Government programmes to fortify staples should be supplemented with initiatives on balanced diets
As a haematologist, I regularly examine patients with anaemia. One of the many causes of anaemia or low haemoglobin is iron deficiency. It primarily impacts children and women. It’s common knowledge that good nutrition is critical for overall health, but what’s not as well-known is the two-way relationship between nutritional deficiencies and certain disorders. Consistent intake of food lacking in essential micronutrients can lead to iron deficiency anaemia and Vitamin A, and zinc deficiency, and impair immunity. Conversely, conditions such as celiac disease and infections like h. pylori or worm infestations can disturb the digestive system, leading to nutrient deficiencies. Malnutrition caused by micronutrient deficiency has inter-generational impacts — anaemic mothers are known to give birth to anaemic babies.
Government programmes like Anaemia Mukt Bharat (AMB) are among the biggest targeted measures to tackle the disorder. It involves administering iron and folic acid (IFA) tablets and other prophylactic measures. The Mid-day Meal Scheme for school children is another such intervention. However, challenges of effective implementation persist.
The burden of malnutrition is complex and needs to be addressed through multiple interventions. Diet plays a significant role. In pre-industrial times, a diverse and balanced diet was the norm. The traditional thaali comprises a balanced quantity of cereals, pulses, and vegetables seasoned with spices and herbs. Consuming fruits, seeds, nuts and dairy options has historically been regarded as an effective means of maintaining a balanced diet. Today, dietary patterns have shifted from seasonal and varied foods to processed and sugar-laden alternatives, which are calorically dense but nutritionally deficient. The onus seems to be on people to recognise that reducing consumption of processed foods is a crucial step towards ensuring better health outcomes.
The bigger challenge is that about 46 per cent of South Asia’s population lacks access to an affordable balanced diet, as per FAO data. According to The State of Food Security and Nutrition in the World, 2023, around 74 per cent of India’s population could not afford a healthy diet, and 39 per cent fell short of a nutrient-adequate one. Recent government interventions such as Large-Scale Food Fortification (LSFF) are timely. These could augment the ongoing efforts at individual and community levels. LSFF, when aligned with micronutrient supplementation programmes, diet diversity promotion and measures to induce behavioural change has immense potential to improve the efficacy of existing initiatives. Food fortification may not be the ideal remedy. However, it is a vital first step. Many countries adopted universal food fortification several years ago. India lags behind here.
At the same, fortification in India is not a completely novel strategy. The adoption of iodised salt under the National Iodine Deficiency Disorders Control Programme in 1992 significantly reduced goitre rates. The country’s food fortification programme now includes adding micronutrients to staples such as wheat flour, rice, edible oils, and salt.
Awareness is critical to the acceptance of fortified foods among the targeted beneficiaries. The appearance and texture of such foods — fortified rice kernels, for instance — often create misgiving. Addressing such concerns requires an intensive information, education and communication (IEC) campaign. An important step in this direction is to inform the beneficiaries about the stringent standards of fortification. Research also shows no danger of iron toxicity from such food — the quantity of iron in fortified foods is similar to that of the naturally occurring nutrient. In any case, the body’s homeostasis in people with normal health prevents excess iron absorption.
Multiple awareness strategies can be adopted to foster greater awareness. This includes utilising communication channels such as community radio, videos and door-to-door outreach. Messages in vernacular languages ensure that the information is easily understood and also helps dispel misconceptions and build trust. The way forward involves not just adoption of healthier dietary practices at the individual and community levels but also strategies by the state such as LSFF.
Written Tulika Seth
Source: Indian Express, 29/01/24
