Skip to main content

'Misleading' Lancet estimates on zero food intake in infants, young children of India

By Srinivas Goli, Shalem Balla, Harchand Ram* 

India is one of the world's hotspots for undernourished children, both in terms of prevalence and absolute numbers. Successive rounds of National Family Health Surveys (NFHS) have revealed that the progress observed since the early 1990s is far from what is expected when compared to the country's economic growth.
The Lancet study reports an astonishing number (i.e. 20%, 18.2%, 10.6%, 17.2%, 17.8%, respectively in 1992-93, 1998-99, 2005-06, 2015-16, 2019-21) of infants and young children with “zero food” consumption in last 24 hours prior to the survey date of successive National Family Health Surveys. The study also reports an increase in “zero-food” intake in India during 2015-16 (17.2%) to 2019-21 (17.8%). They have also reported a rise in “zero-food” intake in several states. The increase reported for states such as Chhattisgarh and Uttar Pradesh have certainly pushed a panic button.
Considering the serious shock waves these estimates have created among the Indian policymakers and popular media, we have evaluated the accuracy of the estimates reported by the Lancet study in this commentary note. Although we acknowledge that India’s rank (107 out of 121 countries) in the Global Hunger Index is not encouraging, the estimates reported by the Lancet study with a newly derived concept of "zero food" intake is completely misleading and technically incorrect. Below, we have systematically highlighted where they might have gone wrong.
The Lancet study used the food consumption questions of NFHS to define “zero food”. Upon reading the Lancet report, we understood that they have not considered whether a child is breastfed in a condition where they have not given any other food in the past 24 hours prior to the interview date.
Despite the authors’ recognition of the contribution of breastmilk to the overall calorific requirement of children in different age brackets (page 3, line no. 6 to 24), question arises as to why do the authors consider breastmilk as having "zero calorific” significance in their definition of “zero-food” intake, even for infants?
Further, to validate their estimates and find the true magnitude of the problem, we have replicated the authors' methodology to define “zero food” and re-produced the estimates for the latest two rounds of NFHS (2015-16 and 2019-21). The latest two rounds are better comparable in terms of their sampling design and the questions used for estimating “zero food” by the Lancet study.
However, our sample size is 92 less and 218 more for 2015-16 and 2019-21, respectively. Unlike what was stated in the Lancet study, for the latest two rounds of NFHS, there is no need to make any re-adjustment of boundaries, and we assume that this could be the one reason why there is a minor difference in the sample sizes for our estimates compared to them.
Using a similar definition of "zero food", comparison of our estimates with the Lancet study suggests a slight difference which can be attributed to sample size variations, as pointed above. However, the state-level patterns align with the Lancet study estimates.
After adjusting to breastfeeding (Figure 1), we found that the percentage of children without any food (and also not breastfed) is much less (1.1% in 2015-16 and 1.3% in 2019-21) compared to what is reported in the Lancet study (17.2% in 2015-16 and 17.8% in 2019-21). Similar differences are also observed across the states.
However, we do agree with the authors that even after adjusting for breastfeeding, both at the all-India level and also across the considerable number of states “zero food” intake have increased. Given that overall levels of zero food intake including breastfed, is very small, it is difficult to predict why these children are not given anything in the past 24 hours prior to the survey.
Apart from the assumption that these families do not have anything to feed their children, the other reason could be that these children are sufficiently fed through breastmilk. However, this can’t be verified accurately using limited information given in the NFHS.
In conclusion, we posit that the concept of "zero food" intake invented by the Lancet study is misleading to the readers and especially for the policymakers. Our main contention with Lancet study' methodology of defining "zero food” is exclusion of breast milk out of the definition of “food”.
If mothers opt for breastfeeding over complementary feeding, it can also be a conscious decision that they have taken based on their capacity to produce to sufficient breast milk for their babies, especially those with younger children i.e. 6 to 11 months.

Assessing the age-wise “zero food” intake results presented by the Lancet study in Table 6 and the age-wise contribution of children to "zero food" intake shown in Figure 2 in this note suggest that a major share (about 65%) of children with “zero food” intake belongs to 6-11 months who have a greater chance to be breastfed and accomplish calorific sufficiency.
Further, our estimates in Figure 3 show nearly 93% of children under 6 to 23 months were being currently breastfed at the time of the survey and this number is even higher for younger children i.e. 6 to 11 months. Therefore, in the absence of breastfeeding from the definition of “food”, the newly designed concept of “zero food" intake artificially inflates the numbers and creates unwarranted alarm among readers and policy makers.
*Srinivas Goli is Associate Professor, International Institute for Population Sciences (IIPS), Mumbai; Shalem Balla is Project Officer, IIPS Mumbai; Harchand Ram is Research Analyst, IIPS Mumbai


Unknown said…
Thanks for sharing this across. This is very eye opening and shall push us to revisit a lot studies done earlier by the reputed organisations.
Vinay Singh said…
Thanks for sharing this; it is very important to revisit and closely look at the definition of indicators chosen in the studies.
vandana said…
Considering our lack of progress on complementary feeding, it defies understanding that the authors consider it reasonable to accept as being desirable that "if mothers opt for breastfeeding over complementary feeding, it can also be a conscious decision that they have taken based on their capacity to produce to sufficient breast milk for their babies, especially those with younger children i.e. 6 to 11 months."

Further they "suggest that a major share (about 65%) of children with “zero food” intake belongs to 6-11 months who have a greater chance to be breastfed and accomplish calorific sufficiency." Is UNICEF changing its recommendation on the need for complementary feeding at teh age of 6 months? Is it being suggested that caloric sufficiency is the only goal of IYCF? I am baffled by this blog from these authors.
Srinivas Goli said…
Dear Vandana,

Don't read between the lines. The full sentence is "Apart from the assumption that these families do not have anything to feed their children, the other reason could be that these children are sufficiently fed through breastmilk. However, this can’t be verified accurately using limited information given in the NFHS". We are trying to tell that the 1.3% of the children who are not eating anything in past 24 hours can belong to any of the above cited categories which can't be verified with the limited information. We are not saying that they have caloric sufficiency through anyone means.

Moreover, none of us belong to UNICEF, rather two of our RAs working in a Project funded by UNICEF at the IIPS, Mumbai. These opinions are independent views of the authors. Nothing to do with UNICEF mandate.


What's Bill Gates up to? Have 'irregularities' found in funding HPV vaccine trials faded?

By Colin Gonsalves*  After having read the 72nd report of the Department Related Parliamentary Standing Committee on alleged irregularities in the conduct of studies using HPV vaccines by PATH in India, it was startling to see Bill Gates bobbing his head up and down and smiling ingratiatingly on prime time television while the Prime Minister lectured him in Hindi on his plans for the country. 

Muted profit margins, moderate increase in costs and sales: IIM-A survey of 1000 cos

By Our Representative  The Indian Institute of Management-Ahmedabad’s (IIM-A's) latest Business Inflation Expectations Survey (BIES) has said that the cost perceptions data obtained from India’s business executives suggests that there is “mild increase in cost pressures”.

Magnetic, stunning, Protima Bedi 'exposed' malice of sexual repression in society

By Harsh Thakor*  Protima Bedi was born to a baniya businessman and a Bengali mother as Protima Gupta in Delhi in 1949. Her father was a small-time trader, who was thrown out of his family for marrying a dark Bengali women. The theme of her early life was to rebel against traditional bondage. It was extraordinary how Protima underwent a metamorphosis from a conventional convent-educated girl into a freak. On October 12th was her 75th birthday; earlier this year, on August 18th it was her 25th death anniversary.

Govt putting India's professionals, skilled, unskilled labour 'at mercy of' big business

By Thomas Franco, Dinesh Abrol*  As it is impossible to refute the report of the International Labour Organisation, Chief Economic Advisor Anantha Nageswaran recently said that the government cannot solve all social, economic problems like unemployment and social security. He blamed the youth for not acquiring enough skills to get employment. Then can’t the people ask, ‘Why do we have a government? Is it not the government’s responsibility to provide adequate employment to its citizens?’

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

IMA vs Ramdev: Why what's good or bad for goose should be good or bad for gander

By Dr Amitav Banerjee, MD* Baba Ramdev and his associate Balkrishna faced the wrath of the Supreme Court for their propaganda about their Ayurvedic products and belittling mainstream medicine. Baba Ramdev had to apologize in court. His apology was not accepted and he may face the contempt of court with harsher punishment. The Supreme Court acted on a public interest litigation (PIL) moved by the Indian Medical Association (IMA).

'Flawed' argument: Gandhi had minimal role, naval mutinies alone led to Independence

Counterview Desk Reacting to a Counterview  story , "Rewiring history? Bose, not Gandhi, was real Father of Nation: British PM Attlee 'cited'" (January 26, 2016), an avid reader has forwarded  reaction  in the form of a  link , which carries the article "Did Atlee say Gandhi had minimal role in Independence? #FactCheck", published in the site The article seeks to debunk the view, reported in the Counterview story, taken by retired army officer GD Bakshi in his book, “Bose: An Indian Samurai”, which claims that Gandhiji had a minimal role to play in India's freedom struggle, and that it was Netaji who played the crucial role. We reproduce the article here. Text: Nowadays it is said by many MK Gandhi critics that Clement Atlee made a statement in which he said Gandhi has ‘minimal’ role in India's independence and gave credit to naval mutinies and with this statement, they concluded the whole freedom struggle.

Youth as game changers in Lok Sabha polls? Young voter registration 'is so very low'

By Dr Mansee Bal Bhargava*  Young voters will be the game changers in 2024. Do they realise this? Does it matter to them? If it does, what they should/must vote for? India’s population of nearly 1.3 billion has about one-fifth 19.1% as youth. With 66% of its population (808 million) below the age of 35, India has the world's largest youth population. Among them, less than 40% of those who turned 18 or 19 have registered themselves for 2024 election. According to the Election Commission of India (ECI), just above 1.8 crore new voters (18-and 19-year-olds) are on the electoral rolls/registration out of the total projected 4.9 crore new voters in this age group.

Indians witnessing 'regression to Hindutva politics' under Modi ahead of elections

By Bhabani Shankar Nayak*  The forthcoming general election in India, scheduled from April 19, 2024, to June 1, 2024, to elect the 543 members of the 18th Lok Sabha and the new Government of India, carries immense significance for the preservation of India's identity as a liberal, secular, and constitutional democracy.

An equine landmark, Cheltenham Gold Cup centenary 'epitomized' heights unparalleled

By Harsh Thakor*  The Cheltenham Gold Cup  is the most prestigious jumping race in the British Isles Steeplechasing calendar and the Cheltenham festival, a cynosure of every English and Irish racegoer. Few sporting events match or surpass the sheer intensity, competitiveness and joy that radiates its legacy. Few moments are more pulsating than witnessing a Gold Cup or a Cheltenham festival. In addition to that the race is run amidst the background of an evergreen English countryside, encircled by hills and pastures, giving a sensation of a paradise or heavenly location.