Food and nutrition in Pakistan (a cross-regional study).
Butt, Shaheen A. ; Mahmood, Tallat
Though the nutritional status of an individual is the outcome of
complex interaction of a host of environmental factors, income is the
mirror-image of a household's purchasing capacity. Another major
factor in determining nutritional status in developing countries is
considered to be the family size.
Higher income levels are regarded as a prerequisite for the
improved nutritional status of household [Berg (1973); Levinson and
Morinda (1974); Seyoam, Kindaue and Gebru (1986)]. It is posited that,
with improvement in a household's income, the absolute expenditure
on food is likely to go up as also the intake of four essential
nutrients. (1) It has been observed in various studies that food intake
level in developing countries varies significantly across income classes
(Seyoam, Kindaue and Gebru (1986). A World Bank study underscored the
fact that serious and intensive nutritional deficiencies that exist in
almost all developing countries are largely a reflection of poverty
(World Development Report 1980).
A large family size may adversely affect the nutritional status of
every member of a household because it may be associated with decreased
per capita human impact i.e. the allocation of food per member is likely
to decrease with the increase in the number of household members which,
in turn, may have a negative effect on per capita nutrient intake.
The main objective of this study is to evaluate the intake of
energy, protein, vitamins and minerals by rural and urban households
across income groups and provinces. A relationship between household
income and size with food nutrients will be developed to see the impact
of these economic and demographic variables on the level of nutrient
intake. This analysis may be very fruitful because preferences for food
nutrients so obtained can be useful in indicating which foodstuffs are
preferred to meet the required allowance of the four important
nutrients.
METHODOLOGY
The data employed in this study is classified on the basis of
different income groups selected from the rural and urban structure in
Pakistan. Food items have been selected from the Household Income and
Expenditure Survey for the year 1979. Food nutrients are calculated from
the Food Composition Table Planning and Development Division, (1985).
Four nutrients i.e. energy, protein, vitamins and minerals are
considered to be important indicators of the nutritional status of a
household. To estimate an average level of intake of various nutrients,
the quantities of various food items consumed by different income groups
are multiplied by its constituents contained in 1000 grams of the given
food items. The work is carried out for rural and urban sectors of all
the four provinces. The impact of household income and size will be
tested for nutrient intake of different income groups. Adequacy of this
relationship will be examined through a log-linear function. (2)
RESULTS
Energy and Protein Intake
A number of nutritionists have strongly argued that protein is
inefficiently metabolized whenever energy intake is inadequate for human
requirement [Goldman and Ranade (1974); Butt and Mahmood (1986); Food
and Agricultural Organization (1974)]. They emphasize that adequacy of
energy intake must receive first consideration so that any additional
protein supplied to meet the estimated protein needs will be efficiently
utilized for body growth, and repair and maintenance. The figures of
energy intake by households in rural areas of the Punjab and NWFP as
reported in Table 1, are almost equal to the recommended allowance of
energy. (3) Other provinces are deficient in energy intake. The most
deficient groups belong to Baluchistan and the urban areas of Sind.
Carbohydrates are the main source of energy intake in Pakistan. Protein
intake is more than the recommended allowance but, in fact, in most of
the regions, particularly, in the lower income groups, it is utilized
more for energy purposes rather than for growth and maintenance of the
body. Table 3 also highlights the sources of energy, protein, fats and
carbohydrates. In all urban areas the percentage of animal protein is
higher than that of rural areas. The opposite results are observed in
the case of fats. In rural areas of Punjab and Sind 55 percent and 44
percent of fat intake is from animals. The greater use of 'desi
ghee' (butter oil) is the main cause. In the urban areas preference
for poultry, fish and mutton are the cause of higher animal protein
intake.
The same is true for the adverse effect of household size. The
results obtained for household size elasticity for animal protein in
case of rural Punjab are opposite to those obtained for other provinces
(Table 4). Here the household size elasticity for energy from animals is
positive. This may be due to the reason that large families are in a
position to look after a larger number of livestock. On the other hand,
in urban areas of Sind the adverse effect of household size on energy
intake is greater than the positive effect of household income. This
shows that the incidence of malnutrition in this region of Pakistan is
mainly due to growth in household size and lower purchasing power. There
may be other reasons like varied diet patterns, illiteracy, and
ignorance, etc.
Vitamins and Minerals
In this paper, five major vitamins i.e. Thiamin (Vitamin B),
Riboflavin Vitamin (B2), B Carotene (Vitamin A) and Ascorbic Acid
(Vitamin C) and two minerals i.e. iron and calcium are analysed across
income groups and urban rural areas of the provinces. There are three
bases of our analysis: (1) To check the level of nutrient intake in each
income group. (2) To check whether a rise in household income or size
shows a positive or negative effect on nutrient intake. (3) To make a
comparison of nutrient intake across regions at each income group level.
According to Tables 1 and 2 most regions in the country are
self-sufficient in Thiamin, Niacin, Iron, Calcium and Ascorbic Acid. But
the people living in rural areas of Baluchistan are deficient in
Ascorbic Acid, Niacin and Calcium. Their deficiency in Ascorbic Acid and
Calcium is serious because on average the recommended allowance for
these vitamins and minerals is 27.22 mg, 470 mg and -570 mg respectively
while their intake is 18.51 mg and 340.34 mg. They are slightly
deficient in Niacin. In this region, the adverse effect of household
size is relatively greater than the positive effect of household income
on nutrient intake. The major reason for deficiency of Ascorbic Acid and
Calcium seems to be either non-availability of food items which contain
higher amounts of Ascorbic Acid and Calcium or that these people do not
prefer such food items. This conclusion is drawn because we have
observed that even people lying in the higher income groups are
deficient in Ascorbic Acid and Calcium intake. Price cannot be the cause
of these" deficiencies in the higher income groups. Another reason
may be the ignorance of people about their nutritional requirements.
Urban areas of Sind and Baluchistan are also deficient in Calcium intake
whereas rural areas of Sind are self-sufficient. In urban areas of Sind
and Baluchistan income elasticity is observed to be .27 and .25
respectively. Both elasticities are significant but their magnitudes are
relatively low as compared to the magnitude of income elasticity
observed for other regions of Pakistan. In Baluchistan, income groups in
the Rs 3001 to Rs 3500 range are deficient in Calcium but in the case of
Sind higher income groups are taking Calcium in excess of the
recommended allowance. The causes of Calcium deficiency in urban areas
of Sind and Baluchistan are different. In the case of Sind, low
purchasing power and adverse household size are the main causes of
deficiency in Calcium intake whereas in Baluchistan non-availability of
food items containing sufficient amount of Calcium or ignorance of the
people about their nutritional requirements may be the main cause of
this deficiency.
Riboflavin is another important vitamin and its deficiency, along
with deficiency of energy, brings about diseases like masmaras and
kwashiakor. In Pakistan the rich and the poor are deficient in this
vitamin which clearly shows that Riboflavin intake is much lower than
the recommended allowance. Whole cereals and pulses are the main sources
of this vitamin. Polishing of rice and grinding of cereals wastes
Riboflavin and this seems to be the main cause of deficiency of this
vitamin, at least in the poorer classes.
Vitamin A is derived from two sources i.e. B-Carotene and Retinal.
Retinal source of Vitamin A is rare and mostly found in animal foods
whereas B-Carotene is freely available in daily diet and easily
accessable. However, the amount of B-Carotene required is twice that of
Retinal(Food and Agriculture Organization 1974).
CONCLUSIONS AND POLICY RECOMMENDATIONS
Severe limitations on the purchasing power of the poor is the main
cause of malnutrition. Our lower income groups are deficient in energy,
Calcium, Vitamin A and Riboflavin. But in rural Punjab, however, the
poor are self sufficient in these nutrients.
From the foregoing analysis one can conclude that with improvement
in the economic status of the poor, adequate emphasis should be placed
on their food consumption patterns. In Baluchistan even the rich are
deficient in important nutrients due to their traditional food
consumption patterns.
The present study shows that the high rate of population growth in
Sind with limited capabilities results in reduced available per capita
food demand culminating in various degrees of malnutrition. Briefly, in
Pakistan for some nutrients in which all income groups are
self-sufficient (protein, thiamin and iron) where there is a wish among
high income groups to meet the nutritional requirements by consuming
high status food, there is a way for the poor to attain the recommended
level through staple food items.
Several measures can be taken to improve the food intake of lower
income groups:
1. There is need for family planning to keep the rate of population
growth within reasonable limits.
2. Government should take into account a range of foods rather than
cash crops only, along with other high nutrient items. Special emphasis
should be given to food crops etc.
3. Agricultural prices should be stabilized and nutritious food
should be made available in the markets.
4. There is need for an optimal trade-off between cash crops and
food crops.
5. Losses due to inefficient handling, transportation and milling
should be minimized.
6. It is necessary that basic nutritional educational information
should be provided at all levels.
7. Government should introduce minimum wage legislation.
Comments on "Food and Nutrition in Pakistan (A Cross-regional
Study)"
First of all I would like to thank the authors for an interesting
and enlightening paper on "Food and Nutrition in Pakistan (A
Cross-regional Study)". This paper attempts not only to assess the
size of the problem, but also to identify the causes and consequences of
inadequate nutrition intake.
I am, however, not a food and nutrition expert and my only
"competence in the field", as Dr Chaudhry so kindly put it, is
in using the 1979 HIES in our paper to be presented tomorrow. It would
have been useful, therefore, for hymen such as myself, if some of the
theory behind the work had been given. Obviously because of size
limitations, this is difficult.
One of my concerns with the paper is the effect that
multicollinearity may have on the equations, as the household size and
income variables are likely to be collinear. Investigation into this
should be carried out as it could have important effects upon the
results. In fact, Sohail Malik et al. (1987) in their paper presented at
this conference, found the family size variable to be strongly
correlated with household income in all years, which led to severe
multicollinearity problems. They overcame these by dividing through by
family size and conducting their analysis on a per capita basis.
Turning to the tables, the number of people in the various
provinces and the [R.sup.2] statistic should possibly have been
produced, and while it is presumed that the figures in brackets on Table
4 are T-statistics it would be nice to have this confirmed. A more
detailed analysis of the allocation of food amongst family members would
also have been interesting. My particular concern is with women being
treated as equal adult members in nutritional consumption. Some of the
work carried out by Amartya Sen (amongst others) may be relevant here as
he appears to have found that adults in a household may have more
nutritional requirements. The female members of the family, however,
will need less vis-a-vis the male members. (1) The composition of food
across regions and provinces, is it the same in terms of minerals,
vitamins, energy and protein, and if not, has this been accounted for?
Further, the question of quality should be remembered. (2) Is it
important to know how family size changes? For instance will there be a
different requirement in nutritional terms if the family size is
increased through marriage rather than through birth?
I would be interested to see a further piece of work that should be
quite easy to achieve and potentially very rewarding. This is, to break
down the 1979 HIES into suitable income groups and find if the
nutritional level varies as one would expect that it does. I would
hypothesize that the more well off are generally above the minimum
nutritional level. It would also be interesting to find out what income
group had the "best" diet, for example, the very wealthy may
not have a nutritionally balanced diet due to their consumption of
excess fats/junk food.
Turning to the conclusions, most of the steps to improve the diet
of the low income group appear to be perfectly reasonable. If people
grow more crops, even highly nutritious ones, they may not consume more
as they may still be sold. Solving the nutrition problem by cutting down
on exports may not be acceptable, as the foreign exchange earnings could
perhaps be used where it would be more socially profitable.
Finally, the work is an interesting starting point for an analysis
of nutrition in Pakistan. More experimentation and research in this area
must be useful.
Stephen E. Ludlow
London School of Economics and Political Science, London
REFERENCE
Malik, Sohail J. et al. (1987). "Rural-Urban Differences and
the Stability of Consumption Behaviour: An Inter-temporal Analysis of
the Household Income and Expenditure Survey Data for the period from
1963-64 to 1984-85". PSDE 1987.
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Bussink, W.C. (1970). "A Complete Set of Consumption
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Butt Shaheen A. and Tallat Mahmood. "protein and Energy
Intake". A Case Study of Rural Pakistan. Pakistan Institute of
Development Economics. (Research Report No. 150).
Goldman, H.W. and C G. Ranade (1974). "An Analysis of Income
Effect on Food Consumption in Rural and Urban Philippine". Journal
of Agricultural Economics and Development. Vol. VII, No. 2.
Joy, L. and P. Payne (1975). "Food and Nutrition
Planning". Document ESN: CRS 175/35, FAO. Rome.
Levinson, F. J., and Morinda (1974). "An Economic Analysis of
Malnutrition Among Children in Rural India". Cornell/MIT
International Policy Series.
Pakistan, Government of (1983). Household Income and Expenditure
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Pakistan, Government of (1985). "Food Composition Table for
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Perisse, J. and Wanda Polacchi (1980). 'Geographical
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Siddique, R. (1982). "The Analysis of Consumption Patterns in
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United Nations (1974). "Hand Book on Human Nutritional
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United Nations (1973). Food and Agriculture Organization.
"Energy and Protein Requirements". Rome.
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(1) Calories, Protein, Vitamins and Minerals.
(2) Log xi = i + i log Y + i log S
where
xi = Stands for various food nutrients consumed by a household
S = Household Size
Y = Household income (in Rs).
(3) The recommended allowances of various nutrients, as reported in
Table 2 are calculated keeping in view the age and sex distribution of
the population in rural urban areas.
SHAHEEN A. BUTT and TALLAT MAHMOOD *
* The authors are Staff Economists at the Pakistan Institute of
Development Economics, Islamabad.
Table 1
Food Nutrient Intake by Region
Punjab Sind
Rural Urban Rural Urban
Calories (kcal) 2326 2045 2067 1816
Protein (gm) 68 59 56 51
Fats (gm) 44 47 48 48
Carbo-hyderates (gm) 419 348 353 294
Calcium (mg) 584.21 502.45 522.94 405.59
Iron (mg) 29.77 24.75 23.67 20.50
Thiamin (mg) 2.05 1.68 1.54 1.38
Riboflavin (mg) 1.11 0.98 0.98 0.85
Niacin-B (mg) 10.09 16.52 16.73 15.13
Carotene (mcg) 689.93 742.99 509.68 588.06
Ascorbic Acid (mg) 30.62 36.54 24.23 30.91
NWFP Baluchistan
Rural Urban Rural Urban
Calories (kcal) 2264 2011 1782 1792
Protein (gm) 64 56 50 50
Fats (gm) 45 51 36 40
Carbo-hyderates (gm) 407 334 313 309
Calcium (mg) 437.34 446.30 340.34 334.11
Iron (mg) 27.85 23.22 21.52 20.23
Thiamin (mg) 1.90 1.54 1.49 1.47
Riboflavin (mg) 1.01 0.93 0.78 0.78
Niacin-B (mg) 18.40 16.09 15.10 15.36
Carotene (mcg) 671.49 718.54 466.50 585.82
Ascorbic Acid (mg) 28.22 33.40 18.51 27.11
Table 2
Food Nutrient Requirement by Region
Punjab Sind
Rural Urban Rural Urban
Calories (kcal) 2339 2355 2296 2290
Protein (gm) 29 29 28 28
Calcium (mg)
Lower Limit 440 440 440 440
Upper Limit 540 540 540 540
Iron (mg)
Lower Limit 7.68 7.64 739 7.16
Upper Limit 14.87 14.99 14.27 13.59
Thiamin (mg) 0.93 0.94 0.91 0.90
Riboflavin (mg) 1.40 1.40 1.37 1.36
Niacin (mg) 15.44 15.54 15.16 15.12
Vitamin A (mcg) 600.20 603.20 578.62 580.40
Ascorbic Acid (mg) 26.06 26.18 25.52 25.25
NWFP Baluchistan
Rural Urban Rural Urban
Calories (kcal) 2241 2350 2462 2232
Protein (gm) 27 29 31 29
Calcium (mg)
Lower Limit 440 440 440
Upper Limit 540 540 540
Iron (mg)
Lower Limit 7.52 7.46 7.65 6.97
Upper Limit 14.83 14.34 14.99 14.23
Thiamin (mg) 0.93 0.89 0.99 0.93
Riboflavin (mg) 1.34 1.42 1.48 1.39
Niacin (mg) 14.79 15.48 16.42 15.39
Vitamin A (mcg) 558.53 597.59 623.17 586.17
Ascorbic Acid (mg) 25.05 25.97 27.22 25.67
Table 3
Animal viz-a-viz Vegetables Sources
(in percent)
Calories Protein
Animal Vegetable Animal Vegetable
Punjab
Rural 13 87 15 85
Urban 11 89 19 81
Sind
Rural 14 86 22 78
Urban 11 89 24 76
NWFP
Rural 19 81 15 85
Urban 11 89 22 78
Baluchistan
Rural 7 93 14 86
Urban 8 92 19 81
Carbo-hyderates Fats
Animal Vegetable Animal Vegetable
Punjab
Rural 2 98 55 45
Urban 2 98 35 65
Sind
Rural 3 97 44 56
Urban 2 98 27 73
NWFP
Rural 2 98 31 69
Urban 2 98 29 71
Baluchistan
Rural 1 99 26 74
Urban 1 99 22 78
Table 4
Household Income and Size Elasticities of Various Food Nutrients
Punjab Sind
Urban Rural Urban Rural
Calorie Intakes
Animal Sources
Income Elasticity .64 .27 .52 .26
(11.41) (3.58) (9.38) (5.31)
Size Elasticity -.49 .58 -.72 -.10
(-3.47) (3.04) (-7.44) (-1.10)
Vegetable Sources
Income Elasticity .10 .19 .08 -.23
(6.47) (10.83) (1.50) (-.91)
Size Elasticity -.13 -.22 -.16 .43
(-3.35) (-4.94) (-1.59) (-0.92)
Protein Intake
Animal Sources
Income Elasticity .60 .36 .53 .29
(10.47) (3.44) (10.29) (8.10)
Size Elasticity -.39 .43 -.72 -.19
(-2.69) (1.65) (-7.65) (-2.84)
Vegetable Sources
Income Elasticity .05 .15 .01 -.38
(2.61) (10.39) (0.20) (-1.22)
Size Elasticity -.09 -.16 -.01 .67
(-1.87) (-4.16) (-.11) (1.90)
Fats Intake
Animal Sources
Income Elasticity .68 .24 .53 .26
(11.64) (3.14) (9.00) (3.96)
Size Elasticity -.55 .65 -.72 -.07
(-3.67) (3.29) (-6.67) (-.62)
Vegetable Sources
Income Elasticity .20 .26 .27 .05
(4.95) (6.08) (2.39) (0.44)
Size Elasticity -.15 -.66 -.54 -.04
(-1.19) (-6.05) (-2.57) (-.23)
Carbo-hyderates
Animal Sources
Income Elasticity .49 .23 .45 .19
(8.19) (3.43) (10.04) (7.59)
Size Elasticity -.36 .43 -.69 -.10
(-2.40) (2.58) (-8.45) (-2.29)
Vegetable Sources
Income Elasticity .09 .19 .03 -.29
(6.42) (10.22) (0.69) (-1.05)
Size Elasticity -.13 -.19 -.06 .54
(-3.90) (-3.94) (-.71) (1.05)
Calcium
Income Elasticity .33 .24 .27 .11
(3.68) (8.35) (7.20) (1.55)
Size Elasticity -.31 .05 -.41 -.02
(-9.88) (0.66) (-5.98) (-.19)
Phosphorous
Income Elasticity .15 .22 .10 -.13
(10.54) (9.85) (2.45) (-.64)
Size Elasticity -.18 -.13 -.13 .32
(-5.21) (-2.38) (-1.77) (-.83)
Iron
Income Elasticity .16 .21 .08 -.07
(8.25) (11.86) (-.200) (-.38)
Size Elasticity -.19 -.12 -.13 -.23
(-3.84) (-2.70) (-1.50) (-.70)
Thiamine
Income Elasticity .09 .17 .04 -.31
(5.84) (11.16) (0.92) (-1.07)
Size Elasticity -.14 -.16 -.04 .59
(-3.58) (-3.96) (-.47) (1.12)
Riboflavin
Income Elasticity .26 .25 .22 .03
(11.28) (10.87) (6.34) (0.51)
Size Elasticity -.26 -.10 -.31 .06
(-4.45) (-1.65) (-4.72) (0.28)
Niacin
Income Elasticity .15 .24 .12 -.15
(11.54) (9.49) (2.64) (-.65)
Size Elasticity -.18 -.14 -.16 .32
(-5.39) (-2.17) (-1.94) (0.76)
B-Carotene
Income Elasticity .41 .34 .34 .07
(6.12) (5.92) (4.16) (0.44)
Size Elasticity -.42 -.30 -.40 .17
(-2.45) (-2.07) (-2.63) (0.59)
Vitamin C
Income Elasticity .25 .28 .36 .15
(2.07) (3.94) (7.65) (1.42)
Size Elasticity -.29 -.30 -.52 -.21
(-.94) (-1.86) (-5.98) (-1.08)
NWFP Baluchistan
Urban Rural Urban Rural
Calorie Intakes
Animal Sources
Income Elasticity .37 .50 .63 .73
(3.30) (4.52) (9.56) (2.95)
Size Elasticity -.32 -.50 -.63 -.50
(-1.07) (-2.29) (-5.93) (-.89)
Vegetable Sources
Income Elasticity .07 .44 .08 .19
(2.11) (8.55) (0.79) (2.51)
Size Elasticity .14 -.64 -.06 -.31
(1.57) (-6.36) (-.36) (-1.78)
Protein Intake
Animal Sources
Income Elasticity .40 .50 .52 .56
(3.38) (5.00) (8.27) (2.78)
Size Elasticity -.33 -.46 -.45 -.24
(-1.06) (-2.33) (-4.56) (-.52)
Vegetable Sources
Income Elasticity .05 .44 -.02 .15
(1.35) (7.89) (-.18) (1.90)
Size Elasticity .16 -.72 .13 -.26
(1.54) (-6.47) (0.75) (-1.41)
Fats Intake
Animal Sources
Income Elasticity .37 .51 .71 .78
(3.07) (4.54) (8.28) (3.16)
Size Elasticity .28 .50 -.74 -.55
(-.92) (-2.25) (-5.50) (-.97)
Vegetable Sources
Income Elasticity .21 .36 .17 .23
(3.08) (8.81) (1.53) (1.82)
Size Elasticity -.08 -.36 -.34 -.50
(-.44) (-4.51) (-1.94) (-1.74)
Carbo-hyderates
Animal Sources
Income Elasticity .37 .40 .56 .86
(4.61) (2.74) (4.70) (1.54)
Size Elasticity -.49 -.50 -.43 -.85
(-2.30) (-1.74) (-2.31) (-.66)
Vegetable Sources
Income Elasticity .04 .45 07 .19
(1.04) (8.04) (0.63) (2.40)
Size Elasticity .19 -.67 .00 -.28
(2.07) (-6.17) (0.02) (-1.56)
Calcium
Income Elasticity .24 .41 .25 .40
(4.91) (4.65) (2.72) (2.00)
Size Elasticity -.25 -.58 -17.00 -.47
(-1.92) (-3.37) (1.19) (1.02)
Phosphorous
Income Elasticity .09 .44 .09 .19
(2.65) (7.89) (0.51) (2.55)
Size Elasticity .11 -.66 .08 -.24
(1.22) (-6.08) (0.54) (-1.41)
Iron
Income Elasticity .10 .42 .08 .24
(2.87) (8.28) (0.80) (2.43)
Size Elasticity .06 -.62 .01 -.36
(0.65) (-6.27) (0.04) (-1.59)
Thiamine
Income Elasticity .06 .43 -.004 .16
(1.61) (7.70) (-.04) (1.96)
Size Elasticity .16 -.68 .15 -.19
(1.67) (-6.10) (1.03) (-1.04)
Riboflavin
Income Elasticity .19 .44 .20 .31
(3.70) (7.91) (2.21) (2.70)
Size Elasticity -.09 -.64 -12.00 -.38
(-.65) (-5.84) (-.86) (1.46)
Niacin
Income Elasticity .11 .45 .08 .24
(2.63) (7.48) (0.78) (2.99)
Size Elasticity .09 -.66 -.03 -.29
(0.82) (-5.62) (0.16) (-1.59)
B-Carotene
Income Elasticity .35 .44 .13 .44
(3.73) (3.22) (0.65) (0.93)
Size Elasticity -.45 -.59 .06 -.21
(-1.81) (-2.20) (0.19) (-.20)
Vitamin C
Income Elasticity .35 .37 .04 .74
(3.35) (3.24) (0.17) (3.67)
Size Elasticity -.58 -.58 .12 -.95
(-2.03) (-2.46) (0.32) (-2.87)