Persistent undernourishment blights the existence of people who may not die as a result of it but whose ability to lead secure, productive and happy lives is severely afflicted by debilitation and morbidity. ~ Amartya Sen

Economic growth can be positively influenced by improved nutrition. In a special section of its annual report, “The State of Food and Agriculture 2001”, the Food and Agriculture Organisation states: “The impact of nutrition on labour productivity, health and education ultimately filters through to higher levels of overall economic growth.”

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Raising the per capita calorie intake to 2770 calories per day in countries where it is below that level could increase per capita gross domestic product in those countries by between 0.34 and 1.48 percentage points per year. The biggest challenge before India, which is emerging as the second fastest-growing economy in the world, is to ensure food and nutritional security. When we endeavor to make India ‘hunger-free’, statistics show that only a certain percentage of our people do not receive two square meals a day.

Actually, it is hunger in terms of inadequate nutrition. It is perfectly possible to feel well-fed by filling the current physiological needs and yet display symptoms of malnourishment that hamper physical needs over many days, weeks, months or years. Recognizing this fact, improvement of the health and nutritional status of the population has always been given the highest priority. Article 47 of the Constitution states that ‘The State shall regard raising the level of nutrition and standard of living of its people and improvement in public health among its primary duties.’

Moreover, Article 25 of the Universal Declaration of Human Rights states that: ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.’ Malnutrition occurs at all stages of the life cycle. Economic growth and human development require a well-nourished population who can learn new skills, think critically and contribute to their communities. Child malnutrition impacts the cognitive function and contributes to poverty through the individuals’ ability to lead productive lives.

Three commonly used measures ~ stunting (height-for-age), wasting ( height-for-age) and the proportion of those underweight (weight-for-age) provide somewhat different data about the nutritional status of children. Stunting denotes chronic undernutrition, wasting indicates the prevalence of acute malnutrition and the third indicator is suggestive of both stunting and wasting. Addressing the problem of infant and young child malnutrition is essential for ensuring healthy growth, proper organ formation and function, a strong immune system, neurological and cognitive development.

The first 1000 days of life ~ the time spanning roughly between conception and one’s second birthday ~ is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established. The health and well-being of a pregnant and lactating woman is directly connected to the growth and health of her child. When the human brain continues to develop and change throughout life, the rapid period of brain-growth and its period of highest plasticity is in the last stages of pregnancy and the first two years of life.

According to scientists, there are al least 50 brain chemicals or neurotransmitters that are affected by the intake of nutritious food and micronutrients by the child in the first 1000 days. The brain requires all nutrients for growth, and certain nutrients for protein. Iron, zinc, copper, iodine, folate, polyunsaturated fatty acids, vitamins A, B6, B12 are particularly critical. Iron deficiency is the most common nutritional deficiency in the world. It is not surprising that the root of the some of the most complex human behaviour are also laid down very early in life.

While the young brain is enormously plastic in its ability to recover from early insults and, hopefully, it is never too late to at least partially correct a deficit, the window of opportunity does narrow with advancing age. Science suggests that it is far better policy to build the brain in the first stage through a nutritional deficit prevention programme rather than depend on replacement therapy once a deficit has occurred. Hence our nutritional policy should ensure that the foetus is fed through the mother nutritionally-enhanced supplementary foods that pack an extra punch when it comes to delivering the vitamins and minerals that children need to reach their full physical and intellectual potential. Investing in nutrition is an investment in the next generation.

Although lack of appropriate food is a major contributor to child malnutrition, it is not the sole cause. The mother’s prenatal nutritional status, enteric infections, and intestinal inflammation also contribute to the risk of childhood malnutrition. Malnourished mothers give birth to babies who are born stunted and thin. Undernutrition transits from one generation to another as a terrifying inheritance. These children do not experience much catch up growth in subsequent years.

They are more likely to be sick, they don’t learn well, and they are less productive as adults. Undernutrition seems to act like a time-bomb that paves the way for lifestyle diseases ~ cardiovascular and endocrine diseases later in life. The so-called ‘Barker Hypothesis’ (1995), also known as Dr David Barker’s theory, posits that maternal dietary imbalances at the critical periods of development of the womb can trigger an adaptive redistribution of foetal resources (including growth retardation). Such adaptations affect the foetal structure and metabolism in ways that predispose the individual to the lifestyle diseases.

India has not only a large number of malnourished women, it also has one of the highest proportions of malnourished women in the developing countries. A third of women of reproductive age in India are malnourished. However, it is important that women’s malnutrition must be viewed as an important issue of human development. Ensuring proper nutrition among women is the best way to turn the vicious cycle of malnutrition into a virtual one. According to one estimate, cause of around 50 percent of all low birth weight babies in the developing countries is Intrauterine Growth Restriction (IUGR) which is attributable to small maternal size at conception (low weight and short stature) and low gestational weight gain (or energy intake during pregnancy). Understanding the genetic risks of malnutrition may help to identify the ideal targets for intervention and treatment of malnutrition.

In the words of Amartya Sen: “There is evidence enough to indicate that more people die from undernutrition than from famines and also that many more people lead severely constrained lives as a result of it.” The study, published in the peerreviewed journal, The Lancet, examined the period from 1900 to 2017 to gauge the state-wise “health disease burden” in the country. The study observed that though the quantum of malnutrition- related deaths among children has come down by twothird since 1990, it is still the cause of 68 per cent of such deaths in the country.

(The writer is a retired IAS officer)