Malnourished and under nourished children in India-A reality check

Food, health and life are intricately interlinked and unless there is a balance and moderation in food intake, health is bound to be seriously affected adversely. An oft repeated question is whether the world to day is a better place to live compared to that which existed 5-6 decades ago? If the yardstick for measuring the quality of life is the health, definitely it is much worse than before. There is terrible inequality in accessing available food across the population with opulent countries enjoying a surplus of foods which are very often wasted ignoring the pitiable living conditions of millions of people spanning the three continents Asia, South America and Africa. The two aspects of food which are important to be kept in mind are quality and quantity. In many developed countries quantity of food available, if taken on an average, is more than sufficient to meet the calorie needs of their population. What is sorely missing is the quality of food consumed by them which leaves very much to be desired. Look at the health status of people in the US where more than half the population is over weight while almost one third is afflicted by obesity epidemic. This raises the inevitable question as to what constitutes a good diet and what happens if the diet is not based on factors that influence maintaining of good health.

As a thumb rule,human beings generally need about 2000 kCal, 50 g of proteins, 50 g of fat, 25 g of dietary fiber, 8 essential amino acids and two essential fatty acids which human body cannot make and vitamins and minerals. Water, though not considered a nutrient is also essential corresponding to an intake of 1 ml per calorie ingested. This is supposed to be a golden guideline for preventing development of many health disorders in life and can be easily met by judicial combination of natural food ingredients like cereals, pulses, milk, nuts, fruits, vegetables with or without animal based foods like meat, egg and fish. If the above assumption is correct why is that Americans eating rich foods including an abundance of highly nutritious animal based products still suffer from many diseases to day? Answer to this lies in the fact that the cereals they consume are highly refined devoid of practically all natural nutrients, most calories coming from highly refined white sugar or HFCS, heavy consumption of fat rich foods such as fried ones, baked goods etc and eating too much animal products. It is only recently that a scientific study in the US brought out the startling truth that eating even a small amount of whole grains about 33 g a day can reduce the chance of premature death very significantly! 

What about situation that is obtaining in India? Here again there are sufficient foods available in the country to meet the needs of every citizen but the access to these foods is constrained by economic factors. For many poor people constituting almost 40% of the country's population high quality foods like milk, pulses, egg and meat in sufficient quantities are beyond their reach. This problem is all the more intractable in the rural hinterlands of the country where most poor people live eking out a dreary existence. The highly unpredictable agricultural situation and lack of opportunities for engaging in income generation avocations make matter worse! The much touted Food Security Act does promise almost 1000 kCal of food in the form of very low priced cereals like rice and wheat, while other needs like proteins, fat and some of the essential nutrients are ignored in the scheme of things. All government programs designed so far and being implemented are just to keep hunger away among the poor people but do not bother about the quality of the food distributed under the social responsibility umbrella. 

The most recent circus government is doing under the FSA is giving away rice at Re 1 per kg and wheat at Rs 2 per kg for almost two thirds of the country's population whether all of them really deserve them or not based on economic criteria. The existing school feeding programs are also heavily loaded in favor of cereals. There are supposed to be about 7 lakh kitchens staffed by 26 lack cooks cum helpers serving about 11 crore children in thousands of schools across the country, probably the largest socially oriented scheme any where in the world. This is no doubt a tremendous feat worth appreciating and admiring. Unfortunately these numbers hide more than what they reveal. The program claims to provides about 300 kCal of energy and 16 g of protein for every kid though no one knows how far this target is fulfilled by cooking foods in these school kitchens out of cereals supplied by the government. Providing calories and proteins once a day may be theoretically adequate partially as far as nutrition is concerned but does it fill the tummy of the child who comes to the school hungry? Hardly! Many kids are reported to be coming to the school with empty stomach and wait eagerly till lunch time to get their share of meals cooked at the school. If this is so can the children be expected to concentrate on the lessons taught in the class rooms?

Some pundits have suggested that government should consider providing break fast also to the school kids besides the midday meals   May be a good suggestion but where is the end for such freebies , especially in a country like India not considered to be very rich to squander its resources? A honest citizen often wonders what is the role of the government in welfare of a citizen? A family which spawns a child has no responsibility to look after it and see through its adulthood and further till it can stand on its own legs? Look at India to day where there are government freebies for practically every thing from conception till the end whether they deserve them or not! If government has to give free medical service, child care service, educational service, housing service, subsidized transportation, special allowances for female children, heavily subsidized food grains, pension for old age population and widows, write off loans taken from government banks, provide subsidized fertilizers to farmers whether rich or poor and many other hidden economic help, what is the role of the parents? In this case if breakfast and lunch are provided at school, what else parents have to do? How can a child consider his parent as his own if they are not providing him with food at home? After all government is even giving jobs under NREGA for at least 100 days that puts about Rs 15000 in the hands of many laborers who declare that they do not have any other income.With Rice and Wheat being made available at Rs 1-2 per kg where is the problem in feeding the children at home? If low response to the NREGA scheme as reported in Karnataka is really true, poor people might be hard to find who are enamored by the Rs 15000 that can be earned by working for 100 days! May be there are a few genuine cases with extremely low income who must be identified  as targets for such freebie schemes.             

Many NGOs and international bodies are lamenting that 1 out of 3 children in India is malnourished and world's largest malnourished children live in India. It may sound shocking that 50% of childhood mortality is attributed to malnutrition and under nourishment. Similarly another stock claim is that 46% of children below 3 years of age in India have low Body Mass Index (BMI) which is supposed to be a manifestation of undernourishment and malnutrition. They further aver that inadequate food in quantity and nutritional quality during pregnancy, lactation and after birth are responsible for this sordid situation. One of the critical deficiencies being focused is essential fatty acids (EFA) like Omega-6 and Omega-3 fatty acids which are necessary for proper development of brain, eyes and preempting onset of diseases like CVD, high blood pressure, diabetes, obesity, Alzheimer's, dementia and others during growth later. Plant foods are not considered excellent sources of these essential fatty acids and well to do population derive them from fish and marine food sources. But two plant sources Soybean and Sunflower seeds can be significant sources of EFA , both Omega-6 and Omega-3 and all the programs presently running under the food service schemes must consider including one or more of these oil seeds in the meal recipes being followed.  

V.H.POTTY

http://vhpotty.blogspot.com

http://foodtechupdates.blogspot.com

DIETARY GUIDELINES-ARE THEY FLAWED?

For a healthy life man must have certain minimum requirements of energy and nutrients which are provided by carbohydrates, proteins, fats, dietary fiber, vitamins, minerals and essential fatty acids. Though there is no uniformity of norms, qualitative and quantitative, diets are recommended based on a consensus in each country. Food requirements vary among people and they are governed by factors like environment, life style, physical activities and personal likes and dislikes. The science of nutrition is still not well defined with gaps of information evident in some areas and this is compounded by inadequate research on many traditional food preparations popular in different regions of the world. It is rather paradoxical that man seems to be knowing more about the negative aspects of food than the positive factors that boost health. Thus ill effects of saturated fats, trans fats, refined cereals, too much carbohydrates and fats, deficiencies vis-a-vis many nutrients, over consumption of sugar and salt are well known. But what is best to maintain robust health or boost the health is still controversial areas with business interests exploiting limited data on this score.

The US Food Pyramid System for recommended good diet was a bible for every dietitian and nutritionist till recently when it was replaced by the MyPlate System, both of them laying emphasis on the role of fruits and vegetables for good health. However both these systems seem to have ignored the cardinal principle that all carbohydrates cannot be considered good. Modern living style has seen a progressive shift from unrefined carbohydrates to refined ones, probably due to the compulsions of processing industry to achieve value addition ( or profit addition?) and to get high sensory quality foods satisfying to the palates of new generation of people. Thus whole wheat flour yielded to refined white flour, raw sugar and jaggery have been replaced with ultra white crystalline sugar, ghanny pressed and expeller oils losing their market after the arrival of crystal clear super refined oils, snow white rice pushing more nutritious red rice to the background and many other similar distortions with disastrous consequences. The result is for every one to see with half the world population already sick with a plethora of diseases, spending trillions of dollars for medical intervention for ameliorating the deteriorating health status.

The debate about the "chicken or egg first" will always continue as long as humanity exists on the planet and such a debate is also thriving in the food area ever since food processing started taking hold of the human weakness for convenient and tasty foods in preference to healthy products. If to day's life style in many affluent countries depend too much on so called junk foods or calorie rich and nutrient light products, blame has to be apportioned to both the consumer and the industry. Where does the government come into the picture is a valid question. Is it not the responsibility of a government to create conditions that will ensure optimum health to its citizens? Can any serious governing system ignore this aspect and promote business interests that deal a body blow to the health standards of the population? It is a bitter truth that "money" is the ultimate tool for influencing any decision by public institutions and this has been amply demonstrated in India where there are innumerate financial scams which have become the landmark of the current governance! It is an indisputable fact that GM foods, created and nurtured  by a handful of business monopolists have overwhelmingly captured the American food market only through their money power for influencing government decisions in their favor!

There are hints now emerging that the new dietary guideline being promoted now under the "MyPlate' icon is also driven by business, especially when it comes to carbohydrate component in the plate. Qualitatively there is a big difference in the nutritional value between whole cereals and refined cereal flours and whether the omission to indicate the quality of carbohydrate, is deliberate or not is an issue meriting consideration. The Glycemic index values (GI) of different carbohydrate ingredients give a clear picture regarding their health promoting capacity and probably the carbohydrate components could have been further split into low GI and high GI factions to help the consumers to evolve their own diets. The allegation that failure to mention this important aspect in the Food Pyramid system has some thing to do with the influence of processing industry which manufactures more than 80% of its products from refined carbohydrate components with high GI values, may have some substance. Also this negligence must have had a role in the obesity epidemic America is facing to day.  The GI value is the only scientific measure of how fast and how high a carbohydrate containing food raises blood sugar when consumed and the lower and slower the better. Refined grains and processed carbohydrates, are known to rank high on the GI scale because they are easily digested, causing a rapid and significant rise of blood sugar and insulin levels. In contrast, low-GI foods, have been shown to be more healthy after clinical validation. They have a much more gradual and healthy effect on blood sugar, raising it more slowly which is considered to be better for managing weight, sustaining energy and disease prevention.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com

"NEW" DIETARY GUIDELINES FOR INDIANS-WHAT IS NEW?

When new knowledge is emerging in the crucial areas of nutrition and health having vital bearing on the well being of humans, there does not appear to be a realization still that all humans are not same and their needs can vary significantly depending on the environment, physical activity and many other factors. Only recently British authorities announced a revised guideline for their population based on the specific needs in that country and surprisingly a recommendation has been made to consume up to 16% more calories for male adults based on their daily physical activity. This is totally against the current trend universally to reduce calorie consumption to combat obesity related disorders. It is not clear as to the basis of new guidelines for Indians, published in some media recently, as no reliable data still exists regarding the nutrient requirement of a "typical" Indian. This country has been faithfully following the parameters that prevail in countries like USA and the nutrition labeling required to be followed by the industry is also based on foreign nutritional parameters.

So called new guidelines look like a tinkered version of a similar one brought out in 1998. A cursory look at the 'new' guidelines does not reveal any major deviation as if nothing much has changed in this country in spite of the explosive growth of GDP and ever increasing purchasing power of the citizens. Suggesting a cut down in the intake of carbohydrate marginally may not be significant because that is the only bulk energy supplier in the diet where as fat is not an accepted choice for making up the calorie need. The increase in protein intake, just marginally, does not make any sense at all. If total calorie need is still maintained at 2000 kC and if carbohydrates are to be reduced how can one derive the required energy? The crucial factor missing is the type of carbohydrate to be consumed and the guideline regarding sugar consumption may not be sound since, from 20-25 gm a day in the earlier version, it has been increased to about 10% of total energy, which amounts to 50 gm a day!. Sugar is increasingly being shunned universally for its adverse effect on health.

It is amusing to read about a recommendation calling for use of a combination of mustard oil and soybean oil which the pundits consider as the best. One cannot help feeling sad because all native oils available and popular in India have been sidelined. That the two oils named, Canola and Soybean are in the forefront in the GM food development platform, may not a coincidence and if GOI takes this line seriously, flood gate is going to be opened for increased imports of these two oils from the US and Canada in the name of good health! Guideline for salt intake, less than 5 gm a day, is very sound but how to go about to achieve this is a million dollar question. Present consumption level is estimated to be around 10-12gm per capita per day, though no one is sure about the real situation. Probably food industry must make an earnest effort to cut down on use of salt in packed foods voluntarily and catering establishment could take a conscious and collective decision to make their preparations with low salt. leaving the choice of adding it by the consumer, if necessary, on the serving table.

Why should a national diet guideline set a limit for alcohol consumption is baffling. Only recently some disturbing reports have come out regarding the harmful effects of alcoholic beverages like wine on women and it is a controversial area best to have been avoided leaving the decision to the individuals and the medical fraternity. In stead of coming out with a report which is neither scientific nor precise, it would have been more appropriate to compile ideal diets for different regions in the country based on the local food habits and availability of food materials in respective areas.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com