Hyderabad: Till recently, nutritionists and researchers associated micronutrient deficiencies such as vitamins and minerals to malnutrition and poverty. The logic put forward was that people with limited financial resources find it difficult to access or afford micronutrients such as vitamins, iron, iodine etc.
However, in due course of time, it became quite clear that micronutrient deficiency was also common among individuals with substantial financial resources. There are a number of studies in the country including that of National Nutrition Monitoring Bureau (NNMB) of Indian Council of Medical Research (ICMR) that point towards severe macronutrient (which are proteins and carbohydrates) and micronutrient deficiencies among cross-section of the population. Considered a ‘magic wand’, micronutrients play a vital role in production of enzymes and hormones needed for growth and development of the body.
According to researchers, the reason for deficiency of micronutrients are too many and usually are related to diet, lifestyle, social and cultural issues. Many also blame the general lack of diversity in the food groups consumed by individuals as a reason for micronutrient deficiency.
In its latest study on micronutrients, published in the journal Nutrition in January, the Hyderabad-based National Institute of Nutrition (NIN) said that seemingly healthy individuals in the twin cities were falling prey to vitamin deficiencies and dietary inadequacies.
Although the respondents covered in the NIN study were just 300 from the twin cities, by and large, clinicians, nutritionists and the spate of research papers taken up in individual Indian States point towards a general trend of micronutrient deficiency among the population in India, irrespective of availability of financial resources.
According to World Health Organisation (WHO), micronutrients are needed to produce energy, proper functioning of the immune system and overall health of the body. Minerals, on the other hand are important for growth, bone health and are needed for other important bodily functions.
According to the NIN, vitamins and other micronutrients are essential for normal cellular and molecular functions, growth and maintenance of body tissues and their deficiency will risk factors for disease burdens in countries such as India.
The NNMB in its study, conducted across India covering a population of over one lakh and close to 50,000 households, said that the average intake of macronutrients such as proteins, carbohydrates and micronutrients such as iron, and other forms of vitamins are lesser than the Recommended Dietary Allowance (RDA) of individuals.
Vitamin D deficiency most common
Among all the micronutrients, Vitamin D deficiency among Indians is the most commonly talked and discussed among physicians, nutritionists and researchers. There are Hyderabad-based studies that have linked Vitamin D deficiency among patients directly to brain strokes, heart ailments and diabetes.
Vitamin D diagnostic tests and supplements are also the most commonly prescribed by doctors. Patients over 50 years with issues related to bone strength and diabetes are prescribed Vitamin D supplements regularly.
While supplements are prescribed frequently, there are, however, no studies in the city that have been successful in measuring the impact of Vitamin D supplements on patients who are on long term Vitamin D supplements.
Administering Vitamin D supplements is not just a phenomenon in Hyderabad but has been a trend across the globe. This over-dependence on dietary supplements by patients and doctors prompted doctors in Europe to take up a five-year long term study on 28,000 patients, which were published in New England Journal of Medicine (NEJM) last year.
According to the study, Vitamin D supplements were not better than a placebo for lowering risks of heart disease or cancer. While they may be of some use for individuals with low bone strength, the efficacy of Vitamin D supplements in prevention of other ailments was still open to discussion and interpretation.
The NEJM landmark study now put physicians, who earlier had based their prescriptions of dietary supplements on observational data, in a quandary. In the last few years, thanks to rampant use of Vitamin D, Omega 3 fatty acids, the dietary supplements industry flourished to a large extent in India.
Expert calls for focus on tackling deficiencies
Assistant Professor, Jayashankar Telangana State Agricultural University, and National Executive member, Indian Dietetic Association (IDA), Dr Janaki Srinath, while interacting with Telangana Today, says micronutrient deficiencies among the general population needs more exploration and focus from all stakeholders.
On micronutrient deficiency
We are so accustomed to consuming food of same texture and form that it is difficult to start making changes in dietary habits all of a sudden. Moreover, while researchers and scientists throw up studies on micronutrient deficiencies among the population, the challenge is to translate these studies and apply them for the benefit of the community. A diet plan replete with all macro and micro-nutrients will vary from person to person.
Basic changes in diet
The Indian population is used to consuming cereals and individuals at a personal level can add sprouts and even include 50 per cent unpolished or unprocessed grains. However, this must be done under the watchful eyes of trained nutritionists. People are accustomed to consuming one kind of food on a daily basis that a small chance in eating habit can trigger indigestion. So, one should not hesitate to take advice from a doctor or a nutritionist.
On dietary supplements
There can’t be one single solution for all kind of health related issues. A single nutrient in the form of a supplement can’t be a solution, as there will be multiple factors. There are studies that indicate that Indians are deficient in Vitamin D and in such situations, supplements can be useful. Nothing, however, can replace a balanced diet.
On fortification of rice, other cereals
There is a lot of talk about fortification of rice and other cereals with additional nutritive value and micronutrients, which is a good step forward. There are, however, questions over availability and affordability of fortified food grains among the general population. How many people will be able to afford and sustain fortified food products for a long time? There is also no clarity on how much fortification is needed and who needs it?