Improving Nutrition in India - Abstract 28-Sep-2020 - OSF

Improving Nutrition in India
Advaith Ravishankar
28-Sep-2020
Abstract
Fitness plays a crucial role in increasing the healthy lifespan of an individual and ensuring that
they are able enough to complete physical labour effectively. Developing countries, in this
instance India, have low median ages, which is an appropriate stage to focus on fitness. One
critical element for succeeding in improving physique is nutrition. However, with current
standings, India is seeing high rates of malnutrition which, in turn, is resulting in poor physical
capability. To test whether this standing can be improved upon, a home for destitute children
permitted us to implement a regimented nutrition system. In this study, the shortcomings of the
nutrition implemented in a sample of a rural household were first identified and then improved
upon to meet internationally agreed standards. Data collected was divided into two sets: Body
Mass Index and Nutritional Composition. For the former, data corresponding to age, weight,
and height - key components of calculating BMI - were collected; for the latter, the components
of their diet from their set weekly menu were extracted and translated into averaged nutritional
values. With this information in hand, a misallocation in the nutritional system was identified
and improved upon by using data published by the Indian government and other reliable
sources such as UNICEF and USDA.

Introduction
Nutrition in India has been an area of concern throughout history. Despite having a 900%
increase in Gross Domestic Product since 19911 (Economic growth generally leads to an
increased standard of living), more than a third of the world’s malnourished child population
reside in India. The National Family Health Survey (NFHS)2 found that across 2015-2016,
35.7% of children under the age of five were underweight. In addition, India is also home to
the greatest percentage of underweight citizens at a staggering 40%3 of the population. With
India’s population currently at 1.3 billion4, 40% translates to 532 million people. This is 162%
times the current population of the United States of America.
One way of determining whether one is nourished or malnourished is their Body Mass Index.
In adults, there is a straightforward classification of being overweight, fit, or underweight. The
table below holds this information:
 Table 1: Body Mass Weight Categorization 5
 Category BMI Range
 Underweight 30

1
 (Mudgill)
2
 (PIB Delhi)
3
 (Varma et al.)
4
 (India Population (2020) - Worldometer)
5
 (CDC)

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However, for children, the determination of BMI depends on two major factors which are not
 considered with adults: Age and Sex.
 Table 2: Body Mass Weight Categorization - Boys 6
Category Age/years

 5 6 7 8 9 10 11 12 13 14 15 16 17
Underweight 28.2

 Table 3: Body Mass Weight Categorization - Girls7
Category Age/years
 5 6 7 8 9 10 11 12 13 14 15 16 17
Underweight 29.6

 The United Nations International Children’s Emergency Fund (UNICEF)8 has published data
 on juvenile malnutrition around the world by showing the percentage of children in each
 country who are either part of the underweight or overweight category.
 Table 4: Weight Category Distribution for Children by Country
 Children Between ages 5-19
 Country Percentage Underweight Percentage Overweight
 India 27 7
 Indonesia 10 15
 China 3 29
 Japan 2 14
 Singapore 2 22
 USA 1 42
 United Kingdom 1 31
 Norway 1 27
 France 1 30
 Switzerland

India has a percentage underweight of children starkly greater than all other developed
countries in the chart, highlighting the fact that in India, malnutrition is huge issue, especially
from ages 5-19.
Even though BMI is widely utilized to determine the nutrition of a country, the actual nutrient
intake is a more conclusive method.
During childhood, nutrition plays a critical role in development as it is responsible for both
physical and mental growth. Proper caloric, protein, vitamin and mineral consumption
constitutes healthy growth in adolescents.
The Mayo clinic9 shows the required calories and proteins a child from ages 4-18 should take,
with differing age groups, and Kaiser Permanente10 shows us the percentage of carbohydrates
and fats a child should consume. The table below collates this information:
 Table 5: Nutrient Distribution for Children’s Balanced diet
 Age group Protein(g) Carbohydrates(g) Fats(g) Calories(kcal)
 4-8(Male) 85-100 150-250 33.3-55.6 1,200-2,000
 4-8(Female) 85-100 150-225 33.3-50.0 1,200-1,800
 9-13(Male) 110-170 200-325 44.4-72.0 1,600-2,600
 9-13(Female) 110-170 175-275 38.9-61.0 1,400-2,200
 14-18(Male) 160-200 250-400 55.6-88.0 2,000-3,200
 14-18(Female) 110-170 225-300 50.0-66.0 1,800-2,400

In India, caloric intake may be sufficed by an Indian meal which mainly comprising of rice.
However, the same is not true for protein content. According to Forbes India, the Indian Market
Research Bureau’s 201711 report states that protein deficiency among Indians stands at more
than 80%. A general diet consists of 1 cup of dal, 1 glass of milk, and 1 cup of yoghurt. To get
to the daily requirement of proteins, one would be forced to eat numerous bowls of dal or drink
a several glasses of milk a day.
Nevertheless, The Central Government created the “Mid-Day Meal Rules”, in September
2015, under the National Food Security Act, 2013. These Rules state that hot cooked meals
provided to children shall be evaluated and certified by the Government Food Research
Laboratory or any other laboratory accredited or recognized by law to ensure that the meals
meet prescribed nutritional standards and quality. The Mid-Day Meal Guidelines prescribe the
following nutritional content to achieve the objectives of the Scheme in the “Mid-Day Meals”:

9
 (Mayo Clinic Staff)
10
 (Staff)
11
 (Khandelwal and Kavishwar)

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Table 6: Table taken from the Indian Government’s Mid-day Meals Guidelines 12

 Items For children of Primary For children of Upper Primary
 classes classes
 A) Nutritional Norms (Per child per day)
 Calorie(kcal) 450 700
 Protein(g) 12 20
 B) Food Norms (Per child per day)
 Food-grains(g) 100 150
 Pulses(g) 20 30
 Vegetables(g) 50 75
 Oil & fat(g) 5 7.5
 Salt & condiments As per need As per need

On the other hand, when this is compared to the dietary mandate of a developed country, in
this instance, the United States of America, a more holistic description is seen.

 Table 7: Table taken from USDA School Diet Composition 13
 Food Group Amount in the 2000-Calorie-level
 Pattern
 Vegetables 2.5 cups/day
 Fruits 2.0 cups/day
 Grains 6.0 oz/day
 Dairy 3.0 cups/day
 Protein 5.5 cups/day
 Nuts, seed 5.0 oz/day
 Oils 27.0 g/day

After looking at all these aspects, nutrition in India is insufficient at the current moment of
writing. Therefore, to test whether a wholesome nutritional plan can be implemented, this study
aims to rework the diets of the children residing at Thayi Mane.

Methods
Thayi Mane is a home for destitute children whose mission is to provide free education,
housing, and food to improve the impoverished community around them.
For the purpose of this experiment, the BMI of the children residing at Thayi Mane was
calculated using primary data collected on site on 22-Nov-2019 which included a sample size
of 74 subjects ranging from ages 7-20 years (Sex ratio of males to females – 29:45).

12
 (School Education | Government of India, Ministry of Human Resource Development)
13
 (2015-2020 Dietary Guidelines for Americans)

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In addition, the diet of the children was also collected in the form of a menu and was broken
down using secondary data collected from nutrient databases such as nutritiondata14,
nutritionvalue15 and Nutritionix16.
The data was then processed and analysed to find short-comings in their diets.
Note: The caloric intake was calculated by taking the caloric value of carbohydrates, protein,
and fats as 4 kcal/g, 4 kcal/g, and 9 kcal/g respectively. The prescribed amount of intake for
proteins, carbohydrates, fats, fibre, vitamin C, iron, calcium, and calories per day is on average
100g, 200g, 50g, 25g, 100%, 100%, 100% and 2000 kcal respectively.

Results
Part 1 - Body Mass Index
The Body Mass Index is a conventional way of looking at the relative healthiness of an
individual. As established above, a suitable BMI differs from males to females and differs for
ages below 18. Therefore, a data set compromising of age, sex, weight, and height to effectively
evaluate the BMI of the children was collected at Thayi Mane. (Names redacted and ages given
in ranges to ensure privacy of the subjects)
 Table 8: BMI for Children Residing at Thayi Mane
 ID Number Age Range (years) BMI Sex
 1 10-15 14.8 Female
 2 10-15 17.7 Female
 3 10-15 20.5 Female
 4 10-15 18.1 Female
 5 10-15 16.9 Female
 6 10-15 20.2 Female
 7 10-15 17.7 Female
 8 5-10 14.9 Female
 9 10-15 22.0 Female
 10 10-15 18.0 Female
 11 5-10 20.7 Female
 12 15-20 20.2 Female
 13 10-15 23.9 Female
 14 10-15 17.3 Female
 15 5-10 15.9 Female
 16 10-15 16.1 Female
 17 10-15 17.1 Female
 18 10-15 18.9 Female
 19 10-15 14.3 Female
 20 5-10 16.8 Female
 21 10-15 19.8 Female
 22 5-10 12.8 Female
 23 10-15 18.8 Female
 24 5-10 14.1 Female

14
 (SELF Nutrition Data | Food Facts, Information & Calorie Calculator)
15
 (Nutritional Values For Common Foods And Products)
16
 (“Nutritionix - Largest Verified Nutrition Database”)

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25 10-15 16.6 Female
26 10-15 18.4 Female
27 10-15 27.9 Female
28 10-15 18.4 Female
29 10-15 22.6 Female
30 15-20 21.3 Female
31 10-15 21.9 Female
32 10-15 15.5 Female
33 10-15 16.6 Female
34 10-15 15.4 Female
35 10-15 20.5 Female
36 10-15 17.4 Female
37 10-15 19.8 Female
38 10-15 17.2 Female
39 10-15 22.3 Female
40 10-15 17.9 Female
41 10-15 15.5 Female
42 10-15 16.1 Female
43 10-15 19.8 Female
44 10-15 14.7 Female
45 10-15 19.1 Female
46 10-15 15.8 Male
47 5-10 14.3 Male
48 10-15 15.0 Male
49 10-15 14.7 Male
50 10-15 16.4 Male
51 10-15 17.0 Male
52 10-15 17.4 Male
53 10-15 14.9 Male
54 5-10 15.1 Male
55 5-10 14.4 Male
56 10-15 16.5 Male
57 5-10 13.4 Male
58 10-15 14.0 Male
59 5-10 15.4 Male
60 10-15 20.0 Male
61 10-15 17.3 Male
62 10-15 17.2 Male
63 10-15 17.8 Male
64 10-15 15.2 Male
65 10-15 18.8 Male
66 10-15 21.7 Male
67 10-15 14.5 Male
68 10-15 18.4 Male
69 10-15 18.9 Male
70 10-15 21.2 Male
71 10-15 14.8 Male
72 10-15 19.2 Male
73 10-15 16.1 Male
74 10-15 19.2 Male

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Analysis
To calculate the BMI, the following formula used:
 ℎ ( )
 = (1)
 [ ℎ ( )]2

The BMI was then compared with table 2 and 3 to identify the distribution of children in the
weight categories:
 Table 9: Distribution of BMI For Children Residing at Thayi Mane
 Weight Category Boys(number) Girls (number) Total
 Underweight 5 2 7
 Normal 24 41 65
 Overweight 0 1 1
 Obese 0 1 1
 Total 29 45 74

Part 2 – Nutrition Composition
To obtain conclusive data to implement a suitable nutrition system, the diets of the children
were taken and broken down to nutritional estimates provided by nutritiondata17,
nutritionvalue18 and Nutritionix19.
 Table 10: Menu for Food at Thayi Mane
 Days Wakeup Breakfast Lunch Dinner
 Monday Milk Avalakki Bath Rice, Sambar, Rice, Sambar,
 Hesaru Kalu Butter Milk Butter Milk
 Tuesday Malt Vangi Bath Rice, Sambar, Horsegrampayla,
 Butter Milk Rice, Sambar,
 Butter Milk
 Wednesday Almond Milk Bisibele Bath Rice, Sambar, Raggimudde, Egg,
 Butter Milk Rice, Sambar,
 Buttermilk
 Thursday Milk Seviya Bath Rice, Sambar, Chapati, Avare
 Madike Kalu Butter Milk Palya, Rice,
 Sambar, Butter
 Milk
 Friday Malt Puliyogare Rice, Sambar, Lemon rice, Chatni,
 Butter Milk Rice, Sambar,
 Butter Milk
 Saturday Almond Milk Pongal, Banana Rice, Sambar, Vegetable Bath,
 Butter Milk Rice, Sambar,
 Butter Milk
 Sunday Milk Dosa/idli, Egg masala,Rice, Speacial Meals,
 Chatni, Sambar Sambar, Butter Puribhaji, Ghee
 Milk Rice, Sambar,
 Butter Milk

17
 (SELF Nutrition Data | Food Facts, Information & Calorie Calculator)
18
 (Nutritional Values For Common Foods And Products)
19
 (“Nutritionix - Largest Verified Nutrition Database”)

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Each food item was mapped to its corresponding Carbohydrate, Protein, Fat, and essential
 Vitamin & Mineral content.
 Table 11: Nutrient Distribution for Each Food Item
Dish Protein(g) Carbohyd Fats(g) Fibre(g) Calcium Vitamin Iron Calories
 rates(g) (%) C (%) (kcal)
Sambar 7.1 26.0 0.7 7.3 4.1 57.0 17.0 130

Rice 4.3 45.0 0.4 0.6 1.2 0.0 1.8 205

Butter Milk 8.1 12.0 2.2 0.0 22.0 4.1 0.7 98

Egg (per 5.5 0.3 4.2 0.0 1.9 0.0 4.3 63
piece)
Milk 8.5 12.0 4.7 0.0 24.0 4.1 0.7 125

Malt 1.3 15 0.0 0.0 1.0 0.0 1.1 67
(tbsp)
Almond 1.1 8.1 2.5 0.6 1.6 0.0 1.1 56
milk
Cooked 2.9 35.0 0.2 0.0 0.3 0.0 2.0 158
Avalakki/Po
ha
Hesaru 14.0 39.0 0.8 15.0 4.2 3.4 16.0 212
Kalu/Mung
Bean
Vangi Bath 3.8 35.6 7.8 3.5 4.3 111.0 13.3 224
(130g)
Bisi bele 6.5 39.0 4.5 5.5 3.2 178 9.6 214
Bath
Seviya Bath 5.0 32.0 3.0 2.0 0.0 0.0 0.0 100
( 100g)
Madike 9.0 22.0 0.6 0.0 2.0 18.0 18.0 106
Kalu/sprout
ed lentil
(100g)
Puliyogare 7.4 51.0 13.0 2.5 3.0 55.0 7.0 344

Pongal 7.3 54.0 8.1 3.8 2.2 1.0 10.0 319

Banana(per 1.3 27.0 0.4 3.1 0.5 17.0 1.7 105
piece)
Dosa (per 3.9 29.0 3.7 0.9 0.4 0.6 4.7 168
piece)
Idli(per 1.6 12.0 0.4 0.5 0.8 0.2 3.3 58
piece)
Chatni(tbsp 0.6 1.7 1.4 0.5 0.5 9.9 0.8 21
)
Horsegramp 8.0 20.0 0.0 2.0 4.0 0.0 6.0 110
ayla/horse
gram(35 g)

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Raggimudd 3.0 21.0 7.2 1.0 1.0 0.0 6.0 160
e(per ball)
Chapati(per 3.1 18.0 3.7 3.9 1.1 0.0 4.9 120
piece)
Avare Palya 20.0 8.0 0.0 0.0 4.0 7.0 4.0 44

Lemon rice 4.9 43.0 2.9 0.3 0.8 3.6 3.9 221

Vegetable 2.0 21.0 16.0 1.0 4.0 15.0 8.0 161
Bath
Ghee Rice 7.0 54.0 10.0 1.0 1.0 0.0 4.0 336

Puribhaji 12.0 92.0 23.0 10.0 12.0 77.0 40.0 608

 After collecting this data, the nutrient intake for each day was tallied to understand the
 distribution of the diet.
 Table 12: Distribution of Nutrients by Day
 Day Protein Carbohydrates Fats Fibre Calcium Vitamin Iron Calories
 (g) (g) (g) (g) % C% % (kcal)
 Monday 64.4 252.0 12.3 30.8 83.1 129.7 57.7 1361
 Tuesday 52.1 236.6 14.4 21.3 63.9 233.2 59.4 1267
 Wednesday 55.1 234.4 25.0 22.9 62.3 300.2 60.0 1359
 Thursday 84.6 258.0 18.6 21.7 85.7 151.3 66.6 1361
 Friday 48.3 233.7 21.0 18.8 59.1 187.1 47.9 1298
 Saturday 50.7 276.1 33.6 24.3 62.9 155.2 59.8 1507
 Sunday (excluding 80.9 348.0 54.3 35.4 98.1 271.0 112.0 2170
 special meals)

 Table 13: Percentage of Nutrients Consumed by Day

 Percentage Prescribed Consumed
 Day Protein Carbohydrates Fats Fibre (g) Calcium Vitamin Iron Calories
 (g) (g) (g) % C% % (kcal)
 Monday 64.4 126.00 24.6 123.2 83.1 129.7 57.7 68.05
 Tuesday 52.1 118.30 28.8 85.2 63.9 233.2 59.4 63.35
 Wednesday 55.1 117.20 50.0 91.6 62.3 300.2 60.0 67.95
 Thursday 84.6 129.00 37.2 86.8 85.7 151.3 66.6 68.05
 Friday 48.3 116.85 42.0 75.2 59.1 187.1 47.9 64.90
 Saturday 50.7 138.05 67.2 97.2 62.9 155.2 59.8 75.35
 Sunday (excluding
 special meals) 80.9 174.00 108.6 141.6 98.1 271.0 112.0 108.5
 Average
 62.3 131.30 51.2 100.1 73.6 204.0 66.2 73.70

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Table 14: Average Percentage Prescribed Consumed Excluding Sunday
 Protein Carbohydrates Fats (g) Fibre Calcium Vitamin Iron % Calories
 (g) (g) (g) % C% (kcal)
 59.2 124.2 41.6 93.2 69.5 192.8 58.6 67.9

Analysis
Indian food makes use of a variety of spices, citric vegetables, and fruits. The meals prepared
contain tomatoes hence, the vitamin C content surpasses the 2000 calorie recommended diet
by 104% with an average of 204% (including Sunday) consumed daily.
The daily carbohydrate intake is also sufficed with a consumption of 131.3% daily average due
to rice playing an overpowering role in the diet as the children at Thayi Mane have rice at least
twice a day.
The consumption of protein in their diet is scarce as the children only consume 62.3% of the
recommended amount. This is due to a vegetarian diet, which doesn’t include meat- a major
source of protein.
The meals on Sunday meet the required amount of nutrients per day with all the above nutrients
other than protein being sufficient. The analysis of the other nutrients is done without the
consideration of Sunday’s diet to get a better idea of the overall nutritional intake
Iron is only supplied at 58.6% of the prescribed amount, and calcium, a mineral required for
bone development, is also low with subjects only obtaining 69.5% of the prescribed amount
for their diet. This due to a lack of vegetables, milk, and meat as they are the main sources of
iron and calcium.
Fats, a key source of energy, is also under consumed with an average intake of 41.6% of the
prescribed amount. In a conventional balanced diet, energy is mainly obtained from fats and
carbohydrates. As carbohydrates are present with 124.2% on days excluding Sunday, the
reason why the caloric intake is at 67.9% is because of the lack of lipids in the diet
The amount of dietary fibers in their diet consumed is closest to the recommended amount as
they take in 93.2% of the current recommendations of a daily diet. This is due to the
consumption of seeds and pulses in their diet.
To sum up, every nutrient in their diet is scarce other than carbohydrates, vitamin C and dietary
fiber.
Evaluation
The above analysis shows that there is a possibility for improvement for the meals currently
administered at Thayi mane. However, the analysis has some flaws to keep in mind:
The entire calculation of nutrition composition is done through a website. These values may be
imprecise as well as inaccurate as the nutrition for each item varies with how it is made and the
variety of spices and condiments and vegetables would be variable. For example, rice could be
of different brands or the exact nutrition facts of the rice are unknown as it changes with
different times of harvest and place of harvest. Likewise, for sambar, the exact quantity of

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vegetable and powder used as well as the type of dal used is extremely variable, causing a
plethora of uncertainties.
Nevertheless, the exact information of how much each child consumes is unknown, leading to
uncertainties. For example, one child could have half a cup of rice while another has several
cups, resulting in fluctuations from child to child. Hence, this entire study is done as analysing
them a as a group and not as individuals.
Post-Study Work
After locating a nutrient deficit in the children’s diet due a lack of vegetables, an ongoing
supply of organic vegetables to the household for no cost was sourced from Maple Tree - an
organic farm - under their Corporate Service Requirement (CSR). This system has been
implemented since the month of February 2020 and is ongoing to the date of writing.
Conclusion
The BMI of the children in the household is in line with international standards as out of the
74 children, 9 children are outside of the suitable range, resulting in 87.8% of the children being
healthy. This is contradictory to the idea that India is malnourished. However, this is not
entirely the case. BMI does not include the idea of a balanced diet which is essential to
determine the quality of the nutrition. Therefore, the BMI acts as an indicator and cannot act
as conclusive evidence.
For this study, 7 major nutrients were considered: carbohydrates, proteins, fats, fibre, vitamin
C, iron, and calcium. During adolescence, growth is fostered by proteins, iron and calcium
which are responsible for muscle and bone growth as well as red blood cell formation. Energy
is also a necessity for them and, therefore, carbohydrates and fats are considered. In addition,
at that stage of growth, having a good immune system is a necessity. Vitamin C is known to
boost the immune response and, hence, it is also considered in this study. Finally, fibre is
considered because roughage is a necessary part of nutrition.
By evaluating the nutrition from the menu at Thayi Mane, it is found that on Sunday’s diet, all
nutrients are in ample quantity with an average of 140.9% of the prescribed amount met.
However, if Sunday is disregarded, a more holistic perspective is seen. Carbohydrates, fibre,
and vitamin C are met with an average of 124.2%, 93.2% and a 192.8% of the prescribed
amount. Within the other nutrients, protein, fats, iron, and calcium were all under consumed
with 59.2%, 41.6%, 58.6%, and 69.5% taken of the prescribed amount respectively.
In peroration, in India, there is a deficit in nutrients barring carbohydrates which hinders the
nutrition of its citizens. To combat this, an ample supply of vegetables and meat is required.
However, as an Indian diet is mainly vegetarian, green leafy vegetables need to be supplied to
improve nutrition in India.
Acknowledgements
I would like to thank Thayi Mane for allowing me to study the problem and improve the overall
nutrition for the children in the home. I would like to thank Mr Abhinandan for coordinating
and ensuring that the study was possible.

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