Indian Kids are Different, their Nutritional Needs are Different

Children and adolescents form the backbone of future generations and their health and nutrition play a significant role in human resource development. In modern times, children in developing countries are exposed to poverty, unstimulating home environments, malnutrition, and other risks, and this affects their growth, development and overall health1. India is a lower-middle-income country facing these problems, and more than 40% of Indian children are stunted2. In spite of poverty alleviation and improved food availability, malnutrition and related health problems are increasing among Indian children3. In India, malnutrition is a problem of multiple dimensions — social, cultural economic, health, educational and nutritional4. India has 1.5 to 2 times stunting and wasting rates compared to global average5. Thus, meeting nutritional needs for Indian kids is essential to bridge the gap of growth milestones.

 

Differences based on RDA of different countries

The purpose of Recommended Daily Allowances (RDA) is to quantify the specific nutrients the body needs on daily basis. Across countries, the RDA and predominant diets are different and are highly related to the overall growth and development of children. For example, the RDA for protein consumption among 4- to-6-year-old Indian children is 20.1 g/day while for American boys of the same age group, it is 19 grams of protein on daily basis.

  • The RDA for Indian children on calories is higher than that for American children, and lower compared to their South East Asian counterparts.
  • The RDA for calcium intake among Indian children is lower than kids in America but higher than British Children. However, in Britain, 7-8 years children are recommended to take 550 mg of calcium per day while Indian children of the same age group are recommended 800 mg/day.
  • In India, the RDA for iron consumption among children is higher than kids in America or South East Asian countries. For example, while 4-6 years old children in India are recommended to take 13 mg iron daily , boys of the same age group are recommended to take 4 mg iron per day in South East Asian countries and children in America to take 10 mg iron daily. On an average the RDA on iron intake for British children is comparatively lower than India, America and South East Asian nations.
  • The recommended daily allowance for folate is lowest in India and Britain when compared to American and South East Asian countries. However, Indian children are recommended to take more zinc on a daily basis than children in America, SEA and UK6,7,8,9.

Food habits

The food habits of children in the United States, Canada, South Korea, Western European nations and other non-third world countries develop under conditions like dietary abundance and availability of inexpensive and ready-to-eat foods that are readily available. They have exposure to large portions of energy-rich foods, and an increased proportion of foods that they eat is consumed away from home10. In India, population explosion, demographic changes and alteration in traditional food habits have led to development of unhealthy eating practices among children, resulting in malnutrition and diet-related chronic diseases9. Myriads of attractions about fast food/junk food float around in electronic and social media which are influencing the food habits of Indian children, particularly in urban population groups. While in India unhealthy lifestyle factors, such as unwholesome food choices have led to inadequate consumption of nutrients by children, children in Western countries are moving towards consumption of 3 meals plus 3 snacks per day, experiencing an increase in snacking behavior11.

Food nutrition content

The dietary patterns in India are diverse. However, the food intake patterns of Indians indicate that most Indian children follow a vegetarian diet and even then, they consume vegetables, fruits, nuts, animal foods and other sources of micronutrients less frequently12. National Nutrition Monitoring Bureau (NNMB) surveys have also shown that except cereal and millets, consumption of all foods in Indian households is lower that the RDA. Intake of pulses and legumes which are important for protein ingestion was found less than 50% of RDA7. As a result, only 20.3% of pre-school children are found nutritionally normal, while the others suffer from mild, moderate, or severe malnutrition12. Improper dietary habits and replacement of traditional home-cooked meals with ready-to-eat, processed foods has contributed to poor nutrition intake in Indian children. Junk food consumption has dramatically increased in India  and tends to be associated with a reduced intake of nutrients  (calcium, fiber and vitamins and minerals that fruits and vegetables provide) and excess intake of sugar, saturated and trans fat , sodium and other nutrients that children need in less quantity13. The omission of a variety of healthy foods from their daily diets and frequent consumption of energy-dense, nutrient-poor foods and sugar-sweetened beverages is putting India children at risk of developing chronic degenerative diseases14. Compared to children in the West, Indian children consume diets that are typically higher in carbohydrates and lower in proteins15.

IAP vs CDC growth charts

The nutritional status of children is expressed as the proportion of weight for age, height for age, or weight for height. For growth and assessment of children below 5 years, IAP (Indian Academy of Pediatrics) recommends the use of WHO standards. However, to supersede the previous charts, IAP growth chart committee recommends revised growth charts for height, weight and BMI assessment of growth of 5-18 years old children in India. This is because it was observed that all children grow at a consistent pattern up to the age of 5 years. However, the trajectory of growth of Asian children including Indians is different during their pubertal years. CDC growth charts for 5-18 year olds are based on statistical reconstruction of 1977 National Centre for Health data on American Children. Also, in developing countries, there have been secular trends in childhood growth. As a result, construction of new growth charts is inevitable. Ideally, prevalence estimated as per new Indian IAP charts should be used as these cut-offs are comparatively more appropriate than the ones shown by CDC for Asian Indian children16.

Comparing the IAP and CDC growth charts for height, weight and BMI of children, it has been found that Indian children are shorter and lighter than their Caucasian counterparts.

  • The height of Indian children seems to be comparable to Caucasian children until the onset of puberty.
  • The growth spurt after the pubertal years of Indian children is attenuated in both the sexes. However, the effect is more pronounced in Indian girls.
  • There is only about 1 cm average difference in height between Caucasian girls and Indian girls from 5 to 11 years of age, and this gap widens to 6 cms at 18 years.
  • The average difference in height between Caucasian and Indian boys from 5 to 12.5 years of age is 1 cm, and it reaches 3.5 cm at 18 years17.

Conclusion

Adequate intake of food and regular nutrition habits are the crucial factors for maintenance of general health status in children. Currently, most of the world’s population, including Indians, have dietary intakes which are much lower than the RDA. India is still home to the highest number of stunted children in the world. To achieve proper growth and development, babies should be breastfed exclusively for the first six months of life. Soon after the baby completes six months, complementary foods rich in nutrients should be introduced and breastfeeding should be continued3.Healthy eating practices should be encouraged in early childhood and a variety of foods should be incorporated into their diet to ensure optimum nutritional intake7.

References

  1. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe, P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007 Jan 6; 369(9555): 60–70.
  2. Pappachan B, Choonara I. Inequalities in child health in India. BMJ Paediatr Open. 2017; 1(1): e000054. doi: 10.1136/bmjpo-2017-000054.
  3. National Health Portal of India [Internet]. Delhi: NHP; c 2016 [updated 2015 Sep 15; cited 2018 Oct 09]. Healthy Nutrition; [about 10 screens]. Available from: https://www.nhp.gov.in/healthlyliving/healthy-nutrition
  4. Ramani AV, D’Souza R. Misunderstanding malnutrition. 2006; 3(3). Doi: 10.20529/IJME.2006.032.
  5. The World Bank [Internet]. Geneva: WHO; c 2018 [updated 2018; cited 2018 Oct 9]. UNICEF-WHO-The World Bank: Joint child malnutrition estimates – Levels and trends; [about 2 screens]. Available from: http://www.who.int/nutgrowthdb/estimates/en/
  6. British Nutrition Foundation [Internet]. London: The Organization; c 2016 [updated 2018; cited 2018 Oct 9]. Nutrition Requirements; [about 8 screens]. Available from: https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Oct%202016.pdf
  7. National Institute of nutrition [Internet]. Hyderabad: NIN; c 2011 [updated 2011; cited 2018 Oct 9]. Dietary guidelines for Indians- A Manual; [about 139 screens]. Available from: http://ninindia.org/DietaryGuidelinesforNINwebsite.pdf.
  8. Office of Disease Prevention and Health Promotion [Internet]. USA: Health.gov; c 2018 [updated 2018 Oct 25; cited 2018 Oct 25]. Dietary guidelines for americans 2015-2020; [about 144 screens]. Available from: https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
  9. Barba CVC, Cabrera MIZ. Recommended dietary allowances harmonization in southeast asia. Asia Pac J Clin Nutr 2008;17 (S2):405-408.
  10. Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007; 35(1): 22–34. doi: 10.1111/j.1748-720X.2007.00111.x
  11. Piernas C, Popkin BM. Trends in snacking among U.S. children. Health Aff (Millwood). 2010 Mar-Apr;29(3):398-404. doi: 10.1377/hlthaff.2009.0666.
  12. Vecchio MG, Paramesh EC, Paramesh H, Loganes C, Ballali S, Gafare CE, et al. Types of food and nutrient intake in India: a literature review. Indian J Pediatr. 2014 Sep;81 Suppl 1:17-22. doi: 10.1007/s12098-014-1465-9.
  13. Butt S, Leon JB, David CL, Chang H, Sidhu S, Sehgal AR. The prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. J Ren Nutr. 2007 Jul;17(4):264-8.
  14. Rathi N, Riddell L, Worsley A. Food consumption patterns of adolescents aged 14-16 years in Kolkata, India. Nutr J. 2017 Aug 24;16(1):50. doi: 10.1186/s12937-017-0272-3.
  15. Mani I, Kurpad AV. Fats & fatty acids in Indian diets: Time for serious introspection. Indian J Med Res. 2016 Oct;144(4):507-514. doi: 10.4103/0971-5916.200904.
  16. Will new Indian growth charts help stem the rise in childhood obesity? BMJ. 2015 Apr 27;350:h2013. doi: 10.1136/bmj.h2013.
  17. Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, Cherian A. Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. 2015; 52:47-55.

 

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