Abstract
BACKGROUND: Although aquatic foods, particularly fish, hold promise as a dietary intervention to address child undernutrition, evidence supporting their role in Indian context remains limited and mixed, thus inconclusive. OBJECTIVES: We assessed the association between fish consumption and undernutrition among children aged 6-23 mo using data from India's nationally representative, cross-sectional 2019-2021 National Family Health Survey (NFHS-5). This survey covered 707 districts across 36 states/union territories. METHODS: Undernutrition indicators included stunting (sample: 59,560), wasting (sample: 59,145), underweight (sample: 61,450), any anthropometric failure (sample: 60,440), and anemia (sample: 58,850). Stunting, wasting, and underweight were defined as <-2 standard deviations from the median of z-scores for height-for-age, weight-for-height, and weight-for-age of the reference population, respectively. Children measured as being either stunted, wasted, or underweight were defined as having any anthropometric failure. Children were classified as having any anemia, based on hemoglobin levels of <10.5 g/dL. Children's 24-h dietary recall provided information on fish consumption. We used modified Poisson regression models with robust error variance to attain the study objective. RESULTS: Nationally, a strikingly low prevalence of fish consumption among young children was recorded, with only 4.5% of them reporting intake in the preceding 24 h. Children in 111 of the 707 districts surveyed in NFHS-5 reported no fish consumption. Regression analysis revealed no association (P > 0.1) between fish consumption and anthropometric indicators (stunting, wasting, underweight, and any anthropometric failure) among children aged 6-23 mo. However, a protective association of fish consumption with anemia was observed (relative risk: 0.947; 95% confidence interval: 0.921, 0.973; P < 0.001). CONCLUSION: Encouraging fish consumption through public initiatives like the National Nutrition Mission could be a valuable strategy for mitigating the burden of anemia among young children. Further research utilizing detailed food consumption data, including fish intake, is warranted to investigate its impact on child health.