The great Indian protein inequality

Malnourished children deprived of eggs. Affluent adults guzzling protein powders. India’s dietary dilemma is one of supreme irony.

Government school students get their share of eggs in their mid-day meal in Puducherry, July, 2016. | Photo Credit: T. SINGARAVELOU

A ‘dual burden of malnutrition’: that is how the Dietary Guidelines for Indians-2024, by the Indian Council for Medical Research (ICMR), describes the skewed dietary dynamic in India, “where both undernutrition and… obesity coexist.” A staggering 56.4 per cent of the total disease burden in India is due to unhealthy diets, it adds.

One point of focus in the report, published last month, is protein, “essential in making enzymes, hormones, cell membrane components and carrier proteins such as haemoglobin (carries oxygen to tissues).”

Animal proteins, sourced from milk, meat, fish and eggs, says the report, “are of high quality as they are bioavailable (absorbed by the body) and provide all the essential amino acids in right proportions” compared to plant or vegetable proteins that “are not of the same quality.” It adds however, that “a combination of cereals, millets and pulses provides most of the amino acids.”

What comes through though, is a glaring inequality in protein consumption in the country.

At one end of the socioeconomic spectrum are adults who buy packaged protein powders to bulk up. But the report cautions against the supplement: they could contain added sugars and vast amounts of branched chain amino acids that “may increase the risk of certain non-communicable diseases.” Large amounts of protein are also associated with bone mineral loss and kidney damage, the report warns.

At the other end of the economic divide are malnourished children under five, 35.5 per cent of who are stunted (height-for-age), 19.3 per cent who are wasted (weight-for-height), and 67.1 per cent who are anaemic, according to the National Family Health Survey 2019-21. Children especially need dietary protein for growth, to build muscle and bones; as for adults, the estimated average requirement is 0.66g of protein per kilo/day, says the ICMR report.

The contentious egg

But this need is not met on the ground. The addition of eggs in midday meals at government schools and anganwadis, for instance, is still a contentious issue in several States. In February this year, the Maharashtra government, following opposition from religious outfits, said that eggs would not be served in school if 40 per cent of its students did not wish to include them in their meals. In 2021, then-Chief Minister of Madhya Pradesh, Shivraj Singh Chouhan, announced that the government would not include eggs in anganwadi meals, replacing them with milk. In 2020, development economist Jean Drèze wrote to the Finance Minister of Jharkhand urging the government to provide “one egg per day in midday meal, six days a week, in schools as well as anganwadis”: Jharkhand’s children are among the most undernourished in the world, he added.

“Protein is an essential component of our diets, especially for young children as they are growing,” Soumya Swaminathan, the former chief scientist at the World Health Organization, told Frontline. “School meals provide essential nutrients to children and India’s mid-day meal programme has been documented to improve school attendance, learning capacity, nutritional status and even has an impact on the next generation. Especially for children coming from poorer families, school meals serve as a platform to provide nutrients that could be missing from their plates at home.”

Eggs and animal protein “are a good source of essential amino acids,” added Dr. Swaminathan, “but being expensive, are not widely consumed.”

No beef

A research paper published in the Journal of Development Economics last year titled ‘The nutritional cost of beef bans in India’ found that the ban on this meat, a rich source of dietary iron, is associated with an increase in anaemia among women within communities that traditionally consume beef. “Bans reduce women’s haemoglobin levels in beef-eating communities by 1.2 g/L and increase severe anaemia by 27 per cent of the mean level,” found the authors, Aparajita Dasgupta, Department of Economics, Ashoka University, et al. Importantly, they add, “beef is also one of the cheapest sources of iron in the diets of groups that traditionally consume beef—Muslims, Christians, and Scheduled Caste Hindus (also known as Dalits).”