NCDs) [1]. The coexistence of undernutrition and overweight/obesity in the same country, communities, and households is known as the double burden of malnutrition (DBM) [2]. ...
Article
Purpose Globally, malnutrition in mother-child pairs is steadily diminishing. However, the coexistence of different forms of double burden of malnutrition (DBM) is rising worldwide, including Bangladesh. This study aimed to explore the coexistence of different forms of DBM and their associated factors in the same household level for Bangladesh. Methods The study utilized the Bangladesh Demographic and Health Survey (BDHS) 2014 dataset. Chi-square test of association was conducted to identify the significant factors for various forms of DBM. For the measurement of adjusted odds ratios with 95% confidence intervals, multivariate logistic regression (MLR) analysis was performed. Results In this study, the overall prevalence of DBM was 5.8% as several sociodemographic and economic factors correlate and contribute to this burden. Results of MLR analyses showed that potential factors with increasing DBM were: poor wealth stratum, use of unhygienic toilet, mother's age in years, child delivery procedure, child's birth order, and father's education. Conclusion The prevalence of DBM is still high in Bangladesh, based on different associated sociodemographic factors. Public health stakeholders in Bangladesh should address these factors and implement appropriate interventions with regard to minimizing the DBM.
... The incidence of overweight and obesity is emerging as a major public health problem. It is not only restricted to urban areas but is now widespread across the rural population, too, leading to a greater incidence of noncommunicable diseases (Meenakshi, 2016). Although the increase in urban BMI is often associated with a decline in the physical intensity of work, as result of sedentary occupational structure (Dang et al., 2019), very few studies have explored the factors that underpin the rise in rural obesity patterns. ...
... Obesity incidence, therefore, is expected to be higher in villages that are closer to urban centers, and this urban effect declines gradually as one moves further away. We also add insights to the small body of literature that has brought attention to the growing concern of rising obesity in rural areas across the developing world (Wang et al., 2009;Sengupta et al., 2015;Meenakshi, 2016;Dang et al., 2019). Our framework helps tease out which structural factors best explain the rapid rise in overweight incidence across these areas. ...
Article
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While obesity across rural India has doubled in the last decade, research explaining such an unprecedented change is sparse. This paper shows that the rise in the incidence of rural obesity is associated with the process of structural transformation, especially within rural spaces. As the distance to nearby towns from the villages has reduced, urban proximity not only leads to improved livelihoods but also a change in dietary practices and access to processed food. Combining the rural sample of India’s latest National Family Health Survey (2015–16) with the estimates for town distance from the village clusters, we show that an additional kilometer of reduction in rural–urban distance increases the risk of obesity among women by 0.06 percent. Our estimates imply that for every kilometer of reduction in rural–urban proximity 3000 rural women become at-risk for obesity. Heterogeneity analysis shows that this burden is higher in towns with a population of over 50,000. We also find that the risk has increased disproportionately among the lower socio-economic classes. Similarly, states at a more mature stage of structural transformation face higher risk of obesity. Finally, we find that higher dietary diversity reduces the influence of urban growth on rural obesity. Our findings underscore the looming dual burden of malnutrition among developing countries and suggest that nutrition policies that promote diet diversity could be a panacea.
... India is home to over 1.3 billion people (almost 20% of the global population) and suffers from a triple burden of malnutrition as high rates of hunger (undernutrition or calorie deficiency), overnutrition (overweight, obesity due to excessive caloric intake), and hidden hunger (micronutrient deficiency, i.e., deficiency of essential vitamins and minerals) coexist. 1 Almost every third child under the age of 5 years in India is undernourished with 36% underweight, 38% stunted (short height for age), and 21% wasted (low weight for height). 2 The number of stunted children in India account for almost one-third of the world's cases of stunting. 3 This coincides with a high prevalence of overweight, obesity, and concomitant non-communicable diseases (NCDs) 4 with an estimated 61% of deaths 5 in India attributable to NCDs in 2017 and almost 20% of men and women suffering from overweight/obesity. 2 In addition, almost two-thirds of the Indian population suffers from deficiency of one or more micronutrients. ...
Article
In recent times, there has been an increased international interest in India's food systems. There is a concern that, with rising population and incomes, India's adoption of unsustainable dietary patterns could have disastrous consequences not only for public health but also for the environment, locally and globally. This in turn can seriously threaten the progress toward achievement of the United Nations global Sustainable Development Goals. Identifying and informing stakeholders of sustainable dietary behaviors is thus essential. Here, using a non-linear optimization algorithm, we identify a sustainable diet for each of India's 35 states. These diets meet daily recommendations for 29 nutrients, exist within five environmental planetary boundaries, including greenhouse gas emissions, freshwater use, cropland use, nitrogen, and phosphorus application, and satisfy several cultural acceptability constraints. Results reveal that, while such a sustainable diet is possible, it will cost 50% more than current diets in most Indian states. Our results offer optimistic news that India's nutrition problem can be solved without jeopardizing the environment.
... As India is in a state of nutrition transition, together with undernutrition, the prevalence of overweight and obesity are also on the rise, especially in urban areas [10,11]. BMI z-score is recommended for screening for obesity in children and adolescents. ...
Article
Background Malnutrition is common in developing countries and is not restricted to young children. For early identification of malnutrition, mid upper arm circumference (MUAC) measurements has been suggested as an easy, accurate and low-cost method. Our objectives were to construct age and gender specific MUAC reference centiles, and define and validate cut offs for assessment of under and overnutrition in 5–17 year-old Indian children. Methods This was a cross-sectional, multicentric, observational study conducted in 7 schools in 7 states (from June 2018-November 2019) on healthy 5–17 year-old children (n=6680). MUAC was measured using non-stretch tapes (UNICEF). Gender specific MUAC percentiles were computed for age and height. Cut-offs for MUAC Z-scores for thinness and overnutrition were defined and validated on healthy school children (n=726) and children with cancer (n= 500). Results Reference centiles for MUAC for age (and height) for boys and girls are presented. Cut offs defined for thinness and for obesity were -0.7 and +1.5 Z-score respectively (corresponding to 25th and 95th percentiles of the MUAC for age/height). For ease of use, rounded off cut-offs for thinness were 16 and 18.5 cms from 5-9 years and 10-14 years respectively in both genders, and a cut-off of 22 cms in boys and 20 cm in girls from 15-17 years. For obesity, 20 and 25.5 cms from 5-9 years and 10-14 years respectively in both genders and a rounded off cut-off of 29 cms in boys and 27 cm in girls from 15-17 years are proposed. Conclusions We have presented MUAC percentiles and cut offs for screening for thinness and overnutrition in Indian children from 5-17 years of age. These data may also be used in children with cancer and other chronic disorders with growth failure.
... Household burden of malnutrition can be classified by the collective burden among individual members of the household. Double/dual burden of malnutrition (DBM) is considered as the co-existence of maternal overweight and obesity along with child undernutrition within the same household (27,28) , while triple burden of malnutrition (TBM) refers to the co-existence of overweight/obesity, undernutrition and micronutrient deficiency (29,30) in the same household. It is also worth stating that, there could be the co-existence of overweight/obesity and micronutrient deficiency in the same individual and this could occur in either a child or the mother (adult woman). ...
Article
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Objective: Undernutrition and anaemia - the commonest micronutrient deficiency, continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. This study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. Setting: The study involved twenty-three countries across SSA who conducted demographic and health surveys between 2008 and 2017. Participants: The analytical sample includes 145,020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under-five years). Design: Logistic regression analyses were used to determine household correlates of household burden of malnutrition. Results: Anaemia was the most common form of household burden of malnutrition, affecting about 7 out of 10 households. Double and Triple burden of malnutrition though less common, was also found to be present in 8 and 5 percent of the households respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. Conclusions: The findings of this study reveal that, both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only, but also address overweight/obesity and anaemia.
... The less privileged are undernourished due to inadequate quantity and quality of diets. Consequently, countries like India face triple burden of malnutrition across different segments of the population: low intake of macronutrients and widespread inadequacy of micronutrient intake among the lower income groups and micronutrient deficiency and high intake of macronutrients specifically lipids among higher income groups (Meenakshi, 2016;Agrawal, et. al., 2014). ...
Technical Report
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In nutrition insecure regions of rural India, farming system with focus on nutrition (or FSN) can prove effective in improving access and availability for nutrient intake. In 2017, a few villages in Koraput district, Odisha and Wardha district, Maharashtra were involved to increase their crop diversity, intercropping of pulses and cereals, promotion of seasonal fruits and vegetables and nutrition awareness. About 75-80 percent of households voluntarily agreed to involve, for whom the reported dietary habits were recorded in 2014, before the FSN interventions and in 2017, after the interventions. This study reports the findings from reported dietary changes for the two years. Household food consumption is converted into its nutrient content and normalized by the demographic composition of the households. The intake of micronutrients like vitamin A, vitamin C, iron and calcium show larger improvements compared to calories and proteins. This is partly because the intervention focused more on dietary quality than in improving energy dense food. The changes are more apparent in Wardha as their nutrient intakes and dietary diversity were low in 2014. Households in Koraput benefitted substantially from the newly introduced schemes for clean cooking fuel and sanitation thereby improving hygienic environment that would enable improved nutrient absorption.
... With green revolution and use of excessive fertilizers add to GHG emissions, another concerning factor is increase in use of processed foods among general public of Indian population. It has been observed recently that there is a huge increase in intake of sugar, oils and processed foods among urban population of India (Meenakshi 2016). However, processed foods are convenient to cook in shorter duration, processed foods are gaining momentum among urban and working population. ...
Article
India is an agrarian country with a long history of traditional food processing practices and Short food supply chains (SFSC). However, last few decades saw a huge investment and steady increase in large scale integrated food processing units to combat globalization, food security and India’s export demands. Recent outbreak of COVID-19 has manifested the drawbacks in the existing production and supply chain system with a wide range of issues and enforces the need for a more balanced approach. This scenario can be commonly observed in many other agrarian developing nations. This article discusses various issues concerning the existing integrated food processing sectors such as high energy consumption, greenhouse gas emissions and food insecurity during disasters and pandemic outbreaks. Moreover, we emphasise a more sustainable approach with a better balance and understanding between SFSC and integrated food processing. A potential solution in this scenario would be, rejuvenating SFSC and traditional food processing approaches along with integrated food processing units. An approach of this kind, opens up new possibilities for a next generation process-supply system.
... It is also becoming increasingly difficult for poor households to consume a diet rich in vegetables, dairy, or meat, as the prices of these foods have risen quickly relative to those of cereals (Meenakshi 2015). The solution to this problem is not clear, as providing households with food subsidies does not guarantee that they will use their freed-up income to purchase and consume nutritious foods. ...
... Most of the climate change impact studies on agricultural crops have concentrated on wheat, maize, rice and potato [3][4][5][6][7] , while fruits and vegetables have not received sufficient attention. The four main agricultural crops address food security, but not nutrition security for essential vitamins and micronutrients, fibre and phytochemicals that individually or in combination may benefit human health 8 . The World Health Organization Global Strategy on Diet, Physical Activity and Health 9 recommends that per capita fruit and vegetable consumption (excluding tubers) should exceed 400 g d −1 (ref. ...
Article
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The global production of processing tomatoes is concentrated in a small number of regions where climate change could have a notable impact on the future supply. Process-based tomato models project that the production in the main producing countries (the United States, Italy and China, representing 65% of global production) will decrease 6% by 2050 compared with the baseline period of 1980–2009. The predicted reduction in processing tomato production is due to a projected increase in air temperature. Under an ensemble of projected climate scenarios, California and Italy might not be able to sustain current levels of processing tomato production due to water resource constraints. Cooler producing regions, such as China and the northern parts of California, stand to improve their competitive advantage. The projected environmental changes indicate that the main growing regions of processing tomatoes might change in the coming decades. The projected increase in temperature will decrease processing tomato production in the three main producing countries by 2050. Temperature increases and water resource constraints in the future might change the main processing tomato growing regions and shift the value chain in the coming decades.
... Since diet plays an important role in nutrition transition, it is crucial that healthy diet remains affordable to all. Meenakshi [28] reports a higher increase in prices of vegetables, dairy, and meat for poor households as compared to richer households. ...
Chapter
The double burden of malnutrition (DBM), i.e., coexistence of under- and overnutrition, is an emerging issue in most of the low- and middle-income countries of the world. Using field survey data conducted in and around the city of Bangalore, India in 2018, we examine the patterns of DBM among women, young children (0–6 years), older children (7–18 years), and intrahousehold DBM between mothers and children. A unique aspect of the survey is that it is conducted in an area undergoing rapid urbanization, which is one of the factors responsible for DBM and can inform on the future of DBM in India. Compared to undernutrition, the prevalence of overnutrition is much higher in our study area. We find that, like other developing countries, the socioeconomic distance in prevalence of under- and overnutrition among women has decreased over time. Additionally, overnutrition among women is no longer an urban phenomenon. Similar trends were observed for older children. For younger children, on the other hand, the socioeconomic and locational differences persist, suggesting that this age group is not witnessing nutrition transition yet. The intrahousehold burden of DBM has also increased over time and the risk increases with maternal education. Although under- and overnutrition are opposite in nature, both have several common drivers, suggesting that an integrated approach might work better in tackling DBM. Several existing programs in India, such as ICDS, PDS, and the school meal program, provide excellent infrastructure to roll out policies and interventions, especially diet-based programs, aimed at both under- and overnutrition.
... The 'consumption puzzle' has been the focus of intense debate and discussion during the last three decades due to the high prevalence of undernourishment and micronutrient deficiencies in India (Meenakshi 2016) and its implications for food and nutrition policymaking. Although both England during the Industrial Revolution and China between 1985 and these periods of economic growth, India's consumption puzzle stood out as it was happening when the calorie intake levels were already low (Eli and Li 2012;Duh and Spears 2017;Rao 2000). ...
Article
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India experienced a consumption puzzle since the 1970s, whereby households' calorie intakes declined over time, despite significant economic growth. This declining trend in calorie intake (consumption puzzle) was reversed for the first time in 2011-12. This is the first empirical study that investigates the relationship between refinements in data collection on food away from home (FAFH) and the trend reversal in per capita calorie intake decline in India. Findings from the study showed that the declining trend in calorie intake in India has been partly due to measurement issues and that correcting for these issues through refinements in data collection for FAFH in 2011-12 had a positive effect on the reversal of the calorie intake decline. India uses per capita calorie intake estimated using data from HCES to define the official poverty line, a benchmark used in designing many social welfare programs. Incorrect estimates of calorie intake will have negative implications on the effectiveness of welfare programs aimed at reducing food insecurity. Findings from this study provide insights for further improvement in data collection regarding household-level consumption expenditures. The study has implications not only for India but also for other countries that use household-level consumption data to understand diets and to design food and nutrition programs.
... Complications during pregnancy or within 42 days after birth are the major contributors to poor maternal outcomes including severe hemorrhage, maternal infections as well as other non-communicable diseases such as diabetes and anemia [145]. In India, the double and triple burden of malnutrition (undernutrition, overnutrition, and micronutrient deficiencies) are challenging the health of adolescents, women and their infants throughout the life course in urban and rural areas, increasing the risk of diet-related non-communicable diseases and pregnancy complications before, during and after birth [30,69,88,118]. For example, anemia in India is a silent killer that accounts for 80% of maternal deaths in South Asia [97]. Iron deficiency is the major cause of anemia; however, it can also result from other nutritional deficiencies (e.g., folate, Zinc, vitamins A and B12), parasitic infections, acute and chronic inflammation and other disorders that affect hemoglobin synthesis [97,144]. ...
Conference Paper
Few studies in HCI4D have examined the lived experiences of women with pregnancy complications. We conducted a qualitative study with 15 pregnant women to gain an in-depth understanding of the context in which pregnancy takes place and everyday experiences living with complications in rural North-West India. To complement our interviews, we conducted six focus groups with three pregnant women, three community health workers and three members of an NGO. Our study reveals insights about the challenges and experiences of the pregnant women with complications while navigating the physical, spatial, social and emotional aspects of antenatal care as part of complex and contradictory structures and settings of their everyday life. We argue that the design of digital health in support of pregnancy care for the Global South must center around supporting the navigational work done by the pregnant women and their families.
... A need for more inclusive terminology is further exemplified by usage of the term "triple burden of malnutrition," though using this term might contribute to confusion if the 3 burdens are not clearly defined. For example, the "triple burden" previously described coexisting communicable disease, NCD, and underweight (6); however, recent literature defines it as coexisting OW/OB, underweight or stunting, and micronutrient deficiencies (56,57). Although we retained the term DBM for this review due to its common usage, including by WHO and the recent DBM series in The Lancet (1, 7-10), we share this perspective on the need for updated terminology that reflects malnutrition's multiple possible phenotypes. ...
Article
Full-text available
Background: Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. Objectives: To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. Methods: Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. Results: We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). Conclusions: Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
... It is interesting to note, unlike CNNS, few states in NFHS-4 such as Tripura, Uttarakhand, Tamil Nadu, Arunanchal Pradesh, Jammu and Kashmir and Kerala, have been rewarded on account of balanced development across its dimensions. This could be a result of continuous efforts directed by the state agency in addressing malnutrition, for instance better implementation of programs such as the Integrated Child Development Scheme and Rural Health Mission in Tamil Nadu and history of interventions in the social sector in Kerala [37]. Use of MANSUH score is thus advantageous as it puts emphasis on the lagging indicator. ...
Article
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Background: India is strongly committed to reducing the burden of child malnutrition, which has remained a persistent concern. Findings from recent surveys indicate co-existence of child undernutrition, micronutrient deficiency and overweight/obesity, i.e. the triple burden of malnutrition among children below 5 years. While considerable efforts are being made to address this challenge, and several composite indices are being explored to inform policy actions, the methodology used for creating such indices, i.e., linear averaging, has its limitations. Briefly put, it could mask the uneven improvement across different indicators by discounting the 'lagging' indicators, and hence not incentivising a balanced improvement. Signifying negative implications on policy discourse for improved nutrition. To address this gap, we attempt to develop a composite index for estimating the triple burden of malnutrition in India, using a more sensitive measure, MANUSH. Methodology: Data from publicly available nation-wide surveys - National Family Health Survey (NFHS) and Comprehensive National Nutrition Survey (CNNS), was used for this study. First, we addressed the robustness of MANUSH method of composite indexing over conventional aggregation methods. Second, using MANUSH scores, we assessed the triple burden of malnutrition at the subnational level over different periods NHFS- 3(2005-06), NFHS-4 (2015-16) and CNNS (2106-18). Using mapping and spatial analysis tools, we assessed neighbourhood dependency and formation of clusters, within and across states. Result: MANUSH method scores over other aggregation measures that use linear aggregation or geometric mean. It does so by fulfilling additional conditions of Shortfall and Hiatus Sensitivity, implicitly penalising cases where the improvement in worst-off dimension is lesser than the improvement in best-off dimension, or where, even with an overall improvement in the composite index, the gap between different dimensions does not reduce. MANUSH scores helped in revealing the gaps in the improvement of nutrition outcomes among different indicators and, the rising inequalities within and across states and districts in India. Significant clusters (p < 0.05) of high burden and low burden districts were found, revealing geographical heterogeneities and sharp regional disparities. A MANUSH based index is useful in context-specific planning and prioritising different interventions, an approach advocated by the newly launched National Nutrition Mission in India. Conclusion: MANUSH based index emphasises balanced development in nutritional outcomes and is hence relevant for diverse and unevenly developing economy like India.
... It is interesting to note, unlike CNNS, few states in NFHS-4 such as Tripura, Uttarakhand, Tamil Nadu, Arunanchal Pradesh, Jammu and Kashmir and Kerala, have been rewarded on account of balanced development across its dimensions. This could be a result of continuous efforts directed by the state agency in addressing malnutrition, for instance better implementation of programs such as the Integrated Child Development Scheme and Rural Health Mission in Tamil Nadu and history of interventions in the social sector in Kerala [38]. Use of MANSUH score is thus advantageous as it puts emphasis on the lagging indicator. ...
Preprint
Full-text available
Background: India is strongly committed to reducing the burden of child malnutrition, which has remained a persistent concern. Findings from recent surveys indicate co-existence of child undernutrition, micronutrient deficiency and overweight/obesity, i.e. the triple burden of malnutrition among children below five years. While considerable efforts are being made to address this challenge, and several composite indices are being explored to inform policy actions, the methodology used for creating such indices, i.e., linear averaging, has its limitations. Briefly put, it could mask the uneven improvement across different indicators by discounting the ‘lagging’ indicators, and hence not incentivising a balanced improvement. signifying negative implications on policy discourse for improved nutrition. To address this gap, we attempt to develop a composite index for estimating the triple burden of malnutrition in India, using a more sensitive measure, MANUSH. Methodology: Data from publicly available nation-wide surveys - National Family Health Survey (NFHS) and Comprehensive National Nutrition Survey (CNNS), was used for this study. First, we addressed the robustness of MANUSH method of composite indexing over conventional aggregation methods. Second, using MANUSH scores, we assessed the triple burden of malnutrition at the subnational level over different periods NHFS- 3(2005-06), NFHS-4 (2015-16) and CNNS (2106-18). Using mapping and spatial analysis tools, we assessed neighbourhood dependency and formation of clusters, within and across states. Result: MANUSH method scores over other aggregation measures that use linear aggregation or geometric mean. It does so by fulfilling additional conditions of Shortfall and Hiatus Sensitivity, implicitly penalising cases where the improvement in worst-off dimension is lesser than the improvement in best-off dimension, or where, even with an overall improvement in the composite index, the gap between different dimensions does not reduce. MANUSH scores helped in revealing the gaps in the improvement of nutrition outcomes among different indicators and, the rising inequalities within and across states and districts in India. Significant clusters (p<0.05) of high burden and low burden districts were found, revealing geographical heterogeneities and sharp regional disparities. A MANUSH based index is useful in context-specific planning and prioritising different interventions, an approach advocated by the newly launched National Nutrition Mission in India. Conclusion: MANUSH based index emphasises balanced development in nutritional outcomes and is hence relevant for diverse and unevenly developing economy like India.
... Affordability is the most important determinant for the population level consumption of NDPFs especially among the rural poor (Dangour et al., 2013;Kehoe et al., 2019;Meenakshi, 2016;Ohlan, 2016;Shetty, 2002). Foods such as fruits, vegetables, milk, poultry and meat are usually perceived to be "costly" foods that are eaten on special occasions or are limited during adverse financial conditions in LMICs owing to their comparatively higher cost, poorer access and availability (Aurino and Morrow, 2018;Morris et al., 2018;Surendran et al., 2020). ...
Article
Full-text available
The triple burden of malnutrition in India is largely contributed by poor quality diets lacking adequate intake of nutrient dense perishable foods (NDPFs) - milk, eggs, fruits and vegetables. This is intriguing because India is one of the largest producers of NDPFs. This review examines possible reasons for this disparity. Poor post-harvest infrastructure, price volatility, unorganized supply chains, long-standing government policies favouring cereals and increasing consumer preference of convenience foods are identified as major reasons for the low intake of NDPFs. While nutrition-sensitive agriculture interventions appear promising to improve intakes of NDPF, stronger evidence is needed to scale up these interventions.
... Dietary risks are amongst the top risk factors for death and disability in India (Prabhakaran et al., 2018). Fruits and vegetables (F&V) are a key food group providing essential vitamins and minerals, and their intake is particularly important in settings where micronutrient deficiencies are widespread, such as India (Meenakshi, 2016). There are important associations between F&V intake and lowered risk of cancer, cardiovascular disease and all-cause mortality (Aune et al., 2017). ...
... India still faces the triple burden of malnutrition including underweight, micronutrient deficiencies and rising overweight and obesity [1]. India's food system is transitioning with significant changes in snacking and eating out behavior across all subpopulations (by age, gender, rural and urban locations, and income classes). ...
Article
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This study examines patterns of snack food consumption (SFC) in the rural-urban-slum transect (RUST) of a large city Pune and its precincts (population 10 million) in India. The transect structure aims to mimic a representative survey for the location capturing differences by age, gender, urbanicity, and socio-economic levels. Dietary data from 1405 individuals were used to describe snacking patterns and other food consumed at different frequencies; extent of physical activity; and Body Mass Index (BMI) and waist circumference of children, adolescents, and adults. Our results indicate high incidence of SFC across all population age groups, gender, socio-economic levels, and locations. A distinctive finding in relation to studies in high income countries is the prevalence of hunger snacking with 70% identifying hunger as the primary reason for SFC. Apart from hunger, particularly for adolescents, peer influence and social interactions played a significant role in SFC. Dietary behaviors of slum dwellers were characterized by three-quarters of them having SFC together with family members at home. SFC supplemented calories for low-income consumers and complemented calorie intake for high income ones. No significant association with BMI is possibly due to obesogenic SFC being likely offset by lower consumption of non-snack food and higher physical activity among poor and slum dwellers. Promoting awareness about diets and lifestyles, improving physical and economic access to healthier snacks and nutrient dense foods can improve diet quality in a large and heterogeneous population such as Pune.
... There are many countries worldwide facing DBM [9]. The TBM, on the other hand, refers to the co-existence of micronutrient de ciencies, undernutrition and overnutrition [10,11]. Micronutrient de ciencies include inadequate consumption of vitamins and minerals. ...
... 5,6 Add micronutrient malnutrition, and many countries face an enormous triple burden of malnutrition. 7,8 At the same time, we have found that in every country in the world, more than 20% of adults have overweight or obesity, 5 and in an increasing number of countries, 30-60% of adults have overweight or obesity. There are less than 20 countries below this 30% cutoff, including Myanmar and countries in South Asia and sub-Saharan Africa. ...
Article
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The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high‐income and many low‐ and middle‐income countries are in a stage of the transition where nutrition‐related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low‐ and middle‐income countries face rapid growth in consumption of ultra‐processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high‐income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra‐processed food intake and increasing prevalence of nutrition‐related noncommunicable diseases.
... India ranks second in fruit and vegetable production in the world, after China [15]. Fruits and vegetables are a key food group providing essential vitamins and minerals, and their intake is particularly important in settings where micronutrient deficiencies are widespread, such as in India [16]. Chhattisgarh food culture is the way forward to adopt ecofriendly practices and utilize available natural resources to enrich our daily diet. ...
Article
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Chhattisgarh state is situated in the central part of India and is also known as the ‘Bowl of rice’. Paddy is the principal crop of this state, and rice is the staple diet of the people. The state largely maintains its ethnic food culture as most of its population continues to live within rural and tribal areas. The state has nearly 44% of forest cover which serves as a decent source of food. People here prefer a vegetarian diet, and over 70 varieties of leaves, 25 varieties of tubers and roots are used here as vegetables. The present article is an attempt to explore the ethnic food culture of Chhattisgarh and to provide information about rice and non-rice-based traditional recipes, sweet dishes, leafy vegetables, tubers and roots which are consumed here. Irrespective of all the modern changes in food habits, the people of Chhattisgarh still preserve their traditional food culture.
... While the meals of infants and young children are predominantly consumed with parents and caretakers, as children age, exposures such as the school food environment, advertising and peer pressure become increasingly more important. India currently faces the triple burden of malnutrition-with high rates of undernutrition (stunting, wasting & underweight), micronutrient deficiencies, overweight and obesity (5). Effectively managing the triple burden of malnutrition will require holistic, integrated programs that improve the diet quality of India's youth and are first able to effectively measure diet quality in children and adolescents. ...
Article
Full-text available
Sustainably addressing the crisis of undernutrition for children and adolescents in underserved and resource-limited communities will require, among other investments, interventions aimed at optimizing the diets of these vulnerable populations. However, to date, there are substantial global gaps in the collection of dietary data in children and adolescents. This review article summarizes the challenges and opportunities in assessing diet among children and adolescents in India. National surveys in India identify the scale of the triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in children and adolescents and assess key nutrition and food security indicators for making informed policy decisions. However, national surveys do not collect data on diet, instead relying on anthropometry, biomarkers of micronutrient deficiencies, and summary measures of diet, such as the WHO infant and young child feeding summary indicators. Sub-national surveys and the scientific literature thus fill important gaps in describing the nutrient intakes of children and adolescents in India; however large gaps remain. Future research can be improved by investments in infrastructure to streamline the assessment of diet in India. The current challenges confronting the collection and analysis of high-quality dietary data occur in both the data collection and data analysis phases. Common methods for assessing diets in low-resource settings—such as 24 h recalls and food frequency questionnaires are particularly challenging to implement well in young children and adolescents due to motivation and memory issues in young respondents. Additionally, there are challenges with parental recall including children having multiple caretakers and meals outside the home. Furthermore, analysis of dietary data is hindered by the lack of affordable, accessible software for dietary data analysis relevant to the diversity in Indian diets. New technologies can address some of the challenges in dietary data collection and analysis, but to date, there are no platforms designed for population-level dietary assessment in India. Public and private sector investment in dietary assessment, as well as collaboration of researchers and the creation of open-source platforms for the sharing of data inputs (local food lists, recipe databases, etc.) will be essential to build infrastructure to better understand the diets of children and adolescents in India and improve dietary interventions in these target groups.
... Triple burden of malnutrition (TBM) refers to the coexistence of overnutrition, undernutrition and micronutrient deficiencies (Meenakshi 2016) Moreover, when DBM couples with micronutrient deficiency (Awasthi et al. 2020) particularly with the long-standing public health problem of anaemia affecting more than 40% of Indian children in the age group of 1-4 years (MOHFW 2019), there arises the "Triple Burden of Malnutrition" i.e., undernutrition, micronutrient deficiency and obesity occurring at the same time (Jain and Agnihotri 2020), within the same household as an overweight mother and an anaemic or an undernourished child (Sunuwar, Singh and Pradhan 2020). At present, this burden of malnutrition (dual and triple both) remains unaddressed, specifically in low-and middle-income countries, where almost a third of the child population is affected by one or more forms of malnutrition at the same time and almost half of them suffer from micronutrient deficiencies (UNICEF 2020). ...
... There are many countries worldwide facing DBM [9]. The TBM, on the other hand, refers to the co-existence of micronutrient deficiencies, undernutrition and overnutrition [10,11]. Micronutrient deficiencies include inadequate consumption of vitamins and minerals. ...
Article
Full-text available
Background Evidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn’t assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia. Methods A total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM. Results The overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38–2.24) and 1.2% (95%CI: 0.83–1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24–35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6–12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM. Conclusion There is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.
... Different sections of society can be targeted through the provision of school meals through the Mid Day Meal Scheme of the Ministry of Education or of food for children in anganwadi (rural childcare centres), or by divulging diet plans for pregnant women in primary health centres. Nutrition awareness campaigns for these target groups are needed to promote millet rice as a nutrient-dense food that can help tackle the triple burden of malnutrition (i.e. the coexistence of overnutrition, undernutrition and micronutrient deficiencies) facing the country today (Meenakshi, 2016). ...
Chapter
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The recognition of family farmers as social actors enables the creation of effective linkages between policies for rural poverty reduction and policies for market-oriented development – as is the case in Public Food Procurement programmes-. However, these programmes face challenges in terms of institutional development. This paper identifies some of the most relevant challenges and analyses institutional innovations that have been developed recently in Latin American and Caribbean countries to tackle them.
... Overall, nutrition can be seen as a Goldilocks problem, moving from undernutrition to overconsumption of each dietary component before reaching an overall healthy diet. Optimal ranges for each aspect of the diet are initially unknown, and are discovered only after some overshooting reveals the boundaries of both deficiency and excess for each nutrient or other bioactive compound in the diet (Meenakshi 2016). ...
Preprint
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Rapid increases in food supplies have reduced global hunger, while rising burdens of diet-related disease have made poor diet quality the leading cause of death and disability around the world. Today's "double burden" of undernourishment in utero and early childhood then undesired weight gain and obesity later in life is accompanied by a third less visible burden of micronutrient imbalances. The triple burden of undernutrition, obesity, and unbalanced micronutrients that underlies many diet-related diseases such as diabetes, hypertension and other cardiometabolic disorders often coexist in the same person, household and community. All kinds of deprivation are closely linked to food insecurity and poverty, but income growth does not always improve diet quality in part because consumers cannot directly or immediately observe the health consequences of their food options, especially for newly introduced or reformulated items. Even after direct experience and epidemiological evidence reveals relative risks of dietary patterns and nutritional exposures, many consumers may not consume a healthy diet because food choice is driven by other factors. This chapter reviews the evidence on dietary transition and food system transformation during economic development, drawing implications for how research and practice in agricultural economics can improve nutritional outcomes.
... Other literature, including a series of articles in the New York Times (2017, 2018) from Mexico, Brazil, Chile, Malaysia, India, China, and Ghana (the "Planet Fat" series, discussed later) have shown that, all else being equal, diet quality worsens with increase in income, accompanied by consumption of energy-dense foods and increased amounts of salt, sugars, and fats, contributing to obesity and NCDs-the so-called dietary transition (Popkin 2001(Popkin , 2009Webb et al. 2006;Popkin, Adair, and Ng 2012;Webb 2013;Masters 2015;Masters et al. 2016). Meenakshi (2016) noted that more than food intake, the quality of diet appears to be strongly correlated with the anthropometric indicators of malnutrition, yet improvements in diet quality have not been very high. Food price inflation, driven increasingly by non-cereals, has likely hindered larger improvements in diet quality, especially for the poor. ...
Chapter
Malnutrition, in all its forms, is a critical global public health problem. Food production and consumption patterns are also the largest challenges to planetary boundaries. Transformative change is needed in research, information and outreach, political commitment, and financial and institutional capacity to achieve sustainable and equitable food systems. Change, to date, has been incremental, not transformative; however, it is essential to significantly improve outcomes, an issue which will be a central theme of the United Nations’ Food Systems Summit 2021 and the intensive discussions leading up to it. The Sustainable Development Goals (SDGs) have powered the recent food security and nutrition discourse. And yet, SDG2 (zero hunger) is not broad enough; it does not pay enough attention to the growing incidence of obesity, as do the World Health Assembly targets for 2025. Furthermore, the interrelationships of the sub-targets of SDG2 are anything but straightforward. Growth in agricultural productivity does not necessarily increase incomes of small farmers, and productivity growth does not always assure improved nutrition. Increased income does not necessarily lead to improved nutrition. This also applies to the relationship of SDG2 to several other of the 16 SDGs. Increasingly, the concept of multidimensional poverty (MDP) has received attention in explaining food security and nutrition. MDP is substantially higher than income poverty, particularly among children. In addition, the chapter examines the relationship of gender inequality and nutrition, gender and obesity, nutrition transition, and the roles of changing lifestyles, food systems, and modern food chains.
... Different sections of society can be targeted through the provision of school meals through the Mid Day Meal Scheme of the Ministry of Education or of food for children in anganwadi (rural childcare centres), or by divulging diet plans for pregnant women in primary health centres. Nutrition awareness campaigns for these target groups are needed to promote millet rice as a nutrient-dense food that can help tackle the triple burden of malnutrition (i.e. the coexistence of overnutrition, undernutrition and micronutrient deficiencies) facing the country today (Meenakshi, 2016). ...
... Indonesia is a country experiencing a triple burden of malnutrition (TBM) and the consequential adverse health outcomes among its population. 1 TBM is defined as the coexistence of overweight/obesity, undernutrition, and micronutrient deficiencies. 2 These three nutritional problems in pregnant women, either singly or together, increase the risk of numerous health issues. 3 Maternal overweight or obesity during pregnancy has been correlated with negative pregnancy outcomes, including gestational diabetes, 4 preeclampsia, 5 preterm birth, 6 high birth weight, 4 low birth weight, 7 congenital malformations, 8 prolonged overweight/ obesity, 9 and obesity-related morbidities. ...
Article
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Background: Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals' views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education. Methods: A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis. Results: The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals' nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education. Conclusions: Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.
... Different sections of society can be targeted through the provision of school meals through the Mid Day Meal Scheme of the Ministry of Education or of food for children in anganwadi (rural childcare centres), or by divulging diet plans for pregnant women in primary health centres. Nutrition awareness campaigns for these target groups are needed to promote millet rice as a nutrient-dense food that can help tackle the triple burden of malnutrition (i.e. the coexistence of overnutrition, undernutrition and micronutrient deficiencies) facing the country today (Meenakshi, 2016). ...
Book
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Sustainable Public Food Procurement (PFP) represents a key game changer for food systems transformation. It can influence both food consumption and food production patterns. It can deliver multiple social, economic and environmental benefits towards sustainable food systems for healthy diets. This publication aims to contribute to the improved understanding, dissemination and use of PFP as a development tool in particular in the case of school meals programmes. Volume 2 of this publication, presents further analysis of the instruments, enablers and barriers for PFP implementation. It also provides case studies with local, regional and national experiences from Africa, Asia, Europe and North and South America.
... Different sections of society can be targeted through the provision of school meals through the Mid Day Meal Scheme of the Ministry of Education or of food for children in anganwadi (rural childcare centres), or by divulging diet plans for pregnant women in primary health centres. Nutrition awareness campaigns for these target groups are needed to promote millet rice as a nutrient-dense food that can help tackle the triple burden of malnutrition (i.e. the coexistence of overnutrition, undernutrition and micronutrient deficiencies) facing the country today (Meenakshi, 2016). ...
Chapter
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The multiple potential benefits of using the public procurement of food for schools as an instrument to support agricultural production by local smallholders – or home-grown school feeding programmes (HGSF) − are widely recognized. However, many countries still face various challenges related to the implementation of such programmes. Of particular prominence here are challenges related to the alignment of the programmes with regulatory frameworks for public procurement. Nevertheless, the debate about the role of public procurement regulatory frameworks in the design and implementation of HGSF programmes is poorly represented in the development literature, especially in contexts of developing countries. This chapter aims to contribute to this debate. It combines a discussion of the experience of Ethiopia with an analysis of the challenges created by public procurement rules and practices for the implementation and scaling up of existing HGSF initiatives.
Article
The importance of the food environment in influencing dietary choices of consumers has been widely acknowledged, but little attention has been paid to the urban food environment in Africa despite the rise in incidence of obesity and other nutrition-related noncommunicable diseases (NR-NCDs). We contribute to the literature on urban food environments by conducting an observational macro-scan of the food environment in three cities – Accra, Cape Coast, and Koforidua – with a view to unravelling the nature of the urban food environment in Ghana. We examine the food environment based on two dimensions of food security – availability and accessibility (affordability) – and also assess the extent to which foods are processed. The results show that all four food categories – unprocessed, processed, processed culinary, and ultra-processed – are available, accessible, and affordable. Ultra-processed foods are just as highly available, accessible, and/or affordable as unprocessed foods. The results also show that processed foods account for the larger share of all foods in Ghana’s urban food environment, and ultra-processed foods account for more than 30% of all processed foods. Overall, these results suggest that physical and economic access to food are not major constraints in urban Ghana. This is certainly a welcome finding from a food policy perspective; however, the high availability and accessibility of ultra-processed foods has serious potential health implications. Regulation will be needed to prevent overconsumption of ultra-processed foods and the resulting increase in obesity and other NR-NCDs.
Article
Currently, the entire globe is facing a pandemic 'COVID-19' and the numbers are rising exponentially. Unfortunately, along with the triple burden of malnutrition and many non-communicable diseases, Corona virus has knocked India's door. As we don't know for how long this battle will continue, the present review is an attempt to highlight the importance of non-pharmacological approaches like a balanced diet, stress management, adequate sleep and physical activity to build up a strong immune system, as it reduces the complications in individuals who are already at nutritional risk and might get exposed to the infection. Globally, scientists are working to find potential vaccines to combat COVID-19, meanwhile, we must utilize this time window in building our immunity by adopting a healthy dietary and other lifestyle measures. Hence, it is the need of the hour to build up immunity by adopting a holistic approach as there is no nutritional magic pill, which can boost immunity instantly.
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Using primary socioeconomic survey data, we studied the nutrient adequacy and nutritional status of households and individuals in the rural–urban interface of Bengaluru (India), respectively. We found that on average the sample households consumed recommended levels of macro-nutrients but lacked recommended consumption of important micro-nutrients. While the nutritional status of children indicated significant undernourishment, overnutrition was a rising concern among women. This shows the complex situation of the coexistence of multiple forms of malnutrition in the rural–urban interface of Bengaluru.
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Understanding soil fertility status is crucial for fertilizer management and sustainable crop production. A study was conducted in the Malda district of West Bengal in 2019 to evaluate the nutrient status of surface soil. A total of 45 composite surface soil samples were collected at a depth of 15 cm, and the actual location of the sampling sites was detected by GPS. The soil fertility parameters such as soil pH, available nitrogen (N), available phosphorus (P), available potassium (K), organic carbon (OC), electrical conductivity (EC), available boron (B), available zinc (Zn), available iron (Fe), available manganese (Mn), available copper (Cu), and available sulfur (S) were analyzed and categorized as low, medium, and high using nutrient index (NI). The spatial distribution of parameters was mapped by inverse distance weighted (IDW) interpolation method. The coefficient of variation (CV) showed that P, K, EC, B, and Cu were highly heterogeneous (CV > 33%). The soil pH reveals that most of the surface soil samples of the study area are neutral and slightly acidic. Available phosphorus, potassium, iron, manganese, and sulfur are more or less satisfactory, whereas widespread deficiencies were observed for nitrogen (54.25%), organic carbon (65.76%), boron (100%), zinc (64.31%), and copper (7.5%) in the study area. More precisely, multinutrient deficiencies were observed in Barind region of the study area that noticeably influenced the productivity of crops.
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The objective of the study was to assess the patterns of the dual burden of malnutrition among children <5 years, including its determinants and multilevel variations in the context of immunization coverage in India. All four rounds of NFHS were employed to accomplish the analyses. The overall undernutrition and stunting vulnerability were observed in the low immunization states, whereas the prevalence of high overweightness was found in the states of having high level of full immunization. The overall absolute and annual changes of stunting and underweight were decreasing, while overweight was increasing irrespective of categorization of the level of immunization across the Indian states. The sex-adjusted annual change reflected the constant rate of decline of stunting and underweight for both male and female children irrespective of the level of immunization. It is found that the odds of being underweight increased with age of children and place of residence, while the odds of being overweight were high for mothers with higher education, among Christian, and other caste group. Focusing on Sustainable Development Goals (SDGs) 2.2, the Indian government should take more necessary public health interventions and policies to prevent the dual burden of malnutrition among under-5 children.
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A comparative assessment of socioeconomic determinants of stunting between India and Bihar is displayed in this study. The data from the National Family Health Survey-4 is used in this study to examine the comparative scenario of stunting between Bihar and India. Primary evidence of childhood stunting from Bhagalpur District has used to represent the eastern Bihar in our study. The bivariate and binary logistic regression models are used to accomplish the study objectives. A comparison in child growth between WHO standard and the sample from Bhagalpur District of Bihar has been also done. There is an over 10% difference in stunting prevalence between India and Bihar. We find that older children, children of higher birth order, children practicing unsafe disposal of stool, children born to lower educated mothers, and belong to poor households have significantly higher odds of stunting in Bihar as well as India. Child height for age only aligned with WHO standards in early childhood (0–12 months) for Bhagalpur District, but the likelihood of child stunting rises as age increases. Thus, we recommend effective program interventions keeping the socioeconomic and demographic vulnerabilities of children into consideration, reducing children stunting to attain the Sustainable Development Goals by 2030 in Bihar as well as India.
Chapter
Since the outbreak of COVID-19 across the globe, there has been serious disruptions in food supply chains leading to poverty, hunger and food insecurity. There is also a more serious problem associated with transportation of goods across the borders due to serious lockdown imposed across the globe to combat COVID-19. There are several drawbacks in the existing food supply chains such as integrated food processing sectors and bulk production of agricultural commodities. The outbreak of COVID-19 necessitated a more balanced approach ensuring the food security of a nation during such crisis. This condition is also observed in various agrarian developing nations during COVID-19 pandemic. Prior to globalization and urbanization, short food supply chains (SFSC) and decentralized food processing (DFP) played a critical role in food supply across the globe. Till date, SFSC and DFP plays a pivotal role in combating food security and providing rural employment among people of developing countries. Integrating the advantages of SFSC in integrated food processing sectors could be a suitable solution to meet the food demands of a country during pandemic outbreak. This will also open up new opportunities for building a more resilient food supply chain for future generations. Under such conditions, there comes a need to look into more traditional and simple solutions for tackling food transportation issues. In this article, relevance of SFSC and DFP has been critically analyzed from an Indian perspective. The Indian scenario can be extrapolated for all the developing countries where the agrarian population is huge.
Article
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Consumption of fruit and vegetable is at the centre of interest from different perspectives, mainly based on the consumers’ behaviour and its impact, which are different for various groups of consumers. When analysing food choice decisions (fruit and vegetable especially) examining subgroups of population is recommended. Article deals with the factors affecting group of Slovak millennials in consumption of fruit and vegetable. The study focused on 146 young and educated consumers who have completed at least the first degree of a university in economic sciences and agriculture since a basic knowledge of food scandals was a precondition to the eligible responses. All of the examined questions were tested using XL stat, compared and described to get the applicable results. Shapiro-Wilk, Durbin-Watson and Kruskal-Wallis tests were applied among the descriptive statistics. Based on our results, we can conclude, that for Slovak educated Millennials perception of label and/ or specific grower was significant factor which influence their consumption of fruit and vegetable according to the most of the examined variables. This was followed by perception of country of origin and perception of quality. Perception of price was significant only according to preferences of origin.
Chapter
In the last few decades, Bengaluru’s rapid urban expansion and associated population growth brought about profound changes in farming practices, reflected in an increase in irrigated land compared to rainfed land and a growing use of mineral fertilizers. Since it is not clear how intensification of land use due to urbanisation is affecting physical soil properties and field water cycle, we attempt to clarify this at two experimental sites established at the University of Agricultural Sciences Bangalore (UASB). The results show higher bulk densities, lower air capacities, and lower saturated hydraulic conductivity (Ksat) values in the rainfed field compared to the irrigated field. Soil moisture was observed to be higher in deeper layers of several plots with low N-level treatments in both experiments. However, it was not significant in other plots. Further statistical investigations and comparisons especially of model simulations are required to assess the effect of land use intensifications. Here the experimental approach and some preliminary results are presented.
Article
Background: The school-based food and nutrition guidelines approach has the potential to combat undernutrition, overnutrition and micronutrient deficiencies among children and adolescents and set the foundation for a healthy adult lifestyle. Aim: To critically compare the Nutrition Friendly School Initiative (NFSI) of the World Health Organization (WHO) with the Food Safety and Standards Authority of India (FSSAI) and the Indian Academy of Pediatrics (IAP) guidelines to gauge the strengths and limitations. Additionally, to summarize the existing studies on implementing school food and nutrition guidelines. Methods: Policy documents of the above guidelines were critically evaluated, and narrative analysis was conducted. An electronic search was conducted for full-text research articles published in the English language between January 2007 to September 2021 in Science Direct, PubMed, Web of Science, and SCOPUS databases. Results: Upon critical comparison of the three guidelines, it was found that the NFSI and FSSAI guidelines shared similarities in many components and the FSSAI guidelines, if implemented adequately, could improve the school food environment and combat the triple malnutrition burden in India. After screening the articles based on the eligibility criteria, 11 studies were included in the preparation of the review. Studies reported partial or inadequate implementation and poor compliance with the guidelines or approach. A few studies identified barriers to guideline implementation. Conclusion: Implementation of school food and nutrition guidelines could improve the nutritional outcomes in children and adolescents. To sustain the effective implementation, adequate resources and preparedness are essential in low-and middle-income countries, including India.
Chapter
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This paper highlights the significant measurement issues in the computation of the prevalence of inadequate calorie intakes in India using NSS data. It focuses on the setting of appropriate norms or cut-offs which determine adequacy or inadequacy, as well as the measurement of intakes. Although energy norms for an individual are biologically determined their use as a policy tool necessitates several additional considerations that have not received sufficient attention in the literature. We demonstrate that changes in assumptions regarding age-sex distribution, average heights of adults, and physical activity status can lead to substantial changes in norms. Also important is the way food intakes are measured: changes in food habits that may lead to greater underreporting as the recall period increases, and the increasing trend, even though small, of eating meals outside the home, can exert a significant influence on the trends in the POU over time. With more realistic assumptions, the prevalence of inadequate energy intakes are quite reasonable in magnitude, although still high in absolute terms. The paper also suggests that by accounting for outliers, there is a correlation between anthropometric indicators for adults and food intakes.
Article
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There are a number of assumptions required to estimate actual calories consumed from expenditure data regarding calories contained in processed foods and meals eaten outside the household. Ideally, estimates of calorie consumption and the assessment of food security would be similar under a wide variety of assumptions, and the range of estimates would be quite small. However, this paper, which estimates the calories consumed per Indian household using the 61st round of the National Sample Survey, finds that the assessment of food security varies significantly under slightly different assumptions. Given the significant amount of measurement error in estimates of calories consumed, it is important to analyse not only household consumption surveys, but also aggregate food availability studies and health surveys collecting anthropometric measures that accompany undernourishment, such as stunting. Sharad Tandon (standon@ers.usda.gov) and Rip Landes are with the United States Department of Agriculture, Economic Research Service.
Article
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Iron deficiency is a widespread nutrition and health problem in developing countries, causing impairments in physical activity and cognitive development, as well as maternal mortality. Although food fortification and supplementation programmes have been effective in some countries, their overall success remains limited. Biofortification, that is, breeding food crops for higher micronutrient content, is a relatively new approach, which has been gaining international attention recently. We propose a methodology for ex ante impact assessment of iron biofortification, building on a disability-adjusted life years (DALYs) framework. This methodology is applied in an Indian context. Using a large and representative data set of household food consumption, the likely effects of iron-rich rice and wheat varieties are simulated for different target groups and regions. These varieties, which are being developed by an international public research consortium, based on conventional breeding techniques, might be ready for local distribution within the next couple of years. The results indicate sizeable potential health benefits. Depending on the underlying assumptions, the disease burden associated with iron deficiency could be reduced by 19-58%. Due to the relatively low institutional cost to reach the target population, the expected cost-effectiveness of iron biofortification compares favourably with other micronutrient interventions. Nonetheless, biofortification should not be seen as a substitute for other interventions. Each approach has its particular strengths, so they complement one another.
Article
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We investigated the geographic distribution and the relationship with neighborhood wealth of underweight and overweight in India. Using multilevel modeling techniques, we calculated state-specific smoothed shrunken state residuals of overweight and underweight, neighborhood and state variation of nutritional status, and the relationships between neighborhood wealth and nutritional status of 76,681 women living in 3204 neighborhoods in 26 Indian states. We found a substantial variation in overweight and underweight at the neighborhood and state levels, net of what could be attributed to individual-level factors. Neighborhood wealth was associated with increased levels of overweight and decreased levels of underweight, and was found to modify the relationship between personal living standard and nutritional status. These findings suggest that interventions to address the double burden of undernutrition and overnutrition in India must take into account state and neighborhood characteristics in order to be successful.
Article
Over the past decade, India has seen a prolonged period of high inflation, to a large extent driven by persistently-high food inflation. This paper investigates the demand and supply factors behind the contribution of relative food inflation to headline CPI inflation. It concludes that in the absence of a stronger food supply growth response, food inflation may exceed non-food inflation by 2½–3 percentage points per year. The sustainability of a long-term inflation target of 4 percent under India’s recently-adopted flexible inflation targeting framework will depend on enhancing food supply, agricultural market-based pricing, and reducing price distortions. A well-designed cereal buffer stock liquidation policy could also help mitigate food inflation volatility.
Article
This article examines a randomised intervention in Delhi, India, that provided unconditional cash transfers to a group of households as a replacement for the food security offered by a below-poverty-level card. The experimental approach can differentiate beneficial effects due to either unconditional cash transfers or newly opened bank accounts. The unconditional cash transfer does not induce a decline in food security; rather, it provides opportunities for households to shift to other nutritious options in non-cereal product categories.
Article
This paper reviews recent evidence on food intake and nutrition in India. It attempts to make sense of various puzzles, particularly the decline of average calorie intake during the last 25 years. This decline has occurred across the distribution of real per capita expenditure, in spite of increases in real income and no long-term increase in the relative price of food. One hypothesis is that calorie requirements have declined due to lower levels of physical activity or improvements in the health environment. If correct, this does not imply that there are no calorie deficits in the Indian population — nothing could be further from the truth. These deficits are reflected in some of the worst anthropometric indicators in the world, and the sluggish rate of improvement of these indicators is of major concern. Yet recent trends remain confused and there is an urgent need for better nutrition monitoring.
Article
A common continuing criticism of the economic reforms in India has been that despite accelerated growth and all-around poverty reduction, the country continues to suffer from worse child malnutrition than nearly all Sub-Saharan African countries with lower per capita incomes. This paper argues that this narrative, nearly universally accepted around the world, is false. It is the artefact of a faulty methodology that the World Health Organisation has pushed and the United Nations has supported. If appropriate corrections are applied, in all likelihood, India will be found to be ahead of Sub-Saharan Africa in child malnutrition, just as in other vital health indicators.
Article
This article is about the two-way causal relationships between the global food system and health and nutrition. It argues that the global food system begins and ends with health and that the prioritization and implementation of agricultural research and policy should consider health and nutrition effects. An integrated health and food policy approach is likely to be more effective in achieving both health and economic development goals that the current practice of separate sectorial policies. The article identifies a large number of health and nutrition factors affecting and affected by the food system and suggests research and policies to enhance positive effects and reduce negative ones. Copyright 2007 International Association of Agricultural Economists.
Trade, tastes and nutrition in India
  • Atkin
Diets, Malnutrition and Disease: The Indian Experience
  • R. Gaiha
  • R. Jha
  • V.S. Kulkarni
The nutrition transition in India
  • Ramachandran
Quantifying Undernutrition in Rural India
  • R. Sharma
Caloric requirements and food consumption patterns of the poor
  • S Eli
  • N Li
Food policy and nutritional security: Unequal access to lipids in India
  • Dorin
Estimation of nutritional intakes
  • Dasgupta
India Infrastructure Report 2013/14: The Road to Universal Health Coverage
  • P. Ramachandran
The Double Burden of Malnutrition in India
  • P Ramachandran
  • Gaiha