A typology of dietary and anthropometric measures of nutritional need among children across districts and parliamentary constituencies in India, 2016

Anthropometry is the most commonly used approach for assessing
nutritional need among children. Anthropometry alone, however, cannot
differentiate between the two immediate causes of undernutrition:
inadequate diet vs disease. We present a typology of nutritional need by
simultaneously considering dietary and anthropometric measures, dietary
and anthropometric failures (DAF), and assess its distribution among children
in India. We used the 2015-16 National Family Health Survey, a nationally
representative sample of children aged 6-23 months (n = 67 247), from
India. Dietary failure was operationalized using World Health Organization
(WHO) standards for minimum dietary diversity. Anthropometric failure was
operationalized using WHO child growth reference standard z-score of <-2
for height-for-age (stunting), weight-for-age (underweight) and weight-forheight
(wasting). We also created a combined anthropometric measure for
children who had any one of these three anthropometric failures. We crosstabulated
dietary and anthropometric failures to produce four combinations:
Dietary Failure Only (DFO), Anthropometric Failure Only (AFO), Both Failures
(BF), and Neither Failure (NF). We estimated the prevalence and distribution
of the four types, nationally, and across 640 administrative districts and 543
Parliamentary Constituencies (PCs) in India. Nationally, 80.3% of children
had dietary failure and 53.7% had at least one anthropometric failure. The
prevalence for the four DAF types was: 44.0% (BF), 36.3% (DFO), 9.8% (AFO),
and 9.9% (NF). Dietary and anthropometric measures were discordant for
46.1% of children; these children had nutritional needs identified by only one
of the two measures. Nationally, this translates to 12 181 627 children with
DFO and 3 281 913 children with AFO; the nutritional needs of these children
would not be captured if using only dietary or anthropometric assessment.
Substantial variation was observed across districts and PCs for all DAF types.
The interquartile ranges for districts were largest for BF (29.8%-53.0%) and
lowest for AFO (5.5%-13.4%). The current emphasis on anthropometry for
measuring nutritional need should be complemented with diet- and foodbased
measures. By differentiating inadequate food intake from other causes
of undernutrition, the DAF typology brings precision in identifying nutritional
needs among children. These insights may improve the development and
targeting of nutrition interventions.