nutritional surveys and its evaluation

NUTRITONAL SURVEYS AND ITS EVALUATION

DR Jj

7

CONTENTS• Introduction

• Nutrition

• Nutritional survey

• Need for nutritional surveys

• Methods of assessment of Nutritional status

• Nutritional surveys in different countries and its results

• Nutritional surveys in India

• Major nutritional programs in India

• Conclusion

• References

INTRODUCTION

• Nutrition is the science that interprets the interaction of

nutrients and other substances in food in relation to

maintenance, growth, reproduction, health and disease of an

organism.

• A nutritional survey is a method by which information is

obtained concerning the nutritional status of a population or a

subgroup. Such information is collected by asking nutrition

related questions in an interview to a representative sample of

the population.

• Surveys to assess dietary intake and nutritional status of the

population are essential to monitor ongoing nutrition transition

and initiate appropriate interventions.

• The nutritional status of an individual is often the result of

many inter-related factors.

• It is influenced by food intake, quantity & quality, & physical

health.

• The spectrum of nutritional status spread from obesity to

severe malnutrition.

Need for Nutritional Surveys

• Identify individuals or population groups at risk of becoming

malnourished.

• Identify individuals or population group who are malnourished.

• To develop health care programs that meet the community needs

which are defined by the assessment.

• To measure the effectiveness of the nutritional programs &

intervention once initiated.

IN INDIA

• After over 60 years of independence, India has the dubious

distinction of having one of the highest prevalence (over 50%)

of under nutrition (as judged by stunting,wasting, and

micronutrient deficiencies like anaemia, vitamin A deficiency

and others), in the world.

• Being a country in developmental transition, the post-

transition, lifestyle and environment-related diseases like

obesity, diabetes, hypertension, CVD, and cancers are also

increasing.

• Individuals born with low birth weight due to intrauterine

malnutrition tend to be more susceptible to the above

mentioned adult- onset degenerative diseases.

• Every third child is born with low birth weight, and may have

impaired mental and physical development and immunity.

• Intra-uterine malnutrition epigenetically predisposes to

cardiovascular diseases in later life. Almost 60% of deaths due

to major infectious diseases are caused by coexistence of

undernutrition.

• In the meantime post-transition life-style related diseases like

obesity and chronic degenerative diseases are increasing. Over

10% Indians are overweight or obese, the incidence being

almost 20% in urban areas.

• Apart from human suffering caused due to morbidity and

mortality, malnutrition, is severely denting India’s productivity

and development, and adding to health expenditure.

NUTRITIONAL SURVEYS

• In nutritional surveys, it is not necessary to examine all the

persons in a given community.

• Examination of a random and representative sample of the

population covering all ages and both sexes in different

socioeconomic groups is sufficient to be able to draw valid

conclusions.

Methods of Nutritional Assessment

• Nutrition is assessed by two types of methods; direct and

indirect.

• The direct methods deal with the individual and measure

objective criteria, while indirect methods use community

health indices that reflects nutritional influences.

Direct Methods of Nutritional Assessment

These are summarized as ABCD

• Anthropometric methods• Biochemical, laboratory methods• Clinical methods• Dietary evaluation methods

Indirect Methods of Nutritional Assessment

These include three categories:

• Ecological variables including crop production.

• Economic factors e.g. per capita income, population density &

social habits.

• Vital health statistics particularly infant & under 5 mortality &

fertility index.

CLINICAL ASSESSMENT

• It is an essential features of all nutritional surveys.

• It is the simplest & most practical method of ascertaining the

nutritional status of a group of individuals.

• It utilizes a number of physical signs, that are known to be

associated with malnutrition and deficiency of vitamins &

micronutrients.

CLINICAL ASSESSMENT

• ADVANTAGES

– Fast & Easy to perform

– Inexpensive

– Non-invasive

• LIMITATIONS

– Did not detect early cases

Clinical signs of nutritional deficiency

HAIRProtein, zinc, biotindeficiency

Spare & thin

Protein deficiency Easy to pull out

Vit C & Vit Adeficiency

CorkscrewCoiled hair


MOUTHRiboflavin, niacin, folic acid, B12 Glossitis

Vit. C,A, K, folic acid & niacin Bleeding & spongy gums

B 2,6,& niacin Angular stomatitis, cheilosis & fissured tongue

Vit.A,B12, B-complex, folic acid & niacin

leukoplakia

Vit B12,6,c, niacin ,folic acid & iron

Sore mouth & tongue


EYES

Vitamin A deficiency Night blindness, exophthalmia

Vit B2 & vit Adeficiencies

Photophobia-blurring, conjunctival inflammation


NAILS

Iron deficiency Spooning

Protein deficiency Transverse lines


SKINFolic acid, iron, B12 Pallor

Vitamin B & Vitamin C Follicular hyperkeratosis

PEM, Vit B2, Vitamin A, Zinc & Niacin

Flaking dermatitis

Niacin & PEM Pigmentation, desquamation

Vit K ,Vit C & folic acid Bruising, purpura


Thyroid gland• in mountainous areas and far

from sea places Goiter is a reliable sign of iodine deficiency.


Joins & bones• Help detect signs of vitamin D

deficiency (Rickets) & vitamin C deficiency (Scurvy)

Anthropometric Methods• It is an essential component of clinical examination of infants,

children & pregnant women.

• It is used to evaluate both under & over nutrition.

• The measured values reflects the current nutritional status &

don’t differentiate between acute & chronic changes .

Anthropometry for children

• Accurate measurement of height and weight is essential. The

results can then be used to evaluate the physical growth of the

child.

• For growth monitoring the data are plotted on growth charts

over a period of time that is enough to calculate growth velocity,

which can then be compared to international standards.

Repeated Surveys

Growth Monitoring

Sentinel Site Surveillance

School Census Data

• Four main data collection methodologies that provide anthropometric information are :

They include: national surveys, and small-scale surveys.

REPEATED SURVEYS

They analyze a representative sample of the population, and assess:

type, severity, extent of malnutrition.

Anthropometry

Repeated surveys are population-based surveys.

The sites may be specific population groups or villages that cover populations at risk.

It can be: centrally-based sentinel site surveillance, or community-based sentinel site surveillance.

SENTINEL SITE SURVEILLANCEAnthropometry

Sentinel site surveillance involves surveillance in a limited number of sites, to detect trends in the overall well-being of the population.

SCHOOL CENSUS DATAAnthropometry

School census data relates to nutritional assessment occasionally undertaken in schools.

The most common deficiencies are: • Iodine, • vitamin A, and• iron

Clinical examination and biochemical testing

Biochemical testing and clinical examination can contribute to diagnosing micronutrient deficiencies.

LABORATORY AND BIOCHEMICAL ASSESSMENT

• (a) LABORATORY TESTS :

• (i)Haemoglobin estimation : Haemoglobin level is a useful

index of the overall state of nutrition irrespective of its

significance in anaemia.

• (ii) Stools and urine : Stools should be examined for intestinal

parasites. History of parasitic infestation, chronic dysentery

and diarrhoea provides useful background information about

the nutritional status of persons.

• Urine should also be examined for albumin and sugar.

BIOCHEMICAL TEST

• Biochemical tests are time - consuming and expensive. They

cannot be applied on a large scale. They are often carried out on

a subsample of the population.

• Most biochemical tests reveal only current nutritional status;

they are useful to quantify mild deficiencies.

• If the clinical examination has raised a question, then the

biochemical tests may be invoked to prove or disprove the

question raised.

GROWTH MONITORING

It can be performed at the individual level, or at a group level. It can also be:

clinic-based growth monitoring

community-based growth monitoring

Measurements for adults

• Height:

• The subject stands erect & bare footed on a stadiometer with a

movable head piece. The head piece is leveled with skull vault

& height is recorded to the nearest 0.5 cm.

WEIGHT MEASUREMENT

• Use a regularly calibrated electronic or balanced-beam scale.

Spring scales are less reliable.

• Weigh in light clothes, no shoes.

Nutritional Indices in Adults• The international standard for assessing body size in adults is the

body mass index (BMI).

• BMI is computed using the following formula: BMI = Weight

(kg)/ Height (m²)

• Evidence shows that high BMI (obesity level) is associated with

type 2 diabetes & high risk of cardiovascular morbidity &

mortality.

FSC

BMI (WHO - Classification)

BMI < 18.5 = Under Weight

BMI 18.5-24.5= Healthy weight range

BMI 25-30 = Overweight (grade 1

obesity)

BMI >30-40 = Obese (grade 2 obesity)

BMI >40 =Very obese (morbid or

grade 3 obesity)

Waist/Hip Ratio

• Waist circumference is measured at the level of the umbilicus

to the nearest 0.5 cm.

• The subject stands erect with relaxed abdominal muscles, arms

at the side, and feet together.

• The measurement should be taken at the end of a normal

expiration.

Waist circumference• Waist circumference predicts mortality better than any other

anthropometric measurement.

• It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified.

• MALES FEMALE• LEVEL 1 > 94cm > 80cm• LEVEL 2 > 102cm > 88cm

Waist circumference

• Level 1 is the maximum acceptable waist circumference

irrespective of the adult age and there should be no further

weight gain.

• Level 2 denotes obesity and requires weight management to

reduce the risk of type 2 diabetes & CVS complications.

Hip Circumference • Is measured at the point of greatest circumference around hips

& buttocks to the nearest 0.5 cm.

• The subject should be standing and the measurer should squat

beside him.

• Both measurement should taken with a flexible, non-

stretchable tape in close contact with the skin, but without

indenting the soft tissue.

Interpretation of WHR

• High risk WHR= >0.80 for females & >0.95 for males i.e.

waist measurement >80% of hip measurement for women and

>95% for men indicates central (upper body) obesity and is

considered high risk for diabetes & CVS disorders.

• A WHR below these cut-off levels is considered low risk.

DIETARY ASSESSMENT

• Nutritional intake of humans is assessed by five different methods.

These are:

– 24 hours dietary recall

– Food frequency questionnaire

– Dietary history since early life

– Food dairy technique

– Observed food consumption

• A diet survey may be carried out by one of the following methods :

• (i) WEIGHMENT OF RAW FOODS : This is the method

widely employed in India as it is practicable and if properly

carried out is considered fairly accurate.

• The survey team visits the households, and weighs all food

that is going to be cooked and eaten as well as that which is

wasted or discarded.

• The duration of the survey may vary from 1 to 21 days, but

commonly 7 days which is called "one dietary cycle“.

• (ii) WEIGHMENT OF COOKED FOODS : Foods should

preferably be analysed in the state in which they are normally

consumed, but this method is not easily acceptable among

people.

• (iii) ORAL QUESTIONNAIRE METHOD : This is useful

in carrying out a diet survey of a large number of people in a

short time.

• Inquiries are made retrospectively about the nature and

quantity of foods eaten during the previous 24 or 48 hours.

24 Hours Dietary Recall

• A trained interviewer asks the subject to recall all food &

drink taken in the previous 24 hours.

• It is quick, easy, & depends on short-term memory, but may

not be truly representative of the person’s usual intake.

Food Frequency Questionnaire• In this method the subject is given a list of around 100 food

items to indicate his or her intake (frequency & quantity) per day,

per week & per month.

• inexpensive, more representative & easy to use.

DIETARY HISTORY

• It is an accurate method for assessing the nutritional status.

• The information should be collected by a trained interviewer.

• Details about usual intake, types, amount, frequency & timing

needs to be obtained.

• Cross-checking to verify data is important.

FOOD DAIRY• Food intake (types & amounts) should be recorded by the

subject at the time of consumption.

• The length of the collection period range between 1-7 days.

• Reliable but difficult to maintain.

Observed Food Consumption

• The most unused method in clinical practice, but it is recommended

for research purposes.

• The meal eaten by the individual is weighed and contents are exactly

calculated.

• The method is characterized by having a high degree of accuracy but

expensive & needs time & efforts.

Interpretation of Data

1. Qualitative Method

• using the food pyramid & the basic food groups method.

• Different nutrients are classified into 5 groups (fat & oils,

bread & cereals, milk products, meat-fish-poultry,

vegetables & fruits)

• determine the number of serving from each group &

compare it with minimum requirement.

Interpretation of Dietary Data/2

2. Quantitative Method

• The amount of energy & specific nutrients in each food

consumed can be calculated using food composition tables &

then compare it with the recommended daily intake.

• Evaluation by this method is expensive & time consuming,

unless computing facilities are available.

NUTRITIONAL SURVEYS

Belgium• ELANGermany • Nationale Verzehrstudie• Nutrition and Cancer RiskFrance: • Enquête Individuelle et Nationale des Consommations

Alimentaires (INCA)• Individuelle Nationale des Consomations Alimentaires 2 (INCA

2)• CRÉDOC 2009U.K. • The National Diet and Nutrition SurveysU.S. • NHANES

• The ELAN (Etude Liègeoise sur les Antioxydants) cohort study,

performed in the province of Liège, Belgium, in 2006, was the first

large-scale trial investigating the relationship between oxidative

stress status and the lifestyle of 897 people aged 40–60 years.

• For this purpose, information on the participants’ age, occupation,

height, weight, blood pressure, smoking habits, alcohol and drugs

consumption, waist circumference and physical activity was

collected.

• In the same time, all participants completed a food

questionnaire at home in order to evaluate their daily intake of

fruit and vegetables.

• According to tables of diet composition, a score reflecting the

daily consumption of both vitamin C and beta-carotene was

established. In addition, plasma concentrations of the

antioxidants were measured in blood samples.

RESULTS

• Men had a lower antioxidant status than women (in agreement with

the French SUIVMAX study).

• 6% of the population were classified as clearly vitamin C deficient

(plasma levels below 3.5 micrograms/ml), and another 10.3% were

identified to be sub-deficient (levels below 6.2 micrograms/ml).

• For beta-carotene the results were significantly worse: almost one

in two individuals (46.6%) was found to be beta-carotene deficient

(levels below 0.22 micrograms/ml).

• 20 years after the last representative survey was carried out in the

western part of Germany before reunification (Nationale

Verzehrstudie I, 1985-1988) the Federal Minister for Food,

Agriculture and Consumer Protection commissioned the Federal

Research Centre for Nutrition and Food to conduct a second

national nutrition survey.

• In 2007, the Nationale Verzehrsstudie II (NVS II) provided

information on the nutrient and energy intake of almost 20,000 14 to

80-year-old Germans, their current food consumption, and on lifestyle

and eating behavior.

• Two reports with the results were published in 2008: the first report

dealing with the description of the participants, and data on health and

lifestyle aspects, and a second report about the food and nutrient intake

data.

RESULTS

• 87.4% of those surveyed do not meet the recommendations of the

German Society for Nutrition (Deutsche Gesellschaft für Ernährung

– DGE) of 400 g/day for vegetable consumption.

• 59% of those surveyed do not consume the amount of fruit

recommended by the DGE (250 g/day).

• 16% of study participants had not eaten fish or food containing fish

in the four weeks preceding the survey.

• 82% of men and 91% of women do not meet the

recommendations for vitamin D consumption. This is

particularly true of young adults and senior citizens.

• 79% of men and 86% of women do not meet the

recommendation for consumption of vitamin B9(folic acid).

• The percentages rise with increasing age.

• The results of the 2008 Nutrition Report confirm the

recommendations of the DGE for a balanced diet in respect of

cancer prevention.

• It should be rich in vegetables and fruit (for adults 400 g of

vegetables and 250 g of fruit per day), and many fiber-rich cereal

products, combined with a moderate consumption of meat and

meat products (approximately 300 to 600 g/week).

• In particular, consumption of red meat should be reduced and

alcohol avoided.

• As part of the national survey on food consumption in France, 1,171

adults recorded their food consumption over seven days.

• Researchers analyzed the results of the study using a statistical

method to assess individual food preferences, individual dietary

patterns and restrictions imposed by food intolerances.

• They determined the percentage of people who could be provided

with 30 essential nutrients by modifying their food intake.

RESULTS• Mathematically, only 22% of the population could obtain all 30

nutrients from their habitual food intake.

• 78% need to add new foods to their diet to meet their nutritional

requirements.

• Women did not take in sufficient calcium, vitamin E or iron.

• Eggs, butter, cheese and foods rich in fat and sugar are the main

sources of vitamin D – foods which should all be consumed in

moderation because of their saturated fat, cholesterol, sugar and

salt content.

•

• The researchers concluded from this analysis that,

mathematically speaking, it is impossible for the great majority

of French adults to achieve an optimal diet with adequate

nutrient content without expanding the range of foods consumed.

• Such information could be useful to committees establishing

dietary recommendations.

• The National Diet and Nutrition Surveys (NDNS) are a series of

government-funded surveys of food intake, nutrient intake and

nutritional status of the British population (adults aged 16 to 64),

undertaken to support nutritional policy and risk assessment.

• In 2008, the UK Scientific Advisory Committee on Nutrition (SACN)

reviewed the latest NDNS, carried out between July 2000 and June

2001, to identify specific health outcomes where the population fails

to meet dietary recommendations and specific groups are at risk.

RESULTS

• Many girls between ages 11 and 19 were missing out on

nutrients they require to grow and develop as a result of not

having a balanced diet.

• Adults taking dietary supplements tended to be those with

higher intakes of these micronutrients from food. In other

words, those who could benefit most from the use of food

supplements are likely not to be taking them.

• In 2014, the combined results from the Years 1, 2, 3 and 4 of the

National Diet Nutrition Survey (NDNS) 2008/09 – 2011/12 were

published.

• The NDNS rolling program aims to provide quantitative data on the

food and nutrient intakes, sources of nutrients and nutritional status.

• The program is carried out in all four countries of the United

Kingdom (UK) and is designed to be representative of the UK

population.

RESULTS

• Adults aged 19 to 64 years on average consumed 4.1 portions of

fruit and vegetables per day, while adults aged 65 years and over

consumed 4.6 portions per day. Only 30% of adults and 41% of

older adults met the “5-a-day” recommendation.

• Mean consumption of fruit and vegetables for children aged 11 to 18

years was only 3.0 portions per day for boys and 2.7 portions per

day for girls. Only 10% of boys and 7% of girls in this age group

met the “5-a-day” recommendation.

• The National Health and Nutrition Examination Survey (NHANES)

is a program of studies designed to assess the health and nutritional

status of adults and children in the United States, and to track

changes over time.

• Findings from the survey are used to determine the prevalence of

major diseases and risk factors for diseases. Information is used to

assess nutritional status and its association with health promotion

and disease prevention.

• 93% of Americans had inadequate dietary intakes of vitamin E.

• The number of individuals with inadequate intakes was also high

for vitamin A (44%) and vitamin C (31%).

• The prevalence of inadequacy was also high for magnesium (56%).

• For some nutrients, intakes were inadequate only for certain segments

of the population: vitamin B6 for females over 50 years of age, and

zinc for males and females over 70 years of age and females 14–18

years of age.

• In India, routine reporting of nutritional status by the health

and social welfare functionaries is suboptimal.

• India has therefore invested heavily in periodic surveys to

obtain data on nutrition transition.

• Given its size and variation it is important that at least state

level data are available .

• In view of the known interdistrict variations in the same state

and the current emphasis on decentralised district based

planning, implementation and monitoring of intervention

programmes, efforts are currently under way to collect and

report district specific data where ever possible.

• There have been several small scale surveys of health/nutrition in India

but the data from these may not be representative of the country as a

whole. The two major national surveys which provide data related to

nutrition and covering large sections of India's population are:

• (i) the surveys carried out by the National Nutrition Monitoring

Bureau (NNMB) of the National Institute of Nutrition, Hyderabad.

• (ii) the National Family Health Survey (NFHS).

National Nutrition Monitoring Bureau (NNMB)

• Recognizing the need for good quality data for monitoring

nutritional status, ICMR in 1972 established the National Nutrition

Monitoring Bureau (NNMB) in the National Institute of Nutrition

(NIN), Hyderabad.

• Since 1973, surveys carried out by the NNMB have been a major

source of data on diet and nutritional status of the Indian

population.

The objectives of NNMB

• To collect data on dietary intake and nutritional status of the

population in the states of India on a continuous basis.

• To monitor the ongoing national nutrition programmes and to

recommend mid course corrections to improve their

effectiveness.

• From 1974 to 1981 annual surveys were carried out in each of

the 10 states on a probability sample of a total of about 500

households each year (rural and urban).

• The households were selected from four representative

districts. Villages were selected in proportion to the

population; households were selected to represent different

socio economic categories in each village.

• In 1983, NNMB linked its sampling frame to that of the

National Sample Survey Organization (NSSO) because the

NSSO sampling frame was more representative.

• In subsequent years a sample of about 750 households in rural

areas and 250 households in the urban areas of each of the ten

states have been surveyed.

• NNMB had carried out surveys in 1975-79, 1980-85, 1988-90,

1996-97, 2000-01 and 2004-05 in rural areas and in 1975-79 and

1993-94 in urban areas.

• In 2000, using data from the above surveys, NNMB produced

separate reports on dietary intake and nutritional status of

adolescents (10 to 17 years of age) and elderly (60+ years).

• India has a large tribal population and hence a special tribal survey

has been carried out by NNMB during the years 1985-87 and the

first repeat survey of this sample was done in 1998-99.

Nutrition intervention programs

• Applied Nutrition programme in the states of Kerala, Uttar

pradesh, Maharashtra, Orissa, Himachal Pradesh and Manipur

(1977-78).

• Vit.A Prophylaxis programme in the states of AP, Gujarat,

Karnataka, Kerala, MP and West Bengal (1977-78).

• Supplimentary Nutrition programme in urban Karnataka

(1980-81).

• Impact evaluation of mid-day meal programme in the states of

AP, Gujarat, Orissa TN, Karnataka and Kerala (1991-92).

• World food programme assisted supplementary nutrition

programme in Bihar, Gujarat, Kerala, MP, Maharashtra,

Orissa, Rajasthan, UP and West Bengal (1981-82).

National Family Health Survey (NFHS)

• Three National Family Health Surveys NFHS-1 conducted in

1992–93, NFHS-2 conducted in 1998–99 and NFHS-3 conducted

in 2004-05 provide national and state-level information on fertility,

family planning, infant and child mortality, reproductive health,

child health, nutrition of women and children, and the quality of

health and family welfare services.

• NFHS-3 collected information from a nationally representative

sample of 124,385 women age 15-49 and 74,369 men age 15-54

in 109,041 households.

• NFHS-3 included biomarker tests for HIV and anaemia, based

on blood collected from eligible respondents.

• Blood samples were collected in every state except Nagaland

(where local opposition prevented the collection of blood

samples).

RESULTS

• Within India, states like Kerala and Tamil Nadu have

relatively better nutrition parameters than states with higher

calorie intake (MP) or economic growth (Gujarat,

Maharashtra) suggesting that the situation is more complex

than mere access to food or income, important as they are.

• There is no reduction in the prevalence or severity of Anemia.

• Non-dietary factors also influence nutrition status. Under

nutrition reduces immunity and infections reduce appetite,

impair absorption and lead to catabolic losses of precious

nutrients.

• Thus access to clean environment and drinking water to

prevent infections are areas of great concern.

• There are marked interstate variations with some of the southern

states, mainly Kerala, and Tamil Nadu, which were traditionally better,

continuing to be better than states like Bihar, Madhya Pradesh, Uttar

Pradesh, Rajasthan, and Orissa.

• Interestingly, the National Family Health Surveys show that the State

of Jammu and Kashmir has shown some improvement in women’s

health as judged by decline in anaemia from 60% to 54% between

1995-96 and 2005-06, whereas in all other states anaemia in women

has remained unchanged or increased over the same period.

• At the other end of the spectrum, overweight and obesity are

increasing.

• According to recent surveys of the National Nutrition

Monitoring Bureau in 9 states, 7.8% men and 10.9% women are

overweight or obese when a cut off value of BMI 25 is used.

• However, currently a lower BMI of 23 is suggested since above

that the susceptibility to hypertension increases.

• The proportion of children under age five years who are

underweight ranges from 20 percent in Sikkim and Mizoram

to 60 percent in Madhya Pradesh.

• In addition to Madhya Pradesh, more than half of young

children are underweight in Jharkhand and Bihar. Other states

where more than 40 percent of children are underweight are

Meghalaya, Chhattisgarh, Gujarat, Uttar Pradesh, and Orissa.

•

• In Meghalaya, Madhya Pradesh, and Jharkhand, more than

one in every four children is severely underweight.

• Although the prevalence of underweight is relatively low in

Mizoram, Sikkim, and Manipur, even in those states more than

one-third of children are stunted.

• Wasting is most common in Madhya Pradesh (35 percent),

Jharkhand (32 percent), and Meghalaya (31 percent).

• After NFHS 3 in 2005-06, the field work for NFHS-4 is currently

on. After data collection there is the laborious and time-consuming

process of checking data quality, verifying data, cross checking and

then analysis.

• The data is not expected before the end of this year and district level

data from it might not be available till well into 2016.

• The first round of NFHS survey took place in 1992-93, the second

round in 1998-99 and the third round in 2005-6.

CURRENT GOVERNMENT RESPONSE

• Successive Five year plans since 1950s laid down the policies,

multi-pronged strategies and multi, and inter-sectoral

programmes to improve availability, and access to food, and

facilitate absorption and assimilation.

• Such nutrition safety net programmes for increasing

availability, and access to food nutrition and improving

assimilation.

• Government has initiated several nutrition 'safety net programmes’ such

as:

• 1. Rashtriya Krishi Vikas Yojana–Increased investment in agriculture

to increase growth.

• 2. National horticulture mission. Horticulture production has

doubled. However,focus is on income and export, rather than nutrition.

• 3. National food security mission. Focus is on rice, wheat and pulses.

CONCLUSION

• Information on factors such as food security, livelihoods, and

health and care practices is usually necessary to interpret

nutritional status data and determine the likely causes of

malnutrition.

• Information on nutritional status, combined with the analysis

of underlying causes, will provide the understanding needed to

select the appropriate intervention.

REFERENCES

• Park K. Park’s textbook of preventive and social medicine.

• http://www.ars.usda.gov/Services/docs.htm?docid=7674 • Schleicher R. L. et al. Serum vitamin C and the prevalence of vitamin C

deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr, August 2009.

• • http://www.ars.usda.gov/vitD_ca_phos_mg_2005-06.

• http://www.cdc.gov/NutrionalSurveys

• Pincemail J. et al. Impact of lifestyle factors on plasma levels of vitamin C and beta-carotene in the ELAN cohort study (Liège, Belgium). SFRR Meeting, Rome, 2009; Free Radical Res. 43(1).

• Department of Women and Child Development. 1995-96. Indian Nutrition Profile. Government of India, New Delhi

• Indian Council of Medical Research. 1989. Nutrient Requirements and Recommended Dietary allowances for Indians. New Delhi

• National Family Health Survey (NFHS-1): http://www.nfhsindia.org/india1.html

• National Family Health Survey (NFHS-2): http://www.nfhsindia.org/india2.html

• National Family Health Survey (NFHS-3): http://mohfw.nic.in/nfhsfa • NNMB National Nutrition Monitoring Bureau. 1979-2002. NNMB

Reports: National Institute Of Nutrition, Hyderabad • National Institute of Nutrition. 2004. Nutritive Value of Indian Foods.

Hyderabad. • National Sample Survey Organization NSSO. 1975-2000.;

http://mospi.nic.in/mospi_nsso_rept_pubn.htm•

nutritional surveys and its evaluation

Healthcare