In India, around 43% of its children under the age of five are malnourished or undernourished. Malnutrition is more common in India than in sub-Saharan Africa. It is estimated that one in every three malnourished children in the world live in India (1). Malnutrition however varies in different states from 13% - 55% from Meghalaya to Madhya Pradesh respectively (2). Malnutrition is considered to be a leading cause of child mortality in India (3). Non availability of food seems to be the major cause of malnutrition. Protein-energy malnutrition (PEM) and micronutrient deficiencies are major contributors to higher mortality rates from illnesses and diseases such as pneumonia, malaria, diarrhea and measles in the developing world (4). Stunting and wasting are significant effects of malnutrition.
Stunting: It is seen with chronic malnutrition. Several studies have documented an inverse correlation between stunting, cognitive and physical development in preschoolers and consequently lower intelligence levels in older children and functional impairment in adulthood both in terms of intellectual and physical aspects (5).
Wasting: It is seen with acute malnutrition. While stunting has long term implications for adult health and productivity; wasting is closely linked to child mortality (6, 7).
Malnutrition & Infection: The vicious cycle of malnutrition, impaired immune response, increased infections and decreased food intake is well recognized (4). Malnutrition (both micro & micronutrients) affect epithelial and mucosal integrity, mucociliary clearance, immunoglobulin synthesis, lymphocyte differentiation and thus lead to impaired immunity which leads to recurrent infections (8).
Problems unique to India: India is in a phase of rapid advance in economic globalization which has led to rapid changes in diet and life styles. Urbanization has led to increased consumption of food with higher fat content and sedentary life style (TVS, computers, lack of space etc). Thus, obesity is also on the rise. However overweight children may still be micronutrient deficient due to imbalanced diet. Thus India is in a unique position to observe both extremes of malnutrition (underweight ? obesity) with micronutrient deficiency in both the conditions. In undernourishment infections, lower immunity and cognitive impairment is common whereas in overweight children, risk of cardiovascular disease increases. However the average Indian diet remains largely deficient in green leafy vegetables, milk and milk products and thus micronutrients such as vitamin A, iodine and iron remain deficient in all children with improper diets.
Dietary recommendations for preschoolers: The general recommendation for 2 years olds is a diet that primarily consists of fruits, vegetables, whole grains, dairy products and beans with fish and lean meat among non-vegetarians. However, it is important to recognize that many children would be nutritionally depleted by end of first year of life due to micronutrient deficiency in breast milk itself and food fortification, micronutrient supplementation and animal source dairy products would be come important to reduce prevalence of malnutrition in preschoolers (9).
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