**1. Introduction**

*'Good nutrition allows children to survive, grow, develop, learn, play, participate and contribute—while malnutrition robs children of their futures and leaves young lives hanging in the balance'*.

Adequate Nutrition is essential for human development. Malnutrition includes both undernutrition as well as over-nutrition and refers to deficiencies, excesses or imbalances in the intake of energy, protein and/or other nutrients. Benefits of good health are perceived not only at the individual level but also at the level of society and country level as well. Health of an individual is determined by interplay of various factors like social factors, economic factors, dietary factors, lifestyle related factors, environmental factors, government policies and political commitment, etc. [1]. Foundation of an individual's health is laid in early phase of life. It is a well-known fact that in some developing nations, India being one of them, nearly half of children under 5 years of age succumb to death every year due to poor nutrition. It is quite difficult for the poor to bear the cost of treatment

especially suddenly occurring out-of-pocket expenditures [2]. A dissimilar trend is observed among individuals of affluent society. Sedentary habits coupled with unhealthy food habits results in weight gain in them. Health experts refer these conditions as malnutrition. The irony is, India being the world's second largest food producer and yet is also home to the large number of undernourished children in the world.

either be due to inadequate intake or an excess intake of calories. The term malnu-

*Stunting* refers to a child who is too short for his or her age. These children can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating effects of stunting can last a lifetime and even affect the

*Wasting* refers to a child who is too thin for his or her height. Wasting is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is

*Overweight* refers to a child who is too heavy for his or her height. This form of malnutrition results from energy intakes from food and beverages that exceed children's energy requirements. Overweight increases the risk of diet-related

Malnutrition is a universal problem that has many forms. No country is untouched. It affects all geographies, all age groups, rich people and poor people and all sexes. All forms of malnutrition are associated with various forms of ill health and higher levels of mortality. Undernutrition explains around 45% of deaths

As far as adverse effects of child malnutrition are concerned, growth failure and infections are quite important. Malnourished children do not attain their optimum potential in terms of growth and development, physical capacity to work and economic productivity in later phase of life. It is commonly observed that school absenteeism is much higher in such child that leads to poor performance in the class. Cognitive impairment resulting from malnutrition may result in diminished productivity. Apart from these, Undernutrition increases the risk of infectious diseases like diarrhoea, measles, malaria and pneumonia and chronic malnutrition can impair a young child's physical and mental development. As per estimates of World Bank, childhood stunting may result in a loss of height among adults by 1%, which may further lead to a reduction in individuals economic productivity

Micronutrient deficiencies can lead to poor health and development, particularly

Malnutrition is also a social and economic problem, holding back development across the world with unacceptable human consequences. Malnutrition costs billions of dollars a year and imposes high human capital costs—direct and indirect on individuals, families and nations. Estimates suggest that malnutrition in all its forms could cost society up to US\$3.5 trillion per year, with overweight and obesity alone costing US\$500 billion per year [5]. The consequences of malnutrition are increases in childhood death and future adult disability, including diet-related

in children. Overweight and obesity can lead to diet-related noncommunicable diseases such as heart disease, high blood pressure (hypertension), stroke, diabetes

among children under-5, mainly in low and middle-income countries.

trition covers two broad groups of conditions namely undernutrition and overnutrition. One is 'undernutrition'—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). Another one is overweight, obesity and diet-related non-communicable

diseases (such as heart disease, stroke, diabetes and cancer).

next generation.

*Childhood Malnutrition in India*

*DOI: http://dx.doi.org/10.5772/intechopen.89701*

non-communicable diseases later in life.

**4. Why childhood malnutrition matters to us?**

possible.

by 1.4% [4].

and cancer.

**11**

It is well acknowledged that investment in human resource development is a pre requisite for any nation to progress. In year 2012, while releasing HUNGaMA (Hunger and Malnutrition) Report-2011, the then prime minister of India, Dr. Manmohan Singh, expressed dismay at the 'unacceptably high' levels of malnutrition despite high and impressive GDP growth and said it was a matter of 'national shame'. He, being renowned economist, also expressed that that 'the health of our economy and society lies in the health of this generation [3]. We cannot hope for a healthy future for our country with a large number of malnourished children'.

India is home to 46.6 million stunted children, a third of world's total as per Global Nutrition Report 2018. Nearly half of all under-5 child mortality in India is attributable to undernutrition. Children of today are citizens of tomorrow, and hence improving nutritional status of children becomes extremely important. Early childhood constitutes the most crucial period of life, when the foundations are laid for cognitive, social and emotional, language, physical/motor development and cumulative lifelong learning.

Recently Millennium Development Goals (MDGs) has been transformed into Sustainable Developmental Goals (SDGs) and maternal & child health (MCH) has received attention in the last two decades as never before. Adequate nutrition has always been a definitive tool for achieving the maternal and child heath targets. Nutrition is defined as the science of food and its relationship with health. Nutrition is a basic human need and a prerequisite for a healthy life. A proper diet is essential from the very early stages of life for growth, development and for a state of overall well-being. Food consumption, which largely depends on production and distribution, determines nutrition and health of the population. Apart from supplying nutrients, food provides other components (non-nutrient phytochemicals), which have a positive impact on health.

#### **2. Methods for the literature review**

We searched PubMed, Google search engine and other databases on the internet for relevant literature. We searched reference lists of all primary and review articles based on the key words 'childhood malnutrition, determinants, diarrheal diseases, India, problem burden, intervention strategies and control program'. Apart from that database of government run nutritional programmes, critical review and analysis of these programmes and related published books were also studied. At few instances, stakeholders of nutritional programmes were also consulted. Relevant data was collected, summarized and analysed.

#### **3. Meaning of malnutrition**

Malnutrition is a term that refers to any deficiency, excess or imbalance in somebody's intake of energy and/or nutrients. In simple words, malnutrition can

#### *Childhood Malnutrition in India DOI: http://dx.doi.org/10.5772/intechopen.89701*

especially suddenly occurring out-of-pocket expenditures [2]. A dissimilar trend is observed among individuals of affluent society. Sedentary habits coupled with unhealthy food habits results in weight gain in them. Health experts refer these conditions as malnutrition. The irony is, India being the world's second largest food producer and yet is also home to the large number of undernourished children in

It is well acknowledged that investment in human resource development is a pre

requisite for any nation to progress. In year 2012, while releasing HUNGaMA (Hunger and Malnutrition) Report-2011, the then prime minister of India, Dr. Manmohan Singh, expressed dismay at the 'unacceptably high' levels of malnutrition despite high and impressive GDP growth and said it was a matter of 'national shame'. He, being renowned economist, also expressed that that 'the health of our economy and society lies in the health of this generation [3]. We cannot hope for a healthy future for our country with a large number of malnour-

India is home to 46.6 million stunted children, a third of world's total as per Global Nutrition Report 2018. Nearly half of all under-5 child mortality in India is attributable to undernutrition. Children of today are citizens of tomorrow, and hence improving nutritional status of children becomes extremely important. Early childhood constitutes the most crucial period of life, when the foundations are laid for cognitive, social and emotional, language, physical/motor development and

Recently Millennium Development Goals (MDGs) has been transformed into Sustainable Developmental Goals (SDGs) and maternal & child health (MCH) has received attention in the last two decades as never before. Adequate nutrition has always been a definitive tool for achieving the maternal and child heath targets. Nutrition is defined as the science of food and its relationship with health. Nutrition is a basic human need and a prerequisite for a healthy life. A proper diet is essential from the very early stages of life for growth, development and for a state of overall well-being. Food consumption, which largely depends on production and distribution, determines nutrition and health of the population. Apart from supplying nutrients, food provides other components (non-nutrient phytochemicals), which

We searched PubMed, Google search engine and other databases on the internet for relevant literature. We searched reference lists of all primary and review articles based on the key words 'childhood malnutrition, determinants, diarrheal diseases, India, problem burden, intervention strategies and control program'. Apart from that database of government run nutritional programmes, critical review and analysis of these programmes and related published books were also studied. At few instances, stakeholders of nutritional programmes were also consulted. Relevant

Malnutrition is a term that refers to any deficiency, excess or imbalance in somebody's intake of energy and/or nutrients. In simple words, malnutrition can

the world.

ished children'.

cumulative lifelong learning.

*Perspective of Recent Advances in Acute Diarrhea*

have a positive impact on health.

**2. Methods for the literature review**

data was collected, summarized and analysed.

**3. Meaning of malnutrition**

**10**

either be due to inadequate intake or an excess intake of calories. The term malnutrition covers two broad groups of conditions namely undernutrition and overnutrition. One is 'undernutrition'—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). Another one is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and cancer).

*Stunting* refers to a child who is too short for his or her age. These children can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating effects of stunting can last a lifetime and even affect the next generation.

*Wasting* refers to a child who is too thin for his or her height. Wasting is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible.

*Overweight* refers to a child who is too heavy for his or her height. This form of malnutrition results from energy intakes from food and beverages that exceed children's energy requirements. Overweight increases the risk of diet-related non-communicable diseases later in life.

## **4. Why childhood malnutrition matters to us?**

Malnutrition is a universal problem that has many forms. No country is untouched. It affects all geographies, all age groups, rich people and poor people and all sexes. All forms of malnutrition are associated with various forms of ill health and higher levels of mortality. Undernutrition explains around 45% of deaths among children under-5, mainly in low and middle-income countries.

As far as adverse effects of child malnutrition are concerned, growth failure and infections are quite important. Malnourished children do not attain their optimum potential in terms of growth and development, physical capacity to work and economic productivity in later phase of life. It is commonly observed that school absenteeism is much higher in such child that leads to poor performance in the class. Cognitive impairment resulting from malnutrition may result in diminished productivity. Apart from these, Undernutrition increases the risk of infectious diseases like diarrhoea, measles, malaria and pneumonia and chronic malnutrition can impair a young child's physical and mental development. As per estimates of World Bank, childhood stunting may result in a loss of height among adults by 1%, which may further lead to a reduction in individuals economic productivity by 1.4% [4].

Micronutrient deficiencies can lead to poor health and development, particularly in children. Overweight and obesity can lead to diet-related noncommunicable diseases such as heart disease, high blood pressure (hypertension), stroke, diabetes and cancer.

Malnutrition is also a social and economic problem, holding back development across the world with unacceptable human consequences. Malnutrition costs billions of dollars a year and imposes high human capital costs—direct and indirect on individuals, families and nations. Estimates suggest that malnutrition in all its forms could cost society up to US\$3.5 trillion per year, with overweight and obesity alone costing US\$500 billion per year [5]. The consequences of malnutrition are increases in childhood death and future adult disability, including diet-related

non-communicable diseases (NCDs), as well as enormous economic and human capital costs [6]. According to UNICEF, one in three malnourished children in the world is Indian. It is estimated that reducing malnutrition could add some 3% to India's GDP.

motor development, impaired brain function and poor school performance, as it

In present era malnutrition is reflected as double burden, one aspect is undernutrition and other being overnutrition. But, in India and other low and

middle-income countries (LMICs), basically malnutrition is synonymous with protein energy malnutrition or undernutrition, which signifies an imbalance between the supply of protein and energy and the body's demand for them to ensure optimal

Globally, approximately 149 million children under-5 suffer from stunting. In 2018, over 49 million children under-5 were wasted and nearly 17 million were severely wasted. There are now over 40 million overweight children globally, an increase of 10 million since 2000 [8]. (**Figures 1**–**3**) It is estimated that by 2050,

India is one among the many countries where child undernutrition is severe and also undernutrition is a major underlying cause of child mortality in India. Pattern

The prevalence of underweight children under age 5 was an indicator to measure progress towards MDG 1, which aims to halve the proportion of people who suffer from hunger between 1990 and 2015. For India, this would imply a reduction in the child underweight rate from 54.8% in 1990 to 27.4% in 2015. Sustainable development

25 million more children than today will be malnourished [9].

of stunting prevalence among Indian districts is shown in **Figure 4**.

often causes these negative impacts.

*DOI: http://dx.doi.org/10.5772/intechopen.89701*

**7. Magnitude of problem**

*Childhood Malnutrition in India*

growth and function.

**7.1 Global scenario**

**7.2 Indian scenario**

**Figure 1.**

**13**

*Global burden of malnourished under-5 children [8].*
