Global Nutrition And Food Security Are Crucial For A Healthy Future. (70 Characters)

Disease burden etiology and epidemiology

Discuss about the Global Nutrition and Food Secruity.

Iron deficiency anemia has been a major public health problem that India has been trying to overcome for several years. Several schemes to tackle the problem have not yielded the desired results. The disease burden due to early deaths, poor health and poor cognitive development among children has incurred major economic losses for families and the country. The statistics of affected populations among children, adolescent and expectant and lactating mothers are staggering. There is plenty of information on the choice of foods that can reduce the malady of anemia but food supplementation is the way forward. Fortified foods are expensive and out of reach of most affected people who mainly have a low socio economic status. Discrimination against girls and women is a social problem and their nutrition is a low priority in most homes. The government of India has launched several programs to find and deliver solutions to the affected. The National Nutritional Anemia Prophylaxis Program and the National Iron+ Initiative are two important programs that are being run by the government.

The disease burden due to Iron deficiency anemia in India is huge. There is burden due to lost years of life when infants and young children die prematurely. Poor quality of life results when children fall sick repeatedly and their cognitive development remains impaired. The two kinds of losses are termed as disability adjusted life years. Even as adults the children whose cognitive development remains impaired remain low in terms of productivity because they can only get low income work leading to monetary losses throughout their lives. The effect of the environments in which children from low socio economic backgrounds grow up is substantial. Children in urban households suffer more due to IDA because they live in highly unsanitary conditions and they are exposed to the risk of infectious diseases. Besides the children with IDA living in rural areas are more likely to get the benefit of social programs directed at them (Plessow, et al., 2015).

The severity of anemia as described by the World Health Organisation, is mild when the hemoglobin level is less than 110g/l for children below five years of age,  below100g/l level of hemoglobin is moderate and those with hemoglobin less than 70g/l are said to be severely anemic (WHO, 2011). In young infants the prevalence of IDA is rather high at 49.5%, in the 24-59 months age-group, IDA is 39.9%. Moderate and severe anemia is higher in children below two years of age (Plessow, et al., 2015). 60-70% of adolescent girls are reported to be suffering from anemia. In a study on a group of 840 village girls aged between 10 and 19 years, 41.6% of the girls were reported to be anemic. About 34.6% girls were mildly anemic while 6.3% were moderately anemic (Biradar, Biradar, Alatagi, Wantamutte, & Malur, 2012). The poor bioavailability of iron in vegetarian diets has been a major cause (Alvarez-Uria, Naik, Midde, Yalla, & Pakam, 2014).

Sources of food rich in Iron

Iron deficiency anemia has been recognized as a mounting public health concern in India. The 20% maternal deaths are solely caused by anemia, another 50% maternal deaths are also indirectly related to anemia. Preventive and curative government schemes to address the problems associated with anemia were started as early as 1970, but even after 47 years later, with several modifications to the problem, answers are still being sought. The strain on the economy due to IDA is substantial. A multipronged approach is required to tackle the issue because several societal factors compound the problem. Multiple pregnancies followed by lactation, poor iron reserves at the time of birth, delayed introduction of complementary food, high frequency of infectious diseases among children and blood loss of a higher degree during child birth increase the incidence of anemia among Indian women and children (Anand, Rahi, Sharma, & Ingle, 2014). Improvements in iron status of children are hard to achieve due to the problem of worm infestation (Lokeshwar, Mehta, Mehta, Shelke, & Babar, 2011).

Food supplements and fortified food are often used to treat anemia. But the consumption of foods rich in iron not only remedies anemia but also prevents chances in high risk individuals. And do not have associated discomfort of abdominal pain and diaorrhoea. The best source of non-heme iron are dark green leafy vegetables, such as, spinach and kale, seeds, nuts and whole grains. The bioavailability or increased absorption of iron from these sources can be enhanced in the presence of ascorbic acid and muscle protein tissue that reduce the ferric ions to ferrous ions to facilitate the absorption (Abbaspour, 2014). When a person suffers from an iron deficiency the uptake of iron increases about 10-fold. Legume seeds, such as, soybean, lentils, chick peas and lupine are very rich in iron in comparison to cereals, such as wheat and rice (Zieli?ska-Dawidziak, 2015). Subsidized iron fortified infant food formulations provide an answer to iron deficiency anemia in infant, but the additional costs may prove it difficult even for urban populations to buy the products (Plessow, Arora, Brunner, & Wieser, 2016).

Non-vegetarian sources of iron include meat, poultry and fish. An increased consumption of fruits and vegetables helps in the absorption of iron while consumption of tea and coffee reduces absorption (Zijp, Korver, & Tijburg, 2000). The presence of phytic acid in food can slow the absorption. And cereals consumed in India are high in phytate content, further adding to the problem of low bioavailability of iron (Kalasuramath, Kurpad, & Thankachan, 2013). Germination and fermentation of food promotes the absorption of iron because the enzymes involved in degradation of phytic acid, the phytases are produced (Gupta, 2015). So it can help to consume sprouts and fermented foods. So along with consumption of foods rich in iron, the combination of foods that enhance absorption of iron is also important in alleviating anemia. The recommended daily intake of iron varies from 8-18 mg per day and varies according to age, gender and whether a woman is pregnant or lactating (Lim, 2013).

Determinants of Iron deficiency in India

Promoting consumption of indigenous foods rich in iron is important. The high iron content in the leaves of Amaranthus gangeticus, Trianthema monogyna and Ipomea batata in the range of 3.49 to a staggering 38.5 mg/100mg makes these a good option for tackling the problem of nutritional deficiency of iron (Ghosh-Jerath, 2015).

The reasons why nutritional deficiencies of Iron and other nutrients occur among Indians are many. The major factor remains gender issues. The girl child is usually deprived of nutrition and food. The public distribution system does not function optimally, target groups are poverty stricken. The reasons why nutrition programs in India fail have reasons that are historical, behavioural, related to governance issues, economic factors and the epidemiology also plays a role. Discriminination against the girl child is rampant and leads to poor nutrition. India's adolescent girls fare badly in the area of nutrition. Poor nutrition continues through adulthood and maternal health is ridden with anemia that causes iron deficiency in  infanthood and early childhood. Several times a raise in household income is directed towards purchase of consumer goods, such as mobile phones and televisions rather than food. Undernourishment among adult women is evident due to the fact that a third of the country's women have low BMI (Aswathy, 2015). Disparities in the public distribution system based on wealth and ethnicity have made most of the nutritional supplementation programs addressing deficiency of iron unsuccessful (Pasricha, et al., 2011).

Agricultural growth in India has not resulted in reduction of infant malnourishment due to the fact that the growth has not focussed on making affordable food available to every household. This may have something to do with the choice of crops and the fact that agricultural growth has not been sensitive to the nutritional requirements of the population. Economic growth has been unequal and governance has fallen short of the demands in the area of food production and distribution. Major shortcomings in food storage have resulted in loss of crucial nutritional resources. Food security may have been achieved in the sense that the country is not dependent on food imports but the ability to buy the food has not reached the poorest sections of the population and growth has remained unsustainable (FAO, 2015). Severe shortcomings in social equity remain and the purchasing power of food has remained inequitable.

National programs for provision of nutrition supplements that contain iron for treatment and prevention of iron deficiency anemia have been part of the strategy to reduce anemia among the Indian population. Two such programs that are currently being run by the government of India are, the National Nutritional Anemia Prophylaxis Program and the National Iron + Initiative.

The program was launched at the national level in 1970 and its objective was to prevent anemia in children and expectant and lactating mothers. In the beginning an iron tablet (60 mg iron) with folic acid (500 mcg) was given, later the dosage of iron was revised to 100 mg of elementary iron. Preference was given to mothers who opted for the program on family planning. All children between the ages of one year and five years received a d tablet containing 60 mg of iron and 100 mcg of folic acid. The challenges in the implementation of nutritional supplements are several and need periodic reviews. Promotional and educational resources targeted at school -age children and their families can help to spread awareness about regular intake of foods containing iron and foods that increase absorption of iron are important steps in reaching the goal of removing the nutritional deficiency of iron in the vulnerable sections of the population (rfhha). The program is implemented through the Primary Health Centres.

Public health initiatives based on distribution of supplements and fortified foods have reduced the incidence of anemia in other countries, but success has been elusive in India (Shet, et al., 2015). Problems have been identified in the procurement and the distribution of the iron and folate supplements. The support system of health workers in rural areas is inadequate. Unfounded beliefs about having larger babies, fear of side effects on taking iron supplements, such as constipation and inadequate supply of iron hamper continuity of programs that address prevention of anemia among women and children. Reduction of knowledge gaps by disseminating information about the importance of adherence to consumption of iron supplements by mothers can improve the rate of cure and prevention of anemia (Pasricha, et al., 2011).

This initiative was started by the government of India in 2013 with the objectives of highlighting the serious impact of anemia on the physical and mental health of the affected individuals, developing effective methods of iron and folic acid supplementation across the life cycle (preventive measures), to devise a strategy for cure of mild, moderate or acute anemia (curative measures) and to identify platforms for delivery of the supplementation services and define the role of service providers. This program is based on the concept of continuum of care and includes expectant and lactating mothers, children between the ages of 6 months to 60 months with the addition of few more age-groups. The program includes a bi-weekly iron supplement for children between 5 months and 60 months of age and once a week supplements for children studying in grades 1 through 5 at government funded or government schools. Adolescents between 10 and 19 years of age are also given weekly supplements as part of the initiative. Communication is recommended in such a way that it stays in the memory of the target groups, use of catch phrases and slogans is promoted. The Accredited social health activists and Auxiliary nurse midwives have been given training to give iron supplements as therapy when they encounter individuals with iron deficiency anemia (Aswathy, 2015). Educational interventions that communicate how to introduce complimentary feeding has been found effective in dealing with infant malnutrition in several developing countries (Shi & Zhang, 2011). There is a need to deliver information in a culturally sensitive manner. Community videos have been used successfully to disseminate nutrition related information in the language of the people through a format of dialogue and discussion rather than an expert delivering information. This can ensure meaningful engagement of the people in rural areas (Koniz-Booher, Upadhyay, Beall, Swain, & Lamstein, 2013).

Conclusion

In conclusion, it is clear that although the public health problem is well understood by all the stakeholders, a solution appears to be elusive. The disease burden is adding to the strain in the economy due to disability adjusted life years. The etiology of the anemia is such that a person suffering from the disease feels tired and cognitive development of children is affected which is not reversible. With 49.5% of infants suffering from anemia, the problem is massive. Since it is a nutritional deficiency, iron can be given to the affected in the form of food, iron supplements with folic acid for better absorption. Consumption of fortified food can help alleviate the deficiency but it is relatively expensive. Several determinants have made the problem of anemia insurmountable in India. The socio economically deprived people from rural and urban India find it difficult to consume enough food. Discrimination against women and the girl child have meant that the nutritional status of women has remained poor. Agricultural growth has occurred but it has failed to make food affordable for the poverty stricken sections. The government recognized the problem of iron deficiency and launched a nationwide program, the National Nutritional Anemia Prophylaxis Program and the National Iron + Initiative. Both programs involve dispensing of iron supplements in the recommended dosage for children and adults. But compliance has been low and there are problems in distribution and supply mechanisms. Community programs to spread awareness in a culturally appropriate manner are being run. The identification of the shortcomings should help to solve this huge problem in the not so distant future

References

Abbaspour, N. H. (2014). Review on iron and its importance for human health. . Journal of Research in Medical Sciences?: The Official Journal of Isfahan University of Medical Sciences, 19(2), 164–174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999603/.

Alvarez-Uria, G., Naik, P., Midde, M., Yalla, P., & Pakam, R. (2014). Prevalence and severity of anaemia stratified by age and gender in rural India. Anemia, 2014:176182.

https://www.hindawi.com/journals/anemia/2014/176182/

Anand, T., Rahi, M., Sharma, P., & Ingle, G. (2014). Issues in prevention of iron deficiency anemia in India. Nutrition, 30(7-8):764-70. https://www.ncbi.nlm.nih.gov/pubmed/24984990

Arlappa, N., Balakrishna, N., Laxmaiah, A., & Brahmam, G. (2010). Prevalence of anaemia among rural pre-school children of West Bengal, India. Annals of Human Biology, 37(2):231-42.

Aswathy, S. (2015). An overview of the development and status of national nutritional programs in India. Journal of Medical Nutrition and Nutraceuticals, 4(1):5-13 . https://www.jmnn.org/article.asp?issn=2278-1870;year=2015;volume=4;issue=1;spage=5;epage=13;aulast=Sreedevi

Biradar, S., Biradar, S., Alatagi, A., Wantamutte, A., & Malur, P. (2012). Prevalence of Anaemia among Adolescent Girls: A One Year Cross-Sectional Study. Journal of Clinical and Diagnostic Research, 6(3):372-377. https://www.jcdr.net/articles/PDF/2064/3852_E(C)_F(T)_PF(V)_PFA(A)_P(_).pdf

FAO. (2015). /a-i4624e.pdf. Retrieved from https://www.fao.org: https://www.fao.org/3/a-i4624e.pdf

Ghosh-Jerath, S. S. (2015). Traditional Knowledge and Nutritive Value of Indigenous Foods in the Oraon Tribal Community of Jharkhand: An Exploratory Cross-sectional Study. Ecology of Food and Nutrition. Ecology of Food and Nutrition, 54(5), 493–519. https://doi.org/10.1080/03670244.2015.1017758. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714238/

Gupta, R. K. (2015). Reduction of phytic acid and enhancement of bioavailable micronutrients in food grains. Journal of food science and technology, 52(2), 676–684. https://doi.org/10.1007/s13197-013-0978-y. https://www.ncbi.nlm.nih.gov/pubmed/25694676

Kalasuramath, S., Kurpad, A. V., & Thankachan, P. (2013). Effect of iron status on iron absorption in different habitual meals in young south Indian women. The Indian Journal of Medical Research , 137(2): 324–330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657856/

Koniz-Booher, P., Upadhyay, A., Beall, K., Swain, T., & Lamstein, S. (2013, September 15-20). /iuns_dg_overview_final_tagged.pdf. Retrieved from https://www.spring-nutrition.org: https://www.spring-nutrition.org/sites/default/files/events/posters/iuns_dg_overview_final_tagged.pdf

Lim, K. H.-G. (2013). Lim, K. H. C., Riddell, L. J., Nowson, C. A., Booth, A. O., & Szymlek-Gay, E. A. Iron and Zinc Nutrition in the Economically-Developed World: A Review. Nutrients, 5(8), 3184–3211. https://doi.org/10.3390/nu5083184. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775249/

Lokeshwar, M., Mehta, M., Mehta, N., Shelke, P., & Babar, N. (2011). Prevention of iron deficiency anemia (IDA): how far have we reached? Indian Journal of Paediatrics, 78(5):593-602. https://link.springer.com/article/10.1007%2Fs12098-010-0130-1

Pasricha, S., Biggs, B., Prashanth, N., Sudarshan, H., Moodie, R., Black, J., & Shet, A. (2011). Factors influencing receipt of iron supplementation by young children and their mothers in rural India: local and national cross-sectional studies. BMC Public Health, 11:617. doi: 10.1186/1471-2458-11-617. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171369/

Plessow, R., Arora, N., Brunner, B., & Wieser, S. (2016). Cost-Effectiveness of Price Subsidies on Fortified Packaged Infant Cereals in Reducing Iron Deficiency Anemia in 6-23-Month-Old-Children in Urban India. PLoS One, 11(4):e0152800. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152800

Plessow, R., Arora, N., Brunner, B., Tzogiou, C., Eichler, K., U, B., & Wieser, S. (2015). Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India. PLoS One, 10(8):e0136581. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136581

rfhha. (n.d.). /NATIONAL_NUTRITION_ANEMIA_PROPHYLAXIS_PROGRAMME.pdf. Retrieved from https://www.rfhha.org/: https://www.rfhha.org/images/pdf/national_health/NATIONAL_NUTRITION_ANEMIA_PROPHYLAXIS_PROGRAMME.pdf

Shet, A. S., Zwarenstein, M., Mascarenhas, M., Risbud, A., Atkins, S., Klar, N., & Galanti, M. R. (2015). The Karnataka Anemia Project 2 — design and evaluation of a community-based parental intervention to improve childhood anemia cure rates: study protocol for a cluster randomized controlled trial. Trials, 16:599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697328/

Shi, L., & Zhang, J. (2011). Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. Journal of Tropical Paediatrics, 57(2):91-8. https://academic.oup.com/tropej/article/57/2/91/1646539/Recent-Evidence-of-the-Effectiveness-of

WHO. (2011). haemoglobin/en. Retrieved from https://www.who.int: https://www.who.int/vmnis/indicators/haemoglobin/en/

Zieli?ska-Dawidziak, M. (2015). Plant Ferritin—A Source of Iron to Prevent Its Deficiency. Nutrients, 7(2): 1184–1201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344583/

Zijp, I., Korver, O., & Tijburg, L. (2000). Effect of tea and other dietary factors on iron absorption. Critical reviews in food science and nutrition, 40(5):371-98. https://www.tandfonline.com/doi/abs/10.1080/10408690091189194