Childhood Malnutrition in India

India 2013

By Joanne Manaster

February 13, 2013

Also published at Joanne Loves Science

Today’s post is number three in the run-up to my International Reporting Project trip to India where I will be part of a team of 10 journalists covering the topic of child survival. First, I addressed Infectious Diseases, then Vaccinations. Today, we will look at Malnutrition. What is the state of malnutrition in India? How has scientific understanding of what good nourishment means helped us work on the malnourishment issue particularly in developing nations? Can science put an end to world hunger? How are sanitation and hygiene related to malnutrition?

Before we go on, let’s define a few terms so there is no confusion:

Malnutrition is the condition that occurs when your body does not get enough nutrients.
Starvation is a severe deficiency in caloric energy, nutrient, and vitamin intake.
Famine is a widespread scarcity of food, usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality.
Emaciation is abnormal thinness caused by lack of nutrition or by disease.
Marasmus is chronic wasting of body tissues, especially in young children, commonly due to prolonged dietary deficiency of protein and calories.
Kwashiorkor is a syndrome occurring in infants and young children soon after weaning. It is due to severe protein deficiency, and the symptoms include edema, pigmentation changes of skin and hair, impaired growth and development, distention of the abdomen, and pathologic liver changes.

We've all seen disturbing photos of children in the malnourished or starving, so I'll not replicate them here.

Facts about Malnutrition in India

Here are some facts about malnutrition in India from Child In Need India (CINI)

The World Bank conducted an analysis of the problem of malnutrition in India and introduced a long document, "Undernourished Children: A Call for Reform and Action" with this statement:

The prevalence of underweight among children in India is amongst the highest in the world, and nearly double that of Sub-Saharan Africa. In 1998/99, 47 percent of children under three were underweight or severely underweight, and a further 26 percent were mildly underweight such that, in total, underweight afflicted almost three-quarters of Indian children. Levels of malnutrition have declined modestly, with the prevalence of underweight among children under three falling by 11 percent between 1992/93 and 1998/99. However, this lags far behind that achieved by countries with similar economic growth rates.  Undernutrition, both protein-energy malnutrition and  micronutrient deficiencies, directly affects many aspects of children’s development. In particular, it retards their physical and cognitive growth and increases susceptibility to infection, further increasing the probability of malnutrition. Child malnutrition is responsible for 22 percent of India’s burden of disease. Undernutrition also undermines educational attainment, and productivity, with adverse implications for income and economic growth.”

Across India, not all children are malnourished and some are more extremely malnourished than others. The numbers of those affected vary between remnants of the caste system, between Indian states, and gender where girls are more likely to be undernourished because of their lower status in society.

Malnutrition and Disease Go Hand in Hand 

Malnourishment and emaciation can be caused by disease. As you can imagine, severe diarrhea (such as from cholera or rotavirus) will interrupt the absorption of nutrients while the feeling of deep malaise will leave a child not wanting to eat. Diseases and disorders associated with emaciation include malaria, cholera, tuberculosis, other infectious diseases with prolonged fever, and parasitic infections.

Malnutrition also increases the risk of infection and infectious disease, and weakens every part of the immune system. It is a major risk factor in the onset of active tuberculosis.  Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection.

Providing adequate nutrition during the first 1,000 days can ensure that children are less susceptible to disease.

The Science of Nutrition and Malnutrition

Clearly, malnutrition is a severe issue in India and has longterm implications for children and the future of the country. Let’s look at how scientific discovery helps us understand nutrition and good nutrition keeps us healthy.

There are six major classes of nutrients:

carbohydrates
fats
minerals
protein
vitamins
water

These nutrient classes can be categorized as either: Macronutrients, which are needed in relatively large amounts, and include carbohydrates (including fiber), fats, protein, and water.

OR

Micronutrients, which are needed in smaller quantities, and are minerals and vitamins.

You probably remember the stories of how lack of vitamin C was discovered to be the cause of scurvy of men on ships or how the cause of Beriberi was the lack of thiamine (vitamin B1). The field of nutrition is full of scientific studies that have provided further understanding into what our bodies need to thrive. This list (modified from Wikipedia) shows us what may result from various nutrient deficiencies.

Many Nobel prizes have been awarded for nutrition research, with heaviest emphasis on the discovery or synthesis of vitamins.

Take a look at this list from nobelprize.org. You will want to read this fascinating article from which this information is taken from, too, as it discusses in more detail how some of these scientists made their findings. 

There was an interesting Nobel awarded to a tireless researcher in the field of nutrition research. In 1949, Lord Boyd Orr from United Kingdom, who studied Biology, Medicine and Nutrition, won the Nobel Peace Prize (Yes, PEACE) "for his scientific research into nutrition and his work as the first Director-General of the United Nations Food and Agriculture Organization (FAO)". He was passionate about understanding malnutrition and metabolism.

Malnutrition and Sanitation

What if children seem to have enough of the appropriate nutritive food, yet still exhibit signs of malnutrition? Could there be something else going on here? Indeed. In the past few years, scientist have discovered a phenomenon called ENVIRONMENTAL ENTEROPATHY which is caused by prolonged exposure to food and water contaminated with feces.

Environmental enteropathy, (EE) also known as gut dysfunction, affects up to 50% of children in the developing world, and causes no overt symptoms or signs in children.

While EE is known to reduce nutrient absorption and to be a significant contributor to child stunting worldwide, there still is no effective treatment for this nor do we understand why it occurs. EE has been recently highlighted as the single most important barrier to achieving normal growth and development of children worldwide.

This chart is a bit hard to see, but if you follow this link you will be taken to the article from the prestigious medical journal, The Lancet, where the authors indicate primary and secondary pathways microbes enter the enteric (digestive) system. We will come back to this when we talk about sanitation and maternal-fetal health over the next few days (From the paper, Child undernutrition, tropical enteropathy, toilets, and handwashing):

A more recent study was published in Science just a few weeks ago, and NPR's All Things Considered covered it in a podcast/article called, Gut microbes may play deadly role in malnutrition.

Can science and engineering help solve world hunger?

Here is a partial answer from wiseGEEK:

“One way to solve world hunger would be to develop new ways to grow food on a worldwide scale. Many people today live in areas of the world which were never capable of producing sufficient food crops or are nearly impossible to irrigate. Some arable land remains underused because it is under the control of rogue governments or is currently too inaccessible for farming. By developing new methods for maximizing crop growth on substandard land, inhabitants can grow enough food to meet their needs.

"Creating new farming technologies could also help solve world hunger. If food can be grown in large hydroponic farms, for example, there would less strain put on traditional soil farms. Farmers in poorer countries could be trained to rotate their crops in order to keep the soil healthier season after season. Better seeds with higher yields or resistance to insect or weather damage could help farmers grow more usable crops on the same amount of arable land. A renewed emphasis on agriculture as a career could also encourage more young people to start their own farms and produce more food for others.

Genetically modified food crops (if accepted by a nation--and there is a lot of resistance to this across the world) may grow better in areas of the world where soil is poor or insects besiege the crops. We can also modify the crops so they are more nutritious. The most promising of these is a vitamin A-rich rice called Golden Rice:

“Genetically modified rice could be a good source of vitamin A for children in countries where deficiency in the vitamin is common. A new study tested so-called Golden Rice against both spinach and supplements in providing vitamin A to 68 six- to eight-year-olds in China. Researchers found that the rice was as effective as the capsules in giving kids a boost of vitamin A, based on blood tests taken over three weeks. And it worked better than the natural beta-carotene in spinach, the researchers report in the American Journal of Clinical Nutrition.” Read more HERE.

With the tools of biotechnology, we can grow more crops on less land, grow new, more nutritious crops, and find new uses for existing crops.

Joanne Manaster is traveling to India on a trip with the International Reporting Project (IRP).