Correspondence to: Dr. Padam Singh, Indian Council of
Medical Research, Ansari Nagar, New Delhi 110 029, India.
Considerable research has been conducted in the
country on three micronutrients, namely, iron, vitamin A and iodine.
Other micronutrients such as zinc, vitamin C and folic acid have also
attracted the attention of researchers. There is a need to compile
available information on micronutrients for use and ready reference. It
is also important to undertake analysis of trend and regional variation
with respect to these micronutrients. Further, it is worthwhile
identifying the gaps in knowledge and thrust areas for further research.
The compilation on ‘Micronutrient Profile of Indian Population’ is an
attempt in this direction(1). The reference period for this compilation
was from 1950 till date. The objectives of the compilation were: (i)
To prepare a scientific document on the micronutrient profile of Indian
population based on a thorough review and analysis of both published and
unpublished data. The aspects covered include dietary intake of
micronutrients as well as their clinical and sub-clinical profiles in
children, adolescent girls and pregnant women; and (ii) To update
analysis of levels, trend with implications for public health programs
and identify gaps in knowledge for future research.
Methodology
Information about prevalence of clinical and
sub-clinical deficiences and dietary intake of micronutrients from 1950
to date was collected from major studies conducted in the last five
decades as well as individual research papers published in various
national and international journals. Information was also collected
through Internet search, cross references, and scrutiny of M.Sc., M.D.
and Ph.D. theses, and through visits to important institutes and
organizations engaged in research in the field of micronutrients.
To start with, all published research papers as well
as scientific reports were summarized under a uniform format, giving
information on important findings for each study in addition to type of
study, place of study, sample size, assessment indicators, etc.
Details of major studies and summary of M.Sc. Ph.D. and M.D. theses are
also provided, in the compilation.
Based on the published research papers and reports,
data have been presented for each micronutrient at regional level, state
level, and district level separately for infants, children of different
age groups, adolescent girls, and pregnant and lactating women; and
again separately for clinical, sub-clinical/biochemical parameters and
intake levels. Current status, regional variations, and trends during
the last 50 years are discussed. A mapping of the country regarding
prevalence and dietary intake levels of micronutrients has also been
attempted.
Key Findings
This effort identified 13 major studies on the
subject, providing information at national/regional level, which are
mainly multicentric and community based. About 600 published research
papers from national and international journals were found having
information on prevalence of micronutrient-deficiences and dietary
intakes. The number of research studies on Iron, Vitamin A and Iodine
were 256, 219 and 87, respectively. The research studies on Vitamin C
and Zinc were 40 each. Only 15 studies were detected for folic acid. As
many as 567 research studies were on children, 165 on pregnant and
lactating women, but only 62 on adolescent girls. During 1991-2002, 334
research studies were published. In the earlier years, there were far
fewer studies; 21 during 1950-60 and 80 during 1961-70. Of these,
community based studies accounted for 41%, hospital based for 28%,
school based 21%, and others fewer than 10%.
The salient findings based on these for two important
micronutrients, namely, Iron and Vitamin A are summarized below.
Iron Deficiency Anemia
Infants and Children
All India level data available from National Family
Health Survey (NFHS-2) (1998-99) for children in the age group 6 months
to 35 months indicated an overall prevalence of anemia of 74.3%. The
prevalence of anemia was generally the highest in the northern and
eastern regions and the lowest in the southern region. The anemia level
was the highest among children in the age group 12-23 months (77.7%) as
compared to children in the age group 6-11 months (71.7%) and 24-35
months (72%).
An analysis of community based work published from
1950 to mid 2002 indicated a high prevalence of anemia among infants
(80%) and in 1 to 2 year old children (78%). The prevalence was 74%
among 2-3 years old children. The mean hemoglobin level was low (9.0 g/dL)
in both infants and children aged up to three years of age, increasing
to only 10.0 g/dL by the age of 6 years.
Only a few studies are available previous to 1970
(mainly in the southern and northern regions). For this early period,
anemia among children under 6 years was 77%. The level showed a decline
to 72% during 1971-90 and remained at around 70% for the period 1991
onwards.
Adolescent Girls
There are a limited number of studies on adolescent
girls. The data collected for NFHS-2 for married women in the age up to
20 years and without any child has been used as a proxy for adolescent
girls. Anemia among this group was about 52%. The other major and
individual community based studies (1991 onwards) indicated an overall
prevalence of 88.6%. The highest prevalence was generally in the eastern
and northern regions.
Because of the dearth of studies previous to 1991 in
particular, analysis of a trend over time is not possible for adolescent
girls or any proxy for this group.
Pregnant and Lactating Women: The Indian Council
of Medical Research (ICMR) multicentre study (District Nutrition
Project, 2001) shows overall prevalence of anemia among pregnant women
at about 85% and over 60% throughout the regions. Major and individual
community based studies (besides NFHS-2) indicated the highest
prevalence of anemia is in the eastern region (88%) and the lowest (57%)
in the southern region. According to the NFHS-2 the overall prevalence
of anemia among pregnant women was 49.7%, with the highest prevalence
(52.7%) in the eastern region and the lowest in the southern region
(46.0%).
Regarding changeover time, considering community
based studies (excluding NFHS-2 data), anemia prevalence among this
group was 80.7% during 1950-90 and 83.6% during the period 1991 onwards.
Dietary Intake in Various Populations: Two major
studies about dietary intake of iron were analyzed, particularaly with
regard to rural population. Information from the National Nutrition
Monitoring Bureau (NNMB) of ICMR indicates that the average intake of
iron is only about 50% of RDA. The India Nutrition Profile (1995-97)
provides dietary intakes of iron for 182 districts in 14 states. None of
the districts had iron intake equal to RDA (28 mg/cu/day) as per revised
values. Only 6% were meeting 75% of RDA, 47% were meeting 50% of RDA,
and the rest (85 districts) did not meet 50% of RDA.
Iron intake is much lower for children, adolescent
girls, and pregnant women. According to NNMB data, intake of iron was
44.2% and 45.0% of RDA for 1-3 and 4-6 years old children, respectively.
For pregnant and lactating women the intake was 36.8% and 48.7% of RDA
respectively.
Vitamin A Deficiency
Children: No data are available at all-India
level for mapping the country on the basis of clinical vitamin A
deficiency. However, for 11 states information is available through NNMB
and India Nutrition Profile reports.
There are studies at district level (69 districts
from 28 states) covering one or more districts per state during last six
years and out of these 69 districts, 44 districts showed prevalence of
Bitot’s spot greater than 0.5%.
The prevalence of Bitot’s spots (based on NNMB pooled
data of seven states) was 1.8, 0.7 and 0.7 respectively, during the
surveys carried out in 1975-79, 1988-90 and 1996-87. Individual studies
carried out between 1950 to date revealed that the prevalence of vitamin
A deficiency was 4% during the period up to 1980.
Adolescent Girls: There are a couple of studies
on adolescents done in south India, which indicate vitamin A deficiency
as 0.8% to 1%.
Pregnant Women: On the basis of NFHS-2, DNP of
ICMR and micronutrient study conducted by Ministry of Health and Family
Welfare, the prevalence of migh blindness of the magnitude of two-digit
level is seen in some parts of the country.
Sub-clinical Vitamin A Deficiency: Screening of
individual research papers with information on serum retinol levels
among children indicated lack of information on the subject.
Intake of Dietary Vitamin A: The average intake of vitamin A is
less than 50% of RDA in most parts of the country.
|
Key Messages |
|
• Prevalence
of anemia is high in children, adolescent girls and pregnant women
in India.
• Magnitude of clinical
vitamin A deficiency has declined significantly in India. |
