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Young Child Undernutrition: Crucial to Prioritize Nutrition Interventions in the First 1000 Days of Life

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Abstract

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the ‘at risk’ households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services.

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References

  1. Gragnolati M, Shekar M, Das Gupta M, Bredenkamp C, Lee Y-K. Health, Nutrition and Population (HNP) Discussion Paper Series. India’s undernourished children: A call for reform and action. Washington DC: World Bank; 2005. p. 1–10.

    Google Scholar 

  2. Bhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382:452–77.

    Article  PubMed  Google Scholar 

  3. Black RE, Victora CG, Walker SP, et al; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51.

    Article  PubMed  Google Scholar 

  4. Swaminathan S, Hemalatha R, Pandey A, et al; India State Level Disease Burden Initiative Malnutrition Collaborators. The burden of child and maternal malnutrition and trends in its indicators in the states of India: Global Burden of Disease Study 1990–2017. Lancet Child Adolesc Health. 2019;3:855–70.

  5. Vir SC, Chugh R. Magnitude of the malnutrition problem in India: An Overview of the situation of children, adolescent girls and women. In: Vir SC, ed. Child, Adolescent and Woman Nutrition in India: Public Policies, Programmes and Progress. India: KW publisher. 2023. p. 71-117.

  6. Vir SC, Ranjan A. Investing in Nutrition: Central to sustainable development. In Vir SC, ed. Public health nutrition in developing countries. 2nd ed. New Delhi: WP1 Publisher. 2021. p. 1-39.

  7. Kar BR, Rao SL, Chandramouli BA. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct. 2008;4:31.

    Article  Google Scholar 

  8. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999;129:1555–62.

    Article  PubMed  CAS  Google Scholar 

  9. Fink GE, Peet G, Danaei K, et al. Schooling and wage income losses due to early-childhood growth faltering in developing countries: National, regional, and global estimates. Am J Clin Nutr. 2016;104:104–12.

    Article  CAS  Google Scholar 

  10. Hoddinott J, Maluccio J, Behrman JR, et al. The consequences of early childhood growth failure over the life Course. IFPRI Discussion Paper 01073. Washington, DC: International Food Policy Research Institute. 2011.

  11. Gillespie S, Haddad L, Mannar V, et al. The politics of reducing malnutrition: building commitment and accelerating progress. Lancet. 2013;382:552–69.

    Article  PubMed  Google Scholar 

  12. Ministry of Finance. Mother and Child. Ministry of Finance, Government of India. 2016. p. 84–95.

  13. Victora CG, Adair L, Fall C, et al; Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: Consequences for adult health and human capital. Lancet. 2008;371:340-57.

  14. Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369:60–70.

    Article  PubMed  PubMed Central  Google Scholar 

  15. World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization. 2016. Available at: https://www.who.int/publications/i/item/9789241549912. Accessed on 1 Mar 2023.

  16. UNICEF. Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women, UNICEF, NY. 2023. Available at: https://www.unicef.org/reports/undernourished-overlooked-nutrition-crisis. Accessed on 15 Mar 2023.

  17. Abu-Saad K, Fraser D. Maternal nutrition and birth outcomes. Epidemiol Rev. 2010;32:5–25.

    Article  PubMed  Google Scholar 

  18. Kajantie E, Osmond C, Barker DJ, et al. Size at birth as a predictor of mortality in adulthood: A follow-up of 350,000 person-years. Int J Epidemiol. 2005;34:655–63.

    Article  PubMed  Google Scholar 

  19. Wu G, Imhoff-Kunsch B, Girard AW. Biological mechanisms for nutritional regulation of maternal health and fetal development. Paediatr Perinat Epidemiol. 2012;26:4–26.

    Article  PubMed  Google Scholar 

  20. Knop MR, Geng TT, Corny AW. Birth weight and risk of type 2 diabetes mellitus, cardiovascular disease, and hypertension in adults: A meta-analysis of 7646267 participants from 135 studies. J Am Heart Assoc. 2018;7:e008870.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chopra H, Paul B, Virk A, Pandey G, Lahariya C. Triple burden of malnutrition among children in India: Current scenario and the way forward. Indian J Pediatr. 2023. https://doi.org/10.1007/s12098-023-04739-x.

  22. Allen LH. Anemia and iron Deficiency: Effects on pregnancy outcome. Am J Clin Nutr. 2000;71:1280S-4S.

    Article  PubMed  CAS  Google Scholar 

  23. Scholl TO. Iron status during pregnancy: Setting the stage for mother and infant. Am J Clin Nutr. 2005;81:1218S-22S.

    Article  PubMed  CAS  Google Scholar 

  24. Lahariya C, Khandekar J. How the findings of national family health survey-3 can act as a trigger for improving the status of anemic mothers and undernourished children in India: A review. Indian J Med Sci. 2007;61:535–44.

    Article  PubMed  Google Scholar 

  25. Cheatham CL. Nutritional factors in fetal and infant brain development. Ann Nutr Metab. 2019;75:20–32.

    Article  PubMed  CAS  Google Scholar 

  26. Vir SC. Vitamin A deficiency prevention and control. In: Vir SC, ed. Public Health Nutrition in Developing Countries. 2nd ed. New Delhi: WPI Publishers; 2021. p. 1067–121.

    Google Scholar 

  27. Sazwal S, Dhingra P. Zinc-An essential micronutrient for health and development. In: Vir SC, ed. Public Health Nutrition Developing. Countries, 1st ed. New Delhi: WPI. Publisher. 2011. p. 737–63.

  28. Parker SE, Mai CT, Canfield MA, et al. Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010;88:1008–16.

    Article  PubMed  CAS  Google Scholar 

  29. Greene LS, Stanbury JB. A retrospective view of iodine deficiency, brain development and behavior from studies in Ecuador. In: Stanbury JB, editor. The Damaged Brain of Iodine Deficiency. New York: Cognizant Communication Corporation; 1994. p. 173–85.

    Google Scholar 

  30. National Family Health Survey (NFHS) 1-1992-93. Ministry of Health & Family Welfare, Government of India. Available at: http://rchiips.org/nfhs/nfhs1.shtml. Accessed on 1 Feb 2023.

  31. National Family Health Survey (NFHS) 2-1998-99. Ministry of Health & Family Welfare, Government of India. Available at: http://rchiips.org/nfhs/nfhs2.shtml. Accessed on 1 Feb 2023.

  32. National Family Health Survey (NFHS) 3-2005-06. Ministry of Health & Family Welfare, Government of India. Available at:http://rchiips.org/nfhs/NFHS-3%20Data/VOL-1/India_volume_I_corrected_17oct08.pdf. Accessed on 1 Feb 2023.

  33. National Family Health Survey (NFHS) 4-2015-16. Ministry of Health & Family Welfare, Government of India. Available at: http://rchiips.org/nfhs/nfhs4.shtml. Accessed on 1 Feb 2023.

  34. National Family Health Survey (NFHS) 5-2019-21. Ministry of Health & Family Welfare, Government of India. Available at: http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf. Accessed on 1 Feb 2023.

  35. Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. Comprehensive National Nutrition Survey (CNNS). 2019. Available at: https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf. Accessed on 1 Feb 2023.

  36. Department of Women and Child Development, Uttar Pradesh. Nutritional Status of Women and Children in Uttar Pradesh. Institute of Applied Statistics and Development Studies (IASDS) and UNICEF. 1999.

  37. Vir SC. Mission Poshan: Project to redesign state wide programme strategy for addressing malnutrition in under three in Uttar Pradesh. Symposium on Nutrition in Late Infancy and Early Childhood (6-24 months). New Delhi: Nutrition Foundation of India. 2006, p. 101–8.

  38. Vir SC, Nigam AK. Nutritional status of children in Uttar Pradesh. NFI Bull. 2001;22:4–6.

    Google Scholar 

  39. NFI. Symposium on ‘Nutrition in Late Infancy and Early Childhood (6-24 months)’. New Delhi: Nutrition Foundation of India. 2006.

  40. Shrimpton R, Victora CG, de Onis M, Lima RC, Blössner M, Clugston G. Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics. 2021;107:e75.

  41. WHO. WHO Child Growth Standards. 2006. Available at: https://apps.who.int/iris/rest/bitstreams/51510/retrieve. Accessed on 3 Jun 2023.

  42. United Nations System Standing Committee on Nutrition. Fifth Report on the World Nutrition Situation for Improved Development Outcomes. 2004. Available at: https://www.unscn.org/layout/modules/resources/files/rwns5.pdf. Accessed on 15 Feb 2023.

  43. Gilmore JH, Knickmeyer RC, Gao W. Imaging structural and functional brain development in early childhood. Nature Rev Neurosci. 2018;19:123–37.

    Article  CAS  Google Scholar 

  44. Nelson CA 3rd, Zeanah CH, Fox NA, Marshall PJ, Smyke AT, Guthrie D. Cognitive recovery in socially deprived young children in Bucharest Intervention Project. Science. 2007;318:1937–40.

    Article  PubMed  CAS  Google Scholar 

  45. Rao S. Maternal and Child Undernutrition in India and Implications for Public Health Policies. Paper presented to Public Health Foundation of India for India Health Report. 2012. Available at: https://phfi.org/wp-content/uploads/2017/02/annual_report2012_13.pdf. Accessed on 30 Jan 2023.

  46. Shrimpton R. Global policy and programme guidance on maternal nutrition: What exists, the mechanisms for providing it, and how to improve them? Paediatr Perinat Epidemiol. 2012;26:315–25.

    Article  PubMed  Google Scholar 

  47. Mason JB, Saldanha LS, Ramakrishnan U, et al. Opportunities for improving maternal nutrition and birth outcomes: Synthesis of country experiences. Food Nutr Bull. 2012;33:S104-37.

    Article  PubMed  Google Scholar 

  48. Armitage JA, Khan IY, Taylor PD, Nathanielsz PW, Poston L. Developmental programming of the metabolic syndrome by maternal nutritional imbalance: How strong is the evidence from experimental models in mammals? J Physiol. 2004;561:355–77.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Bhatia N, Vir SC. Nutrition care of adolescents: crucial for optimum, growth, development and intergenerational health. In: Vir SC, ed. Public Health Nutrition in Developing Countries. 2nd ed. New Delhi: Woodhead Publishers, India; 2021. p. 649–716.

    Google Scholar 

  50. Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Mater Child Nutr. 2013;9:27–45.

    Article  Google Scholar 

  51. Vir SC. Undernutrition in children: Significance, current situation, determinants, programme principles and intervention package. In: Vir SC, ed. Public Health Nutrition in Developing Countries. 2nd ed. New Delhi: Woodhead Publishers, India; 2021. p. 143–222.

    Google Scholar 

  52. Adhikari T, Vir SC, Pandey, et al. Undernutrition in children under two years (U2) in India: An analysis of determinants, National Institute of Medical Statistics and Public Health Nutrition and Development Centre. New Delhi: National Institute of Medical Statistics. 2014.

  53. Dalal RM, Agnihotri SB. Nutrition care in the first year of life: Significance, key experiences and emerging lessons in preventing growth faltering and promoting “catch up” growth. In: Vir Sheila C, editor. Public Health Nutrition in Developing Countries. 2nd ed. New Delhi: Woodhead Publishers, India; 2021. p. 499–562.

    Google Scholar 

  54. Vir SC, Ranjan A. Investing in nutrition: central to sustainable development. In: Vir SC, editor. Public Health Nutrition in Developing Countries. 2nd ed. New Delhi: Woodhead Publishers, India; 2021. p. 1–39.

    Google Scholar 

  55. Sanghvi T, Nguyen PH, Tharaney M, et al. Gaps in implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India. Mater Child Nutr. 2022;18:e13293.

    Article  Google Scholar 

  56. Kachwaha S, Nguyen PH, Tran LM, et al. Specificity matters: Unpacking the impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India. J Nutr. 2022;152:612–29.

  57. MWCD. ICDS Mission, The Broad Framework for Implementation: Ministry of Women and Child Development, Government of India. Available at: https://wcd.nic.in/sites/default/files/IcdsMission%20-%20Broad%20Framework_0.pdf. Accessed on 20 Feb 2023.

  58. MoHFW. Anaemia Mukt Bharat-Operational Guidelines for Intensified National Iron Plus Initiative (i-NIPI) for Programme Managers. Ministry of Health and Family Welfare, Government of India. Available at: https://anemiamuktbharat.info/. Accessed on 15 Feb 2023.

  59. United Nations Children’s Fund. Fed to Fail? The Crisis of Children’s Diets, in Early Life. Child Nutrition Report. UNICEF, New York. 2021. Available at: https://www.unicef.org/reports/fed-to-fail-child-nutrition. Accessed on 31 Jan 2023.

  60. Government of India. The Infant Milk Substitute, Feeding Bottles and Infant foods (Regulation of Production, Supply and Distribution) Act 1992. Available at: https://wcd.nic.in/sites/default/files/infantmilkpact1.pdf. Accessed on 1 Mar 2023.

  61. Government of India. Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution Act 1992, as amended in 2003. Available at: http://www.bpni.org/documents/IMS-act.pdf. Accessed on 10 Mar 2023.

  62. UNICEF. Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods. Geneva: World Health Organisation and the United Nations Children’s Fund. 2021 Licence: CC BYNC-SA 3.0 IGO: Available at: https://creativecommons.org/licenses/by-nc-sa/3.0/igo. Accessed on 10 Mar 2023.

  63. Ministry of Women and Child Development. Saksham Anganwadi and Poshan 2.0. A Strategic Intervention to Address Malnutrition Concerns. No 11/4/2021-CD-1(e-95706) Ministry of Women and Child Development MoWCD. 2022. Available at: https://wcd.nic.in/sites/default/files/Final_Saksham_Guidelines_with_covering_letter_0.pdf. Accessed on 1 Mar 2023.

  64. MoHFW. Guidelines for Enhancing Optimal Infant and Young Child Feeding Practices, Ministry of Health and Family Welfare, Government of India. 2013. Available at: https://pib.gov.in/PressReleasePage.aspx?PRID=1606698. Accessed on 13 Mar 2023.

  65. UNICEF. Child Food Poverty: A Nutrition Crisis in Early Childhood, UNICEF, New York. 2022. Available at: https://data.unicef.org/wp-content/uploads/2022/10/Child-Food-Poverty-Report-2022.pdf. Accessed on 1 Mar 2023.

  66. Swabhimaan. Multi Sector Integrated Programme Through Women Collective (Promoted by Aajeevika) to Improve Girls and Women’s Nutrition, Swabhimaan (2016-20) UNICEF. 2017. Available at: http://www.roshni-cwcsa.co.in/UploadDocument/UnicefSwabhimOverviewReport.pdf. Accessed on 20 Mar 2023.

  67. Vir SC, Koheler K. Self help group of women involved in farm and non-farming economic activities in a northern hilly state of India: Nutrition status of women and children. J Epidemiol Public Health Rev. 2017;2. https://doi.org/10.16966/2471-8211.139.

  68. United Nations Children’s Fund. (UNICEF). Nutrition, for Every Child: UNICEF Nutrition Strategy 2020–2030. UNICEF, New York. 2020. Available at: https://www.unicef.org/reports/nutrition-strategy-2020-2030. Accessed on 1 Mar 2023.

  69. Ministry of Health and Family Welfare. Policy on Management of Vitamin A Deficiency 1991 (no.Z 28020/30/2003 -CH .government of India, Ministry of Health and Family Welfare, Child Health Division, Dated 2nd Nov 2006). Available at: https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/goi_vit_a.pdf. Accessed on 1 Mar 2023.

  70. Ministry of Health and Family Welfare. Use of Zinc as an Alternate in the Treatment of Diarrhoea. Child Health Division, Department of Health and Family Welfare, MoHFW No. Z 28020/06/2005-CH 2nd Nov 2006. Available at: https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/goi_zinc.pdf. Accessed on 10 Mar 2023.

  71. Lahariya C, Paul VK. Burden, differentials, and causes of child deaths in India. Indian J Pediatr. 2010;77:1312–21.

    Article  PubMed  Google Scholar 

  72. Datta V, Ghosh S, Aquino LD. Progressing towards SDG 2030 goals with system changes: The India Newborn Action Plan. BMJ Open Qual. 2022;11:e001971.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Deshmukh V, Lahariya C, Krishnamurthy S, Das MK, Pandey RM, Arora NK. Taken to health care provider or not, under-five children die of preventable causes: Findings from cross-sectional survey and social autopsy in rural India”. Indian J Community Med. 2016;41:108–19.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Lahariya C. “Ayushman Bharat” program and universal health coverage in India. Indian Pediatr. 2018;55:495–506.

    Article  PubMed  Google Scholar 

  75. Lahariya C, Roy B, Shukla A, et al. Community action for health in India: Evolution, lessons learnt and ways forward to achieve universal health coverage. WHO South East Asia J Public Health. 2020;9:82–91.

    Article  PubMed  Google Scholar 

  76. Lahariya C. Health & wellness centres to strengthen primary health care in India: Concept, progress and ways forward. Indian J Pediatr. 2020;87:916–29.

    Article  PubMed  PubMed Central  Google Scholar 

  77. IFPRI. International Food Policy Research Institute. Global nutrition report 2016: from promise to Impact: Ending Malnutrition by 2030. 2016. Available at: https://www.ifpri.org/publication/global-nutrition-report-2016-promise-impact-ending-malnutrition-2030. Accessed on 1 Mar 2023.

  78. Vir SC, Suri S. The role of maternal nutrition in reducing childhood stunting. ORF Occasional Paper, Issue number 355. 2022. Available at: https://www.orfonline.org/research/maternal-nutrition-in-reducing-childhood-stunting. Accessed on 10 Mar 2023.

  79. Stein AD, Adair LS, Donati G, et al; COHORTS Group. Early-life stature, preschool cognitive development, schooling attainment, and cognitive functioning in adulthood: a prospective study in four birth cohorts. Lancet Glob Health. 2023;11:e95–e104.

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Vir, S.C., Suri, S. Young Child Undernutrition: Crucial to Prioritize Nutrition Interventions in the First 1000 Days of Life. Indian J Pediatr 90 (Suppl 1), 85–94 (2023). https://doi.org/10.1007/s12098-023-04732-4

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