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Slow Progress in Achieving Global Nutrition Targets: Lancet Study

 A recent Lancet study evaluating global progress on the Global Nutrition Targets (GNTs) from 2012 to 2021 has highlighted the slow progress in addressing maternal and child malnutrition, undernutrition, and overweight.

The findings underscore concerns regarding policy design and the need for innovative strategies to address these persistent issues.

What are Global Nutrition Targets (GNTs)?

In 2012, the World Health Assembly endorsed a Comprehensive Implementation Plan on maternal, infant, and young child nutrition, which set six global nutrition targets for 2025:

  1. Achieve a 40% reduction in the number of children under 5 who are stunted.
  2. Achieve a 50% reduction in anaemia in women of reproductive age.
  3. Achieve a 30% reduction in low birth weight.
  4. Ensure no increase in childhood overweight.
  5. Increase the rate of exclusive breastfeeding in the first 6 months to at least 50%.
  6. Reduce and maintain childhood wasting to less than 5%.

Key Terms

  • Malnutrition: An imbalance between the nutrients the body needs and the nutrients it receives, including both undernutrition (such as stunting, wasting, and underweight) and overnutrition (such as overweight and obesity), which together pose a dual burden on public health.
  • Anaemia: A condition where there is a shortage of red blood cells or haemoglobin, reducing oxygen supply to tissues, primarily affecting women and children.

Key Findings of the Study

  • Slow and Insufficient Progress: From 2012 to 2021, progress in meeting the GNTs has been slow and insufficient across 204 countries. Projections for 2050 suggest limited success in achieving these targets.

    • Few countries are expected to meet the stunting targets for children under 5.
    • No country is projected to meet targets for low birth weight, anaemia, and childhood overweight by 2030.

  • Anaemia in India: Anaemia prevalence in India has remained static for two decades, with iron deficiency accounting for only one-third of cases. Other unknown causes contribute significantly to the remaining cases. The COVID-19 lockdown led to an increase in anaemia prevalence when school meal schemes were disrupted, highlighting the need for broader nutrition strategies. Additionally, discrepancies in anaemia measurement methods in India were noted, with venous blood-based measurements showing lower prevalence compared to capillary blood-based measurements used in national surveys.

  • Stunting: Stunting typically develops in the first two years of life, with rates increasing from 7-8% at birth to 40% by age two in India. Overfeeding children after age two may lead to overweight rather than correcting stunting. Poor children in India consume only 7 grams of fat per day, far below the recommended 30-40 grams.

  • Childhood Overweight: Overweight in children is rising globally, including in India. This contributes to "metabolic overnutrition," increasing the risk of chronic diseases such as non-communicable diseases. In India, 50% of children face metabolic overnutrition, contributing to these health risks.

Recommendations

  • Diversify diets to address anaemia, as it is not solely caused by iron deficiency.
  • Focus on preventing stunting in the first two years of life.
  • Improve energy intake, particularly fat intake, for children under three.
  • Adopt more accurate and context-specific methods for measuring anaemia and stunting.
  • Address both undernutrition and overnutrition in policy to prevent non-communicable diseases.

Challenges in Achieving GNTs

  • Global:

    • Persistent Anaemia: Anaemia remains a global issue, particularly in low-income countries, rural areas, and among uneducated populations. There is a lack of targeted policies and awareness.
    • Slow Progress on Stunting: Despite efforts, the number of stunted children is expected to reach 127 million by 2025, far above the target of 100 million.
    • Rising Overweight and Obesity: The prevalence of overweight and obesity is increasing, particularly among children under 5, and is influenced by urbanization, dietary changes, and reduced physical activity.
    • Childhood Wasting: Affects approximately 45 million children under 5 globally, with challenges in preventing it due to food insecurity, limited healthcare, and poor sanitation.

  • India:

    • Limited Dietary Diversity: Diets in India often lack diversity, dominated by rice, wheat, and cereals, with insufficient intake of fruits, vegetables, dairy, and proteins. This limits access to essential micronutrients.
    • Economic Barriers: Low incomes and high food prices prevent many from affording a nutritious diet.
    • Inadequate Data: The absence of comprehensive national surveys on dietary diversity hampers targeted interventions.
    • Non-Communicable Diseases: Rising diet-related diseases, such as obesity, diabetes, and hypertension, add strain to the healthcare system, requiring a focus on both under- and over-nutrition.
    • Food Systems Constraints: Climate change and extreme weather events threaten food security, impacting crop yields and food availability.

India’s Initiatives Related to Nutrition

  • Mission Poshan 2.0
  • Integrated Child Development Services (ICDS) Scheme
  • Pradhan Mantri Matru Vandana Yojana (PMMVY)
  • Mid-Day Meal Scheme
  • Scheme for Adolescent Girls (SAG)
  • Mother’s Absolute Affection (MAA)
  • Poshan Vatikas

Way Forward

  • Policy Realignment: Incorporate region-specific dietary solutions in national programs like POSHAN Abhiyaan and promote initiatives like the National Millets Mission (NMM).
  • Set National-Level Targets: Establish baselines and annual reduction goals specific to country contexts.
  • Strengthen Resource Allocation: Mobilize resources to implement nutrition-sensitive programs.
  • Integrate Nutrition Across Sectors: Include nutrition outcomes in health, food systems, and water, sanitation, and hygiene (WASH) policies.
  • Strengthen Primary Healthcare: Enhance maternal and child nutrition services.
  • Develop Monitoring Mechanisms: Improve surveillance systems to track nutrition progress.
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