| dc.description.abstracteng | While economic growth in many low- and middle-income (LMICs) has led to the reduction of poverty and undernutrition, some of these LMICs are undergoing a simultaneous increase in overnutrition and micronutrient deficiency. Urbanization is one of the widely attributed factors for this nutrition transition. However, urbanization in many LMICs is non-linear, messy, and hidden. Due to this, there has been a horizontal and outward growth of cities extending their formal boundaries. This has resulted in the creation of complex rural-urban interfaces at the peripheries of rapidly urbanizing cities. The rural-urban interfaces offer unique opportunities as well as challenges for the food consumption and nutritional status of people. For example, proximity to urban centers facilitates improved access to input, output, and labor markets and enables households to engage in diversified livelihood strategies. This increases average household income. With the increased income individuals and households might consume a diversified diet that is rich in nutritional quality. However, urbanization and globalization of the region might increase the temptation among people to consume energy-dense, fatty, salty foods, and sweetened beverages. In addition, the better infrastructure of the region and livelihood diversification into off-farm employment popularize a sedentary lifestyle among inhabitants of the rural-urban interface. Interactions among all these factors – such as increased income, diversified and globalized diet, and sedentary lifestyle – might lead to a faster transition of the nutrition-related problems from undernutrition to overnutrition in the rural-interface regions. Thus, studying the food consumption pattern and nutritional status of millions of people who live in the rural-urban interfaces might provide important insights into the rapid nutrition transition occurring in many LMICs.
To this end, this dissertation considers the rural-urban interface of Bangalore, a mega-city in southern India, to study individual and household nutrition in the face of the rapid urbanization of the region. For this, the data from a primary socioeconomic survey of 1275 households conducted between December 2016 to May 2017 was used in the empirical analyses. The first two essays presented in this dissertation study how the consumption of diversified diets and the energy-dense processed foods are associated with the nutritional status of individuals. The third essay of this dissertation studies how different livelihood strategies – such as agricultural operations and off-farm employment – are associated with household nutrient consumption adequacy.
The first essay investigates the association of dietary diversity with the anthropometric outcomes of children and women. This relationship is estimated not just at mean but also at different points of the conditional distribution of anthropometric outcomes using the quantile regression method. This estimates whether the relationship between dietary diversity anthropometrics outcomes differs for undernourished vs. overnourished individuals. In addition, the use of six different measures of the individual- and household-level dietary diversity helps to test whether the relationship between dietary diversity and anthropometric outcomes depends on the indicator used. The results of this essay show that there is no strong and monotonic relationship between dietary diversity and (most) anthropometric outcomes among children and women. A consistent and significant association is found only for overweight/obese children. That is, for these demographics increased dietary diversity is associated with adverse anthropometric outcomes. These results indicate that the increased dietary diversity as a means to improve anthropometric outcomes might not be effective, especially, in those areas facing multiple burdens of malnutrition.
The second essay investigates the relationship between processed foods and obesity. It applies a probit regression model to estimate how the share of calories from the semi- and ultra-processed foods are associated with the prevalence of obesity among women. The results show that excess consumption of calories from semi-processed foods is positively associated with the increased prevalence of obesity among women. This association is stronger for women in lower-income groups in the rural-urban interface of Bangalore. For the high-income groups, the diet correlates of obesity shift towards ultra-processed foods. This shows that the increased risks for obesity are occurring at a lower level of dietary transition in India. This calls for strategic interventions to prevent a rapid increase in the obesity epidemic among lower-income groups in India.
The third essay estimates how the diversification of livelihood strategies affects household nutrition. This essay is particularly interested in estimating the full composite effect of different employment choices – agricultural operations and off-farm employment – on households' nutrient consumption adequacy. It applies a multivariate regression framework to household-level nutrient adequacy ratios of three macronutrients (calories, protein, and fat) and three micronutrients (vitamin A, iron, and zinc). The results show that it is not just either of the employment choices but also different combinations of agricultural operations and off-farm employment that are important to explain household nutrition. The results also imply that the relationship between income generated from different combinations of agricultural operations and off-farm employment and nutrition is non-linear. That is, increased income improves household nutrient consumption in the beginning, however, a further increase in income is associated with overnutrition. Furthermore, undernutrition is most prevalent among socio-economically disadvantaged households.
The findings of these three essays provide important insights into the food consumption and nutritional status in the rural-urban interface regions. The relationships between diets and nutritional status, and the relationship between livelihood strategies and nutrient consumption are mostly non-linear in the context of the rural-urban interface of Bangalore. To understand these intricate relationships it is, thus, necessary to go beyond the mean analysis and study different sub-samples (such as undernourished vs. overnourished, lower-income vs. higher-income, calorie-adequate vs. calorie-inadequate, etc.). This also calls for strategic interventions that follow a double-duty policy action framework to cater to the nutrition-related problems of different subsets of the population in the rural-urban interface regions. | de |