Breaking the inter-generational cycle of malnutrition with focus on adolescent girls

By Dr. Jaideep Malhotra

For any country to do well as far as the health of its population is concerned, the focus has to be at the right points of breaking the intergenerational cycle of Malnutrition. According to UNICEF, almost 80% of the adolescent girls in India have malnourishment of one or the other kind. This can account for almost 63 million adolescent girls, who will be future mothers and almost 12 million become pregnant before they even leave their teens. 30% of our babies are born with low birth weight. Today we do understand that the Fetal origins of adult diseases (FOAD) hypothesis suggests that risk factors from intrauterine environmental exposure (under & over nutrition) affects the fetal development during sensitive periods & increases the risk of specific diseases (NCDs) in adult life.

We do understand that “Womens deprivation in terms of nutrition and health care rebounds on society in the form of ill-health of their offsprings-males and females alike” Siddiq Osmani and Amartya Sen.

The fundamental cornerstone of a womans’ health is adequate nutrition at every stage of life and Nutritional insult at any stage can wreak havoc on their health and our future generations. There is enough evidence to suggest that children of undernourished mothers are more likely to have impaired cognition, shorter height and bone health, anemia, low resistance and higher risk of disease and death.

Adolescents are more vulnerable to malnutrition because of various reasons, like faster growth spurts, more demands to meet the increased needs of this fast growing body of proteins, carbohydrates, essential vitamins and micronutrients and on top of it with menstruation the loss of blood dictates increased demand for Iron. The effects of undernutrition of female child results in alteration of epigenetics in adolescent girls and could affect next two generations. Really don’t know, which is the right age group for efficient interventions, is it inutero, or early childhood or adolescent age group? Though I am convinced, Inutero is the best time, as that lays a good foundation for the early years to later life, but on hind sight if you think that if we really have to break the vicious cycle of intergenerational under Nutrition and prevent fetal origin of adult diseases, then we have to catch them at every stage wherever possible and young adolescents might be a good stage for nutritional interventions.

To bring in these changes, Governments and other agencies should be working together to build up policies and strategies to reduce malnutrition in this age group and this would definitely have far reaching repercussions not only on the growth and development of adolescents,but also influence the quality of life and future health of our generations.

Adolescent & child hood care (ACE) programme should aim at addressing them on these 10 points (NUTRITION : HEALTH : VACCINATION). It takes only the will and structured focussed approach to achieve these goals and spreading awareness, in a cumulative way amongst parents, teachers and children. Sound advise and subtle nudging at a very young age from school itself can bring about a lot of mindset changes and is worth trying.

Adolescent care endeavour 10/10 check list for parents.

1. Encourage eating wholesome breakfast
2. Discourage foods high on sugar, fat, salt to avoid weight gain
3. Instill habit of drinking 6-8 glasses water or fresh juices
4. Ensure regular sound sleep for 8hrs (Not too much, not too less)
5. Monitor school performance daily
6. Be observant to change in behaviour; have to talk
7. Know & stay connected with friends
8. Ensure 3 visits to paediatrician per year before 10 years age for complete check up
9. Vaccinate boys & girls
10. Specific vaccination for girls (Rubella & H.P.V.)

A young girls nutrition should be complete with nutrition for brain development (DHA, Choline, Iodine & folic acid) for growth (Proteins, Calcium, Vit D, Carbohydrates and fats) for immunity (Vitamins C, E & Zinc & B-Complex) for healthy digestion F.O.S. (Fructooligosaccharides) (Dietary fibre)

An under / over nourished adolescent girl will have numerous health issues (PCOS, Insulin resistance, increased adiposity, decreased B cells, fertility issues, metabolic issues, cardiovascular diseases, under weight her obesity). And these will have longterm repercussions and health implications may be transmitted to offsprings as a epigenetic trigger to the bad genes which may effect future generations.

So, Adolescent period is our great window of opportunity to break this intergenerational malnutrition cycle.

“Women’s deprivation in terms of nutrition and health care rebounds on society in the form of ill-health of their offspring — males and females alike.”

— SIDDIQ OSMANI AND AMARTYA SEN

To have a healthy nation ,we must address Adolescent Malnutrition and fortified foods & supplements to our growing girls and also encourage them for good physical activity.

(The author has done MD, FICMCH, FICOG, FICS, FMAS, FIAJAGO, FRCOG and FRCPI, and is Managing Director ART-Rainbow IVF & Global Rainbow Healthcare. Views expressed are personal.)