Exclusive cereal-dependence

The ICDS programme launched inthe 1970s was based on the resultsof extensive surveys which identifiedrampant child under-nutrition inIndia. Using the weight-for-age andheight-for-age criteria, only 10 per centchildren under five could be classifiednormal. And 15-20 per cent were underweighteven when they were short.

The situation has not improved inthe past 35 years despite juggling withclassification. With a 500-600 calories(cal) deficit in energy intake, it is notsurprising there is unimaginable hungeramong Indian children. Over 70-80 percent of the calories consumed by childrenare derived from cereals and somepulses. The intake of other protectivefoods such as eggs, milk, fruits and oil isminimal. The reasons for this nutritionemergency are many but the mostimportant are undoubtedly poverty andinadequate diet.

A modified adult diet of cereals/gruel in inadequate amounts servesas the only complementary food forchildren in poor households. Thoughthe actual deficit in intake was around500 cal, and about 10 gm of protein,nutritionists decided on a supplementof 300 cal and 10 gm of proteins whenICDS was launched.

The early menus under the schemewere based on a cereals, pulses, groundnut,oil, milk powder and sugar combinationto fill the calorie gap; it was calledthe Hyderabad Mix. Deficits were notlaid out in terms of food, but in terms ofcalories and proteins, assuming recipeswould be adapted to regional tastes andtranslated into foods appropriate forchildren, like milk.

In the 1930s, W R Aykroyd, directorof the Nutrition Research Laboratoriesin Coonoor, realized the importance ofproteins, fats, vitamins and minerals fora child's growth. He wrote, "It is importantto work out diet schedules in such amanner that the non-cereal portion ofthe diet (milk, vegetables, fruits, andeggs) provide most of the essentialnutrients. Subsequently carbohydraterich foods such as rice, wheat and sugarcan be included."

He advocated milk for childrenbecause milk proteins are ideal forgrowth compared to cereal and pulseproteins. He even advocated replacingmilled rice with parboiled rice andadding oil or ghee in children's diet.

With this background, ICDS shouldhave included foods necessary for children'sgrowth. But this was not to be.Planners, bureaucrats and even nutritionistsreworked basic principles ofchild nutrition, and the mantra was'least cost diets'. Not surprisingly300 cal was constructed with cereals likerice and wheat with minimum pulse andjaggery. Even this was altered dependingon costs and the cynicism of the implementingauthorities. After all, about300 cal can be derived from any of thefollowing combinations: a) 50 gmof cereal, 10 gm of pulse and 10 gmsugar and 5 gm oil, b) 60 gm cereal, 10gm groundnut, 10 gm sugar,
c) 85 gm of rice or wheat, or even starch,
d) even 75 gm of sugar.

In the 1960s, nutritionists--upperclass, no doubt--abetted this crimeagainst poor hungry children by providing"laboratory evidence" in favour of"vegetarian sources of proteins", stating"a combination of vegetarian proteins(from cereal, pulse, milk) was nearly asgood as egg protein". Bureaucrats werenow free to create artificial diets providing300 cal, because proteins were safelyincluded in the cereals (cereals contain6-8 per cent protein). It was not theirfault, they remembered the operativeterm vegetarian and forgot about thenecessary combination of foods. In anycase, the money allocated to ICDS couldonly provide dalia (broken wheat)equivalent to 300 cal.

Children who desperately required aproper meal of eggs, milk, pulse andvegetables, were provided calories frombroken cereals. They are unable to consumedry unappetizing cereals to makeup for the calorie deficiency, because ofits sheer bulk, monotony and lack ofenergy density. (WHO recommends 40per cent calories must come from fatsand oils).

Providing double the ration of inediblecereals for the severely malnourishedonly made matters worse. It isknown undernourished children haveloss of appetite, infections and other illnesseswhich requires special diets, notdouble the ration of cereals.Unless proper food is providedmalnutrition in India can only get worsewith the present ICDS.

Veena Shatrugna retired as head of the clinical division, National Institute of Nutrition, Hyderabad, and is currently a consultant at the Indian Institute of Public Health, Hyderabad