Calorie intake as nutritional measure needs a relook

Calorie intake as nutritional measure needs a relook
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First Published: Tue, Sep 29 2009. 09 26 PM IST

Updated: Tue, Sep 29 2009. 09 26 PM IST
A long-standing puzzle of the Indian development experience has been the declining calorie intake that has been accompanied by declining poverty and malnutrition. This pattern has persisted since the 1970s and even during periods of high growth. The declining calorie intake has often been advanced as evidence of increasing impoverishment and, therefore, increasing poverty. However, calorie intake has now been questioned both as an indicator of malnutrition and as an indicator of poverty.
One of the primary reasons that calorie intake has been invoked as a measure of impoverishment and poverty has been the fact that our poverty lines thus far have been anchored to some normative requirement of food, essentially based on calories (recommended dietary allowance, or RDA, of 2,400 kcals per capita in rural areas and 2,100 kcals per capita in urban areas) prescribed by the Indian Council of Medical Research. Although proponents of this argument have stretched their line of reasoning to limits beyond what was argued by the Expert Group on Poverty Estimation of 1993, these continue to remain valid as a measure of nutrition. For example, the India State Hunger Report of the International Food Policy Research Institute (Ifpri) uses calorie intake as a measure of hunger and malnutrition for international comparison as well as comparison across states in India. However, recent evidence, particularly from the National Family Health Survey (NFHS) and also from the National Nutrition Monitoring Bureau (NNMB), on nutritional outcomes has shown that calories may not be a correct or adequate measure of nutrition, too.
Measured against RDA, the percentage of population that is undernourished is almost three-fourths of the Indian population. That is much higher than corresponding estimates of malnutrition from the NFHS or the NNMB surveys. Not only that, while calorie intake figures show gradual decline, suggesting worsening malnutrition over time, there is no such evidence from either the NFHS or the NNMB surveys.
More than that, even across states, there is no correlation between nutritional intake indicators such as calorie intake and nutritional outcome indicators such as body mass index for adults or underweight, stunting and wasting for children. For example, the two best states in terms of nutritional outcomes are Kerala and Tamil Nadu. The calorie intake in these two states, however, is among the lowest—almost 25-30% lower than RDA. On the other hand, states such as Bihar and Uttar Pradesh, which are among the best performers in terms of calorie intake, also happen to be the states with the worst malnutrition indicators from NFHS.
However, all these factors do not lead to the inference that calorie intake is irrelevant for nutritional outcomes. It remains important, but so do other determinants of nutritional outcomes such as access to clean drinking water, hygiene and health services. Changes that have taken place over the years, in particular sustained growth of 5-6% per year since the 1980s, mean that calorie intake is not the sole or the most important measure of nutrition. Along with increasing per capita incomes, these have also implied better access to transportation, material comfort, technical improvements and so on. All these have also led to lower calorie requirements. Along with demographic change and lesser requirements of manual hard labour, these would certainly imply a much lower calorie requirement than what was used as RDA in the early 1970s.
Consequently, our RDAs are perhaps not a true measure of nutrition. Even otherwise, international nutritional standards on calorie requirements are much lower than what RDAs stipulate. For example, The State of Food Insecurity Report of the Food and Agricultural Organization suggests an RDA of 1,776 kcal only for India. Also, Ifpri uses a calorie intake cut-off of 1,820 kcals per capita for its Global Hunger Index reports. These are not only more realistic than the outdated RDAs, nutritional intake figures based on these are also much closer to the nutritional outcome indicators emerging from the NFHS or the NNMB surveys. All these certainly suggest a relook at the issue of calories as a measure of nutrition with or without any norm.
Despite these, our poverty lines are still rooted to calorie norms. While it is important to reiterate that these norms were only invoked as a first order approximation of the monetary equivalent of minimum food requirements, these were not meant to be used as a measure of poverty either directly or indirectly. This was made clear in the expert group report in no uncertain terms. In fact, even for 1973-74, which was the base year for poverty estimation, there is very little correlation in calorie intakes and poverty ratios by states. Further, not all those whose calorie intakes are lower than RDA were necessarily poor by consumption expenditure measure and vice versa. On the contrary, a large percentage of rich households shows lower calorie intakes than RDA. Even otherwise, equivalence of calorie norms and poverty measures based on consumption expenditure data violate the basic principle of consumer sovereignty. It is well known that calorie Engel curves have been shifting downwards not only for the rich, but also the poor in rural as well as urban areas. That this has happened secularly over the years not only suggests that consumers, rich as well as poor, have been moving away from cereals to other sources of food, but also reflects the changing requirement of calories for nutritional purposes for reasons mentioned earlier.
These point to the obvious problems of using calories as a measure of nutrition or poverty. Let’s hope that the Tendulkar committee, currently examining the issue of poverty estimation, takes a more balanced view on the relevance of calorie norms. But even for calories as a measure of nutrition, it is high time that the norms are suitably revised, keeping in mind the changes in the demographic structure, prevalence of disease, climatic factors and so on.
Himanshu is an assistant professor at Jawaharlal Nehru University and visiting fellow at Centre de Sciences Humaines, New Delhi. Farm Truths looks at issues in agriculture and runs on alternate Wednesdays.
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First Published: Tue, Sep 29 2009. 09 26 PM IST