Introduction

The physical growth and nutritional status of an individual and/or a community plays a critical role in maintaining optimal health and well being. Adequate nutrition is essential for growth, development and the prevention of various chronic diseases. [1] Understanding and assessing the physical growth and nutritional status of population is crucial for implementing effective public health interventions and designing targeted strategies to address nutritional deficiencies. Nutritional status refers to the overall status of an individual’s health as influenced by their dietary intake and nutritional well-being. Optimal nutritional status is essential for the maintenance of physiological functions, immune system integrity, and the prevention of nutrition-related diseases.[2]

The intake of recommended amounts of nutrients during childhood or adolescence is necessary for growth. Good nutrition is an essential need for children's health development, well-being, learning, physical fitness and the ability to withstand stress and to function at optimum productivity.[3] Numerous studies have demonstrated the significant impact of nutritional status on health outcomes across different life stages. Inadequate nutritional intake and imbalances in essential nutrients can lead to malnutrition (both under and over nutrition), which is associated with increased susceptibility to infections, impaired growth and development, and higher mortality rates, particularly among children. [4-5]

Accurate assessment of nutritional status is essential for identifying individuals and populations at risk of malnutrition or specific nutrient deficiencies. Anthropometric measurements, including body mass index (BMI), waist circumferences, and skin fold thickness are commonly used to evaluate overall body composition and identify under nutrition or obesity. [6]

In India, recent Comprehensive National Nutritional Survey (CNNS) 2016-2018 among the children from birth to 19 years showed that adverse nutritional status of children is not only restricted to the prevalence of under nutrition but also to over nutrition as India is passing through double burden of malnutrition. [7] The studies of nutritional status among children and adolescent using anthropometric measures, have been conducted in different Northeast Indian tribes for the last two decades but only few have been reported from Arunachal Pradesh. [8 -15] This state having around 26 distinct major tribes with numerous minor or lesser known tribes is less studied in term of nutritional status of the children. While the nation has developed its public health policies to crop off the double burden of nutrition, the state is yet to develop a baseline data to represent the nutritional status of various major and minor communities. Therefore, this study was conceptualized to assess the physical growth and nutritional status using anthropometric measures and index in the Apatani and Nyishi tribal children aged five to fifteen years and compare the two populations living in a similar ecological setting in Lower Subansiri and Kamle districts of Arunachal Pradesh.

Methods

Area of Study

The present cross-sectional study was conducted among the Apatani tribe of Ziro valley, Lower Subansiri district and Nyishi tribe of Raga, the headquaters of Kamle district, Arunachal Pradesh, India. The data was collected from 12^th January to 28^th February 2023.

Sample size and sample selection

The total number of participants was 442 children from two different tribal groups (Apatani 231 and Nyishi 211) aged 5 to 15 years. The data were collected using purposive sampling due to the different terrain of settlements of the studied households, which created operational difficulties. Besides, unavailability and unwillingness from the participants was another cause for not using appropriate statistical sampling. However, with respect to the selection of households and interviewees, an attempt was made to cover all those households, whose members were willing to cooperate in the study, where written consent was also collected from their parents. The data of the Apatani samples were collected from several villages of Ziro valley, Lower Subansiri district such as Bulla, Siibey, Hari, Hija, Hong, Bamin-Michi and Dutta and data of Nyishi sample were collected from several villages of Raga, Kamle district such as Yada I, Yada II, main Raga and Raga II. The study was approved by the Institutional Ethical Committee of Rajiv Gandhi University, Arunachal Pradesh, India.

Age estimation

It may be mentioned that great difficulties were experienced in the assessment of age, especially from the Raga headquarter due to their illiteracy and lack of any written records. Even parents were not aware of their children’s age. Consequently, in these cases, estimation of age was done through referencing to some important local events (horoscope, flood, storm, festivals etc.) and to the known age of some individuals who seemed to be in the same age group and some was ascertained from birth certificates and official school records. Thus, in this connection, there could be some error in the estimation of age.

Socio-economic data

A pre-tested and pre-structured scheduled questionnaire was used to collect some of the socio-economic data including age, sex and number of parity. Besides, a detailed ethnographic profile of the two studied communities was also collected from the field for general description of the population.

Anthropometric measurements

The anthropometric measurements of height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and mid upper arm circumference (MUAC), were collected using standard technique and instruments. Anthropometer rod was used to collect height (cm) with a measuring error 0.1 cm, a portable weighing machine was used to collect weight nearest to 0.5 kg deviation. All circumference measurements were taken using measuring tape. For height and weight, the children were wearing light cloths and standing in anatomical positions with bare feet and horizontal planes. For circumferences the cloths were lifted up. [16]

Data analysis

To assess the nutritional status of the studied Apatani and Nyishi children aged 5 to 15 years, a single anthropometric measure of Body Mass Index (BMI) was used for obvious operational benefit. BMI was calculated by using the formula [BMI = weight (kg) / height (m²)]. After calculating the BMI, age and sex matched graded international cut –off points were used for getting undernutrition and overnutrition prevalence as per classification proposed by Cole et al. [17,18]

Statistical Analysis

Age and sex- wise descriptive statistics like arithmetic mean, standard deviation and standard error of mean was calculated for all the anthropometric measures. Contingency Χ² test was used to assess the association between communities under study and nutritional status. Bivariate logistic regression was performed to identify the selected significant factors associated with overweight and obese children who were coded as 1 in comparison to their counterparts coded as 0 for logistic regression analysis. All the analyses were done using SPSS 16.0 version and MS Excel 2000.

Brief description of the population

The Apatani

The Apatani, designated as a scheduled tribal group, comprising of approximately 25,000 individuals, live in Ziro Valley/ Apatani Valley in the Lower Subansiri district of Arunachal Pradesh, India. Their language belongs to the Sino-Tibetian family. The Apatani has a rich oral tradition and hardly any written records. The inhabitants of the Apatani valley constitute a community distinct in language, dress and distinct manner of living. The Apatanis are mainly agriculturists. This tribe practices wet rice cultivation, choosing to permanently settle rather than live a nomadic lifestyle that comes with slash-and-burn type of cultivation. This type of cultivation is unique to the Apatanis. Taking the sustainability of their fields a step further, the tribe also harvests fish in the wet fields alongside rice. This instantly doubles the food production of their field. The Apatanis have had an intricate irrigation system of canals and channels from the time they started wet rice cultivation. Along with agriculture, the others are engaged in poultry, hunting and fishing. The people also rear cattle, pig and goats. The Apatani women are also skilful weavers. The women collect the firewood for the household from the woods. They also go to the nearby food market to sell their agricultural products. Basketry is a popular handicraft among the man folk. In recent years, there has been an increase in white-collar jobs with many of them engaged as government employees, doctors, engineers and other modern professionals.

The Nyishi

The Nyishi is the largest tribal group of Arunachal Pradesh in India. The word Nyishi is the combination of two words ‘Nyi’ means ‘a human’ and the word ‘shi’ denotes ‘highlands’. They are spread across eight districts of Arunachal Pradesh viz., Kra-Daadi, Kurung Kumey, Papum Pare, East Kameng, West Kameng, Kamle, Pakke Kessang and parts of Lower Subansiri district. The presently studied Nyishi children live in Kamle district. Nyishi speak the Tibeto-Burman language of the Sino-Tibetan family. There’s no script yet. Like many other tribes, they have a rich oral tradition of folklore, tribal history, and folk wisdom. Whatever is known of them is passed from generation to generation through oral traditions. Nyishi food choices revolve around their agricultural produce viz. rice, millet, maize, and yams. Rice is the staple food that is supplemented by meat and vegetables. They consume boiled food mostly. The meat is boiled with a little salt in it. No oil or spices are used. It’s garnished with leafy vegetables and grated ginger. Sometimes, the meat is roasted or smoke-dried and kept in bamboo baskets to preserve it for future use. Bamboo shoots are used to add flavor to the food. They are particularly fond of smoked meat.

Results

The arithmetic means and standard deviations of anthropometric measures and BMI for both the Apatani and the Nyishi boys aged 5 to 15 years are shown in Table 1. The height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and mid upper arm circumference (cm) showed a gradual increase over the age. However, the BMI (kg/m²) showed fluctuating growth pattern. The maximum height difference (10.34 cm) between two successive age groups was found between 12 and 13 years of age among the Apatani boys and 11 and 12 years (8.95 cm of height differences) among the Nyishi boys. In case of weight measure, the maximum weight difference (5.56 kg) between two successive age groups was observed between 11 and 12 years of age among the Apatani boys and 11 and 12 years (5.13 kg of weight differences) among the Nyishi boys. Rest of the anthropometric measures showed similar kind of increasing trends among both the Apatani and Nyishi boys.

The arithmetic means and standard deviations of anthropometric measures and BMI for both the Apatani and Nyishi girls aged 5 to 15 years are shown in Table 2. Like boys, the height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and mid upper arm circumference (cm) showed a gradual increase over the age among the girls. However the BMI (kg/m²) showed fluctuating growth pattern. The maximum height difference (7.37 cm) between two successive age groups was found between 9 and 10 years of age among the Apatani girls and 10 and 11 years (10.50 cm of height differences) among the Nyishi girls. In case of weight measure, the maximum weight difference (5.82 kg) between two successive age groups was observed between 10 and 11 years of age among the Apatani girls and 9 and 10 years (7.53 kg of weight differences) among the Nyishi girls. Rest of the anthropometric measures showed similar kind of increasing trends among both the Apatani and Nyishi girls.

Table 3 shows the mean differences of various anthropometric measurements between Apatani and Nyishi boys and girls, separately. In most of the ages, Apatani boys were observed as heavier, taller, with higher value of other anthropometric measures as compared to Nyishi boys. Similarly, Apatani girls were observed as heavier, taller, with higher value of other anthropometric measures as compared to Nyishi girls. The differences of anthropometric measures in both the boys and girls were statistically significant (p<0.05; p<0.01) between the ages 8 and 10 years.

Table 4 shows community-wise percentage distribution of nutritional status based on BMI for age among the studied boys and girls. It was observed that more than 70% boys from Apatani and Nyishi communities and more than 80% girls from those respective communities had normal nutritional status. Overall percentage of under nutrition was slightly higher among the Nyishi children (10.4%) compared to the Apatani children (9.5%) as shown in Figure 1. On the other hand, the percentage of overweight and obese children among the Apatani group (12.6%) was little bit higher than their Nyishi counterparts (9.5%). In spite of that, boys of both the communities showed slightly higher percentages of overweight and obesity compared to their girl counterparts. However, in both the occasions, the differences between gender and community-wise distribution of nutritional status were not statistically significant (p>0.05).

Figure 1: Distribution of Nutritional status among the Apatani and Nyishi children under study

Table 5 depicts the binary logistic regression analysis of community, sex and number of live births on overweight and obese children under study. In this analysis, the gender and communities were merged as there was insignificant differences of nutritional status between parameters. It was found that the Apatani children were 1.383 times more likely to have overweight and obesity compared to Nyishi children. Besides, boys were 1.690 times more likely to be overweight and obese than girls and finally children of those families who had ≤ 3 number of live births were observed to have higher chance of overweight and obesity than those with more number of children.

Discussion

This study presents a glimpse of physical growth patterns and nutritional status using anthropometric measures and index of the Apatani and the Nyishi children aged 5-15 years who live in a similar geographical hilly terrain (Ziro at Lower Subansiri and Raga at Kamle districts). Analysis of various anthropometric measurements (height, weight, WC, HC, MUAC) and BMI of both the populations revealed that the mean values of different body measurements represent an increasing trend with the advancement of age. The study shows that the Apatani children are significantly taller and heavier during pre-adolescent stage compared to the Nyishi children of both the sexes. A study on urban Meitei children and adolescents of Manipur in northeast India also showed that height and body weight increase along with the advancing of age in both boys and girls. [19]

It is also evident from the present study that there was a variation in both undernutrition and overnutrition prevalence amongst pre-adolescents and adolescent children (boys and girls) aged 5 to 15 years among both the tribes. Comparatively, Nyishi children had higher prevalence of undernutrition compared to the Apatani children. In contrast, the Apatani children had higher prevalence of overweight/obesity compared to Nyishi children. Similar kind of studies had been reported by Asghar et al., where there was significant variation in both the undernutrition and overweight prevalence amongst pre-adolescent and adolescent children among the Sartang and Miji tribal children aged 5 to 18 years.[8] From the bivariate logistic regression analysis, the Sartang children were significantly more than two times likely to be overweight compared to Miji counterparts.[8] In the present study, the Apatani children were 1.383 times more likely to be overweight and obese compared to Nyishi children, although the differences were not statistically significant.

It was found during the ethnographic fieldwork that Apatani children were more modernized in their lifestyle and consumed fast food, had better medical and educational facilities and exposure to urban culture than their counterparts among Nyishi children. It was evident that traditional food pattern among the tribes of Arunachal Pradesh had been changed a lot due to globalization.[20] Therefore, in-depth study of dietary pattern, physical activity level and morbidity pattern may be the major limitation of the present study.

Immunization is one of the important factors related to nutritional status of children. The immunization status of the studied children showed that the percentage of complete doses of immunization was higher among the Apatani group (87.01%) compared to Nyishi group (36.97%) (Not shown in the table). This was due to lack of awareness among the Nyishi populations of Raga, Kamle district. In other words, the majority of the Nyishi children were born in home and less immunized (63.03%) compared to National averages. [21] They do not consider immunization of children as important and also do not have good medical facility. In contrast, Apatani population was well aware of it and had better medical facility than that of Nyishi population. A micro level regional study among the Aka boys aged 9 to 18 years in Arunachal Pradesh showed them to be comparatively overweight (1.67%) than the present children. [22]

Conclusion

There are some notable differences between the children of Apatani and the Nyishitwo tribes in terms of the mean values of anthropometric measures; the Apatani children are taller and heavier compared to the Nyishi counterparts and Nyishi children have higher values of undernutrition compared to Apatani children. This suggests that a greater proportion of Nyishi children in the studied population are experiencing undernutrition, which can have detrimental effects on their growth and development. Addressing undernutrition should be a priority for policy makers, with a focus on providing adequate nutrition and healthcare interventions for Nyishi children. On the other hand, a larger proportion of Apatani children in the studied population are overweight or obese, which can increase the risk of various health issues such as cardiovascular diseases and diabetes in their early age. This data can be useful for policy makers as it highlights the need for targeted interventions to address both undernutrition and overweight/obesity among children in these tribes. Policies should be developed to improve access to nutritious food, healthcare facilities, and education on balanced diets for Nyishi children to combat undernutrition. Similarly, policies should also focus on promoting healthy eating habits, physical activity, and awareness about the risks associated with overweight/obesity among Apatani children. However further study is also required to identify the factors responsible for this disparity between Apatani and Nyishi children.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest concerning this article's research, authorship, and publication.

Funding sources: 

None

Acknowledgments:

The authors are thankful to the participants of the present study and also thankful to Rajiv Gandhi University, Arunachal Pradesh, India for Financial and logistic support.

References

1. World Health Organization (WHO). Physical status. The use and interpretation of anthropometry. WHO Technical Report No. 854. Geneva: WHO, 1995.
2. Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 2020; 12(4):1181. doi:10.3390/nu12041181.
3. Lassi Z, Moin A, Bhutta Z. Nutrition in Middle Childhood and Adolescence. In: Bundy DAP, Silva Nd, Horton S, et al., editors. Child and Adolescent Health and Development. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017. doi: 10.1596/978-1-4648-0423-6_ch11
4. Black RE, Victora CG, Walker SP et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382: 427–451. doi: 10.1016/S0140-6736(13)60937-X
5. Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying causes and co-existence of malnutrition and infections: an exceedingly common death risk in cancer. Front Nutr. 2022; 9:814095. doi: 10.3389/fnut.2022.814095
6. Piqueras P, Ballester A, Durá-Gil JV, Martinez-Hervas S, Redón J, Real JT. Anthropometric indicators as a tool for diagnosis of obesity and other health risk factors: a literature review. Front Psychol. 2021; 12:631179. doi: 10.3389/fpsyg.2021.631179
7. CNNS. Comprehensive National Nutrition Survey -  Birth to Adolescence Arunachal Pradesh Factsheet 2018. Ministry of Health and Family Welfare, Government of India, 2018.
8. Asghar Md, Amung R, Chakrabarty S. Nutritional status of children (5-18 years) by using Anthropometric indices: A cross-sectional study among the Sartang and Miji, lesser known tribes of Arunachal Pradesh, India. J Nepal Paediatr Soc. 2021; 41(3):413-418.
9. Singh MS, Devi RKN. Nutritional Status among the Urban Meitei Children and Adolescents of Manipur, Northeast India. J Anthropol. 2013: 1-5. http://dx.doi.org/10.1155/2013/983845
10. Longkumar T. Physical Growth and Nutritional Status among Ao Naga Children of Nagaland, Northeast India. J Anthropol. 2013: 1-6. http://dx.doi.org/10.1155/2013/291239
11. Khongsdier R, Mukherjee N. Growth and nutritional status of Khasi boys in Northeast India relating to exogamous marriages and socioeconomic classes. Am J Phys Anthropol. 2003; 122(2):162-170.
12. Sikdar M. Nutritional status among the Mising tribal children of northeast india with respect to their arm fat area and arm muscle area. Hum Biol Rev. 2012; 1(4): 331-341.
13. Maken T, Verte LR. Nutritional status of children as indicated by z-scores of the Hmars: A tribe of N.E. India. Antrocom: Online J Anthropol. 2012; 8(1): 213-27.
14. Saha S, Roy S, Sil SK. Physical growth and nutritional status of Chakma tribal children of tripura. Studies in Tribes and Tribals. 2017; 15(1): 18-22.
15. Sil SK, Saha S, Roy S, Sarkar SR. Nutritional status of urban Tripura tribal boys of Agartala, Tripura. The Anthropologist. 2012; 14(2): 167-9.
16. Weiner JS, Lourie JA. Practical Human Biology. Oxford: Blackwell Scientific Publications, 1981.
17. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000; 320(7244):1240-1243. doi:10.1136/bmj.320.7244.1240.
18. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ. 2007; 335(7612):194. doi: 10.1136/bmj.39238.399444.55.
19. Dkhar JW, Singh MS. Prevalence of Overweight and Obesity among the Meitei Adolescent of Manipur, India. The Anthropologist. 2012; 14(4): 347–351. https://doi.org/10.1080/09720073.2012.11891256
20. Rinya P. Food transition among tribal and globalization with reference to Arunachal Pradesh. J Soc Work Educ Prac. 2017; 2(1): 1-6. https://www.jswep.in/index.php/jswep/article/view/20
21. Summan A, Nandi A, Schueller E, Laxminarayan R. Public health facility quality and child immunization outcomes in rural India: A decomposition analysis. Vaccine. 2022;40(16):2388-2398. doi: 10.1016/j.vaccine.2022.03.017.
22. Das P, Begum G. Nutritional Status of the Aka Boys of Arunachal Pradesh. In Converging Spectrum of Anthropology with Emphasis on Assam and Adjoining Areas, edited by Bezbaruah, D, EBH Publishers, India, Guwahati, 2020.