An individual’s growth with good fitness and sound medical condition critically depends on appropriate nutrition in early life. The latest National Family Health Survey (NFHS)-5, however, reveals some worrying data about the state of health in Karnataka — starting with newborns and going on into adult life.
The NFHS-5 reveals that over one-third (35 per cent) of children in Karnataka under the age of five are stunted, indicating that they are undernourished. One-fifth of children are wasted — a medical process induced by lack of nutrition causing muscle and fat to waste away — or are too thin for their height, a result of inadequate food intake or illness. Up to 8 per cent of children in this age group are severely wasted, while one-third of them are underweight, both chronic and acutely undernourished.
According to experts, undernutrition occurs due to inability to absorb adequate nutrients for energy and body growth, which in turn has a telling effect on the immune system, especially crucial in times of the pandemic. The children grow into adults, exposed to a range of medical conditions — like diabetes or heart disease — which, in turn, make them comorbid and more vulnerable to viral infections.
Vitamin-A is an essential nutrient for the immune system, and its deficiency can cause eye damage and a higher risk of dying from measles and diahorrea. The Centre recommends that children under five be given vitamin-A supplements every six months, starting at nine months. In Karnataka, about 86 per cent of children aged 9-35 months have been given a vitamin-A supplement in the past six months, but only 48 per cent of children aged 6-23 months consumed vitamin A-rich foods, the survey found.
The percentage of children who are stunted has decreased from 36 per cent to 35 per cent in the four years between NFHS-4 (2015-16) and NFHS-5 (2019-2021). The percentage of children who are wasted, too, decreased substantially from 26 per cent to 20 per cent, and children who are underweight decreased from 35 to 33 per cent since NFHS-4. However, high levels of under-nutrition is still a major problem in the state.
ROOT OF THE PROBLEM
Deficiency in micronutrients occurs when the body lacks one or more micronutrients (like iron, iodine, zinc, vitamin-A or folate), affecting growth and immunity. It also causes clinical conditions such as anaemia (iron deficiency), hypothyroidism (iodine deficiency) or deficiency of vitamin-A. Experts say this comes about due to lack of micronutrients right through early life.
However, although breastfeeding is universal in Karnataka, only 61 per cent of children under six months are exclusively breastfed. As per the World Health Organisation (WHO) recommendations, 89 per cent are breast-fed in the first day of life, but the NFHS-5 found only 49 per cent are breast-fed in the first hour — which is understood to fight off infections in the newborn and build its immunity.
Although exclusive breast-feeding indicators show improvement over NFHS-4, many infants are still deprived of the highly nutritious first milk (colostrum) and the antibodies it contains, the survey says. It is, therefore, recommended that the newborns be fed only breast milk in the first three days even if the mother is not adequately lactating. However, 13 per cent of children are given something other than breast milk during the first three days.
Also, after the first six months, breast milk is no longer enough to meet the nutritional needs of infants, and complementary foods should be added to the child’s diet. However, in Karnataka, at 6-8 months, less than half (45 per cent) of the children receive complementary food in addition to breast milk. Due to this, although the babies are breastfed, 20 per cent are stunted, 27 per cent wasted and 25 per cent underweight.
Anaemia, a condition marked by low levels of haemoglobin in the blood, is one result of poor nutrition in early childhood, particularly, iron deficiency, although it can also be caused by malaria, hookworms and other helminths, other nutritional deficiencies, chronic infections and genetic conditions.
The condition results in maternal mortality, weakness, diminished physical and mental capacity, increased morbidity from infectious diseases, perinatal mortality (death of foetus), premature delivery, low birth weight and impaired cognitive performance, motor development and scholastic achievement. It is a major health problem in Karnataka, especially among women (48 per cent) and children (66 per cent), according to NFHS-5.
Also, childhood obesity, if ignored, can lead to severe problems in future. Dr Aditya S Chowti, Senior Consultant, Internal Medicine, Fortis Hospital, Bengaluru, says, “Childhood obesity has to be curtailed at the earliest, lest it predisposes to metabolic diseases such as diabetes mellitus, hypertension, increased cholesterol levels, cardiac issues as they grow into young adults.”
While there is stunting, wasting, anaemia and underweight among children, on the one hand, there is also obesity among young adults, which raises a question on the quality of nutrition. Dr Sudarshan Ballal, Chairman, Manipal Hospitals, explains, “This problem will aptly fit into the description of ‘dysnutrition’, wherein one’s diet has an excess of calories in the form of carbohydrates, processed foods, junk foods, etc., but lacks essential nutrients, leading to obesity and lifestyle diseases, as compared to ‘malnutrition’, which is traditionally seen among the poorer sections where there is a deficiency of calories, protein and nutrients in the diet. Unfortunately, our country is moving from malnutrition to dysnutrition, and we need to make a significant effort to achieve balanced nutrition right from childhood.” He says public health policies, awareness programmes at various levels and education of parents and care-givers at schools will be needed to achieve this important goal.
PROBLEMS IN ADULTS
Interestingly, malnutrition is linked with deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients, and includes undernutrition as well as overweight and obesity. The body mass index (BMI) is a measure that indicates the nutritional status in adults.
Going by that, the NFHS-5 finds two-fifths of women (47 per cent) and men (45 per cent) in Karnataka are either too thin or overweight, or obese. While undernutrition is blamed for lack of growth in childhood and subsequent problems, excessive consumption of wrong foods is found to lead more to obesity among men and women being overweight than being thin — a pattern continuing from NFHS-4.
Seventeen per cent of women and 14 per cent of men in Karnataka are too thin; 30 per cent of women and 31 per cent of men are overweight or obese. Over half of women (53 per cent) and men (55 per cent) have a healthy weight for their height.
For the first time, NFHS-5 includes the waist circumference and hip circumference of women and men age 15-49 years. This information was used to calculate the waist-to-hip ratio (WHR), which helps identify the distribution of body fat and predicts abdominal obesity.