AYURVEDIC INTERVENTIONS FOR MALNUTRITION: ENHANCING INDIA’S NUTRITION PROGRAMS FOR CHILDREN

AYURVEDIC INTERVENTIONS FOR MALNUTRITION: ENHANCING INDIA'S NUTRITION PROGRAMS FOR CHILDREN

Rakesh Kumar Nagar, Brahmdutt Sharma, Nisha Kumari Ojha, Sanjeev Sharma and Shraddha Kumawat

National Institute of Ayurveda, Deemed to be University (De-novo), Jaipur, Rajasthan, India.

ABSTRACT: Malnutrition continues to be a significant public health concern, affecting the survival, growth, and well-being of both current and future generations, especially in developing nations such as India. This study examines the intricate characteristics of malnutrition, including insufficient and excessive nutrition, with a major emphasis on protein-energy malnutrition (PEM) in children, the high occurrence of stunting, wasting, and underweight conditions in children, based on data from the National Family Health Survey (NFHS-5) and multiple studies conducted in Jaipur. It emphasizes the notable gender discrepancies and socio-economic factors contributing to these conditions. Ayurveda emphasizes the significance of maintaining a well-balanced diet (Aahara) and recognizes the influence of Vata dosha in disturbing the process of digestion and absorption of nutrients, resulting in ailments like Karshya, Balashosha, and associated disorders. Ayurvedic therapies prioritize dietary alterations, herbal supplementation, and lifestyle adjustments to restore physiological equilibrium and enhance overall well-being. This article suggests incorporating Ayurvedic concepts into current government nutrition initiatives, such as POSHAN Abhiyaan and Pradhan Mantri Matru Vandana Yojana (PMMVY). Concrete suggestions encompass prenatal and postnatal care measures, guidelines for infant and toddler nutrition, and Ayurvedic therapeutic therapies aimed at improving maternal and child health outcomes. The integration includes customized nutrition regimens, prenatal yoga, herbal assistance, and educational workshops to promote comprehensive well-being. By integrating Ayurvedic principles with contemporary nutrition programs, this approach presents a hopeful plan to address the malnutrition epidemic in India by promoting long-term health and well-being, making a significant contribution to national development and the progress of public health.

Keywords: Malnutrition, Nutrition programs, Balashosha, Phakka

INTRODUCTION: Growth and development are intimately correlated with nutrition. The greatest growth and development will occur throughout childhood. A child must receive appropriate nutrition supplements to meet the growing body's calorific needs.¹

Malnutrition, particularly protein energy malnutrition (PEM), poses significant challenges for children, exacerbated by various factors including poor habits and socio-economic issues. Malnutrition is referred to as a silent emergency ².

The term malnutrition encompasses excessive and insufficient nourishment, ranging from severe dietary deficits to obesity ³. Approximately 155 million children (22.9%) and 52 million children (7.7%) worldwide are wasted and stunted, respectively. Children under five are becoming less nourished, with 11 out of 17 states experiencing a rise in stunting or chronic malnutrition, defined as low height relative to age. Thirteen out of 17 states have seen an increase in severely wasted youngsters, a condition known as acute malnutrition or wasting. At least 40% of children under five in Gujarat and Bihar are underweight, highlighting the need for improved nutrition and health outcomes for these vulnerable children ⁴. 36% of children under age five years are stunted (short for their age); 19 percent are wasted (thin for their height); 32 percent are underweight (thin for their age); and 3 percent are overweight (heavy for their height) ⁵.

Malnutrition is mostly caused by a poor diet and recurrent infections, which result in insufficient protein intake, carbohydrates, fats, and minerals. Children who are undernourished are more likely to experience severe and frequent infectious infections; even modest undernutrition raises the risk of morbidity and mortality in children. Long-term developmental issues in children can also result from chronic undernutrition. Undernutrition symptoms include thinning and dry hair, moon face, low sleep, pituitary hormone abnormalities, thyroid function changes, low body temperature, heart fat loss, lightheadedness, slow heart rate, mild anemia, fine-raised white hair, constipation, amenorrhea, brittle nails, subcutaneous fat loss, diminished muscle mass, dry skin, slower reflux, and edema ⁶.   

According to ancient Ayurvedic texts, one of the Trayopsthambha of life is Aahara (food) ⁷. Ahara, Viharaja, and Mansika are the causes of undernutrition, according to Ayurveda. Energy production and the maintenance of living tissues are the two primary objectives of the Aahara. Vata dosha is the primary element to make children malnourished. Vitiated vata results in Rukshta and Agni mandyata that proceeds to cause improper digestion of food. This leads to emaciation in children as the body will not get appropriate nutrients. Emaciation of body fat and muscles results from undernutrition, which vitiates bodily tissues, causes dryness, and interferes with their ability to absorb nutrients ⁸. The primary risk factor for this condition is Ahara Dosha; in particular, erroneous intake habits called Alpasana and Vishamasana lead to the development of Karshya. Karshya is a Vata-Pradhan Aptarpanjanya Vyadhi ⁹. Malnutrition is referred to in Ayurveda as Apatarpanjanya Vyadhis ¹⁰. These conditions can be classified as Karshya, Phakka, Parigarbhika, and Balashosha depending on their severity and cause.

Prevalence of Malnutrition in Jaipur:

1. A cross-sectional study on 1007 under 5-year children, was conducted by Sharma et al in 2021 in Jaipur, and they found that 22.8% of children were malnourished ¹¹.
2. Gupta et al in their record-based retrospective analytical observational study which was conducted in Jaipur in the year 2023, found that 86% of children out of 264 enrolled malnourished children were below 2 years of age group ¹².
3. Pragati Chaudhary et al. conducted a community-based cross-sectional study from 2016 to 2017 in a slum area of Jaipur city, Rajasthan. A total of 2007 children aged 6-59 months were selected for the study. Among the screened children, 35.7% were found to be underweight, 43% were stunted, and 10.5% were wasted. Additionally, 2.5% of the children had severe acute wasting, and 8.0% had moderate acute wasting ¹³.

Different Disorders can be corelated to Malnutrition in Ayurveda:

Karshya: It is a condition characterized by excessive emaciation, caused by factors such as a fat-free diet, excessive fasting, inadequate food intake, over-administering of Sanshodhan treatment or Panchkarma procedures, Shoka, Ruksha udvartan, Krodha, Ativyayam, etc.

Clinical features include Daurbalya, Dhamani-jaladarshanam, Sthula parva, Nidra nasha, Shushka-sphika- udara-griva. Excessive emaciation can lead to Pleeharoga, Kasa, Kshaya, Shwasa, Gulma, Arsha, Udara roga, Grahani roga ¹⁴.

Principle of Treatment ¹⁵: Acharya Charak has advised Brimhana and Laghu Santarpan.

1. Daivyapashray- Gandha Malya Dharan.
2. Yuktivyapashray- Nava anna, Nava Madhya, Gramya-anupa-audakamansa rasa, Dadhi, Sarpi, shali, masha, godhuma, gud-vaikrit, Basti, Taila abhyanga, Udwartan, timely dosha-avasechan, rasayan.
3. Satvavjaya- Swapna, Harsha, Sukh shaiyya, Chinta viram, Priya darshan.

Balashosha: Balashosha is only described by Acharya Vagbhatta in his books Astangasangraha and Astangahridaya. Other Acharya like Charak and Sushruta discussed the term ‘Shosha’ and ‘Krusha’, Sharangadhara named it ‘Gatrashosha’ and ‘Daurbalya’ and Yogaratnakara termed it ‘Karshyaroga’ ¹⁶.

Ashtang Hridaya ¹⁷ and Ashtang Sangrahya ¹⁸ describe symptoms of Bala Shosha, including Arochaka, Pratishyaya, Jwara, Kasa, Shosha, Snigdha mukha, Snigdha netra, Suklamukha, and Suklanetra.

Principle of Treatment: Acharya Vagbhatta provides a comprehensive treatment plan for Balashosha, with a focus on addressing the root reasons, balancing the Dosha, and rejuvenating Agni at every level. The treatment is divided into two categories: one for the mother (Dhatri) and the other for the child.

Treatment for Mother: In Ksheerapa and Ksheerannada, breastfeeding is the mother's primary source of nourishment for her child. However, imbalanced doshas can impact the child's health. To prevent this, the mother should follow three steps: 1) Nidana Parivarjana, which prioritizes prevention over cure, 2) Samsodhan Chikitsa, which treats impaired or corrupted breast milk, and 3) Samsarjana karma, which includes a healthy and nutritious diet and the use of "Stanya Sodhaka" and "Stanya Janana" medications.

Acharya Kashyapa classifies Pathadi and Patoladigana as "Stanya Sodhaka" gana, while Acharya Charaka recommends medications with Tikta, Kashaya, Katu, and Madhura tastes for Stanya Shodhana. The Stanya Shodhaka Dasemani formula includes Patha, Shunthi, Devdaru, Musta, Murva, Guduchi, Kutaja, Kiratatikta, katurohini, and Sariva.

Treatment for Children: Ayurvedic treatment for children includes multiple modalities, including Nidana Parivarjana, Samshodhana, and Basti treatment. In Balashoshaa, the Amarasa creation occurs due to the deterioration of Jatharagni states, leading to srotasa obstruction and increased Kapha dosha. Deepana-Pachana medicines, such as Chitraka, help disrupt the pathogenesis of Balashoshaa. Balashoshaa treatment prioritizes clean air, sunlight, proper cleanliness, and loving attention. Aushadhi Chikitsa, Anupana, powdered medications, and Aushadha can be used to treat Balashoshaa. Malnourished children and individuals with anorexia can also be treated using various herbal remedies and powdered substances.

Dusthaand Kshina Stanya: Nutritional deficit in children aged up to 1 year, known as Ksheerapa, is primarily caused by inadequate food or a lack of breast milk (referred to as Kshina Stanya or Stanya Kshaya). Malnutrition causes a decrease in both the amount and quality of breastfeeding, leading to insufficient production of bodily tissues (Dhatus) and imbalance of the Vata dosha ¹⁹. As a result, this causes irregular digestion and extreme thinness. The Kapha Dosha ²⁰, which is responsible for the growth and development of children, might be further weakened if it is already weakened.

Sushka Revati ²¹: The condition is characterized by a gradual wasting away of all bodily parts, accompanied by symptoms such as diarrhea, loss of appetite, changes in the skin, swollen nodules in the abdomen, and a condition known as geographic tongue. Personal hygiene procedures like as anointment, bathing, fumigation, seclusion, and cleaning of surrounds are employed to control it. Several medications such as Swarna Basant Malti, Shilajatvadi Lauha, Shringa Bhasma, Vardhaman Pippali, and medicated Ghrita are recommended.

Phakka Roga: Phakka is a term used to describe slow movement in children due to inadequate physical growth and alterations in psychomotor function. It is categorized into three groups: Kshiraja Phakka, Garbhaja Phakka, and Vyadhija Phakka. Kshiraja Phakka refers to malnutrition during infancy, while Garbhaja Phakka is a complication arising from various infant disorders. Vyadhija Phakka is marked by extreme malnourishment, weak limbs, subcutaneous fat mobilization, increased stool and urination frequency, irritability. The chapter "Phakka Chikitsa Adhyaya ²²" by Acharya Kashyapa discusses the treatment of Phakkaroga by balancing the Kapha and Vatadoshas. The treatment can be divided into two main categories: one for Dhatri (wet nurse) and the other for Balaka (child). The severity of Stanya vitiation in Dhatri is caused by Kapha Dosha, resulting in symptoms like Jadatva, Mukatva, and Pangutva Samprapti. Agnimandya, caused by Samprapti Vighatan, Dushta Stanya, Stanyabhava, and other ailments, leads to undernourished Dhatu, resulting in a frail and malnourished body in infants.

TABLE 1: PREVIOUS CLINICAL STUDIES

Malnutrition, often known as Karshya, is a state marked by a sequence of physiological disturbances. The main dosha implicated is Vata, which can be exacerbated by circumstances such as inadequate food, stress, and excessive physical exertion. Pitta and Kaphadoshas may also have an influence. When Vata aggravation occurs, it impairs Agni, which is responsible for digestion and metabolism. This impairment leads to difficulties in digestion and the absorption of nutrients. When Agni is not functioning properly, it leads to the creation of Ama, which blocks the digestive pathways and hinders the absorption of nutrients. Dysfunctional Agni disrupts tissue metabolism, resulting in insufficient feeding of bodily tissues, specifically muscle and adipose tissue. Ama and an imbalanced Vata dosha obstruct the body's pathways, leading to nutrient insufficiency and subsequent weight loss. Karshya is characterized by the presence of symptoms such as extreme thinness, weakness, reduced desire to eat, dry skin, and overall physical weakness.

Government Schemes for Combating Malnutrition: The Government has accorded high priority to the issue of malnutrition and is implementing several schemes/programs of different Ministries/Departments through States/UTs to address various aspects related to nutrition. The Ministry of WCD is implementing POSHAN Abhiyaan, ‘Pradhan Mantri Matru Vandana Yojana’, Anganwadi Services and Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services Scheme as direct targeted interventions to address the problem of malnutrition in the country including the State of Rajasthan. Under the Anganwadi Services of the Umbrella ICDS Scheme, Supplementary Nutrition is provided to children under 6 years of age in the form of Take-Home Ration, Morning Snacks and Hot Cooked Meals as per the provisions of the National Food Security Act, 2013. The Supplementary Nutrition is provided to bridge the gap between the Recommended Dietary Allowances (RDA) and the Average Daily Intake (ADI) among this age group as per the nutritional norms provided under Schedule II of the Act. Severely malnourished children are provided additional nutrition in the form of food supplements providing 800 Kcal of energy and 20-25 g of protein ³⁴.

DISCUSSION: Malnutrition remains a significant public health challenge, especially in developing nations like India. This condition, encompassing both undernutrition and overnutrition, detrimentally impacts children’s immune systems and mental development, contributing to high rates of infant and child mortality. Protein-energy malnutrition (PEM), a prevalent form of undernutrition, is particularly concerning as it leads to various health complications. In India, the prevalence of malnutrition is alarming, with numerous children suffering from stunting, wasting, and being underweight, as highlighted by the National Family Health Survey (NFHS-4). These conditions are predominantly driven by inadequate diets and recurrent infections, resulting in insufficient intake of essential nutrients. Ayurveda, an ancient system of medicine, offers valuable insights into addressing malnutrition. According to Ayurvedic principles, factors like improper diet and lifestyle choices contribute to conditions like Karshya, Balashosha, and other related disorders. Ayurvedic texts emphasize the significance of a balanced diet (Ahara) and suggest that imbalances in Vata dosha can lead to malnutrition by impairing digestion and nutrient absorption. Ayurvedic treatments focus on holistic approaches, including dietary modifications, herbal supplements, and lifestyle interventions, to restore balance and promote optimal health.

Malnutrition, mostly caused by Vata, can be alleviated by the use of different herbs and practices. Herbs infused with Guru, Shlakshan, Ushna, Pichila, and Guna are employed to allievate Vata. Deepana and Pachana substances are utilized to augment Agni. To rectify Rasavahasrotodushti, Langhanchikitsa is indicated. Balya and Brimhana Chikitsa are therapeutic approaches aimed at addressing conditions such as Daurbalyata (weakness), Oja kshaya (depletion of vital essence), and stunted stature along with low body mass. Nidana Parivarjana encompasses changes in nutrition, lifestyle, and dietary interventions. Ahara encompasses a nourishing diet that include easily digestible foods like as milk, ghee, fruits, vegetables, whole grains, and pulses.

Medhya Rasayana incorporates cognitive-enhancing herbs such as Brahmi and Shankhapushpi to improve memory and cognition. Vihara encompasses a daily regimen that includes sufficient rest, physical activity, and methods for relaxing. Engaging in Yoga and Pranayama exercises helps aid digestion, alleviate stress, and promote general well-being. Herbal medications encompass Balya and Brimhana herbs, Agni Deepana and AmaPachana, as well as Panchakarma, which refers to cleansing therapy. Rasayana Therapy utilizes revitalizing herbs and formulations such as Chyawanprash and Triphala. Tonics are specialized remedies designed to enhance the body's immune system and promote optimal feeding of tissues. In Jaipur, the prevalence of malnutrition among children is notably high, with significant percentages suffering from varying degrees of underweight, stunting, and wasting. Studies indicate that malnutrition rates are higher among female children compared to males, underscoring the need for targeted interventions. These interventions should address both the immediate nutritional needs and the underlying socio-economic factors contributing to malnutrition.

Integrating Ayurvedic principles into existing government nutrition programs can significantly enhance their effectiveness. Initiatives like POSHAN Abhiyaan and Pradhan Mantri Matru Vandana Yojana (PMMVY) can incorporate Ayurvedic dietary plans, prenatal yoga, and herbal support to improve maternal and child health outcomes.

Anganwadi centers can offer Ayurvedic-inspired meals and snacks, along with herbal liquids such as decoctions of specific medicines, specific Yusha/Ksheerpak preparations etc. indicated in Karshya Chikitsa, Rasayan and Brimhana formulations, to provide holistic nutritional support. For adolescent girls, personalized nutrition plans and workshops on Ayurvedic lifestyle practices can address specific needs related to growth, development, and menstrual health.

Implementing Ayurveda to Address Malnutrition:

Antenatal Care:

Ayurvedic Dietary Guidelines for Pregnant Women: Promote a well-rounded diet which is abundant in whole grains, vegetables, fruits and dairy products. Incorporate Garbhini Paricharya. It includes month wise dietary plan for the mother and each month has different pattern of herbal and dairy supplements to fulfill needs of growing fetus.

Prenatal Yoga and Meditation: Advocate for the adoption of prenatal yoga and meditation practices to guarantee the mother's physical and emotional well-being.

Education and Training: Organize educational workshops for pregnant women, providing guidance on Ayurvedic nutrition and lifestyle practices to promote a healthy pregnancy.

Postnatal Care:

Postpartum Nutrition: Recommend a diet including of readily digested foods such as khichdi, soups, and herbal teas to facilitate recuperation and promote lactation. Sutikaparicharya can be followed for better health of the mother.

Ayurvedic Postpartum Therapies: Implement Abhyanga (oil massages) and other Ayurvedic therapies to facilitate recuperation and alleviate postpartum depression.

Herbal Supplements for New Mothers: Offer Ayurvedic tonics and supplements such as Dashamoola and Bala to aid in postpartum recuperation and enhance lactation. Care for Infants (Ages 0-6 Months).

Breastfeeding Support: Encourage the practice of exclusively breastfeeding for the initial six months, with the aid of Ayurvedic techniques to improve the quality and quantity of breast milk. Shatavari churna should be used to enhance lactation. In non-availability of breast milk, milk from Dhatri should be taken.

Maternal Nutrition: It is important for the mother to consume a nourishing and well-balanced diet that includes Ayurvedic foods. This will help in the baby's development through breast milk. Childcare for Toddlers (Ages 6 Months - 3 Years).

Introduction of Solid Foods:  Gradually incorporate semi-solid foods made using Ayurvedic principles, such as rice porridge, pureed fruits, and vegetables. Acharya Kashyapa prescribed to give Anna (solid food) in 10th month of life.

Nutrient-Rich Foods: Incorporate Ayurvedic foods that are high in nutrients, such as ragi (finger millet), ghee, and seasonal fruits, to promote healthy growth and development.

Natural drinks and Decoctions: Give moderate herbal teas such as fennel or cumin water to improve digestion and enhance immunity.

Establishing Regularity and Discipline: Implement consistent meal schedules and routines based on Ayurvedic principles to foster healthy eating habits and optimize digestion.

Monitoring Growth and Development: Consistently observe and evaluate the progress and nutritional condition of toddlers, administering supplementary Ayurvedic supplements as necessary.

Parental Education: Provide parents with information about the significance of adopting an Ayurvedic lifestyle for their children's overall well-being, with a specific emphasis on dietary choices, sleep patterns, and daily routines Integrated Approach. 

Partnership with Healthcare Providers: Provide comprehensive training to Anganwadi workers and healthcare personnel in Ayurvedic practices to enhance their ability to provide knowledgeable guidance and assistance.

Holistic Health Camps: Arrange camps that offer comprehensive Ayurvedic health evaluations, dietary guidance, and botanical supplements for expectant mothers and young individuals.

Community Outreach Programs: Conduct awareness campaigns and seminars to educate communities about the advantages of Ayurvedic nutrition and lifestyle practices from pregnancy to early childhood.

CONCLUSION: Incorporating Ayurvedic concepts into current government nutrition programs may provide a comprehensive method for tackling malnutrition in India. Ayurveda places great importance on maintaining a harmonious diet, ensuring efficient digestion, and adopting lifestyle habits that contribute to general well-being.

By integrating Ayurvedic dietary principles, herbal supplements, and therapies into initiatives such as POSHAN Abhiyaan and Pradhan Mantri Matru Vandana Yojana (PMMVY), the nutritional and health results for mothers, children, and adolescents can be greatly enhanced. This collaboration will address current dietary requirements and promote long-term health and well-being, ultimately contributing to the country's progress.

FIG. 1: PROBABLE SAMPRAPTI OF MALNUTRITION

ACKNOWLEDGMENT: Nil

CONFLICT OF INTEREST: Nil

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    How to cite this article:

    Nagar RK, Sharma B, Ojha NK, Sharma S and Kumawat S: Ayurvedic interventions for malnutrition: enhancing India’s nutrition programs for children. Int J Pharm Sci & Res 2025; 16(3): 670-79. doi: 10.13040/IJPSR.0975-8232.16(3).670-79.

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