9 in 10 at risk of hidden hunger
Micronutrient deficiency is eating away at India’s potential and the power to effect change may lie in the hands of mums and dads.

By : Dr V. V. Varadarajan MD, (PED), DCH
Hidden hunger amidst plenty
India’s tremendous economic progress in recent years can sometimes obscure an uncomfortable reality: the country remains home to 184 million undernourished people, many of them children.1 A key underlying issue is micronutrient deficiency, also known as hidden hunger, which is the inadequate intake of crucial vitamins and minerals ‒ such as zinc, vitamin A, vitamin D and folate ‒ needed for children to grow up mentally and physically healthy. On the global hidden hunger charts, prosperous India fares worse than sub-Saharan countries like Burkino Faso and the Congo.2

A recent study of 634 Bangalore school children, drawn equally from the various socio-economic classes, found that up to 95% could be at risk of inadequate micronutrient intake, with almost 70% at risk of having insufficient intake of four or more micronutrients.3 The intake of nutrients that were most inadequate in the Bangalore study was vitamin A, folate, vitamin b12 and iron, leaving children susceptible to stunting, weakened immune systems,4 impaired cognitive function, anaemia, low energy levels5 and other devastating effects of hidden hunger.

As India surges, ahead on the world stage, the growth and development of its people, especially its future generations, is of critical importance.
The burden of hidden hunger in India
A significant number of children in developing countries suffer from hidden hunger, which increases their vulnerability to infection and impaired development. Often, the signs of this form of malnutrition are ‘hidden’, as individuals may ‘appear healthy’ but suffer extremely negative impacts on health and well-being. For example, children may be stunted, have poor night vision or suffer frequently from illness. Adults, too, may succumb more frequently to illness and fatigue easily6. The impact of long term deficiency of micronutrients is clearly evident. Among Indian children under five years of age, almost 40% are stunted, 60% suffer from anaemia,7 often a consequence of inadequate iron intake, which reduces vitality and impairs cognitive development. India is also home to more than 85% of all children in South Asia with xerophthalmia, the world’s leading preventable cause of blindness and an important indicator of vitamin A deficiency.8 Besides these issues, deficiencies of B group vitamins, zinc and vitamin D are also widely prevalent.9

Hidden hunger also has a powerful impact from an economic standpoint. It is estimated that annual GDP losses from low weight, poor child growth, malnutrition and micronutrient deficiencies average 11% in Asia and Africa – greater than the loss experienced during the 2008 – 2010 financial crisis.10
Why is this happening?
One of the biggest problems in dealing with hidden hunger is its invisible nature. Clinical manifestations of deficiencies often become visible only when they are severe, by which time it is usually too late.

The Bangalore study also showed that the risk of inadequacy in nutrient intake can exist regardless of socio-economic class. The children surveyed were split among lower, middle and high socio-economic groups and had macronutrient dietary intakes that met standard recommendations, yet were found to be at risk of inadequate intake of micronutrients3.

Unfortunately, parents don’t often get the nutritional education they need to spot hidden hunger. A paediatric study in Mumbai of 111 urban affluent mums found that more than half were unable to tell if their children were under or overweight,11 and attributed this to Indian mothers’ general perception of a chubby baby as healthy.12 Yet, paradoxical as it may seem, an obese or overweight child can still suffer from hidden hunger.13 Indian parents may also not have a good understanding of the nutritional breakdown of foods. For example, carbohydrate-dense foods such as rice and chapati may fill their children’s bellies but lack essential micronutrients.

Various efforts are being taken up by the Government to tackle the issue of malnutrition. Though, many missions have been declared to improve nutrition in six states, few have set measurable, time bound targets. Despite four decades of a national supplementation programme, only slight progress has been made to reduce critical nutrient deficiencies in India. The need of the hour calls for a shift in focus from approaches for tackling malnutrition towards implementing the schemes and creating awareness to promote health.14,15
Mums and dads can turn the tide
While Government is taking steps through its initiatives, parents can champion this cause and make an immediate difference.
As healthcare professionals, we are well placed to educate our patients on how to spot hidden hunger. For example, the warning signs of iron deficiency ‒ loss of appetite, lethargy, breathlessness, to name a few ‒ are also strong indicators of other micronutrient deficiencies as the condition rarely occurs in isolation. With the advent of the digital age, we can also direct parents to publicly available online tools that to keep track of their children’s diets and make sure they’re getting all they need. Multiple studies have shown that educating parents about good nutrition has strong positive effects on the health of their children, even after accounting for socio-economic levels.16

Sometimes the solution can be as simple as helping parents to improve shopping habits at the neighbourhood grocery store or kirana. Firstly, feeding children a diverse diet including a variety of cereals, legumes, fruits, vegetables, and animal-source foods is one of the most effective ways to sustainably prevent micronutrient deficiency.17

Parents can also look out for foods and drinks fortified with micronutrients. The provision of micronutrients has been ranked as the world’s best investment for development by the Copenhagen Consensus, a panel of eight of the world’s most distinguished economists.18 A study on semi-urban school children concluded that supplementation with a beverage fortified with micronutrients significantly improved height, weight and attention-concentration.19,20

Considering how important better nourished children are to maximising India’s developmental potential, working with parents for better childhood nutrition is increasingly becoming an imperative, not just an option. Empowering ordinary mums and dads to lead the charge to spread awareness and take action can only hasten efforts to make hidden hunger a thing of the past. For the future of our children and for India, it’s time we helped them to step up to the plate.
Dr V. V. Varadrajan, MD, (PED), DCH
Consultant Paediatrician, Infectious Diseases & Pulmonology
Hony Director – Division of Paediatrics – Sooriya Hospital
Senior Visiting Consultant – KKCTH
Part Time Consultant – SRM Institute of Medical Sciences (SIMS)
Private Practice – Lalitha Child Care Centre
Ph: +91 - 44 4558331/ 24831075/ 24725929/ 7395991720

The information in this article was prepared with the support of GSK Consumer Healthcare.
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