Association between anthropometric‐based and food‐based nutritional failure among children in India, 2015

Inadequate dietary intake is a critical underlying determinant of child
undernutrition. This study examined the association between anthropometricbased
and food-based nutritional failure among children in India. We used the
2015-2016 National Nutrition Monitoring Bureau data where anthropometric
outcomes and food intake were both measured for each child. We followed
the World Health Organization child growth reference standards to define
anthropometric failures (i.e., height-for-age z score < -2 SD for stunting,
weight-for-age z score < -2 SD for underweight, and weight-for-height
z score < -2 SD for wasting), and the Indian Council of Medical Research
recommended dietary allowance (RDA) to define adequacy in intake of calorie,
protein, and fat. We used descriptive and regression-based assessments to
test the association between the two indicators of nutritional failure and also
computed the area under the receiver operating characteristic curve (AUC).
The prevalence of stunting, underweight, and wasting was 28.6%, 24.3%,
and 12.8%, respectively, whereas 78.2%, 27.4%, and 50.8% of the children
had below RDA norms consumption of calorie, protein, and fat, respectively.
We found weak-to-null correlation between anthropometric failures and
food failures (Pearson correlation ranging from -0.013 to 0.147) and poor
discriminatory accuracy (AUC < 0.62), suggesting that in the Indian context,
anthropometric failures are not directly associated with food intake. This finding highlights the need for improving adequate intake of macronutrients
and draws attention toward adopting a multifactorial approach to improve
child nutrition in India. Poor food intake itself merits exclusive policy focus as
it is an important nutrition and health concern.