Background Malnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets. Methods We analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990-2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets. Findings Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68•2% (95% UI 65•8-70•7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17•3% (16•3-18•2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6•8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21•4% (20•8-21•9), child stunting 39•3% (38•7-40•1), child wasting 15•7% (15•6-15•9), child underweight 32•7% (32•3-33•1), anaemia in children 59•7% (56•2-63•8), anaemia in women 15-49 years of age 54•4% (53•7-55•2), exclusive breastfeeding 53•3% (51•5-54•9), and child overweight 11•5% (8•5-14•9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8•9% excess prevalence for low birthweight, 9•6% for stunting, 4•8% for underweight, 11•7% for anaemia in children, and 13•8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10•4% excess prevalence for wasting, 14•5% excess prevalence for overweight, and 10•7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states. Interpretation Malnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the...

Micronutrients play an important role in the proper growth and development of the human body and its deficiency affects the health contributing to low productivity and vicious cycle of malnutrition, underdevelopment as well as poverty. Micronutrient deficiency is a public health problem affecting more than one-fourth of the global population. Several programmes have been launched over the years in India to improve nutrition and health status of the population; however, a large portion of the population is still affected by micronutrient deficiency. Anaemia, the most common form of micronutrient deficiency affects almost 50 to 60 per cent preschool children and women, while vitamin A deficiency and iodine-deficiency disorders (IDD) have improved over the years. This review focuses on the current scenario of micronutrient (anaemia, vitamin A, iodine, vitamin B12, folate, ferritin, zinc, copper and vitamin C) status in the country covering national surveys as well as recent studies carried out.

Background: To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods: We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 £ 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Sociodemographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states. Findings: The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2À17.8) to 62.8% (95% UI 61.5À64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1À6.1) to 30.0% (95% UI 28.2À31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5À11.9) to 51.0% (95% UI 49.9À52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3À42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3À46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8À55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys. Interpretation: CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has inc...

Objective: The present study was conducted to assess the prevalence of hypertension in adult population residing in slums of West Delhi. Methods:A cross-sectional study was conducted among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured using digital machine (OMRON). The data obtained were analyzed for percent prevalence, mean, standard deviation, and median. Joint National Committee (JNC)on prevention, detection, evaluation, and treatment of high blood pressure (JNC)VI and JNC VII criteria were used to classify hypertension. Results:The overall prevalence of hypertension was 25.3%. The prevalence was higher (27.9%)in males than females (22.8%)and also in the age group 46-59 years (43.0%)as compared to 18-45 years (19.8%). The overall prevalence of prehypertension, Stage I and Stage II hypertension, respectively, was 35.2%, 16.1% and 9.2%. Conclusion:A one-fourth of the adult population is hypertensive. Early diagnosis and treatment are advisable, besides awareness about dietary and lifestyle modification.

The Global Hunger Index (GHI) is calculated and disseminated annually. India, which is the 5 th largest economy in the world and has a good ranking in many other indicators, has a poor ranking based on this index. After a critical review of the appropriateness of the indicators used in GHI, the Indian Council of Medical Research has the viewpoint that the indicators of undernourishment, stunting, wasting and child mortality do not measure hunger per se . Referring to this index as a Hunger Index, and thereby ranking countries is not appropriate, since many of the measures that are used to evolve an index that measures hunger are probably contextual. Countries should therefore evolve their own measures that are suitable for their own context.

Objective: The objective of this study is to assess the risk factors of hypertension among adults residing in urban slums of West Delhi. Methods:A cross-sectional study was carried out among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured twice using digital machine (OMRON). Height, waist circumference, and hip circumference were measured, weight was taken, and body mass index (BMI) was calculated. The Joint National Committee VII criteria were used to define hypertension, and the National Cholesterol Education Program and Adult Treatment Panel-III guidelines were used to define different categories of dyslipidemia. The World Health Organization (2014) criteria were used to classify the BMI. Results:The overall prevalence of hypertension among adults (n=423) was 25.3%. Among hypertensive adults, the prevalence of obesity was 22.7%, while among non-hypertensives, it was 10.9%. Similarly, overweight prevalence was higher (27.3%) in hypertensive adults compared to non-hypertensive adults (20.6%). The overall prevalence of hypercholesterolemia, hypertriglyceridemia, high-density lipoprotein-cholesterol <40/<50 mg/dl, and low-density lipoprotein-cholesterol (LDL-C) ≥130 was 19.7%, 33.7%, 75.7%, and 21.8%, respectively. The prevalence of hypercholesterolemia, hypertriglyceridemia, and serum LDL-C ≥130 mg/dl was 38%, 50%, and 32% among hypertensive adults, while among nonhypertensive adults, it was 15%, 29%, and 19%, respectively. Conclusion:Hypertensive adults had higher BMI, serum cholesterol, triglycerides, and LDL-C compared to non-hypertensives.

Objective: The objective of the present study was carried out to explore the potential association between fluoride concentration in drinking water and severity of dental fluorosis (DF) in the children. Methods:The study of DF in the children (6-14 years old) was conducted in the two blocks (a) Jamwa Ramgarh block in; Heerawala, Palera, Nayabas, Saipur and Birasana, (b) Amber block in; Jugalpura, Chitanukalan, Sunder ka bas, Peelwa and Sirsali of Jaipur district, Rajasthan, India of the study villages. Totally, 150 children were surveyed. The role of fluoride (F) levels in drinking water in the etiology of DF and the cases of DF in both dentitions and teeth were also assessed using Dean's classification. The fluoride (F) concentration in source of drinking water was estimated by fluoride (F) ion specific electrode (Thermo Scientific Orion Star A329, USA). Results:The F concentration in (Tube well and Hand pump) water ranges from 0.7 to 15.0 parts per million (ppm) in Jamwa Ramgarh block and 1.40-5. 10 ppm in Amber block. The prevalence of DF 27 (36%) in Jamwa Ramgar block and 26 (34.66%) in Amber block out of 75 children were examined in each block. Significantly increase in levels of F in drinking water is positively correlated with DF. Conclusion:This study finding has shown the relation of DF to high fluoride (F) levels in drinking water sources. A higher fluoride (F) levels in source of drinking water is a major risk factor for DF. In view of the severity of the problem, the intake of calcium-rich foods and defluoridation techniques may help reducing risk of DF in the children.

Objective: The present study was carried out to assess the prevalence of anemia, vitamin B 12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi. Methods:A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B 12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B 12 deficiency as serum Vitamin B 12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 µmol/l. Results:The overall prevalence of anemia, Vitamin B 12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B 12 deficiency and hyperhomocysteinemia, respectively. Conclusion:More than half of the elderly population was anemic, while one-third was having Vitamin B 12 deficiency.