PROB­LEM OF EX­TREMES

Both eat­ing too much and too lit­tle are caus­ing health prob­lems. A bal­anced diet is es­sen­tial for a healthy life­style.

India Today - - HEALTH SPECIAL - By Amar­nath K. Menon

Atwin bur­den cur­rently plagues the coun­try, where there is an ex­tra­or­di­nary co- ex­is­tence of un­der- nu­tri­tion and over­nu­tri­tion. While one in ev­ery three In­di­ans is un­der­nour­ished, at least one in ev­ery six is overfed. Both are im­prop­erly nour­ished.

So while un­der- nu­tri­tion and mi­cronu­tri­ent de­fi­cien­cies re­main ma­jor pub­lic health is­sues, obe­sity is emerg­ing as a ma­jor life­style prob­lem which in turn is lead­ing to di­a­betes and car­dio­vas­cu­lar ail­ments.

The num­ber of deaths from car­dio­vas­cu­lar dis­eases an­nu­ally is pro­jected to rise from 2.26 mil­lion in 1990 to 4.77 mil­lion in 2020. Obe­sity and phys­i­cal in­ac­tiv­ity are im­por­tant de­ter­mi­nants of meta­bolic ab­nor­mal­i­ties in ur­ban and ru­ral In­dia, lead­ing to in­crease in blood pres­sure, ab­nor­mal lipid pat­terns and en­hanced re­sis­tance to in­sulin. The chang­ing meta­bolic pat­terns in­crease the risks of coro­nary heart dis­ease ( CHD), stroke, di­a­betes and some can­cers.

Di­a­betes and CHD oc­cur at an ear­lier age in In­di­ans than in popu- la­tions in de­vel­oped so­ci­eties. The es­ti­mated preva­lence of CHD, in those over 20, is 3 to 4 per cent in ru­ral ar­eas and 8 to 10 per cent in ur­ban ar­eas, rep­re­sent­ing a twofold rise in ru­ral ar­eas and a six­fold rise in ur­ban ar­eas be­tween 1960 and 2002. A meta- anal­y­sis of stud­ies on stroke in­di­cates a preva­lence rate of 154 for ev­ery 1,000 peo­ple. The pro­por­tion of strokes in younger adults is also high. The preva­lence rate for hy­per­ten­sion is 164 for ev­ery 1,000 peo­ple in ur­ban ar­eas and 157 for ev­ery 1,000 peo­ple in ru­ral ar­eas. It is es­ti­mated that 1.56 bil­lion peo­ple will be af­fected with hy­per­ten­sion glob­ally by 2025. In­dia is also known as the di­a­betes cap­i­tal of the world. Over the next decade, the num­ber of di­a­betic pa­tients is ex­pected to reach 200 mil­lion.

“Re­duc­tion in phys­i­cal ac­tiv­ity is driv­ing the over- nu­tri­tion epi­demic in In­dia and the real rem­edy is to in­crease dis­cre­tionary phys­i­cal ac­tiv­ity. Walk­ing is the best and eas­i­est form of ex­er­cise,” says Dr Prema Ra­machan­dran, di­rec­tor, Nu­tri­tion Foun­da­tion of In­dia.

There are other health con­cerns. Ma­ter­nal and in­fant mor­tal­ity rates re­main high and well above the Mil­len­nium De­vel­op­ment Goals, and a large sec­tion of the so­ci­ety is af­fected with anaemia. Nearly a third of the in­fants are un­der­weight at birth.

The triad of low birth weight and stunt­ing due to mal­nu­tri­tion in early

life, ac­cess to en­ergy- dense foods at later stages cou­pled with seden­tary habits leads to changes in body com­po­si­tion, es­pe­cially with re­spect to fat de­po­si­tion, in­sulin re­sis­tance and di­etre­lated chronic dis­eases. De­fi­cien­cies of mi­cronu­tri­ents such as vi­ta­min B and omega fatty acids can ex­ag­ger­ate dys­func­tion and dis­or­ders.

Vi­ta­mins and min­er­als are nec­es­sary for reg­u­la­tory func­tion in the body, for ef­fi­cient en­ergy me­tab­o­lism and for other func­tions such as cog­ni­tion, im­mu­nity and re­pro­duc­tion. Nearly one in three in In­dia is af­fected by one or more mi­cronu­tri­ent de­fi­ciency. Pe­ri­odic sur­veys car­ried out by the National Nu­tri­tion Mon­i­tor­ing Bureau dur­ing the past 10 years show that our di­ets are in­ad­e­quate and de­fi­cient in many known mi­cronu­tri­ents such as zinc, fo­late, vi­ta­mins B6, B2, B12, D and B.

The three most preva­lent mi­cronu­tri­ent de­fi­cien­cies that In­di­ans suf­fer are iron, io­dine and vi­ta­min A de­fi­cien­cies. “What is needed is bet­ter ac­cess to a va­ri­ety of af­ford­able mi­cro-nu­tri­en­trich veg­eta­bles, nu­tri­tion ed­u­ca­tion, bet­ter san­i­ta­tion and easy ac­cess to med­i­cal care,” says Dr C. Gopalan, pres­i­dent, Nu­tri­tion So­ci­ety of In­dia. Dr K. Mad­ha­van Nair, deputy di­rec­tor of National In­sti­tute of Nu­tri­tion ( NIN) adds, “Reg­u­lar con­sump­tion of a va­ri­ety of foods should be en­sured to sat­isfy our re­quire­ment for mi­cronu­tri­ents. It is im­per­a­tive that our reg­u­lar diet must con­tain ele­ments from at least eight food groups: Ce­re­als and mil­lets, pulses, leafy veg­eta­bles, fruits, fish and meat, milk and milk prod­ucts, nuts and veg­etable oils.”

Ex­perts say that time has come when the au­thor­i­ties con­cerned should fo­cus on the qual­ity of food sup­plied and not just the quan­tity. “Food pro­cess­ing in In­dia is a frag­mented in­dus­try in­volv­ing many small en­trepreneurs. The key is­sues are qual­ity of the food prod­ucts and paucity of so­phis­ti­cated tech­nol­ogy,” says NIN Di­rec­tor Dr Kal­pagam Po­lasa.

When it comes to health, one more fac­tor plagu­ing In­di­ans is the avail­abil­ity of clean and safe drink­ing wa­ter. As Vikas Shah, COO, US- head­quar­tered Wa­ter Health In­ter­na­tional, says, “In In­dia, the ma­jor fo­cus of govern­ment con­tin­ues to be on the avail­abil­ity of wa­ter and not the qual­ity of wa­ter. The scale of this prob­lem has over­whelmed many a state govern­ment.” Vi­ta­min D de­fi­ciency due to in­ad­e­quate ex­po­sure to sun­light is an­other prob­lem In­di­ans are in­creas­ingly fac­ing.

Nu­tri­tion re­mains a pri­mary con­cern in In­dia and the med­i­cal pro­fes­sion­als and nu­tri­tion sci­en­tists of the coun­try con­tinue to face ma­jor chal­lenges. How­ever sci­en­tists pin their hope on tech­no­log­i­cal ad­vance­ments. “Emerg­ing strate­gies such as crop bio for­ti­fi­ca­tion and ge­netic ma­nip­u­la­tion to en­hance the nu­tri­ent in food crops and use of nan­otech­nol­ogy have the po­ten­tial to ad­vance the science of nu­tri- tion,” says Dr G. S. Rao, man­ag­ing di­rec­tor, Yashoda Hos­pi­tals, Hyderabad. Th­ese ad­vances, to­gether with a bet­ter un­der­stand­ing of the mech­a­nisms of nu­tri­ent ac­tion, should, in the next few years, pro­vide bet­ter strate­gies that will ul­ti­mately lead to im­proved health through en­riched nu­tri­tion in In­dia.

THINKSTOCK PHO­TOS/ GETTY IM­AGES

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