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Context

• When it comes to nutrition, or more specifically micronutrient malnutrition, there is an urgent need to address the maladies that poor nutrition can inflict on the masses, especially given the diverse populations in India.

What is malnutrition?

• Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
• The term malnutrition covers 2 broad groups of conditions.
• One is ‘undernutrition’ which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
• The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).

What are micronutrients and why they are so important?

• Micronutrients are vitamins and minerals needed by the body in very small amounts.
• They perform a range of functions, including enabling the body to produce enzymes, hormones and other substances needed for normal growth and development.
• However, their impact on a body’s health is critical, and deficiency in any of them can cause severe and even life-threatening conditions. This can lead to reduced educational outcomes, reduced work productivity and increased risk from other diseases
• Deficiencies in iron, vitamin A and iodine are the most common around the world, particularly in children and pregnant women.
• Low- and middle-income counties bear the disproportionate burden of micronutrient deficiencies.
• Many of these deficiencies are preventable through food fortification and supplementation, where needed.

The worrying status of malnutrition in India

• According to National family Health survey (NFHS): As in NFHS-5 data, every second Indian woman is anaemic, every third child is stunted and malnourished, and every fifth child is wasted.
• According to an FAO Food Security Report for 2021: India ranks 101 out of 116 countries in the Global Hunger Index 2021, with a 15.3% undernourished population, the highest proportion of stunted children (30%), and wasted children (17.3%).
• Higher rate of stunting: The picture the Global Nutrition Report 2021 paints is cause for concern, noting that stunting among children in India is significantly higher than the Asian average of 21.8%.

How the countries are tackling malnutrition?

• Since the 1920s, developed countries and high-income countries have successfully tackled the issue of malnutrition through food fortification.
• Of late, the low-and middle-income countries, such as India, have pursued food fortification as one of the strategies to tackle micronutrient malnutrition.
• The health benefits accruing from food fortification have made 80 countries to frame laws for the fortification of cereal flour, and 130 countries with iodised salt, where 13 countries have mandated rice fortification.

What is food fortification?

• Food fortification is the process of adding nutrients to food.
• For instance, rice and wheat are fortified with iron, folic acid and vitamin B12, and salt fortified with iron and iodine. Iodised salt has been in use for the past few decades.

How India is tackling malnutrition and anemia?

• Fortified rice though PDS: Pilot projects on the distribution of fortified rice have been taken up in select States, including Maharashtra (Gadchiroli district) as part of a targeted Public Distribution programme for the masses.
• Scaling up the distribution through various food security schemes: The programme has been a success in terms of preventing cases of anaemia from 58.9% to 29.5%, within a span of two years, prompting the central government to declare the scaling up of the distribution of fortified rice, the major staple diet of 65% of the population, through the existing platform of social safety nets such as the PDS, ICDS and PM-POSHAN.
• Cost-effective strategy: Experiences from the different States on the fortified rice project, so far tally with the results of global programmes that use fortified food as a cost-effective strategy.
• Reduction in anaemia: The study found a promising reduction (29.5%) in the prevalence of anaemia among women, adolescent girls, and children put together in Gadchiroli district.

Case study of Noon meal scheme in Gujarat

• In Gujarat, an eight-month long study on multiple micronutrient fortified rice intervention for schoolchildren (six-12 years) in 2018-2019, as part of the Midday Meal Scheme, found increased haemoglobin concentration, 10% reduction in anaemia prevalence, and, more importantly, improved average cognitive scores (by 11.3%).

The probable outcome according to NITI Aayog

• Iron deficiency anaemia is a major public health concern, because it is responsible for 3.6% of disability-adjusted life years or DALYs (years of life lost due to premature mortality and years lived with disability) according to the World Health Organization (WHO) i.e., a loss of 47 million DALYs, or years of healthy life lost due to illness, disability, or premature death (2016).
• According to NITI Aayog (based on WHO meta-analysis on the impact of rice fortification), a rice fortification budget of around ₹2,800 crore per year can save 35% of the total or 16.6 million DALYs per year with no known risk of toxicity.
• In India, the cost of one DALY lost due to iron deficiency anaemia (IDA) is approximately ₹30,000, while the cost of averting an IDA-related DALY is only ₹1,545, resulting in a cost-benefit ratio of 1:18.
• Rice fortification, which costs less than 1% of the food subsidy bill (2018-19), has the potential to prevent 94.1 million anemia cases, saving ₹8,098 crore over a five-year period.

Concerns over the excess of per capita nutrients intake?

• Despite the programme’s proven efficacy, activists have expressed concern that excess iron overload from fortified rice has been dangerous for Jharkhand’s tribal population suffering from sickle cell anaemia and thalassaemia.
• Iron levels in fortified rice range from 28 mg to 42.5 mg, folic acid levels from 75 mcg-125 mcg, and vitamin B12 levels from 0.75 mcg to 1.2 mcg (FSSAI standards).
• Considering the per capita intake, in a family of three members with a rice consumption of approximately 60 grams per person, the additional intake is 2.45 mg of iron. This in fact compensates our daily losses of iron from the body, which is 1 mg-2 mg per day.

Conclusion

• Given its proven efficacy and cost-effectiveness, food fortification can help us in reducing micronutrient deficiencies and address overall health benefits. The intervention, carried out with precautions is the key to address the issue of the malnutrition.

Mains question

Q. What is micronutrient malnutrition? Food fortification programmes have made great strides in India, reducing micronutrient deficiencies in recent decades but more efforts are needed. Discuss

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