Tropical dietaries in general have been found to be nutritionally poor and those in India are no exception. Professor de Castro, in his newly published book, Geography of Hunger, states that the principal reason for this is that the soil in tropical regions is not capable of supporting growth of plants of higher nutritive value and is also not suitable for raising animal food which contributes so much to nutrition in countries of the temperate regions. A generalization such as the above can hardly stand closer scrutiny. It must be admitted, however, that the contention may be partly true for regions where rice forms the principal crop.
Even there, the fundamental reasons for the absence or poverty of livestock may be altogether different than those imagined by the proponents of the above-mentioned view. Even in India one finds a great variety in the quality of the soil, differences in the chief crops grown and in the quality of livestock. The quality of the diets seems to follow almost closely the pattern of the crops grown and the relative animal wealth. It is often stated that the diets of the people in North India are nutritionally nearer adequacy than those in the southern part of the country.
From this it was sought to prove that rice is nutritionally inferior to wheat as a staple article of diet, a conclusion for which there is not much scientific basis. Intrinsically, there is nothing in wheat which would make it a nutritionally superior cereal except probably its higher protein content. It is the manner in which rice is treated before consumption that is responsible for the loss of much of its nutritive value. The adequacy of North Indian diets was mainly due to the consumption of appreciable quantities of milk and milk products.
The superiority of northern diets over their South Indian counterparts has markedly decreased during the last decade or more. One change that has been noticeable and which has had a profound influence on the nutritive value of these diets was the decrease in the availability and hence the consumption of protective foodstuffs chiefly milk and milk products. This has caused a general levelling down of the quality of Indian diets.
RESULTS OF DIET SURVEYS
A considerable amount of valuable information on Indian dietaries has been obtained by a large number of diet surveys carried out by nutrition workers in different parts of India. Between 1935 and 1949, 843 diet surveys were conducted, of which 486 surveys were in families and 357 in institutions such as students hostels, borstal schools and prisons, etc. Different communities and people belonging to different professions and economic strata of society have been covered in family diet surveys.
A special report (No.20) published by the Indian Council of Medical Research describes in detail the results of these surveys. The diet of an average Indian as obtained after analysing the results of all these surveys is given in the following table. For purposes of comparison, the composition of a well balanced diet recommended by the Nutrition Advisory Committee of the Indian Council of Medical Research in 1944 has been given in column 3.
Foodstuff Average in-take Recommended allowances
Cereals 16.6 14
Pulses 2.3 3
Leafy vegetable 0.9 4
Other vegetable 4.1 6
Ghee and vegetable oil 0.9 2
Milk & milk products 3.3 10
Meat, fish and eggs 0.9 4
Fruits 0.6 3
Sugar and jaggery 0.7 2
Condiments 0.4 –
A diet is considered nutritionally adequate if it supplies sufficient energy to provide for daily needs, has protein in adequate amounts and variety, a sufficiency of fat and the required vitamin and mineral content. A comparison of columns 2 and 3 in the table will reveal the utter inadequacy of the average Indian diet. The most important deficiencies in this diet are those of (a) leafy vegetables (b) milk and milk products (c) flesh foods and (d) fruits. Flesh foods provided the necessary proteins of high quality. Milk adds almost all the essential nutrients to the diet and fruits are important because of the contribution to the quota of water soluble vitamins. At the present juncture we could do little to ensure large supplies of these three categories of foodstuffs, but the same need not be the case with green leafy vegetables.
PLACE OF LEAFY VEGETABLE
In India, leafy vegetables seem somehow to hold a lowly place in ones choice of foodstuffs. Yet there is hardly any other category of foodstuffs which provides so much for so little. Green leafy vegetables are the least expensive of all foodstuffs and there is a large variety of them which can be utilized as human food. They make an insignificant contribution to the diet so far as the energy content of the latter is concerned, but their most important contribution is in vitamins and minerals by means of which they can convert a nutritionally inadequate diet into a tolerably good one at comparatively little expense.
A sufficient in-take of green leafy vegetables can replace fruit in the diet almost entirely and also to a large extent can function as substitute sources of nutrients which are found in milk. Unfortunately, this fact is not sufficiently appreciated by the people in this country, even by the so-called educated people. In higher economic strata of society one finds an increase in the consumption of vegetables but not of the green leafy type. Fruit and root vegetables are comparatively very much poorer in nutritive value. It should be clear, therefore, that one necessary improvement in our diet which can be brought about with ease is a higher consumption of green leafy vegetables.
One hears so much about the food shortage in the country. Most of the time it is the cereal shortage that is referred to and very widely emphasized. Yet from the standpoint of nutritional adequacy it is the least important. Given favourable climatic conditions and more effort on the part of the people directed towards prevention of wastage between the field and the consumer, the making up of this 10 per cent deficit in cereals should not present a difficult problem. But it is indeed a herculean task to increase the production of meat, fish, milk, eggs, edible fat, fruit, etc. within a reasonably short period. However, it is in the adequacy of these that a lasting solution of the nutrition problem of the Indian population will be found. Yet it is astonishing to see, how little one hears of plans to increase production of these necessary items of food although there is little doubt that they exist.
Man can and should be able to bear the inconvenience caused by a 10 per cent shortage in cereals, which after all is only of recent origin. But no animal can lead a healthy life for long in conditions of chronic deficiency of proteins, vitamins and minerals. These deficiencies leave a permanent mark and if continued over generations produce marked deterioration in the health of the community. An exceptionally high infantile mortality, retarded growth, poor physical development, the presence of specific deficiency conditions in children and adolescents and the overall lowered resistance to disease are, in India today, manifest proofs, if proof was needed, of our low nutritional state.
In nutrition surveys on school children carried out in different parts of India, 5 to 10 per cent of the school going children have been found at various times to display signs and symptoms of deficiency which could only be ascribed to lack in their diets of one or more essential nutrients. The adults on their part have a fair share of nutritional deficiency as well. To quote only one instance, numerous surveys have revealed the wide prevalence of anaemia in the rural adult population. This condition has disastrous consequences in women of child-bearing age, particularly when pregnancy supervenes.
It is true that anaemias in rural population are not entirely nutritional in origin. Parasitic infection and infestation have contributory roles. Their damaging effects are considerably enhanced, however, when a condition of chronic malnutrition co- exists as it does in India to-day. That good food alone can eliminate the anaemia was repeatedly demonstrated during war time when recruits (Indian) drawn from hundreds of villages showed marked improvement in their anaemic condition within three to six months after they were placed on the standard army ration.
The nutrition of infants in their post-weaning period and for nearly two to three years after, presents a particularly difficult problem to the poor. The infant, deprived of nutrition at mothers breast, is incapable of digesting and assimilating food fit only for the grown-up, and of necessity receives food mainly based on cereal preparations and that too in insufficient quantities. Under these conditions of malnutrition at a time when needs of the growing body are rather high, the effect on the child is surprisingly quick and severe.
Retardation of growth, diarrhoea, oedema, depigmentation of hair, enlargement of liver and dermatosis are some of the symptoms which these malnourished children display at one time or other. If neglected or improperly treated, the condition proves fatal. The first picture illustrates a typical case; the other is of the same child treated on reconstituted skim milk alone. Could there be any clearer indication of the significance of the role of proper nutrition in infancy?
Such cases as are referred to above have been known recently to occur with increasing frequency in various parts of India. Assam, Bengal, Madras, Bombay, all have their proper share of these. It is likely that they are not diagnosed as cases of malnutrition but treated symptomatically. East, South and West Africa, Latin America, the Carribean region and also the South Sea Islands are other regions in which such manifestations of malnutrition occur. It looks as if one could find a belt of malnutrition girdling the earth through the tropics.
Even in these regions, special efforts had to be made to acquaint the medical profession of the genesis and correct methods of treatment of this type of malignant malnutrition. The after effects of malnutrition in infancy and childhood are serious. Although the condition may be cured, it leaves a mark for life on the individual and may permanently damage one or more vital organs of the body. It is, therefore, all the more important to try and prevent malnutrition in early life.
The brief account given above would show that there is widespread malnutrition in India. It is primarily due to two causes: (1) insufficiency of quality food and (2) poverty of the masses. To this one can add prejudices born of ignorance and superstition; these obviously play a minor role only. Unless the two main hurdles are successfully crossed there is little chance for any improvement in the existing state of affairs.
One, therefore, devoutly hopes that the Government efforts to increase food production and to improve the economic status of the masses meet with success. They cannot succeed, however, without the whole- hearted co-operation and unstinted active support from the people. It is a long road that we have to travel and quick results should not be expected. Given determination and perseverance, however, one must obtain tangible results within a reasonable time.