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Dismantling five decades of public health policy with spurious interpretation of a single study may relapse nutritional blindness among vulnerable children in India

European Journal of Clinical Nutrition volume 77, pages 140–141 (2023)Cite this article

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Response to Letter to the Editor:

A Letter to the Editor is a powerful forum that allows researchers to discuss a study’s relative strengths and deficits that may have been overlooked by the original authors and reviewers [1]. As members of a scientific community, authors of the letters should be professional and avoid personal attacks, colloquial words, and impolite language [2]. The collective efforts of the authors, as a rebuttal [3] to my published paper [4], are of little surprise. Those authors share a speculative view that India’s national vitamin A supplementation (VAS) programme is not required and should be dismantled. Clearly, the content of their letter (2) does not appreciate the scientific discussion raised in my perspective [3]. I differ from the speculative views of the Expert Committee of Sub-Group on Vitamin A Policy (SGVAP) and those of Reddy et al [5], as they persistently deny the facts published in the Comprehensive National Nutrition Survey (CNNS) report [6]. I, therefore, presented my viewpoints and raised my concerns in my Letter to the Editor [7] and perspective [4] regarding their speculative recommendations to discontinue universal VAS based on a single study with a gross deficit in sample size. Sachdev et al. claim that the data presented in my perspective is flawed, outdated and inflated. The data I presented concerning the prevalence of vitamin A deficiency (VAD) in different states of India is based on state representative studies with adequate sample sizes. Those data represent what is presented in Table 2.6 (Page 39) & Table 7.4 (Page 196) of the original CNNS report [6] and National Nutrition Monitoring Bureau (NNMB) published Technical reports.

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Data availability

Comprehensive National Nutrition Survey (CNNS) National Report 2016–18. https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf.

References

  1. Baethge C, Seger G. Our readers’ voice: Letters to the Editor are an important component of the discussion of scientific articles, in DeutschesÄrzteblatt as in Other Journals. Our correspondence pages reflect a diversity of opinion thanks to the love of debate among our readers—and thanks to a few rules. DeutschesArzteblatt Int. 2009;106:207–9.

    Google Scholar 

  2. Falavarjani KG, Kashkouli MB, Chams H. Letter to Editor, a scientific forum for discussion. J Curr Ophthalmol. 2016;28:1–2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sachdev HS, Reddy GB, Pullakhandam R, Ghosh S, Rajkumar H, Kurpad AV. Flawed analyses and historical data inflate vitamin A deficiency in India to misdirect policy. Eur J Clin Nutr. 2022. https://doi.org/10.1038/s41430-022-01164-9.

  4. Arlappa N. Vitamin A supplementation policy: a shift from universal to geographical targeted approach in India considered detrimental to health and nutritional status of under 5 years children. Eur J Clin Nutr. 2022;28:1–6.

    Google Scholar 

  5. Reddy GB, Pullakhandam R, Gosh S, Boiroju NK, Tattari S, Laxmaiah A, et al. Vitamin A deficiency among children younger than 5 y in India:an analysis of national data sets to reflect on the need for vitamin A supplementation. Am J Clin Nutr. 2021;113:939–47.

    Article  PubMed  Google Scholar 

  6. Comprehensive National Nutrition Survey (CNNS). CNNS National Report 2016-18. New Delhi, India: Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council, 2019. https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf.

  7. Arlappa N. Sample size covered for serum vitamin A is not nationally representative:data are not suggestive for Targeted Vitamin A Supplementation Programme in India. Am J ClinNutr. 2021;113:1708–9.

    Google Scholar 

  8. Reddy GB, Pullakhandam R, Ghosh S, Boiroju N, Tattari S, Laxmaiah A, et al. Reply to J Sheftel et al. and N Arlappa. Am J Clin Nutr. 2021;113:1709–11.

    Article  PubMed  Google Scholar 

  9. Dwyer J. Dietary Requirements of Adults, Editor(s): Benjamin Caballero, Encyclopedia of Food Sciences and Nutrition (Second Edition), Academic Press, 2003, p. 1863–8. https://www.sciencedirect.com/science/article/pii/B012227055X003503.

  10. Nutrient Requirements for Indians: Recommended Dietary Allowances and Estimated Average Requirements for Indians –A Report of the Expert Group, 2020.

  11. Baye K, Laillou A, Seyoum Y, Zvandaziva C, Chimanya K, Nyawo M. Estimates of child mortality reductions attributed to vitamin A supplementation in sub-Saharan Africa: scale-up, scale-back, or re-focus? Am J Clin Nutr. 2022;116:426–34.

    Article  PubMed  Google Scholar 

  12. International Institute of Population Science. National Family Health Survey India 2019–2021: India fact sheet. Mumbai: Ministry of Health and Family Welfare, Government of India; 2021.

  13. GAVA. Conditions for scaling back universal preschool vitamin A supplementation: policy brief. The Global Alliance for Vitamin A; 2019.

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  1. Scientist-F, Division of Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad, India

    Nimmathota Arlappa

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  1. Nimmathota Arlappa
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Correspondence to Nimmathota Arlappa.

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Arlappa, N. Dismantling five decades of public health policy with spurious interpretation of a single study may relapse nutritional blindness among vulnerable children in India. Eur J Clin Nutr 77, 140–141 (2023). https://doi.org/10.1038/s41430-022-01228-w

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