Users Online: 559 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
     

 Table of Contents  
DR. J E PARK MEMORIAL ORATION
Year : 2017  |  Volume : 61  |  Issue : 3  |  Page : 155-162  

Malnutrition-free India: Dream or reality


Professor, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication15-Sep-2017

Correspondence Address:
C P Mishra
Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_217_17

Rights and Permissions
   Abstract 

In spite of great efforts done by the Government of India to tackle the problem of malnutrition, proportion of population normal on nutrition scale has been stationary; nearly half of them have been a victim of under- and over-nutrition. Over a period, undernutrition has declined but this has been compensated by overnutrition. Hidden hunger is a still an unfinished agendum. The achievement of food grain security at the national level did not percolate down, and households' food insecurity and level of chronic food insecurity are still high. High economic growth rates have failed to improve food security in India. There is a need and scope for organizational, financial, and managerial reforms in this direction. The repercussion of malnutrition is not limited to physical deterioration, but it also affects the psychological level of victims. The legislative, service, and educational approaches should be optimized to fulfill the dream of malnutrition-free India.

Keywords: Energy balance, food security, malnutrition, nutritional imbalance, parental paradox, poverty


How to cite this article:
Mishra C P. Malnutrition-free India: Dream or reality. Indian J Public Health 2017;61:155-62

How to cite this URL:
Mishra C P. Malnutrition-free India: Dream or reality. Indian J Public Health [serial online] 2017 [cited 2017 Oct 20];61:155-62. Available from: http://www.ijph.in/text.asp?2017/61/3/155/214814


   Conceptual Framework Top


Indian population are witnessing demographic, epidemiological, and nutritional transition. Therefore, the problem of malnutrition is of serious concern. Malnutrition in one form or the other is common in India. Mechanistically, malnutrition is defined as “a state wherein adequate nutrients are not delivered to the cells to provide the substrate for optimal functioning.”[1] It refers to pathological state arising from deficiency/excess of one or more nutrients over an extended period. It can occur at any age as either general malnutrition, i.e., starvation, or as a syndrome due to the deficit of specific nutrients such as calories, protein, vitamins, and minerals. Types of malnutrition are a spectrum in itself, namely, undernutrition, overnutrition, specific deficiency diseases, and nutritional imbalance. Historically, undernutrition has been associated with higher prevalence of infectious diseases, whereas overnutrition has been associated with a chronic degenerative disease process.


   Existing Scenario Top


Although great efforts have been made by the Government of India within the past few years to tackle the problem and burden of malnutrition, it is still present in the country and remains a major public health issue. The 2016 Global Hunger Index Report ranked India 97th among 118 countries.[2] Misdiagnosed and unrecognizing cases are also a substantial factor for the persistence of the problem.


   Child Malnutrition Top


In spite of progress in reducing the prevalence of underweight among children under five from over 67.3% in 1974–1975 to 41% in 1996–1997, the proportion of underweight children rose to 44.4 in 1998–1999, and remained almost unchanged at 43.5% in 2005–2006.[3] The National Family and Health Survey (NFHS) 1, 2, and 3 also recorded the marginal change in the situation of underweight among under three, i.e., 53.4%, 47.0%, and 45.9%, respectively. In the case of wasting in under three children, corresponding values were 17.5%, 15.5%, and 19.1%, whereas 52.0%, 45.5%, and 38.4%, under three children in respective categories were stunted. An overview of child malnutrition in 0–5 years [Table 1] clearly reflects that nutrition and health policies and programs have not been able to reduce this problem to the desired extent.[4],[5],[6] This has been corroborated by the findings of Rapid Survey on Children (RSoC) as well.[7] This situation stated earlier refers to the overall situation in India. There has been wide variation in the extent of underweight (14%–44%), wasting (14%–26%), and stunting (20%–48%) in different states.[8]
Table 1: Child under nutrition in 0-5 years in India

Click here to view


Hidden hunger in terms of deficiency of vitamins and minerals remains a perpetual problem. Vitamin A deficiency expressed in terms of the prevalence of Bitot's spot has been 0.7% (NIN, 1997), 0.21% (India Nutrition Profile, 1998), 0.70% (District Survey, 2001 [ICMR]), and 0.2% (National Nutrition Monitoring Bureau Survey, 2011–2012). As far as iodine deficiency disorder (IDD) is concerned, the whole population is at risk, but 200 million people are at a serious risk of IDD. There are 71 million people suffering from goiter and other IDDs,[10] whereas 6.6 million and 2.2 million people have mild neurological deficit and cretins, respectively. Zinc deficiency results in impaired immunity, which may increase the risk of infections. It is quite prevalent among children below 5 years of age; the overall prevalence of zinc deficiency was reported to be 42.6%, whereas this was 43.8% in children below 5 years of age in five states.[11] As per the NFHS-3 (2005–2006) and NFHS-4 (2015–2016), children aged 6–59 months who are anemic (hemoglobin <11.0 gm/dl) were 69.4% and 58.4%, respectively.[6],[8]


   Adolescent Malnutrition Top


Inadequate nutrition in adolescence can potentially retard growth and sexual maturation. Although these are likely consequences of chronic malnutrition in infancy and childhood, this can put them at high risk of chronic diseases, particularly if combined with other adverse lifestyle behaviors.[12] Several studies conducted in different rural and urban settings also substantiated the fact that problem of malnutrition in adolescents is quite prevalent in general and adolescent girls in particular. A study conducted on 400 adolescent girls of urban Varanasi revealed that 62.5% of adolescent girls were underweight (body mass index [BMI] <18.5 kg/m 2); this study also explored that in the case of 48% of individuals, weight for age was <80%.[13] According to a cross-sectional study on 270 adolescent girls in the rural area of Varanasi, 68.5% of adolescent girls were undernourished.[14] As per the WHO report, India has shown deficiencies in the intake of all nutrients, particularly iron, calcium, Vitamin A, and Vitamin C among adolescent age group. The main reasons are low educational level of their parents and low family income.[15] Although there is a disparity in iron deficiency anemia in rural and urban areas as well as school and nonschoolgoing children, it is still a prominent issue in adolescent age group, especially in adolescent girls. As much as 55.8% of adolescent girls aged 15–19 years were anemic and 1.7% were severely anemic.[6] A cross-sectional study from urban Varanasi reported that 49.5% of individuals had at least one nutritional deficiency sign. Adolescent girls belonging to Muslim religion, middle socioeconomic status, and having mother's occupation as homemaker and business plus labor had significantly higher risk of nutritional abnormality in the logistic model.[16] Dietary intake of individuals in terms of energy, protein, and fat was 56.0%, 67.2%, and 67.1% of respective estimated recommended dietary allowances (RDAs),[17] whereas dietary inadequacy of micronutrients in adolescent urban girls in the concerned study from Varanasi reported that, in 72.8%, 71.2%, 88.2%, and 6.2% of individuals, calcium, iron, Vitamin A, and Vitamin C intakes, respectively, were <50% of RDAs.[18] The dietary diversity of urban adolescent girls has been far from being satisfactory. According to a study on urban adolescent girls of Varanasi, milk, other vegetables, and fruits were consumed by 37.2%, 47.8%, and 11.2% of girls, respectively. One out of ten individuals consumed green vegetables on a daily basis.[19]


   Adult Malnutrition Top


There are several scientific evidences which highlight the problem of under- and over-nutrition in adult population both in urban and rural settings. Nutritional profile of adult women from 1975 onward is given in [Table 2]. Overall nutritional status of adult population as per the NFHS-3 and 4 clearly reflects decline in the extent of chronic energy deficiency (CED) (BMI <18.5 kg/m 2) in males (34.2%–20.2%) and females (35.5%–22.9%). On the contrary, there has been increase in the proportion of overweight or obese (BMI >25.0 kg/m 2) in men (9.3%–18.6%) and women (12.6%–20.7%).[6],[8] Linkages of negative energy balance with under nutrition and CED in rural reproductive age group females has been established by taking caste as a proxy indicator of socioeconomic status.[20] Adverse nutritional status based on BMI as well as waist–hip ratio has been also observed in rural women of Varanasi.[21] A recent countrywide survey reported that 53% of women (15–49 age group) and 22.7% of men were anemic.[8]
Table 2: Adult malnutrition in India

Click here to view


Well-developed nutrition programs for women need to ensure adequate consumption of macro- and micro-nutrients. Deficiency of both macro- and micro-nutrients is conspicuous in rural women of reproductive age group.[22],[23]

Malnutrition in geriatric individuals

The vulnerability of geriatric individuals in terms of under- and over-nutrition can be internalized by findings of several studies conducted in urban and rural settings of India [Table 3].
Table 3: Malnutrition in geriatric individuals

Click here to view



   Malnutrition Versus Food and Nutrition Security Top


Considering the fact that nutrition is directly linked to the human resource development, productivity, and prosperity of a country, raising the nutritional status of the population has been a global concern, and therefore, food security has been the major concern of governments, particularly in developing countries. A group of experts primarily consider food security synonym to the availability of food at national, regional, household, and individual levels. Food security exists when all people, at all times, have physical and economic access to sufficient safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. The amount and quality of food available globally, nationally, and locally can be affected temporarily or for long periods by many factors including climate, disasters, wars, civil upset, population size and growth, agricultural practices, environment, social status, and trade.

There are evidences based on program evaluations of Applied Nutrition Program, green, white, and blue revolutions that even those who produce food do not consume adequately in terms of quality and quantity for economic gains. It is not necessary that the money generated out of this will be judiciously used for improving nutritional status. For those who are not directly involved in food production, food security primarily depends on their capacity to purchase food which is a function of their purchasing power. Food security has three components, namely, availability of food in the home and market, access to food through adequate purchasing power, and absorption of the food in the body. Even if the required quantities of macro- and micro-nutrients are met, a serious disability in achieving nutrition security arises from poor sanitation, environmental hygiene, and lack of clean drinking water. Thus, nutrition security involving physical, economic, and social access to balance diet, clean drinking water, sanitation, and primary health care for every child, woman, and man is fundamental and thus gives all citizens an opportunity for healthy and productive life. The costs of death, hygiene-related illness, reduced productivity, and reduced tourism revenues as a result of inadequate sanitation facilities were estimated by World Bank Study to be 6.4% of the gross domestic product, not to mention the social costs of the issue.[33]

Food security has been the major developmental objective of the India since the beginning of the planning. India achieved self-sufficiency in food production during the 1970s and has sustained it since then. However, the achievement of food grain security at the national level did not percolate down to the households, and the level of chronic food insecurity is still high. India's malnutrition and CED figures are not coming down despite a number of government programs. The body adapts to the low level of energy by limiting its size with the following inherent drawbacks: severe undernutrition in early childhood often leads to defects in cognitive development; stunted individuals suffer a far higher rate of disease and illness than those who have not undergone stunting; premature failure of vital organs occurs during adulthood.

India's progress has been remarkable in the green revolution. In fact, 4000 years of progress in wheat production, since Mohenjo-daro excavations, was repeated in 4 years. India has launched a campaign “Hunger-free India” on February 20, 2009, to rededicate its efforts in terms of Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal Program for improved performance. The National Research Agricultural System (NARS) has been playing a catalytic role in the overall growth and development of agriculture through the generation of technologies for enhancing the production and productivity by overcoming production constraints. The Indian Council of Agricultural Research continues to lead the country in the area of agricultural research, education, and extension through its wide network of 98 research institutes and 578 Krishi Vigyan Kendras across the country. In addition, it supports 45 State Agricultural Universities.[34] Intensive farming often leads to a vicious cycle of exhaustion of soil fertility and decline in agricultural yields. The land available for agricultural use is also declining very fast due to urbanization and industrialization. Droughts, floods, cyclones, and pests can quickly wipe out large quantities of food as it grows or when it is in storage for later use. Similarly, seeds can be destroyed by such environmental dangers. These along with improper storage account for 30%–40% wastage of food. Many agrarian policies, especially the pricing of agricultural commodities, discriminate against rural areas. Governments often keep prices of basic grains at such artificially low levels that subsistence producers cannot accumulate enough capital to make investments to improve their production. Women play a vital role in providing food and nutrition for their families through their roles as food producers, processors, traders, and income earners.


   Poverty Estimates and Household Food Insecurity in India Top


Considering poverty as the root cause of undernutrition, several anti-poverty and income generation activities were initiated in India. In spite of various poverty reduction programs in India, poverty remains a major threat to food security. Poverty in India is widespread with the nation estimated to have a third of the world's poor. According to a 2005 World Bank estimate, 42% of India falls below the international poverty line of US$ 1.25 a day (purchasing power parity, in nominal terms, 21.6 a day in urban areas and 14.3 in rural areas); having reduced from 60% in 1981.[35] This is corroborated by the existing scenario of household food insecurity in India [Table 4].
Table 4: Existing scenario of household food insecurity in India

Click here to view



   Major Concerns in Relation to Malnutrition Top


Lack of awareness and knowledge of feeding recommendations for children during sickness and health contributes significantly to under-five mortality and morbidity. Adverse child feeding practices still prevail in India and are one of the most important root causes of malnutrition in early childhood (NFHS-4; RSoC).[7],[8] Research done in the urban area of Varanasi district revealed that awareness and utilization of ICDS service were not up to the mark [Figure 1].[44]
Figure 1: Awareness and utilization of Integrated Child Development Scheme services for 0–6-year-old children in urban Varanasi.[44]

Click here to view


Currently, India accounts for about 12% wheat, 21% paddy, 25% pulses, 10% fruits, 22% sugarcane, and 16% milk of global production. This is being achieved from 2.3% global land, 4.2% of water, and little over 11% of arable land having only 50% potential for irrigation to support 18% of the world's population.[34] India has been self-sufficient in terms of per capita availability of food grains [Table 5].[45] However, this has not been the case for other nutrients.
Table 5: Per capita net availability of food grains in India[45]

Click here to view


Effect of globalization and technological revolution brought significant changes in nutrition transition, and consumption of fast food and lifestyle changes have been responsible for obesity and its consequences.

Globalization of fast food has provided the flexibility of having many consumption alternatives at reasonable prices and created a slew of expectations moving forward. Fast food consumption has a significant impact on physical as well as mental health.[46] It leads to fatigue feeling and craving for sugar, adult obesity, hypertension, noncommunicable diseases, effect on kidney and liver, carbonyl stress, caffeine toxicity, type 2 diabetes mellitus, gastritis, dental carries, cancers, childhood obesity, allergic manifestations, osteoporosis, growth retardation, disruption of cellular environment structure and function, drowsiness, and infertility in young men and women. Researches on junk food consumption and their impact on mental health have shown that too much of junk food alters the chemistry of the brain and are addictive like cocaine. Monosodium glutamate, hydrogenated oils, refined salt, and other chemical preservatives in processed junk food do the same thing to a person's brain as cocaine does. Trans fats present in fast food can shrink the brain. The impact of trans fatty acids begins to take place at the fetal stage. Hydrogenated fats and kind of food children eat are responsible for the attention-deficit hyperactive disorder. Junk food contains low nutrition value, hence tends to reduce the intelligence quotient level of children. Losses of essential nutrients like amino acid tryptophan and the lack of which may increase the feeling of depression. On the other hand, imbalanced fatty acids in junk food cause depression in the adult population [Figure 2].
Figure 2: Junk food and mental health.

Click here to view


To control the adverse effect of malnutrition, especially effect of obesity and its relative/associated risk in any age group, physical activity should be promoted. It helps to control weight, improves blood circulation, increases flexibility, lowers blood pressures, lowers blood sugar level, improves emotional well-beings, relieves stress, increases energy level, improves balance thereby dangers of falls, and improves bone density thereby preventing osteoporosis.[35]


   Consequences of Malnutrition Top


Chronic malnutrition results in growth failure and stunting, delayed sexual development, reduced muscle mass and strength, impaired intellectual development, in early childhood and in adolescent age group, and increased lifetime osteoporosis which are the common consequences of malnutrition in adulthood. In addition to these physical consequences, malnutrition also results in psychological effects such as apathy, depression, anxiety, and self-neglect. Due to malnutrition, several other nutrition disorders may develop, depending on which nutrients are lacking or consumed in excess. Malnutrition is the gravest single threat to public health during childhood. It usually results in worse health in children who are severely malnourished and typically experiences slow behavioral and intellectual development, which may lead to intellectual disabilities and lower educational achievement results during adulthood. Malnutrition follows a vicious cycle, namely, malnourished children tend to become adults who have small babies.


   Reforms for Ensuring Food and Nutrition Security Top


Several programs enacted by the Government of India in the field of food and nutrition providing food security to different age groups of people have not been able to tackle the problem of malnutrition, particularly undernutrition. Persistence of the problem of undernutrition in any age group clearly indicates that there is a need of reforms of existed programs for ensuring food and nutrition security at micro- and macro-levels. The restructuring of the programs includes: (a) Reforms for enhancing productivity by ensuring land reforms, blending traditional and modern technologies, harnessing production of urban agriculture, increasing productivity without ecological harms, transforming micro successes into macro movements, and prioritizing varietal improvement programs; (b) organizational reforms by harnessing indigenous food preservation practices, expanding storage facilities for both perishable and nonperishable items, cooperative movement initiatives, establishing e-PDS through computerized record, biometric and smart cards, and geographic information system tracking system for enhancing transparency, efficiency, and accountability; (c) financial reforms through expanding productive and remunerative employments, assistance to small and medium enterprises and self-employed groups, addressing issues pertaining to payment of wages, promoting productivity in the unorganized sector, ensuring microfinance and loan requirements, improving efficiency of ongoing anti-poverty and income generation activities, instituting macroeconomic policy framework and economic reforms inclusive of urban development; (d) managerial reforms emphasizing on capacity building of both for the self-employed and those seeking or already in wage employment, promoting just governance in general and for PDS in particular, efficient monitoring and supportive mechanisms for midterm corrections; (e) reforms for enhancing coverage and content include broadening the food basket to ensure dietary diversity, emphasis on micronutrient deficiencies, safe water supply, basic sanitation, and access to health services. Elected urban local bodies should involve local communities in promoting hygiene and sanitation. Special attention has to be paid on small and medium towns which have poor access to safe drinking water and basic sanitation. Advance contingency plans for vulnerable populations in terms of geographical inaccessibility, climate adversities and natural calamities, and community-based nutrition education programs should be executed to build awareness about existing income generation activities and social safety nets and to remove socio-cultural barriers and reverse parental paradox.[34],[47]


   Approaches for Malnutrition-Free India Top


In any country, primarily, three types of strategies (viz., legislative, service, and educational) can be adopted for freedom from malnutrition. If these approaches are executed optimally, they can serve as effective tools toward the fulfillment of the dream of malnutrition-free India.

Legislative

A legislative framework should be in existence to minimize the threat of undernutrition often resulting due to food deprivation, particularly in vulnerable (viz., under five, women, and geriatric individuals) section of the society. The Indian government has taken a historical step in 2013 in the form of National Food Security Act (2013). Right to food and legal entitlement deliver grains to 67% of the population (75% rural and 50% urban) and ensures economic access to basic staples by providing food at subsidized price.[48] On the other hand, globalization of fast food consumption has raised the problem of overweight and obesity in the young generation of India; it can be potentially reduced by imposing regulatory measures such as a heavy tax on imported and manufactured readymade junk/fast food items. There should be a rigorous control on media advertisements and publicity by the Ministry of Information and Broadcasting. Media rules and regulations set by Cable Television Network Act (1994) and Advertising Standard Council of India (1994) should be strictly enforced and guidelines related to the quality of food products advertised in Indian media should be urgently evolved, implemented, and evaluated for midterm corrections.[46]

Service

Since independence, the Government of India has initiated several anti-poverty, nutrition, and health programs; however, desired outputs were not achieved in terms of nutritional well-being. To do so, rigorous implementation, monitoring, and surveillance of ongoing programs should be ensured.

Educational

In the development of any nation, citizen education plays a foremost role. Unfortunately, large section of Indian people is still living in an educationally deprived condition which is responsible for their poor nutritional status. As time passes, development in information technology has brought changes in the society, thus there should be a strategy to use media to combat the problem of malnutrition in different age groups. To improve the nutritional status, educational material and messages should be disseminated by television, newspaper, posters, and campaigns. Multi-sectoral and multidimensional information education and communication approach should be involved to wipe out the problem of malnutrition from India.

Besides these approaches to cut down the problem of malnutrition, energy balance of the individuals should be given due consideration in view of the increasing burden of noncommunicable diseases. This is likely to reverse the existing trend of compensation of decrease in undernutrition by increasing the prevalence of overnutrition; in fact, half of the population are normal on nutrition scale. It is not essential that human should be in energy balance on a day-to-day basis. However, over a period of a week or a fortnight, one can be in energy balance, that is his/her daily energy expenditure and daily intake averaged over this period should be in a state of balance.[49] There is a strength of evidence as convincing (regular physical activity and high intake of dietary fiber), probable (home and school environment that support healthy food choices for children), and possible (low glycemic index foods) for factors protecting against weight gain.


   Conclusion Top


Making India malnutrition free is possible, but it is not easy. It requires great and target-oriented efforts toward every relevant field. Besides monitoring and surveillance of ongoing programs, a comprehensive approach involving legislative, service, and educational inputs is also needed. To curtail the problem of undernutrition which has persisted since the independence of India and to tackle the emerging problem of overweight and its relative health risks as results of nutrition transition require grass-root level planning considering the rationale behind the problem instead of blanket approach. In spite of agricultural country and having enough grain availability, unfortunately, a large section of the country is in the condition of food deprivation; thus, there is a need to adopt modified strategies to ensure food and nutrition security to people living in India. This also requires organizational, financial, and managerial reforms. Considering the statement “if one dreams, it is dream, if all start dreaming, it becomes a reality,” calls for concerted efforts by all stakeholders to make malnutrition-free India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Vazir S. Malnutrition and psychological development. In: Bamji MS, Rao NP, Reddy V, editors. Textbook of Human Nutrition. 2nd ed. New Delhi: Oxford & IBH Publishing Company Pvt. Ltd.; 2003. p. 207-20.  Back to cited text no. 1
    
2.
Global Hunger Index; 2016. Available from: http://www.ifpri.org>topic>global-hunger-inaccess. [Last accessed on 2017 May 19].  Back to cited text no. 2
    
3.
Sharma P, Gulati A. Approaches to Food Security in Brazil, China, Malaysia, Mexico and Nigeria: Lesson for Developing Countries. ICRIER Policy Series No. 14 March, 2012. p. 1-35.  Back to cited text no. 3
    
4.
International Institute for Population Sciences. India Fact Sheet National Family Health Survey-(NFHS I); 1992-1993. p. 1-2.  Back to cited text no. 4
    
5.
International Institute for Population Sciences. National Family Health Survey (NFHS-II) 1998-1999; 2001. p. 1-330.  Back to cited text no. 5
    
6.
International Institute for Population Sciences. National Family Health Survey (NFHS III); 2005-2006. p. 1.  Back to cited text no. 6
    
7.
Ministry of Women and Child Development, Government of India. Rapid Survey on Children (RSoC) 2013-2014 National Report 2014; 2014. p. 1-403.  Back to cited text no. 7
    
8.
International Institute for Population Sciences. India Fact Sheet National Family Health Survey-(NFHS IV); 2015-2016. p. 1-6.  Back to cited text no. 8
    
9.
HUNGaMA Fighting Hunger and Malnutrition. The HUNGaMA Survey Report-2011; 2011. p. 1-269.  Back to cited text no. 9
    
10.
Lal S, Adarsh, Pankaj. Applied nutrition programs and interventions. In: Text Book of Community Medicine. 5th ed. New Delhi: CES Publisher & Distributors Pvt. Ltd.; 2017. p. 189-247.  Back to cited text no. 10
    
11.
Kapil U, Jain K. Magnitude of zinc deficiency amongst under five children in India. Indian J Pediatr 2011;78:1069-72.  Back to cited text no. 11
[PUBMED]    
12.
Dasgupta A, Butt A, Saha TK, Basu G, Chattopadhyay A, Mukherjee A. Assessment of malnutrition among adolescents: Can BMI be replaced by MUAC. Indian J Community Med 2010;35:276-9.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Krishna J, Mishra CP. Anthropometrically determined under nutrition in urban adolescent girls of Varanasi. Int J Prev Public Health Sci 2016;2:25-30.  Back to cited text no. 13
    
14.
Choudhary S, Mishra CP, Shukla KP. Nutritional status of adolescent girls in rural area of Varanasi. Indian J Prev Soc Med 2003;34:54-61.  Back to cited text no. 14
    
15.
World Health Organization Adolescent Nutrition a Review of the Situation in Selected South East Asian Countries. SEA-NUT-163 Distribution: General World Health Organization Regional Office for South East Asia New Delhi; March 2006. p. 1-96.  Back to cited text no. 15
    
16.
Jaya K, Mishra CP. Correlates of nutritional deficiency among urban adolescent girls of Varanasi. Indian J Prev Soc Med 2013;44:102-7.  Back to cited text no. 16
    
17.
Jaya K, Mishra CP. Correlates of macronutrient intake of urban adolescent girls of Varanasi. Int J Food Nutr Sci 2014;3:67-76.  Back to cited text no. 17
    
18.
Jaya K, Mishra CP. Dietary inadequacy of micronutrients in adolescent girls of urban Varanasi: Call for action. J Nutr Ther 2015;4:149-65.  Back to cited text no. 18
    
19.
Jaya K, Mishra CP. Singh GP. Dietary diversity of urban adolescent girls in Varanasi. Indian J Prev Soc Med 2012;43:339-43.  Back to cited text no. 19
    
20.
Mishra CP, Yadav S, Srivastava P. Energy balance vis-a-vis nutritional status of rural reproductive age group females of Azamgarh District, Uttar Pradesh. Indian J Prev Soc Med 2011;42:329-34.  Back to cited text no. 20
    
21.
Khanam Z, Mishra CP, Shankar H. Validity of body mass index for predicting overweight and obesity in Indian Rural women. Int J Food Nutr Sci 2013;2:107-12.  Back to cited text no. 21
    
22.
Khanam Z, Shankar H, Mishra CP. Macro-nutrient intake of reproductive age group women: Findings of a community based study from Rural Varanasi. Int J Community Med Public Health 2016;3:566-75.  Back to cited text no. 22
    
23.
Khanam Z, Shankar H, Mishra CP. Intake of micro nutrients among women of reproductive age group in rural Varanasi. Indian J Prev Soc Med 2014;45:83-9.  Back to cited text no. 23
    
24.
Hazarika NC, Biswas D, Mahanta J. Hypertension in the elderly population of Assam. J Assoc Physicians India 2003;51:567-73.  Back to cited text no. 24
[PUBMED]    
25.
Swami HM, Bhatia V, Gupta AK, Bhatia SP. An epidemiological study of obesity among elderly in Chandigarh. Indian J Community Med 2005;30:11-3.  Back to cited text no. 25
  [Full text]  
26.
Mohpatra SC, Shah AK, Gambhir IS, Singh IJ, Mishra NK. Nutritional status in elderly people of Varanasi district. Indian J Prev Soc Med 2009;40:151-6.  Back to cited text no. 26
    
27.
Jain A, Mangal S, Jain A. Assessment of nutritional status of elderly by mini nutrition assessment scale in old age homes of Jaipur. Indian J Gerontol 2010;24:290-8.  Back to cited text no. 27
    
28.
Saxena V, Kandpal SD, Goel D, Bansal S. Health status of elderly - A community based study. Indian J Community Health 2012;24:269-70.  Back to cited text no. 28
    
29.
Mishra CP, Gupta PK. Correlates of nutritional status in geriatric population of a rural area of Varanasi. Indian J Prev Soc Med 2012;43:6-10.  Back to cited text no. 29
    
30.
Saika AM, Mahanta N. A Study of nutritional status of elderly in terms of body mass index in urban slums of Guwahati city. J Indian Acad Geriatr 2013;9:11-4.  Back to cited text no. 30
    
31.
Kandpal SD, Kakkar R, Aggarwal P, Bansal S. Pattern of prevalence of risk factors for non-communicable diseases in the geriatric population of district Dehradun. J Indian Acad Clin Med 2013;14:214-7.  Back to cited text no. 31
    
32.
Keshari P. Shankar H. Nutritional status of urban geriatric population of Varanasi. Indian J Prev Soc Med 2016;47:84-94.  Back to cited text no. 32
    
33.
Biswas A. At the heart of the problem-water and sanitation for all. In: The World we Want Looking Beyond 2015 Voices from India. New Delhi: Wada Na Todo Abhiyan; 2012. p. 19-20.  Back to cited text no. 33
    
34.
Mishra CP, Khanam Z. Food security challenges and options. Indian J Prev Soc Med 2010;41:127-37.  Back to cited text no. 34
    
35.
Mishra CP. Nexus of poverty, energy balance and health. Indian J Community Med 2012;37:71-8.  Back to cited text no. 35
[PUBMED]  [Full text]  
36.
Mitra C. Going Beyond Calories Looking at Experiential Food Insecurity in Urban Slum Households in Kolkata Discussion Paper No. 523 June, 2014 School of Economics the University of Queensland. Available from: http://uq.edu/economics/abstract/2523.pdf. [Last accessed on 2016 May 11].  Back to cited text no. 36
    
37.
Chatterjee N, Fernandes G, Hernandez M. Food insecurity in urban poor household in Mumbai India. Food Secur Springer Sci 2012;4:619-32. [DOI 10.1007/12571-012-0206-z].  Back to cited text no. 37
    
38.
Mushir A, Hifzur R, Husain SM. Status of food insecurity at household level in rural India: A case study of Uttar Pradesh. IJPSS 2012;2:227-44.  Back to cited text no. 38
    
39.
Gupta P, Singh K, Seth V. Food insecurity among young children (6-35 months) in urban slums of Delhi India. Indian J Matern Child Health 2013;15:1-6.  Back to cited text no. 39
    
40.
Chinnakali P, Upadhyay RP, Shokeen D, Singh K, Kaur M, Singh AK, et al. Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India. J Health Popul Nutr 2014;32:227-36.  Back to cited text no. 40
[PUBMED]    
41.
Krishnan NK, Kundapur R, Kiran NU, Badiger S. Food security and nutrition consumption among households in the semi urban field practice area of K.S. Hegde Medical Academy, Mangalore: Pilot study. NUJHS 2015;15:31-7.  Back to cited text no. 41
    
42.
Keshari P, Shankar H. Extent and spectrum of household food insecurity in urban Varanasi. Int J Prev Public Health Sci 2016;2:31-5.  Back to cited text no. 42
    
43.
Khanam Z, Shankar H, Mishra CP. Household food security with special reference to individual food security of rural women. Int J Sci Res 2017;4:61-3.  Back to cited text no. 43
    
44.
Vishal R, Keshari P, Mishra CP. Study on awareness and utilization of ICDS services for 0-6 years children of urban Varanasi. Indian J Pre Soc Med 2015;46:118-27.  Back to cited text no. 44
    
45.
Jadhav KD. Food security in India. Int Interdiscip Res J 2013;3:313-19.  Back to cited text no. 45
    
46.
Keshari P, Mishra CP. Growing menace of fast food consumption: Time to act. Int J Community Med Public Health 2016;3:1355-62.  Back to cited text no. 46
    
47.
Keshari P, Shankar H. Strategic gaps in provision of universal nutrition security: Indian perspective. Int J Food Nutr Sci 2016;5:56-65.  Back to cited text no. 47
    
48.
National Food Security Act NFSA. Department of Food and Public Distribution Ministry of Consumer Affairs, Food and Public Distribution Government of India; 2013. Available from: http://www.dfpd.nic.in/nfsa-act.htm.  Back to cited text no. 48
    
49.
Expert Group of the Indian Council of Medical Research (ICMR) Nutrient Requirements and Recommended Dietary Allowances for Indians. Draft Document. Hyderabad NIN, ICMR; 2009. Available from: http://www.pfndai.com/draft_rda-2010.pdf. [Last accessed on 2012 Feb 17].  Back to cited text no. 49
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Conceptual Framework
   Existing Scenario
   Child Malnutrition
    Adolescent Malnu...
   Adult Malnutrition
    Malnutrition Ver...
    Poverty Estimate...
    Major Concerns i...
    Consequences of ...
    Reforms for Ensu...
    Approaches for M...
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed310    
    Printed3    
    Emailed0    
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal