As a rapidly growing economy, India is often clubbed with China, but in the Beijing Olympics of 2008, China won 51 gold medals while India managed just one – in shooting. When the question of India’s poor standing in the area of sports is raised, blame is put on a variety of factors like the lack of a sporting culture, poor funding, inadequate training opportunities, inability to identify talent at an early age, and so on.
Important as these are, the basic issue is that a malnourished nation cannot be a sporting nation. Finally, it comes down to this: No health without good nutrition, and this is what I argued in piece for ‘Current Science’, on which the present piece is based.
Over the years, some improvement has occurred in terms of reduced mortality. But the resistant problem of malnutrition continues to defy a solution. Thus, almost 30 per cent of infants in India have low birth weight (less than 2.5 kilos). Almost 50 per cent pre-school children suffer from protein calorie malnutrition as judged by anthropometric indicators like wasting and stunting, and the past decade has seen little improvement. Nearly 30 per cent of adults are also undernourished as judged by the body mass index. There is rampant deficiency of micronutrients (vitamins and minerals). There is iron deficiency that causes anaemia (50-70 per cent), with iodine deficiency and vitamin A deficiency being of particular concern. Other deficiencies knocking at the door to be recognised on the basis of recent evidence are vitamin D deficiency (despite our tropical sun), B-vitamins (folic acid, B 12 and B 2) and zinc.
Undernutrition impairs growth, immunity and productivity in day-to-day life, leave aside performance in sports, which demands strength, stamina, and concentration. This is clearly the issue of our times and a panel of economists, who are also Nobel laureates, gave high priority to nutrition for human development. In fact, of the top-ten priorities selected for development in the Copenhagen Consensus, five were in the area of nutrition – micronutrient supplements, micronutrient fortification, biofortification, de-worming and other nutrient programmes at the school and community level.
We need, not just food security – often interpreted as adequate stocks of cereals at the national level – but nutrition security. For this there has to be awareness as well as physical, economic and social access to an age-appropriate balanced diet. There also has to be clean drinking water, a safe environment and primary healthcare for all. A balanced diet implies the right blend of cereals, legumes (dals), vegetables, fruits and foods of livestock origin – milk, eggs, meat and fish.
Thanks to our price support policies, India has been encouraging the consumption of fine cereals like rice and wheat. Yet, coarse grains like maize and sorghum (jowar) and millets like pearl millet (bajra), finger millet (ragi) and minor millets that are rich in nutrients and fibre, need to be prioritised in our nutrition security policies. They have the added advantage of requiring less water for their cultivation, and being more resistant to climate change.
The link between malnutrition and disease is often overlooked. It is, in fact, a vicious cycle. Undernutrition compromises immunity and predisposes a person to infection, which in turn depletes the body of nutrients. Today, countries in transition like India are facing the double burden of pre-transition diseases like undernutrition and infections, and post-transition degenerative diseases like obesity and associated conditions like diabetes, hypertension and cardiovascular diseases (CVD), cancer and arthritis. India is the diabetic capital of the world and CVD hits South Asians, including Indians, at a younger age than in other countries.
Research done over the last two decades has suggested a link between undernutrition at the foetal stage and increased susceptibility to these age-onset degenerative diseases. Intra-uterine nutritional deprivation (resulting in low birth weight) affects foetal programming and body composition. Babies born to malnourished mothers tend to have low birth weight. Such individuals have a higher percentage of body fat than babies born to well-nourished mothers. Indulgence in later life (sedentary lifestyle, high-fat, low-fibre, refined diet, which would be the lot of individuals who move up the economic ladder), predisposes people to obesity, diabetes and CVD. Obesity also aggravates arthritis.
To break this multigenerational cycle, the nutrition and health of girls has to be ensured from birth. A low birth-weight baby has to be rehabilitated nutritionally within the first year, through simple measures like the introduction of breast milk within one hour of birth, exclusive breast-feeding for six months and the introduction of complementary food after six months. These are low-cost interventions needing only mass awareness campaigns.
Ordinary Indian diets are not particularly high in their nutritive content. Visit any village in south India and you will see children eating a pile of rice, with a little chutney or some vegetable or a little dal (lentil). In north India, replace the rice with wheat ‘rotis’ and it is essentially the same picture. Surveys done by the National Nutrition Monitoring Bureau, run by the National Institute of Nutrition (NIN), Hyderabad, under the Indian Council of Medical Research, as well as other surveys, have shown that Indian diets are qualitatively deficient in micronutrients (vitamins and minerals), and within the family the diet of pre-school children are most deprived, primarily because of ignorance of a child’s dietary needs and the inability or lack of time on to ensure that the child gets small meals at frequent intervals.
Among vegetables, green leafy vegetables are a treasure trove of micronutrients. They are easy to grow, available throughout the year and cheap. Horticulturists have given little importance to this precious resource. Orange, yellow vegetables and fruits (carrot, papaya, yellow pumpkin and mangoes) are rich in pro-vitamin A (beta carotene). Fruits, particularly citrus fruits, like amla (Indian gooseberry), guava and tomato are rich in vitamin C, which is a good antioxidant. Vitamin C promotes iron absorption and hence helps prevent anaemia. With a little knowledge and understanding, agriculture can be nutritionally oriented. Vegetables and fruits are also rich in health-promoting phyto-chemicals that protect against the onset of age-degenerative diseases.
India needs to put nutrition security at the heart of its missions like the National Food Security Mission, National Horticulture Mission and the National Rural Health Mission. The Food Security Bill is a step in the right direction. But it only includes cereals and millets. While the inclusion of millets needs to be appreciated, we should bring in other items like pulses, vegetables, fruits, animal products and oil into the Bill’s ambit. The Public Distribution System should widen its food basket to include at least pulses, millets and some oil. Some states are, in fact, already doing this.
Several excellent plans of action have been proposed. The Coalition for Sustainable Nutrition Security under the leadership of M.S. Swaminathan made recommendations for an agenda for action. The Indian National Science Academy, New Delhi, one of the highest scientific bodies in India, released two papers, ‘Nutrition security for India – issues and the way forward’ (2009) and ‘Micronutrient security for India – priorities for research and action’ (2011), based on detailed scientific deliberations. Let us hope that these recommendations are heard and implemented.
So to return to the theme we started with, India cannot hope to become a sporting nation without adequate attention to the nutrition of its people. Before the country thinks of winning medals, it needs to look again at what its ordinary citizens are eating.
(The writer is a retired Director Grade Scientist, National Institute of Nutrition, Hyderabad and currently INSA Hon. Scientist, with Dangoria Charitable Trust, engaged in Science and society work. This piece is based on a commentary that appeared in ‘Current Science’, Vol. 101, No. 5)