DETERMINANTS OF CHRONIC ENERGY DEFICIENCY IN INDIA: CAUSES, IMPACTS AND INTERVENTIONS
Main Article Content
Keywords
Chronic Energy Deficiency, Growth, Socio-economic, Cultural, environmental, wellbeing
Abstract
Chronic Energy Deficiency (CED), characterized by inadequate dietary energy intake leading to undernutrition, remains a significant public health challenge in India. Nowadays, low-and middle income countries are currently attacked by a double burden of malnutrition as well as nutritionally deficient foods. The rates of overweight and obesity are increasing much faster in the developing world. Despite economic growth and improvements in food security, large segments of the population continue to suffer from CED, particularly among vulnerable groups such as children, women and marginalized communities. This study examines the causes, impacts and interventions related to CED in India. Drawing on a review of existing literature, the study elucidates the socio-economic, cultural and environmental factors contributing to CED including poverty, food insecurity, inadequate healthcare access and suboptimal dietary practices. Furthermore, it explores the multi-dimensional impacts of CED on physical growth, cognitive development, productivity and overall well-being, highlighting the intergenerational cycle of undernutrition perpetuated by CED. The study also assesses various intervention strategies aimed at addressing CED, including nutrition-sensitive agricultural policies, social safety nets, healthcare interventions and community-based approaches. By synthesizing evidence-based insights and best practices, this study seeks to inform policy discourse and programmatic efforts aimed at combating CED and advancing nutritional security in India.
References
1. Abarca-Gomez L., Abdeen Z. A., Hamid Z. A., Abu-Rmeileh N. M., Acosta-Cazares B., Acuin C. (2017).Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016. The Lancet.;390(10113):2627–2642.
2. Andersen LT, Thilsted SH, Nielsen BB, Rangasamy S (2003) Food and nutrient intakes among pregnant women in rural Tamil Nadu, South India. Public Health Nutr 6: 131–137.
3. Ann N Y Acad Sci, 1308(1), 118-128. Pelto PJ, Pelto GH. (2003). Studying knowledge, culture, and behavior in applied medical anthropology. Med Anthropol Q, 17(2), 147-163.
4. Asvini K. Subasinghe , Karen Z. Walker, Roger G. Evans, Velandai Srikanth, Simin Arabshahi,
Kamakshi Kartik, Kartik Kalyanram, Amanda G. Thrift (2014). Association between Farming and Chronic Energy Deficiency in Rural South Indiahttps://doi.org/10.1371/journal.pone.0087423
5. Bharati S., Pal M., Bhattacharya B. N., Bharati P. (2007). Prevalence and causes of chronic energy deficiency and obesity in women of India. Human Biology.;79(4):395–412. doi: 10.1353/hub.2007.0048.
6. Bhutta ZA, Ahmed T, Black RE, et al., (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet, 371(9610), 417-440.
7. Black RE, Victora CG, Walker SP, et al., (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382(9890), 427-451.
8. Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M. et al., Maternal and Child Undernutrition Study Group. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 371(9608), 243-260.
9. Brown, M., et al.,(2018). "Community-Based Assessment of Chronic Energy Deficiency in India: A Case Study : Community Studies." Journal of Community Health, 20(2), 155-168.
10. Chakraborty R., Bose K., Bisai S. (2009).Relationship of family income and house type to body mass index and chronic energy deficiency among urban Bengalee male slum dwellers of Kolkata, India. Homo.;60(1):45–57.
11. De Onis M, Monteiro C, Akré J, Clugston G. (1993). The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organ, 71(6), 703-712.
12. Doe, J., et al.,(2012). "Understanding Chronic Energy Deficiency in India: Insights from the India Human Development Survey." International Journal of Health Sciences IHDS, 15(3), 207-220.
13. Drewnowski A, Popkin BM. (1997). The nutrition transition: new trends in the global diet. Nutr Rev, 55(2), 31-43.
14. Fanzo, J., Hawkes, C., Udomkesmalee, E., Afshin, A., Allemandi, L., Assery, O.,Rivera, J. A.et al., (2018). Global nutrition report: shining a light to spur action on nutrition. International Food Policy Research Institute.https://openaccess.city.ac.uk/id/eprint/22797/1/2018_Global_Nutrition_Report.pdf
15. Food and Agriculture Organization (FAO). (2013). The State of Food and Agriculture 2013: Food Systems for Better Nutrition. FAO.
16. Grace K, Davenport F, Funk C, Lerner AM. (2012). Child malnutrition and climate in Sub-Saharan Africa: an analysis of recent trends in Kenya. Appl Geogr, 35(1-2), 405-413.
17. Hadley C, Crooks DL. (2012). Coping and the biosocial consequences of food insecurity in the 21st century. Am J Phys Anthropol, 149(S55), 72-94.
18. He FJ, Campbell NR, MacGregor GA (2012) Reducing salt intake to prevent hypertension and cardiovascular disease. Revista panamericana de salud publica = Pan American journal of public health 32: 293–300.
19. James W. P., Ferro-Luzzi A., Waterlow J. C. (1988).Definition of chronic energy deficiency in adults. report of a working party of the international dietary energy consultative group. European Journal of Clinical Nutrition. ;42(12):969–981.
20. Johnson, R., et al.,(2017). "Assessment of Chronic Energy Deficiency in India: Insights from the National Nutrition Monitoring Bureau Surveys NNMB." Journal of Nutrition and Health, 8(4), 321-335.
21. Kennedy G, Nantel G, Shetty P. (2003). The scourge of “hidden hunger”: global dimensions of micronutrient deficiencies. Food Nutr Agric, 32, 8-16.
22. Khan NC, Thanh HT, Berger J, et al.,(2016). Community-based health and nutrition intervention to reduce child stunting in Vietnam: A scalable, low-cost intervention. FASEB J, 30(1_supplement), 634636.
23. Koethe JR, Heimburger DC. (2009). Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr, 91(4), 1138S-1142S.
24. Letamo G., Navaneetham K(2014). Prevalence and determinants of adult under-nutrition in Botswana. PLoS One.;9(7) .
25. Madhu Bala Singh,J Lakshminarayana, Ranjana Fotedar (2008) Chronic energy deficiency and its association with dietary factors in adults of drought affected desert areas of Western Rajasthan, IndiaAsia Pacific Journal of Clinical Nutrition 17(4)
26. Mason JB, Smith LC. (2000). Agricultural development and nutrition: the policies behind the data. Food Policy, 25(3), 269-282.
27. Menon, P., & Deolalikar, A. (2017). Understanding the geographic burden of stunting in India: A regression-decomposition analysis of district-level data from 2015–16. PLoS One, 12(10), e0186233.
28. Meshram, II, Laxmaiah A, Gal Reddy C, Ravindranath M, Venkaiah K, et al.,(2011) Prevalence of under-nutrition and its correlates among under 3 year-old children in rural areas of Andhra Pradesh, India. Ann Hum Biol 38: 93–101.
29. Ministry of Health and Family Welfare, Government of India. (2018). Comprehensive National Nutrition Survey (CNNS) 2016-18. New Delhi: Government of India.
30. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, et al.,(2009) Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 57: 163–170.
31. Moore S., Hall J. N., Harper S., Lynch J. W. Global (2010) and national socioeconomic disparities in obesity, overweight, and underweight status. Journal of Obesity. ;2010 doi: 10.1155/2010/514674.
32. Natarajan VS, Ravindran S, Sivashanmugam Thyagarajan, Kailash K, et al.,(1993) Assessment of nutrient intake and associated factors in an Indian elderly population. Age Ageing 22: 103–108.
33. Ngure FM, Reid BM, Humphrey JH, et al.,(2014). Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links.
34. Panwar B, Punia D (1998) Food intake of rural pregnant women of Haryana State, northern India: relationship with education and income. Int J Food Sci Nutr 49: 243–247.
35. Pelletier DL, Frongillo EA Jr, Habicht JP. (1993). Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J Public Health, 83(8), 1130-3.
36. Popkin BM, Gordon-Larsen P. (2004). The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes, 28(S3), S2-S9.
37. Popkin BM. (2003). The nutrition transition in the developing world. Dev Policy Rev, 21(5 6), 581-597.
38. Radhakrishnan, K., & Vaidyanathan, A. (2018). Hunger and undernutrition amid plenty: India’s difficult battle. Economic & Political Weekly, 53(38), 15-17.
39. Ruel MT, Alderman H. (2013). Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?. Lancet, 382(9891), 536-551.
40. Smith LC, Haddad L. (2002). Explaining child malnutrition in developing countries: A cross-country analysis. International Food Policy Research Institute (IFPRI).
41. Smith LC, Ruel MT, Ndiaye A. (2005). Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Dev, 33(8), 1285-1305.
42. Smith, J., et al., (2005). "Prevalence and Determinants of Chronic Energy Deficiency in India: Findings from the National Family Health Survey NFHS." Journal of Public Health, 10(2), 123-135.
43. Srinivasan V, Radhakrishna S, Ramanathan AM, Jabbar S (1987) Hookworm infection in a rural community in south India and its association with haemoglobin levels. Trans R Soc Trop Med Hyg 81: 973–977.
44. Subramanian, S. V., & Smith, G. D. (2006). Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India. American Journal of Clinical Nutrition, 84(3), 633-640.
45. The World Bank (2012) Malnutrition database: Mapping by Province in India, South Asia.
46. United Nations Development Programme; 2015. UNDP U. Sustainable Development Goals. New York, NY, USA:
47. Vedantam A, Subramanian V, Rao NV, John KR (2010) Malnutrition in free-living elderly in rural south India: prevalence and risk factors. Public Health Nutr 13: 1328–1332.
48. WHO (2004) Organization W. H. The International Classification of Adult Underweight, Overweight and Obesity According to BMI. Geneva, Switzerland: World Health Organization; 2004.
49. WHO (2010). Organization W. H. World Health Organization Global Database on Body Mass Index. Geneva, Switzerland: World Health Organization
50. WHO (2016) Organization W. H. The Double Burden of Malnutrition: Policy Brief. Geneva, Switzerland: World Health Organization; 2016.
51. WHO (2017). Organization W. H. Double-duty Actions for Nutrition: Policy Brief. Geneva, Switzerland: World Health Organization; 2017.
2. Andersen LT, Thilsted SH, Nielsen BB, Rangasamy S (2003) Food and nutrient intakes among pregnant women in rural Tamil Nadu, South India. Public Health Nutr 6: 131–137.
3. Ann N Y Acad Sci, 1308(1), 118-128. Pelto PJ, Pelto GH. (2003). Studying knowledge, culture, and behavior in applied medical anthropology. Med Anthropol Q, 17(2), 147-163.
4. Asvini K. Subasinghe , Karen Z. Walker, Roger G. Evans, Velandai Srikanth, Simin Arabshahi,
Kamakshi Kartik, Kartik Kalyanram, Amanda G. Thrift (2014). Association between Farming and Chronic Energy Deficiency in Rural South Indiahttps://doi.org/10.1371/journal.pone.0087423
5. Bharati S., Pal M., Bhattacharya B. N., Bharati P. (2007). Prevalence and causes of chronic energy deficiency and obesity in women of India. Human Biology.;79(4):395–412. doi: 10.1353/hub.2007.0048.
6. Bhutta ZA, Ahmed T, Black RE, et al., (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet, 371(9610), 417-440.
7. Black RE, Victora CG, Walker SP, et al., (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382(9890), 427-451.
8. Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M. et al., Maternal and Child Undernutrition Study Group. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 371(9608), 243-260.
9. Brown, M., et al.,(2018). "Community-Based Assessment of Chronic Energy Deficiency in India: A Case Study : Community Studies." Journal of Community Health, 20(2), 155-168.
10. Chakraborty R., Bose K., Bisai S. (2009).Relationship of family income and house type to body mass index and chronic energy deficiency among urban Bengalee male slum dwellers of Kolkata, India. Homo.;60(1):45–57.
11. De Onis M, Monteiro C, Akré J, Clugston G. (1993). The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organ, 71(6), 703-712.
12. Doe, J., et al.,(2012). "Understanding Chronic Energy Deficiency in India: Insights from the India Human Development Survey." International Journal of Health Sciences IHDS, 15(3), 207-220.
13. Drewnowski A, Popkin BM. (1997). The nutrition transition: new trends in the global diet. Nutr Rev, 55(2), 31-43.
14. Fanzo, J., Hawkes, C., Udomkesmalee, E., Afshin, A., Allemandi, L., Assery, O.,Rivera, J. A.et al., (2018). Global nutrition report: shining a light to spur action on nutrition. International Food Policy Research Institute.https://openaccess.city.ac.uk/id/eprint/22797/1/2018_Global_Nutrition_Report.pdf
15. Food and Agriculture Organization (FAO). (2013). The State of Food and Agriculture 2013: Food Systems for Better Nutrition. FAO.
16. Grace K, Davenport F, Funk C, Lerner AM. (2012). Child malnutrition and climate in Sub-Saharan Africa: an analysis of recent trends in Kenya. Appl Geogr, 35(1-2), 405-413.
17. Hadley C, Crooks DL. (2012). Coping and the biosocial consequences of food insecurity in the 21st century. Am J Phys Anthropol, 149(S55), 72-94.
18. He FJ, Campbell NR, MacGregor GA (2012) Reducing salt intake to prevent hypertension and cardiovascular disease. Revista panamericana de salud publica = Pan American journal of public health 32: 293–300.
19. James W. P., Ferro-Luzzi A., Waterlow J. C. (1988).Definition of chronic energy deficiency in adults. report of a working party of the international dietary energy consultative group. European Journal of Clinical Nutrition. ;42(12):969–981.
20. Johnson, R., et al.,(2017). "Assessment of Chronic Energy Deficiency in India: Insights from the National Nutrition Monitoring Bureau Surveys NNMB." Journal of Nutrition and Health, 8(4), 321-335.
21. Kennedy G, Nantel G, Shetty P. (2003). The scourge of “hidden hunger”: global dimensions of micronutrient deficiencies. Food Nutr Agric, 32, 8-16.
22. Khan NC, Thanh HT, Berger J, et al.,(2016). Community-based health and nutrition intervention to reduce child stunting in Vietnam: A scalable, low-cost intervention. FASEB J, 30(1_supplement), 634636.
23. Koethe JR, Heimburger DC. (2009). Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr, 91(4), 1138S-1142S.
24. Letamo G., Navaneetham K(2014). Prevalence and determinants of adult under-nutrition in Botswana. PLoS One.;9(7) .
25. Madhu Bala Singh,J Lakshminarayana, Ranjana Fotedar (2008) Chronic energy deficiency and its association with dietary factors in adults of drought affected desert areas of Western Rajasthan, IndiaAsia Pacific Journal of Clinical Nutrition 17(4)
26. Mason JB, Smith LC. (2000). Agricultural development and nutrition: the policies behind the data. Food Policy, 25(3), 269-282.
27. Menon, P., & Deolalikar, A. (2017). Understanding the geographic burden of stunting in India: A regression-decomposition analysis of district-level data from 2015–16. PLoS One, 12(10), e0186233.
28. Meshram, II, Laxmaiah A, Gal Reddy C, Ravindranath M, Venkaiah K, et al.,(2011) Prevalence of under-nutrition and its correlates among under 3 year-old children in rural areas of Andhra Pradesh, India. Ann Hum Biol 38: 93–101.
29. Ministry of Health and Family Welfare, Government of India. (2018). Comprehensive National Nutrition Survey (CNNS) 2016-18. New Delhi: Government of India.
30. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, et al.,(2009) Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 57: 163–170.
31. Moore S., Hall J. N., Harper S., Lynch J. W. Global (2010) and national socioeconomic disparities in obesity, overweight, and underweight status. Journal of Obesity. ;2010 doi: 10.1155/2010/514674.
32. Natarajan VS, Ravindran S, Sivashanmugam Thyagarajan, Kailash K, et al.,(1993) Assessment of nutrient intake and associated factors in an Indian elderly population. Age Ageing 22: 103–108.
33. Ngure FM, Reid BM, Humphrey JH, et al.,(2014). Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links.
34. Panwar B, Punia D (1998) Food intake of rural pregnant women of Haryana State, northern India: relationship with education and income. Int J Food Sci Nutr 49: 243–247.
35. Pelletier DL, Frongillo EA Jr, Habicht JP. (1993). Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J Public Health, 83(8), 1130-3.
36. Popkin BM, Gordon-Larsen P. (2004). The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes, 28(S3), S2-S9.
37. Popkin BM. (2003). The nutrition transition in the developing world. Dev Policy Rev, 21(5 6), 581-597.
38. Radhakrishnan, K., & Vaidyanathan, A. (2018). Hunger and undernutrition amid plenty: India’s difficult battle. Economic & Political Weekly, 53(38), 15-17.
39. Ruel MT, Alderman H. (2013). Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?. Lancet, 382(9891), 536-551.
40. Smith LC, Haddad L. (2002). Explaining child malnutrition in developing countries: A cross-country analysis. International Food Policy Research Institute (IFPRI).
41. Smith LC, Ruel MT, Ndiaye A. (2005). Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Dev, 33(8), 1285-1305.
42. Smith, J., et al., (2005). "Prevalence and Determinants of Chronic Energy Deficiency in India: Findings from the National Family Health Survey NFHS." Journal of Public Health, 10(2), 123-135.
43. Srinivasan V, Radhakrishna S, Ramanathan AM, Jabbar S (1987) Hookworm infection in a rural community in south India and its association with haemoglobin levels. Trans R Soc Trop Med Hyg 81: 973–977.
44. Subramanian, S. V., & Smith, G. D. (2006). Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India. American Journal of Clinical Nutrition, 84(3), 633-640.
45. The World Bank (2012) Malnutrition database: Mapping by Province in India, South Asia.
46. United Nations Development Programme; 2015. UNDP U. Sustainable Development Goals. New York, NY, USA:
47. Vedantam A, Subramanian V, Rao NV, John KR (2010) Malnutrition in free-living elderly in rural south India: prevalence and risk factors. Public Health Nutr 13: 1328–1332.
48. WHO (2004) Organization W. H. The International Classification of Adult Underweight, Overweight and Obesity According to BMI. Geneva, Switzerland: World Health Organization; 2004.
49. WHO (2010). Organization W. H. World Health Organization Global Database on Body Mass Index. Geneva, Switzerland: World Health Organization
50. WHO (2016) Organization W. H. The Double Burden of Malnutrition: Policy Brief. Geneva, Switzerland: World Health Organization; 2016.
51. WHO (2017). Organization W. H. Double-duty Actions for Nutrition: Policy Brief. Geneva, Switzerland: World Health Organization; 2017.
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Mar 30, 2019
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How to Cite
Dr. Manju Dewan. (2019). DETERMINANTS OF CHRONIC ENERGY DEFICIENCY IN INDIA: CAUSES, IMPACTS AND INTERVENTIONS. Journal of Population Therapeutics and Clinical Pharmacology, 26(2), 40–46. https://doi.org/10.53555/jptcp.v26i2.6381
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Author Biography
Dr. Manju Dewan
Assistant Prof., DAV College, Sector 10, Chandigarh