Nutrition Foundation of India

: National iron plus initiative recommended that anaemic pregnant women should be treated with 200 mg of elemental iron and 1 mg folic acid. An increase in vitamin B12 deficiency has been reported in last two decades. An open randomised study was taken up in urban antenatal clinics to assess the impact of addition of vitamin B12 to the iron and folic acid supplementation.: Anaemic pregnant women willing to participate in the study were randomised into Group 1 (240 iron mg and 5 mg folic acid) or Group 2 (240 mg iron, 1.5 mg of folic acid and 15 µg vitamin B12); the impact of supplementation on Hb, ferritin, folic acid and vitamin B12 was assessed.: In both groups mean Hb improved by 1g/dL at 8 weeks and by 1.5g/dL by 38 weeks of pregnancy; at 38 weeks only 30% were anaemic. Mean ferritin and folic acid levels improved in both groups. There was a fall in the mean vitamin B12 levels in the group which received 5 mg of folic acid.: With assured supply and supportive supervision, the supplementation achieved substantial reduction in anaemia in both groups. Supplementation with folic acid 5 mg should not be done because it causes a fall in vitamin B12 levels. The reason why addition of vitamin B12 to iron folic acid supplementation did not result in improvement in mean Hb, or vitamin B12 levels has to be investigated.

Global and Indian studies have shown that there are substantial seasonal variations in vitamin (vit) D levels. A study to assess seasonal changes in vit D levels in women in reproductive age was undertaken in urban low middle income families in Delhi. Paired blood samples were collected in spring and autumn in Group 1; and in summer and winter in Group 2. Vit D3 estimation was done using electro-chemo-luminescence immunoassay. Mean vit D levels were highest in autumn and lowest in summer. The differences in mean vit D levels between spring and autumn, summer and winter, spring and summer, summer and autumn, autumn and winter were statistically significant. Prevalence of vit D deficiency (vit D levels below 20 ng/ml) were higher in spring and summer as compared to autumn and winter; these differences were statistically significant. Nearly half of the women had vit D level ≥ 20 ng/ml in both the paired samples (spring and autumn as well as summer and winter). About 14% had vit D levels <20 ng/ml in both paired samples (spring and autumn as well as summer and winter). About one third of women with paired samples were deficient in one season but not in the other season. Pregnant women received calcium and vit D supplementation from early second trimester till delivery. It is essential to take into account the seasonal variation in vit D levels, while undertaking impact assessment of calcium and vit D supplementation in pregnancy on vit D levels prior to and after the supplementation.

Studies on intra-family differences in nutritional status in under-five siblings reported that prevalence of stunting, underweight, and wasting were higher in the elder sibling. A mixed longitudinal study was taken up to document changes in anthropometric indicators with increasing age in pre-school children and to assess whether the observed differences in nutritional status between the two under-five siblings were due to changes in anthropometric indices with increasing age.The study was undertaken in three groups of children from urban low middle-income families: Group A (cross-sectional data), Group B (paired data of the siblings, one in the 0-23 months and the other, in the 24-59 month age group), and Group C (first measurement in the 0-23 month age and the second measurement in the 24-59 month age in the same child). Changes in anthropometric indices and nutritional status in relation to age were computed in all three groups and compared.There was an increase in stunting and underweight, and a decrease in wasting rates with increasing age in Groups A, B, and C. The trend and magnitude of change in nutritional status were similar in Groups A, B and C.Intra-family differences in the nutritional status of under-five siblings were due to the changes in nutritional status with increase in age. Interventions focussed on growth monitoring, early detection and effective management of growth faltering may reduce the deterioration in nutritional status with increasing age in children.

In India, the prevalence of vitamin D deficiency as assessed by vitamin D levels below 20 ng/ml is high across the country, in all socio-economic, age and sex groups. Studies from India have documented that prevalence of vitamin D deficiency is high in breast-fed infants. Stunting in young children continues to be a major public health problem in India. It is possible that in addition to low birth weight and chronic energy deficiency, vitamin D deficiency may contribute to the high stunting rates in breast-fed Indian children. If this were so, vitamin D supplementation may reduce the magnitude of linear growth retardation in the first two years of life. A community-based randomised, double-blind supervised daily supplementation of 250 mg of calcium and 250 IU of Vitamin D (Group A) or placebo (Group B) to breast-fed infants from the first month up to 23 months of age was undertaken to assess the impact, if any, of vitamin D supplementation on linear growth in children and height attained at 23 months. At enrolment, there were no significant differences in weight, length and BMI between infants belonging to Group A or Group B. There were no significant differences in infant and young child feeding practices, morbidity due to infection, or linear growth and height attained at 23 months between Group A and Group B. These data suggest that daily supplementation of calcium and vitamin D between 0-23 months did not have any significant impact on linear growth of children from urban low middle income families.

Background & objectives:Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children.Methods:Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits.Results:3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001).Interpretation & conclusions:The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.

Background: Anaemia is one of the most common public health challenges. The objective of this paper was to estimate the prevalence of anaemia among non-pregnant and non-lactating women (NPNLW) (15-49 years) from low-income families and to assess the associations between socio-demographic and economic factors, and the prevalence of anaemia.Methods: Primary data of non-pregnant and non-lactating women of reproductive age (15 to 49 years) from low-income families collected from two selected districts of Madhya Pradesh state, India were used. Inferential statistical tools like; multiple binary logistic regressions and random forest analysis were adopted to assess the socio-demographic and economic factors associated with anaemia.Results: The results revealed that prevalence of anaemia in both the districts are quite high at 60.8% (95% CI: 58.6%, 62.9%) in Vidisha to 63.7% (95% CI: 61.6%, 65.7%) in Raisen with mean haemoglobin levels of 11.27±1.92 g/dl in Vidisha to 11.24±1.70 g/dl in Raisen, which is close to &lt;12 g/dl cut-off based on WHO categorization. It was also found that those who are from the scheduled caste and other castes were less likely to be anaemic compared to those who were from scheduled tribes in Vidisha district. Majority of women not consuming iron supplements were found to be anaemic.Conclusions: Education was observed to be the most predominant factor inversely associated with anaemia. Age and the type of household were also found to be associated factors. Along with supplementation and nutrition education, fortification of foods is also recommended in addressing the anaemia burden.

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors.

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