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Hidden Hunger in India

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Hidden Hunger in India

I just returned from a week in India where I traveled the country speaking to physicians, nutrition professionals and bloggers as part of a campaign to increase awareness of hidden hunger in Indian children, a condition that is taking hold in under-nourished and over-nourished children.

Hidden hunger is the chronic deficiency of micronutrients, leading to disturbances in immunity, growth and cognitive milestones in children.

You may already know about the dire levels of malnutrition in Indian children:

  • 48% of Indian children are stunted (acquired short stature from under-nutrition);
  • 330,000 annual deaths due to complications related to vitamin A deficiency;
  • anemia, iodine deficiency and folic acid deficiencies are rampant, causing numerous health complications.

And, what you may not realize is that Indian children are just as taken with fast food and junk food as American children, and hence the incidence of childhood obesity is on the rise, along with its sidekick, diabetes.

Like their American counterparts, these micronutrient deficiencies exist not only among undernourished Indian children, but also among those who are of normal weight, and who have obesity.

Hidden hunger is especially hard to recognize, but the consequences are real, including frequent illness (and in some cases death), missed school, slowed growth, and delayed cognitive outcomes.

Causes of Hidden Hunger

There are many stakeholders in India working to bring greater awareness of hidden hunger and its effect on children—I partnered with GlaxoSmithKline Consumer Healthcare (GSK) to launch an educational campaign about the implications of micronutrient deficiencies on Indian children, particularly the effects on immunity and growth, and how they can be addressed.

Frankly, I was moved beyond measure to see real nutrient deficiency at work. Yes, I learned about the myriad effects of nutrient deficiencies in college and in my dietetic internship: scurvy, anemia, thalassemia, stunting, and more. But until this week, those were theoretical conditions—possibilities to watch out for—not common realities.

There are many reasons for micronutrient deficiencies in India. Naturally, the diet is a concern, with one end of the spectrum being a lack of adequate nutrition and the other end, a high calorie, low nutrient, Western-influenced diet. While some children are obviously suffering from malnutrition, others are outwardly healthy appearing, yet malnourished, according to several studies conducted in children attending school.

The commonplace vegetarian diet and the reliance on pulses and grains limits the availability of important micronutrients, either due to low nutrient content in the diet itself, or poor nutrient bioavailability. Common feeding practices such as offering diluted milk for breakfast, missing fruit and vegetables throughout the day, and repetitive meals (rice twice a day or more) further limits the nutrient quality of the diet.

Poor immunity is a big concern, raising the risks of infection, while simultaneously increasing the demand for nutrients. Getting sick throws a nutritional punch at Indian children, as they are limited in their ability to mount an immune defense in the face of nutrient deficiencies.

How Nutrient Fortification Helps

The United States isn’t perfect when it comes to nutrition, but we do have many safeguards that help our children start off with a sound nutritional foundation. Here are a few examples:

What Safeguards?Why?
Vitamin D supplementationat Day 2 of lifePrevents rickets; Breast milk is an inadequate source; infant formula does not meet needs until consumption is 32 ounces per day
Iron supplementationfor breast fed babies;

initiation of iron-rich solids

Iron requirements increase to 11 mg/day which breast milk cannot supply alonePrevents anemia
Folic acid and B vitamin fortificationPrevents neural tube defects (ie, spina bifida)

B vitamins are added back to flour to replenish the losses associated with processing

Vitamin D fortification of foodsThere are limited foods naturally containing vitamin D, making it difficult to meet requirements with food sources

Promotes bone health, immunity and other benefits

Iodized saltPrevents iodine deficiency such as goiter, and impairment of brain development
Fluoridated waterPrevents fluoride deficiency such as dental caries and osteoporosis

Not only do we fortify, we regulate that fortification through governance, which largely protects our children from contamination and toxicity. Without governance, as seen in our supplement industry, fortification may include dangerous substances, contaminants and inaccurate levels of added substances. In India, I was made aware of milk containing detergent, passing as “fortified” milk. Without governance and regulation, this is what can happen.

In America, a systemized approach to fortification, timed at critical developmental moments (ie, pregnancy and infancy) prevents many of the nutrient deficiencies with which Indian children struggle.

Again, the US isn’t perfect. We have our own food questions: are there too many preservatives and artificial food colors and sweeteners in our food? Is there, on a whole, too much added sugar? What does the evidence fall on GMO, BPA, and more?

But the fact is, despite nutrient fortification, we still have nutrient deficiencies in America:

  • 14% of children are anemic
  • Rickets, a deficiency of vitamin D, is on the upswing
  • Calcium consumption gets worse as children get older, compromising bone health and increasing the risk for osteopenia and osteoporosis {My Calcium e-book can help you understand and shape your child’s calcium consumption}
  • Nutrient deficiencies in children who are overweight or obese do exist, including vitamin A, D and E, calcium, and magnesium

As I made my way through India, I was reminded (in a big way) of how important nutrients are to the health, growth and brain function of all children, regardless of where they live, how educated they (or their parents) are, or their economic status.

As stakeholders in the health of children, whether we are nutrition professionals, doctors, nurses, or the parents of precious little ones, we need to pay attention to nutrients and the potential for hidden hunger.

Were you aware of hidden hunger?

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