Saturday, February 7, 2015

Dietary changes, nutritional decline and economic improvement-Is there any relationship?

Do all the surveys and statistics doled out by the government agencies really reflect the ground reality? If there is a country in this planet where statistics can be grossly misleading, that is india! It may not be proper to condemn them as unrealistic and totally inaccurate as there can be some truth some where in such reports. The latest survey in India, findings of which have recently been published, tries to narrate a story which may not be 100% true. We all know that Indian economy is on a decent growth path and people do have money sufficient to fulfill some of their aspirations. The moot point is how badly or how properly this money is spent? If this survey is to be fully believed, the economic growth achieved has not translated into better food, better health and better nutrition. Probably such a broad conclusion may be on par with similar changes undergone by populations in other countries during their growth curve. Another conclusion which is significant tells about the wide disparity between the food intakes between rich and the poor which is natural because rich man can always buy more foods with better quality in terms of health and nutrition.  

There is a general perception that Indians are eating better foods over the last two decades, especially after the opening of the economy during nineteen nineties and naturally more income makes dairy products, eggs and meat, fruits and vegetables more affordable to most families. India's eating habits are bound to change and it should not be a surprise that such changes will be reflected in their health status also. However there appears to be a disconnect between such changes in food consumption and nutrition quality of the diets. To day people seem to be eating less cereals and indulging themselves with the increasing consumption of more and more fatty foods including fried snacks, sugar sweetened beverages and many unhealthy processed foods. Consequently protein levels in the diets have significantly declined, especially in rural regions.

What about the calories intake? The average calorific value of food consumed was 2,099 kilocalories (Kcal) per person per day in rural areas and 2,058 Kcal in urban areas in 2011 compared to the recommended level for normal health. This is less than the calorie values prevalent in 1993-94,viz, 2,153 kCal in rural areas and 2,099 kCal in urban areas. If we go by the national guidelines the recommended calorie intake 2320 Kcal per day for a man aged 18-29 years weighing 60 kg and doing sedentary work. The erstwhile Planning Commission had set a norm of 2,400 Kcal per person per day for the rural sector and 2,100 Kcal for the urban sector. These are averages for the whole country, which hide as much as they reveal. One aspect that is hidden in them is variations across states. Kerala, Tamil Nadu and Gujarat have nutritional levels that are almost 10% lower than the national average for rural areas while UP, Punjab, Haryana and Rajasthan have levels 10 to 20% higher. 

Another much interesting revelation by the survey is that the huge difference in calorie intake between rich and the poor residing in rural regions of the country. For example a person belonging to the poorest 10% of population is consuming daily foods that can yield only 1724 kCal, 45g of protein and 24g of fat. In contrast a person from the richest 10% segment consumes more than 2,531 Kcal every day, almost 47% more than the poor person. A similar chasm can be seen in protein and fat consumption too. The survey has just reiterated the skewy nutrition landscape in the country though averages may gloss over this fundamental fault line. A moot question that begs for an answer is how far such "under eating" is impacting on the health of the poor folks in the country? Since no data is available regarding the incidences of diseases directly linked to under eating it may be far fetched to come to any conclusion in this regard. 

Probably it is time that the country takes a call on the nutritional needs of Indians without being biased by the western standards. The story of such countries provides a sad story as to what happens when the whole population gets hooked on to processed foods most of the calorie rich but imbalanced in terms of vital nutrients like dietary fiber, phytonutrients and whole foods without too much processing. If obesity, CVD, Blood Pressure diabetes and similar diseases are widely prevalent it can be attributed solely to unscientific diets, improper eating habits and sedentary life styles. It is relevant to recall the universally acknowledged scientific finding that a calorie restricted diet is invariably more healthy, being able to confer longevity of life. Could it be that our rural cousins are much better of with diets with lower calories than their urban counterparts? Probably true!.

Such views as stated above are bound to attract criticism about our bias against rural folks whose cause is supposed to be "dear" to the vote seeking politicians of the country. Nutritional science as we know to day, as propounded by the pundits in the ICMR prescribes what is optimum blend of food for leading a healthy life but whether these guidelines are universally applicable to all the people with different ethnic, cultural and social background is a gray area. While calorie needs may need some revision, the requirement of proteins, essential amino acids, essential fatty acids, micro nutrients and dietary fiber may be relevant. There was a time when whole country was talking about protein malnutrition which later shifted to protein-calorie malnutrition with other deficiencies of nutrients like iodine, vitamin A etc. When nutrition and health issues are considered, average figures cannot work in a country like India with vastly divergent populations living in different geographical areas with different environmental conditions.  


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