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Overcoming Malnutrition in India

Malnutrition: How to overcome in India

Focussing on women’s education, Access to sanitation & potable water, diet rich in proteinaceous foods and biofortification of grains can curb malnutrition

President Donald Trump applauded India’s achievements in his address at the crowded Motera stadium. These ranged from religious freedom to reducing poverty to the giant emerging economy. This should have made every Indian feel proud, except that only in the next three days, riots in Delhi made us feel ashamed of our poor governance, lack of communal harmony, and intolerance of opposing ideas. In this piece, however, we want to focus on the UN’s top three Sustainable Development Goals (SDGs), namely poverty elimination, zero hunger, and good health and well being by 2030.

The World Bank’s estimates of extreme poverty, defined as $1.9 per capita per day at the 2011 purchasing power parity, show a secular decline in India from 45.9% to 13.4% between 1993 and 2015 (see graphic). If the overall growth process continues, as has been the case since, say, 2000, India may succeed in eliminating extreme poverty by 2030, if not earlier. Also, given the overflowing stocks of foodgrains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90% of its cost for 67% of the population, there is no reason not to believe that India can also attain the goal of zero hunger before 2030.

The real challenge for India, however, is to achieve the third goal of good health and well being by 2030. India’s performance in this regard, so far, has not been satisfactory.

In 2015-16, almost 38.4% of India’s children under the age of five years were stunted, 35.8% were underweight, and 21% suffered from wasting, as per National Family Health Survey (NFHS) 2015-16. The situation is some states like Bihar, Jharkhand, and Uttar Pradesh is even worse (see graphic). No wonder, the Global Hunger Index (GHI) ranked India 102nd out of 117 countries in terms of severity of hunger in 2019.

How can India overcome this colossal challenge of malnutrition? The National Nutrition Strategy 2017 aims to reduce underweight prevalence in children (0-3 years) by 3 percentage points from the NFHS 2015-16 estimates every year by 2022. This is an ambitious target given that the decadal decline in underweight children from 42.5% in FY06 to 35.8% in FY16 amounts to less than 1% annual decline. Similar targets have been set by the National Nutrition Mission (renamed POSHAN Abhiyaan) 2017 for reducing stunting, undernutrition, anaemia (among young children, women and adolescent girls), and low birth weight by 2%, 2%, 3%, and 2% per annum, respectively.

Our research at ICRIER tells us to focus on four key areas if India has to make a significant dent on malnutrition by 2030. First and foremost is women’s education as it has a positive multiplier effect on child care, and access to health care facilities. It also increases awareness about nutrient-rich diet, personal hygiene, etc, and can help contain family size in poor, malnourished families. Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way to tackle this problem.

Second, is the access to improved sanitation and safe drinking water. From that angle, the Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.

Third, there is a need to shift dietary patterns from cereal dominance to consumption of nutritious foods like livestock products, fruits and vegetables, pulses, etc. But, they are generally costly, and their consumption increases only with higher incomes and better education. Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.

Lastly, India must adopt new agricultural technologies of bio-fortifying cereals—zinc-rich rice and wheat, iron-rich pearl millet, and so on. The Indian Council of Agricultural Research has to work closely with Consultative Group of International Agricultural Research’s The Harvest Plus programme to make it a win-win situation and curtail malnutrition in Indian children at a much faster pace and a much lower cost than a business-as-usual scenario would achieve.

Global experience shows that with the right public policies focusing on agricultural, improved sanitation, and women’s education, a country can have much better health and well being for its citizens, especially children. In China, agriculture and economic growth significantly reduced the rates of stunting and wasting among the population, and lifted millions of people out of hunger, poverty, and malnutrition. According to the Food and Agriculture Organization, Brazil and Ethiopia have transformed their food systems, and have targeted their investments in agricultural R&D, and social protection programmes to reduce hunger in the country. Despite India’s improvement in child nutrition rates since FY06, it is way behind the progress experienced by China and other countries. According to the Global Nutrition Report 2016, at current rates of decline, India will achieve the stunting rates currently prevalent in China by 2055. India can certainly do better, but only if it focuses on this issue.

Micronutrient Premix

Modernizing mineral ingredients: Advances in the nutritional minerals market

The minerals market is growing, thanks to ongoing research, government recommendations, and ever-increasing public awareness of the role minerals play in good health. And as the market grows, all interested parties are changing the way they do business with it. Mineral suppliers are constantly innovating to create more trusted products that are easier to work with, and brands are answering to the constantly changing interests and attitudes of their mineral consumers. We explore the science and innovation behind today’s most popular minerals—but also the challenges in making sure your product can stand out from the rest.

The nutritional minerals market is evolving to meet today’s formulating and delivery system demands.

Magnesium

Magnesium continues to dominate mineral sales. With poor soil health depleting the amount of magnesium available in fruits and vegetables worldwide, magnesium supplementation and food fortification has become a widespread practice. Add to that a growing body of positive clinical research on magnesium, and there are plenty of factors contributing to the market success this ingredient has enjoyed in recent years.

“Many researchers are emphasizing the importance of magnesium for wellbeing,” says Youval Saly, vice president of business development for Gadot Biochemical Industries (Haifa Bay, Israel), a specialty minerals supplier. “There has been a significant increase in sports nutrition awareness and the importance of magnesium in athletic recovery. In addition, consumers are starting to take note of magnesium’s benefits for brain health and not just the body. Aspects of mood, sleep, and migraine support are becoming emerging areas of interest as well.”

One way to distinguish a magnesium product from others in today’s marketplace may be to formulate with citrate-based magnesium. Though many existing magnesium products are made with magnesium oxide, research (old and recent) suggests that citrate-based magnesium is significantly more bioavailable.

Combining magnesium with calcium in a single product may also prove worthwhile, since the two ingredients work together to support bone health. Gadot Biochemical Industries is marketing citrate-based magnesium as well as calcium and magnesium compositions for powders and tablets in response to frequent requests from around the world.

Sea Minerals

The market for sea minerals has been around for at least a decade, but suppliers with vested interest in the category say demand has increased in recent years. Marigot Ltd. (Cork, Ireland), which supplies Aquamin brand minerals from sea water and red algae, says the growth is in part a result of increasing demand for plant-based products. “The fortification of plant-based products with plant-based minerals seems to be a perfect solution,” the company says. CK Nutraceuticals (Oakville, ON, Canada), another player in the category, supplies its Deep Ocean Minerals. The ingredients are sourced from deep ocean water in Taiwan, and they are said to mimic the body’s natural mineral composition.

In sea minerals, manufacturers can get standardized amounts of macro-minerals like magnesium and calcium, but these ingredients come with an attractive, extra feature: trace minerals.

So far, Marigot and CK say they are seeing strong demand for their minerals in liquids and beverages in particular. Each has been active in pursuing clinical research on its own products. Marigot is involved in ongoing studies on joint health, arthritis, gut health, and cognitive health, and CK Nutraceuticals recently announced the publication of an independent study1 on its minerals and potential benefits for high-intensity running.

Trending Delivery Systems

For those unfamiliar with mineral fortification in the health products marketplace, potential applications include but are not limited to cereals, snacks, beverages, powder mixes, infant formulas, tablets, and capsules. In catching up with custom manufacturers, however, Nutritional Outlook learned that a few delivery systems are trending more than others.

“I’ve worked in the dietary supplement manufacturing space for nearly 15 years, and over the last 12 months I’ve seen a considerable uptick in demand for hydration formulas,” says Blayney McEneaney, vice president of sales for dietary supplement contract manufacturer NutraScience Labs (Farmingdale, NY). His customers are formulating beverages with magnesium, potassium, and sodium, while demand for tablets specifically has waned some.

McEneaney’s observations are confirmed by several other suppliers and contract manufacturers we reached out to for this story. In general, demand from product manufacturers is for all types of convenient, on-the-go applications. Gummies are another growing area of mineral business. Like beverages, they appeal to children, older adults, and anyone seeking convenience and/or who has trouble swallowing tablets and capsules.

Stability and Taste

As varied as mineral applications are, they are ultimately limited by whether or not the final product has acceptable sensory properties since certain minerals can have an unpleasant flavor and metallic aftertaste.

In response to this problem, Balchem Corp. (New Hampton, NY), supplier of Albion branded minerals, introduced a Taste Free line of Albion minerals, including calcium, iron, magnesium, and zinc.

NutraScience Labs also says it is seeing its own success by joining minerals with natural flavors and sweeteners in final formulas.

Improving the stability of minerals in a given system can sometimes indirectly improve the flavor of minerals. Prinova (Carol Stream, IL) says that it’s able to mask off-notes in ingredients like iron and magnesium by encapsulating or coating ingredients, which also improves ingredient stability.

Transparency and Clean Labels

With increasing access to information, consumers are demanding more of their dietary supplement and functional foods than ever before. Ingredient suppliers and contract manufacturers are witnessing this firsthand in the requests they get from finished product manufacturers. While general label claims such as organic and non-GMO were once the highest standard for many shoppers, Best Formulations (City of Industry) says that full supply chain and formulation transparency have emerged as additional requests.

The contract manufacturer adds that vegetarian alternatives continue to see upward traction. With tablets now losing some of their previous popularity, capsule formulations create a growing need for non-animal softgels, which Best Formulations is now committed to on a large scale.

 

Sidebar: Mineral Research Update

The library for clinical research on minerals is vast at this point, but new studies are added every month. Nutritional Outlook reached out to Balchem Corp. (New Hampton, NY), supplier of Albion minerals, with a request for new research that could be impacting sales and popularity of minerals. Here’s what we got:

Zinc: In reviewing 78 previous studies on zinc supplementation, U.S. researchers concluded that zinc supplementation in children under five years of age was associated with significantly improved growth outcomes.2 Not long after, a research paper broke with a proposed model for predicting growth response to zinc supplementation in zinc-deficient infants.3

Magnesium: Sara Adaes, PhD, an investigator of neurobiological pain at the University of Porto in Portugal, writes that magnesium is a regulator of neurotransmitter signaling and that it regulates the activity of calcium channels in brain cells.4

Choline: Though not classified as a mineral, choline is often provided in mineral supplements. A recent study concluded that maternal choline supplementation during the third trimester may result in cognitive benefits for offspring.5

References:
  1. Higgins MF et al. “Oral ingestion of deep ocean minerals increases high-intensity intermittent running capacity in soccer players after short-term post-exercise recovery: A double-blind, placebo-controlled crossover trial.” Marine Drugs. Published online May 24, 2019.
  2. Liu E et al. “Effect of zinc supplementation on growth outcomes in children under 5 years of age.” Nutrients, vol. 10, no. 3 (March 2018): 377–398
  3. Wastney ME et al. “A dynamic model for predicting growth in zinc-deficient stunted infants given supplemental zinc.” American Journal of Clinical Nutrition, vol. 107, no. 5 (May 1, 2018): 808–816
  4. Adaes S. “Nurturing the Brain – Part 11, Magnesium.” Brain Blogger. Published online July 26, 2017. Accessed at www.brainblogger.com/2017/07/26/nurturing-the-brain-part-11-magnesium
  5. Caudill MA et al. “Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.” FASEB Journal, vol. 32, no. 4 (April 2018): 2172–2180

Source : nutritionaloutlook

Vitamin D: The “sunshine” vitamin

Vitamin D — also known as the sunshine vitamin — is extremely important and has multiple effects on several systems in the body. Yet, the prevalence of vitamin D deficiency gets reported worldwide; it still remains an under-diagnosed and under-treated nutritional deficiency.

India being a tropical country has adequate sunlight throughout the year. Yet, the prevalence of vitamin D3 (an important compound in the vitamin D group) deficiency is very high in India;

65-70 per cent of our population is vitamin D deficient and for 15 per cent, it’s insufficient. In fact, worldwide, more than a billion people have low D3 levels. An increased level of melanin pigment in the Indian skin, which gives the skin a brown colour, also makes vitamin D absorption difficult.

Besides this, urban lifestyle — one in which people go to sleep late, have hardly any exposure to the sun in the morning hours, live in air-conditioned environs, tackle high levels of pollution and maintain poor diet — is one of the major contributors to the deficiency.

The role of Vitamin D

Unlike most vitamins (A, B, C, E, K), vitamin D functions like a hormone and every cell in the body has a vitamin D receptor. It is a fat-soluble vitamin and plays a vital role in our day-to-day physiological functions. The role of the vitamin is endless — it helps regulate blood pressure, prevents osteomalacia, helps fight depression, reduces stress and tension, reduces respiratory infections (strong immune system), improves insulin sensitivity, improves overall skin health and makes the skin soft, strong and smooth. Vitamin D3 acts as a steroid hormone in the body, like cortisol, which means it is anti-inflammatory.

It relieves the body of aches and pains by reducing muscle spasms; it improves the health of one’s joints, hair and nails; helps in differentiation of the cells; and improves cardiovascular strength by protecting the arteries. The list, in fact, goes on and on!

When vitamin D3 is low, the body is unable to absorb enough calcium from food, resulting in the production of the parathyroid hormone, which depletes calcium from the skeleton to maintain one’s pH levels.

Who are at risk?

  • The elderly.
  • The overweight or obese.
  • People who don’t eat enough fish or dairy products.
  • Those who live far from the equator, where there is little sunshine around the year.
  • People who use excessive sunscreen when going out.
  • Those who continuously stay indoors.

Symptoms of D3 deficiency

  • Poor immunity.
  • Pain in the bones and backache.
  • Chronic fatigue and tiredness.
  • Delayed healing.
  • Hair loss.
  • Muscular pain.
  • Chronic illness.

In such cases, a simple blood test called 25-hydroxy vitamin D should be done.

Can it cause cancer?

Vitamin D is an essential nutrient that researchers link to the prevention of an array of diseases — colds and flu to multiple types of cancer.

Recently, vitamin D deficiency and its association with the risk of several types of cancer is receiving considerable attention. Studies have found a protective relationship between sufficient vitamin D status and lower risk of cancer. Vitamin D and its metabolites reduce the incidence of many types of cancer by inhibiting tumour growth. A reduced level of vitamin D is associated with increased incidences and death rates from colon, breast, prostate and ovarian cancer.

A warning

However, for severe deficiencies, supplements should be consumed after diagnosis by a medical practitioner. That’s because, although rare, vitamin D overdose or toxicity can be as dangerous as its deficiency. It causes a build-up of calcium in the bloodstream. Symptoms include vomiting, nausea, stomach pain, constipation, diarrhoea, fatigue, dizziness and confusion. It can affect the liver, heart and brain. Too much vitamin D is also detrimental to bone health, leading to bone loss. In extreme conditions, it can damage the kidneys.

Vitamin D deficiency is incredibly common and neglected due to poor awareness.

Also, the symptoms are often subtle and non-specific, which makes it difficult to know if they’re caused by low levels of vitamin D or something else. If you think you have a deficiency, get your blood tested and consult your family physician. Fortunately, vitamin D deficiency is usually easy to fix.

Help at hand

  • In its most natural form, humans receive the required daily dose of vitamin D from exposure to the sun, especially the morning sun, between 7am and 1pm. You need to sun yourself for at least half an hour with 40 per cent of your body exposed. This practice may be repeated two to three times a week. Of course, one is not supposed to apply any sunblock cream during this time. Spending more time outdoors and enjoying sport of some kind (walking, running, cycling or swimming) are beneficial because physical exercises burn more calories, help reduce body fat and promote higher levels of vitamin D blood cells.
  • From a traditional point of view, one can do asanas such as Surya Namaskar (sun salutation) and also the traditional maalish (applying oil all over the body while sitting in the sun).
  • Though for severe deficiencies no food can actually provide an optimum supply of D3, but the following food, when taken regularly and in good quantities, maybe of help:
  • Vitamin D is a fat-soluble vitamin and so good fats should be taken to enhance its absorption.
  • Cod liver oil comes from the liver of the codfish and is considered extremely healthy. It helps ease joint pains and can be taken in capsule form or in the form of oil.
  • if you love mushrooms, you are covered. Dried shiitake mushrooms are a brilliant source of vitamin D3 as well as vitamin B. It is low in calorie and can be consumed daily.
  • Salmon is another good source of D3, Omega 3 and protein.
  • Sunflower seeds not only have vitamin D3 but also come with monounsaturated fats and protein.

Source : https://www.telegraphindia.com/health/soak-in-the-sun-for-some-vitamin-d/cid/1683495

by Shikha Prakash