Being beaten up at home could be making Indian women and children frail and undernourished. In an interesting research, a team of social scientists from Harvard School of Public Health has for the first time found a strong association between domestic violence and chronic malnutrition among Indian women and children. After analyzing data from 69,072 women aged 15-49 years and 14,552 children aged 12-35 months from the Indian National Family Health Survey, scientists found that women who reported being physically assaulted more than once in the last one year had 11% increased risk of suffering from anaemia and 27% increased risk of having severe anaemia, compared to women who were treated better. The risk for being severely underweight was 21% greater in women reporting more than one instance of domestic violence. On the other hand, researchers found that children of mothers who were physically abused regularly were 18% more likely to be wasted, 14% more likely to be stunted and 34% more likely to be severely underweight. The study was published on March 26 in the American Journal of Epidemiology. Explaining the reason behind the connection between exposure to domestic violence and malnutrition, social scientist S V Subramanian from Harvard's department of society, human development and health told TOI that two explanations could prove the association, the first relating to empowerment. According to Dr Subramanian, perpetrators of domestic violence use different types of abuse, such as physical and psychological, to control the behaviour of their family members. "The withholding of food is a documented form of abuse in Indian households and is likely correlated with the perpetration of physical violence. An inadequate diet resulting from this results in nutrient deficiencies that cause anaemia and underweight. Additionally, domestic violence is strongly associated with a woman's inability to make decisions for herself including the choice of types and quantities of food that a woman prepares,' Dr Subramanian said. He added: "The second explanation is psychological stress. Women who experience domestic violence tend to have higher levels of psychological stress. Children who have witnessed domestic violence in their homes go through the same.' According to the team, psychological stress is a risk factor for oxidative stress, a term describing a number of chemical reactions that produce free radicals and other organic molecules capable of damaging living tissue. This destroys red blood cells prematurely, acting as a potential cause of haemolytic anaemia. Additionally, although acute stressful incidents temporarily increase blood levels of both haemoglobin and erythrocytes, chronic stress has been found to result in long term reductions, suggesting that stress interferes with protein synthesis required to create new red blood cells. Psychological stress could also be linked to underweight status. Most research in food-rich environments in industrialized nations has documented a link between chronic stress and obesity. Chronic stress also increases metabolic rate and energy expenditure, a process that could cause weight loss in a person with a fixed and limited caloric intake. "Under stressful conditions, lean subjects tend to lose weight while overweight subjects tend to gain weight,' Dr Subramanian said. "Clearly, this study demonstrates yet another adverse health effect of domestic violence, besides its links to asthma and smoking. More efforts are needed to be focused on social conditions that influence human health,' Dr Subramanian, who along with Leland Ackerson from the Dana-Farber Cancer Institute, Boston, conducted the study, added. Malnutrition is the leading risk factor for mortality in the world, contributing to nearly 12% of all deaths and 16% of all disability. Anaemia causes poor cognitive development, weakened resistance to infection, maternal mortality and stunting. Nutritional anaemia results from inadequate availability of micronutrients required for haemoglobin synthesis.