Public Health and Nutrition

Introduction

Around 50 percent of infant deaths, even today, are majorly attributed to malnutrition in many developing countries. One of the major consequences of malnutrition is leading to increased cases of low birth-weight children. Low birth weight can have serious life-long consequences in the life of a child, affecting growth and development and can continue its ill effects in adulthood too and can even result in child mortality. Low birth weight cases are usually attributed to low socioeconomic groups, and such children present with severe micronutrient deficiencies. The major micronutrient deficiencies involve iron, zinc, vitamin A, vitamin C, vitamin D, iodine, folic acid, and B12. Hence, public health services play a major role in taking necessary steps to tackle the problem of malnutrition and nutritional deficiencies among the public.

What Is Public Health Nutrition?

Public health nutrition is the art and science of promoting good health practices among the public or community, which mainly focuses on improving the quality of life and prolonging longevity by preventing nutritional deficiencies and their disease counterparts through various measures taken by the public health sector.

What Is the Current Scenario Pertaining to Nutrition Status in Small Children in India?

• From time immemorial, India has been facing the problem of malnutrition, and around one-fifth of childbirths result in low birth weight babies weighing less than 2.5 kgs. Apart from being a malnutrition capital, India houses many obesity cases.

• Due to advancements in technology, people are attracted to making nutrition-low (lack of protein, good fats, fiber, vitamins, and minerals) and calorie-rich food choices like burgers, pizzas, biscuits, chocolates, cakes, and pastries, soft drinks, samosas, which are of less nutritive value) instead of having a well-balanced food packed with all essential nutrients like ( whole grains, pulses, vegetables, and fruits) thus increasing the possibility of acquiring metabolic diseases at a very young age.

• Moreover, a sedentary lifestyle has increased the risk even more due to a lack of physical activity among both adults and children, directly affecting the quality of life.

• Poor lifestyle choices lead to obesity, overweight, and related health issues such as hypertension, heart disease, diabetes, cancer, arthritis, etc.

• The lifestyle disorders are non-communicable, but they have a huge impact on health care costs owing to their nature of chronicity and pose a huge economic threat to the country.

• Having a long-standing lifestyle disorder can make the patient immunocompromised and vulnerable to many epidemic or pandemic community outbreaks like viral and bacterial infections and HIV, thus affecting the quality of life.

• This, in turn, causes a huge financial crisis to meet the healthcare costs affecting the country’s economy and also is a challenging task for public health professions, doctors, and the government to tackle the diseases and their spread in an already comorbid patient.

What Are the Major Nutritional Deficiencies Encountered in Recent Times?

Deficiency of Protein:

• Protein deficiency is commonly found in both developed and underdeveloped countries.

• Proteins are the building blocks of the human body. Improper protein intake can affect the various metabolic processes of the body.

• Also, lack of protein intake can lead to deprived energy levels as protein metabolism releases energy in the body to carry out daily activities.

• Improper protein intake among children will badly affect the overall growth and development of the child, leading to various disabilities.

• Protein deficiency among children leads to a condition called kwashiorkor, and severe undernourishment and lack of energy due to improper food intake causes marasmus.

• Undernourishment and lack of dietary protein intake can result in under-weightedness, stunting, and wasting.

• Underweightness occurs when the individual does not consume adequate calories and the weight is disproportionate to the age.

• Stunting usually happens due to inadequate growth and development as a result of poor protein intake during the growing period of a child, leading to short stature.

• Wasting occurs when the weight of the individual is disproportionate to the height, as in cases of the elderly, tuberculosis, and AIDS (acquired immunodeficiency syndrome) characterized by unexplained weight loss.

Micronutrient Deficiencies:

• Modern eating choices and technology have created an imbalance in the availability of food that is rich in calories and poor in nutrition.

• The term “hidden hunger” is used when the food fails to supply the essential micronutrients, leading to various deficiencies.

• Today’s food is lacking various micronutrients like iron, vitamin A, iodine, zinc, vitamin B12, folic acid, calcium, vitamin D, and riboflavin, which are of public health concern, and some of them are mentioned below:

Iron Deficiency Anemia (IDA):

• Iron deficiency anemia (IDA) is referred to as the most common nutritional disorder that is prevalent globally, affecting both developed and underdeveloped countries.

• Young women, adolescent girls, pregnant women, and school children are most commonly affected.

• When the production of hemoglobin is reduced, it results in low levels of hemoglobin, leading to IDA.

• As hemoglobin carries oxygen to different parts of the body, due to lack of hemoglobin in iron deficiency anemia, shortness of breath occurs even due to the slightest of physical exertion and also causes lethargy and tiredness.

Symptoms include:

1. Generalized pallor.

2. Paleness involves the conjunctiva of the eyes, tongue, nail beds, and soft palate.

3. Cognitive functions like memory, concentration, and alertness are affected in children.

Vitamin A Deficiency:

• Vitamin A is required for the proper functioning of the eyes.

• Vitamin A is required for maintaining the health of the epithelium of the eye and vision and helps in increasing immunity.

• Vitamin A deficiency causes night blindness, which eventually leads to complete blindness if not intervened at the right time.

• Deficiency of vitamin A leads to decreased resistance to infection and thus negatively affects immunity.

• Childhood blindness is mainly caused by vitamin A deficiency.

Iodine Deficiency Disorders (IDD):

• Iodine is an essential micronutrient for the optimum functioning of mental health and overall growth and development.

• IDD is mainly caused by iodine deficiency

• IDD is caused by the deficiency of iodine in soil, an ecological factor, and the following states in India are more prone to IDD: Jammu and Kashmir to Arunachal Pradesh in the Himalayan belt, Andhra Pradesh, Karnataka, Kerala, Maharashtra, and Madhya Pradesh.

• A deficiency of iodine leads to inadequate synthesis of thyroid hormone from the thyroid gland, causing its enlargement.

• The enlarged thyroid gland is referred to as ‘goiter’ and is the major presentation of iodine deficiency in adults.

• Deficiency of iodine in children is called cretinism.

• Pregnant women suffering from Iodine deficiency can suffer from mental retardation and congenital defects in the baby.

• Statistics reveal that IDD affects 13 percent of the population globally.

What Are the Strategies Devised to Overcome the Public Health Nutrition Problems?

Diet or Food-Based Strategies:

• Diet or food-based strategies form a comprehensive and preventive approach to tackle nutritional deficiencies.

• This strategy mainly focuses on the nutritional value of the food by increasing the availability of micronutrients in the food to prevent nutritional-related disorders.

• This approach involves food-based approaches like diversification and modification of dietary ingredients, horticulture modifications, and inventions such as conducting programs on nutrition and health, home gardening, and fortification of food substances.

• The advantages include:

1. Long-term benefits.

2. This is a cost-effective technique.

3. Adapts easily to various dietary and cultural traditions.

4. As it is a food-based approach, it seldom causes toxicity, as in the case of nutrient-based or medicinal approaches.

Nutrient-Based Approach or Medicinal Approach:

• This method involves providing dietary supplements to the underserved groups suffering from deficiencies and the ones who are at a high risk of developing deficiencies.

• This is a short-term approach employed in the case of vitamin A and folic acid deficiencies in India.

• This is a more expensive approach compared to the diet-based programs.

• Our country has adopted various nutrition plans to eradicate malnutrition, which include:

ICDS (Integrated Child Development Services): This is an outreach program designed to fulfill the nutritional requirements of pregnant women, nursing mothers, infants, and small children.

1. Various programs to prevent nutritional deficiencies, like the National Prophylaxis Program for preventing blindness caused by deficiency of Vitamin A, the National Nutritional Anemia Prophylaxis Program, and the National Iodine Deficiency Disorder Control Program, are launched.

2. Food supplementation programs like the Mid-Day Meal Program are designed to eliminate malnutrition among school children.

3. Food security programs like the Public Distribution System, Antodaya Anna Yojana, Annapurna Scheme, and National Food for Work Program are conducted to eliminate hunger and undernourishment.

Conclusion

Public health nutrition as a whole is an important global health concern that, if not addressed properly, can affect the physical, mental, and cognitive development of a child. This, in turn, will have a negative impact on the individual’s productivity and quality of life. Hence, measures need to be taken in the field of public health nutrition in India to tackle malnutrition by providing proper nutrition facilities to each and every child, thereby contributing directly to the economic growth of the country.