Food needs are of two types : (a) quantitative, which if not met results in undernourishment, and in extreme circumstances, starvation; and (b) qualitative, which if not fulfilled, produces malnutrition and deficiency diseases.
Malnutrition is more deceptive for its sufferers may not be aware of the cause of their debility or of the disease to which they are prone. Malnutrition is defined as “a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients.” It has four forms: (a) under nutrition, (b) over nutrition, (c) imbalance, and (d) specific deficiency. In India under nutrition is more prevalent because the average caloric intake is here far less than other countries (India 1945 calories, U.K. 3150 and USA 3200 calories/person).
The National Institute of Nutrition at Hyderabad, in its Diet Atlas of India (1971) has prescribed separate balanced dietary scales fulfilling the basic needs for calories and protein for vegetarians (28% of India’s population) and non- vegetarians (Table 8. XVII).
The study also shows that as against the daily requirement of 2357 calories and 44.3 grams of protein the average diet available is only 1945 calories and 49 grams of protein per head per day. About 30% people get less than 1700 calories, 40% between 1780 and 2300 calories and the remaining 30% more than 2300 calories. The more disturbing is the gradual decline in the per capita availability of pulses and oil seeds the major sources of protein and fats in the country.
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Cereals play a much larger role in the Indian diet than they do in the more developed countries, and the overall provision of calories and proteins is much lower. In the Indian diet about two-thirds of the calories come from the cereal foods while in the western countries only one-third, the remainder being derived from sugars, fats, oils and meat. In 1970, a food year as far as crop production was concerned; the average Indian had 17.5 per cent less than the desirable level of calories. Very many in the poorer section of the community must have had much less than this. Studies in Maharashtra in the 1960s showed that the poor consumed only 1120 calories, while the rich exceeded 3000 (Johnson, 1980, p. 25).
According to one study made by P. V. Sukhatme in 1965 about 25 to 33 percent of India’s population had too little food and malnutrition affected about half of the people. Lack of properly balanced diet is a major factor reducing the resistance to diseases and protein deficiency leads to retarded growth in children. Indian diets are generally lacking in first class animal protein. Pulses provide only second class protein and their scarcity makes common man’s life miserable. Also there is lack of vegetables and milk in the average diet which are important sources of protective vitamins and minerals and which could be abundantly produced in the agrarian economy of the country.
Among the factors influencing malnutrition mention may be made of: (a) physical environment, (b) demographic variable, (c) socio cultural factors, and (d) economic variable. While physical environment affects the crop-variety, dietary habit and occurrence of diseases demographic variables affect the quantity and quality of the food. For example, swamps, dense vegetation, heavy rainfall and excessive irrigated areas promote the origin of vectored diseases like malaria, and filaria etc. Iodine deficiency in the mountainous and sub-mountainous regions enhances the incidence of endemic goitre in these areas. Seasonal changes also have role in the incidence of diseases. In general rainy and summer seasons promote the occurrence of diseases. The size of the family and spacing in the birth of children affect the per capita availability of food. In India poor and economically depressed households are generally larger in size and low spacing in the child birth.
Amongst socio-cultural factors castes and religions affect the dietary habits and food intake. Brahmins in Hindus, Jains and Buddhist avoid flesh foods. Hindus and Muslims observe fasts on religious occasions. One of the main causes of anemia in the Indian women is related to their excessive religious fasting. Economic variables affect both the quantity and quality of the food. On the one hand caloric intake is low in poor and low income groups on the other hand they have to perform a lot of physical work which require more nourshing diet. This has detrimental effect on their health.
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Spatial Patterns of Malnutrition
There exist considerable regional differences in the spatial pattern of malnutrition in the country.
The well-fed states seem to be those where wheat diet predominates together with a high level of protein intake. In Jammu and Kashmir rice, maize and wheat are eaten, and the high level of calorie consumption reflects the climatic stress of its winters. The ragi, jowar and bajra eaters, supplementing their millet with wheat or rice as the case may be, come in the middle, with the rice eating states at the bottom of the list. In general the caloric intake appears to decrease southwards and eastwards into warmer regions of the country (Table 8. XVIII). According to the Tamil Nadu Nutrition Study by Sidney M. Cantor Associates Inc. (1973) even 80% of the calorie needs of the half of the families of the state remains unfulfilled. On average younger pregnant or lactating women get only 60% of their calorie needs. That is why mortality rate in children is very high and out of every 1000 live births only 555 survive to celebrate their 6th birthday (cf. Europe and North America, 950).
Except cereals most other foods fall below the recommended daily need in most of the states of the country. In milk and milk products only states of Punjab and Haryana exceed the recommended allowance of 180 gms, per capita per day. Madhya Pradesh and Rajasthan are closer to the limit, but all other states show far less consumption of milk. Similarly the consumption of meat, fish and eggs is far less than the required need in most of the parts of the country; the consumption of pulses is less in the southern states of the country. That is why protein- calorie malnutrition is more pronounced in the south than in the north.
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Some nutritional disorders are endemic in certain parts of the country. Endemic goiter due to the deficiency of iodine is a major public health problem in the sub-Himalayan belt. Lathyrism, a disabling paralytic disorder caused by the excessive consumption of Khesari pulse, affects the health of the people in Central India, eastern Uttar Pradesh and Bihar. Skeletal fluoric caused by the excessive consumption of fluoride is endemic in parts of Andhra Pradesh and Punjab. Similarly pellagra, a deficiency of nicotinic acid is peculiar to the Deccan plateau where jowar forms the staple food. Future Prospects.
According to one study of K. Bhatia, Jagpal Singh and V.P. Agarwal (1991) India’s population will reach 922.9 million by 1994-95. For the requirement of 60 grams of proteins and 2550 K. Cal. of energy per day to a 60 kg adult (corresponding to 1.6 bmr = basal metabolic rate as per FAO/UNO report on ‘Energy and Protein Requirements’ 1985) there will be necessity of 268 gms. Of rice, 137 gms. Of wheat, 76 gms. Of pulses, 76 gms. Of millets, 39 gms. Of sugar, 38 gms. Of fat, 10 gms of fish. 6 gms of other animal products (including eggs), 20 gms. Of tubers, 50 gms. Of milk and 5 gms. Of coconut. Assuming at the current (1991) level of age-struc- ture the country will require 76 million tons of rice, 48,9 million tons of wheat, 23.7 million tones of pulses, 25 million tons of jowar-bajra, 3.42 million tones of potato 16.13 million tons of sugar and 2.83 million tons of fish to feed its population by 1994-95.
Due to good harvest the actual production in 1994-95 was 81.81 million tons of rice, 65.77 million tons of wheat, 29.88 million tones of coarse grains, 14.04 million tones of pulses and 14.8 million tons of sugar. The shortfall in the production of pulses is a matter of serious concern because these are the main source of protein in the country. This requires better use of HYV seeds, agricultural inputs like fertilisers, pesticides etc, adoption of new bio-technology, and judicious exploitation of water resources. More so the per hectare yield of pulses and oil seeds has to be increased from the current level of 610 kg and 843 kg (1994-95) to 1000 kg and 1500 kg respectively.
According to one estimate there are about 20 million species of plants of which about 50,000 may be utilised for food. But we only use 200 species in our food. About 80 per cent of the food requirement is derived from only eight species of plants. At present we are developing hybrid varieties which are detrimental to the bio-diversity. In fact this is high time when we should add some more plant varieties in our food basket. Especially there are many new varieties of plants in coarse cereals group which can be utilised for food.
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We should not be very complacent about the gains of the Green Revolution especially when in some areas of the Green Revolution the production is either stagnant or is exhibiting declining trend. Hence there is need for a new Green Revolution in coarse grains, pulses, oil seeds more so in areas of deficient rainfall. In addition, the wastage due to post- harvest operations, which is estimated at a conservative figure of 10% of the total production, has to be minimised.
The population of the country has reached 1027 million in 2001 AD which requires increase in the productivity level of the crops. Similarly to improve the quality of the diet there is a need to focus attention on augmenting the production of milk, animal meat, poultry products, fruits and vegetable.
Since malnutrition is the outcome of several factors, the problem can be solved only by taking action simultaneously at various levels-family, community and national levels. It requires coordinated approach of many disciplines-nutrition, food technology, health education, health administration, marketing etc. Both the husband and the wife need to be educated on the selection of right kinds of local foods and in the planning of nutritionally adequate diets within the best limits of their purchasing power.
The nutritional needs of expectant and nursing mothers and children should attract our foremost attention. Other important measures at family level include the package of mother and child health, family planning and immunization services etc.
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Action at the community level should commence with the analysis of the nutrition problems in terms of : (a) the extent, distribution and types of nutritional deficiencies, (b) the population groups at risk, and (c) the dietary and non-dietary factors contributing to malnutrition.
Similarly such programmes like midday school meals, integrated child development services (ICDS), health education, improvement of water supply, control of infectious diseases, increasing agricultural production, stabilization of population, small family norms etc. may be undertaken at state and national levels.