Lifestyle-related diseases in an urban setting have become the norm.
Now a large-scale nutrition study involving almost 1.72 lakh subjects from 52,577 households across 16 Indian states has revealed that Kerala has the highest prevalence of hypertension as well as high cholesterol in urban men and women.
Not far behind is Puducherry that tops in the list of the highest prevalence of diabetes. The study also found that nutritional indicators of children in marginalised communities like SC and ST are much worse than children in other communities.
The survey was carried out by National Nutrition Monitoring Bureau (NNMB) during the year 2015-16. Its objective was to assess diet and nutritional status of urban population and the prevalence of obesity, hypertension, diabetes and dyslipidaemia among representative urban population. The study was done under the guidance of the Director, National Institute of Nutrition, Hyderabad and DG, Indian Council of Medical Research (ICMR), Delhi.
The concluding report, ‘Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidaemia in Urban Men and Women’ brought to light telling statistics on the prevalence of stunting, undernutrition and obesity in children under 5 years of age.
The researchers used the method of a 24-hour dietary recall to collect food and nutrient information. They also interviewed 5,642 mothers, who have children of less than 36 months, for information on antenatal care and infant and young child feeding (IYCF) practices.
Here are the key findings:
The report found that intake of cereals, millets, pulses and legumes in urban Indian households was on par with the levels suggested by ICMR.
The average intake of cereals and millets was 320g/CU/day, while the intake of pulses and legumes was 42g/CU/day.
However, the intake of green leafy vegetables (GLV), milk and milk products and sugar and jaggery were lower than the suggested level of ICMR.
“Only half of the population who fall in the age bracket of 1-3-years (56%), two-thirds of the population of 4 to 6-year-old children (68%) and 56% of the pregnant women surveyed were consuming adequate amounts of both protein and calories,” the report said.
The report says that Puducherry had the lowest proportion of underweight children (14.2%), while Uttar Pradesh had the highest (43.6%). Puducherry, Tamil Nadu (16.2%) and Kerala (17%) had the lowest prevalence of underweight children in the survey.
The report found that there wasn’t a significant difference in the numbers between boys and girls.
The overall prevalence of underweight, stunting and wasting among children below 5 years of age was 25%, 29% and 16% respectively.
Stunting was found to be more prevalent among boys (29.8%) than girls (27.6%). Here too, Puducherry (11%) and Tamil Nadu (15.4%) had the lowest number of children suffering from stunting and Uttar Pradesh had the highest. The latter also had the highest count of wasting in children (28.9%).
While these numbers may indicate that there is no preferential treatment to the male child and indeed, girls are better nourished, scientist Avula Laxmaiah, who led the survey, said otherwise.
Avula, who has been studying nutrition in urban and rural areas for the past two decades, told GS Mudur of The Telegraph that he found girls consistently better nourished than boys, even though there was discrimination against them in access to education and healthcare.
He added that while the precise reason was unclear, some have speculated that girls expend less energy than boys, leading to their higher nutritional indicators.
The most significant connections were drawn between undernutrition in under five children and socio-economic variables. A look at the graphss below shows that the children belonging to Scheduled Tribes and Scheduled Tribes, with illiterate fathers, lack of access to sanitary latrines and families having significantly low per capita incomes are significantly undernourished than the others.
Prevalence of obesity in urban adults
Four states from south India were among the 10 with the highest prevalence of obesity among urban adults. Puducherry topped the list with almost 60% women and 42% men being overweight. Tamil Nadu was close behind with 54% men and 38% women recorded as obese. Kerala, Karnataka and Andhra Pradesh also recorded high levels of obesity among its urban men and women.
Diet-related chronic non-communicable diseases
The highest prevalence of hypertension was found to be in Kerala (31.4% women and 38.6% men) and lowest in Bihar (22.2% men and 15.7% women). Puducherry had the highest number of diabetic men and women (42%), followed by Delhi (36%), Karnataka and Kerala (33% each). Diabetics were highest in number in the age group 60-70 years and lowest in the age group of 18-30 years.
The study found that urban men in Tamil Nadu, Karnataka, Andhra Pradesh and Kerala were among the top six states with most tobacco smokers.
The prevalence of diabetes was found to be significantly associated with overweight and obesity, physical inactivity, hyperlipidaemia (high cholesterol). “It was also significantly associated with high percentage of body fat, and those who indulged in risk behaviours like abnormal consumption of tobacco and alcohol,” the report said.
Most users, researchers found, had been consuming tobacco and alcohol for over a decade.
The study also said that consumption of high fat, high salt and high sugar diet was found to be high among the urban population, and was also significantly associated with hypertension.
The following charts show the relationship between hypertension and variables like diabetes, high percentage of body fat and tobacco and alcohol consumption.
The study concludes that almost one-third of the men and women surveyed were found to be suffering from hypertension, and one in every four was diabetic. One in every three men and women had high cholesterol.
The study recommends sensitisation of the community on “consequences of obesity, hypertension, diabetes etc through health and nutrition using IEC activities, and behaviour change communication methods.” The study emphasises on healthy lifestyles and dietary habits to prevent non-communicable diseases related to them.
Researchers also pointed out that simply doling out nutritious food is not enough to tackle the issue of children in disadvantaged groups having worse nutritional indicators. Suparna Ghosh-Jerath, Additional Professor at the Indian Institute of Public Health, Delhi, who wasn’t associated with the study, told The Telegraph that many things apart from the food itself affected children’s nutrition.
“Lack of education and nutritional awareness, unhealthy household environment, inadequate child care, household food insecurity and lack of human, social, political and financial resources — all of these factors can influence the nutritional status of children,” she said.
All graphs courtesy NNMB Nutrition Survery Report.