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