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      Food deprivation among adults in India: an analysis of specific food categories, 2016–2021

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          Summary

          Background

          Adult undernourishment remains pervasive throughout India, and often results from food deprivation, which refers to the inadequate consumption of foods with caloric and nutrient significance. Therefore, understanding the extent to which food groups are missing from an individual's diet is essential to understanding the extent to which they are undernourished.

          Methods

          We used data from two National Family Health Surveys conducted in 2016 and 2021 for this cross-sectional analysis. The study population consisted of women and pregnant women between the ages of 15–49, and men between the ages of 15–54. We examined shifts in the percentage of people not consuming dairy, pulses/beans/legumes, dark leafy green vegetables, fruits, eggs, and fish and meat among women, pregnant women, and men between the two time points. We also examined these patterns by household wealth and education, two important markers of socioeconomic status.

          Findings

          Overall, we found that fewer women, pregnant women, and men were not eating each of the six food groups in 2021 than in 2016. Additionally, the gap in food group consumption between women, pregnant women, and men in the lowest and highest socioeconomic groups shrank between 2016 and 2021. Yet, food group deprivation remained most prevalent among those in the lowest socioeconomic groups. The two exceptions for this were for eggs and meat/fish. Nevertheless, the majority of India's poorest and least educated adults are not consuming high-quality protein sources, including dairy, the consumption of which is far more common among wealthier and more educated Indian adults.

          Interpretation

          Our results show that fewer adults were not consuming important food groups in 2021 than in 2016. However, many of India's poorest and least educated adults are still not consuming high-quality sources of protein or fruits, two food groups that are essential for good health. While adults might be getting protein and nutrients from pulses, legumes, beans, and other vegetables, efforts are needed to improve affordability of, and access to, high-quality sources of protein and fruits.

          Funding

          This work was supported by the doi 10.13039/100000865, Bill & Melinda Gates Foundation; , INV- 002992.

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          Most cited references39

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          Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

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            What works? Interventions for maternal and child undernutrition and survival.

            We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.
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              The role of protein in weight loss and maintenance.

              Over the past 20 y, higher-protein diets have been touted as a successful strategy to prevent or treat obesity through improvements in body weight management. These improvements are thought to be due, in part, to modulations in energy metabolism, appetite, and energy intake. Recent evidence also supports higher-protein diets for improvements in cardiometabolic risk factors. This article provides an overview of the literature that explores the mechanisms of action after acute protein consumption and the clinical health outcomes after consumption of long-term, higher-protein diets. Several meta-analyses of shorter-term, tightly controlled feeding studies showed greater weight loss, fat mass loss, and preservation of lean mass after higher-protein energy-restriction diets than after lower-protein energy-restriction diets. Reductions in triglycerides, blood pressure, and waist circumference were also reported. In addition, a review of the acute feeding trials confirms a modest satiety effect, including greater perceived fullness and elevated satiety hormones after higher-protein meals but does not support an effect on energy intake at the next eating occasion. Although shorter-term, tightly controlled feeding studies consistently identified benefits with increased protein consumption, longer-term studies produced limited and conflicting findings; nevertheless, a recent meta-analysis showed persistent benefits of a higher-protein weight-loss diet on body weight and fat mass. Dietary compliance appears to be the primary contributor to the discrepant findings because improvements in weight management were detected in those who adhered to the prescribed higher-protein regimen, whereas those who did not adhere to the diet had no marked improvements. Collectively, these data suggest that higher-protein diets that contain between 1.2 and 1.6 g protein · kg(-1) · d(-1) and potentially include meal-specific protein quantities of at least ∼25-30 g protein/meal provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes; however, further strategies to increase dietary compliance with long-term dietary interventions are warranted.
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                Author and article information

                Contributors
                Journal
                eClinicalMedicine
                EClinicalMedicine
                eClinicalMedicine
                Elsevier
                2589-5370
                20 November 2023
                December 2023
                20 November 2023
                : 66
                : 102313
                Affiliations
                [a ]Boston University School of Public Health, 715 Albany St. Boston, MA, 02118, USA
                [b ]Tata Trusts, R.K. Khanna Tennis Stadium, Africa Avenue, New Delhi, India
                [c ]Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea
                [d ]Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
                [e ]Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
                [f ]Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea
                Author notes
                []Corresponding author. Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA. svsubram@ 123456hsph.harvard.edu
                Article
                S2589-5370(23)00490-X 102313
                10.1016/j.eclinm.2023.102313
                10679480
                38024478
                e2cd67ab-4a08-4e9e-8a04-49b81906a011
                © 2023 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 3 August 2023
                : 27 October 2023
                : 27 October 2023
                Categories
                Articles

                food deprivation,india,food group consumption,adult food consumption,national family health survey

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