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Context

• The comprehensive guidelines issued by the National Institute of Nutrition (NIN) in India address the growing concerns related to noncommunicable diseases (NCDs) and malnutrition among vulnerable groups.

Details

Background

• About 4% of India's total disease burden is attributed to unhealthy diets, emphasizing the need for dietary improvements.
• A healthy diet and physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.

Focus on Vulnerable Groups:

• Optimal nutrition during crucial periods like pregnancy, lactation, and early childhood (up to age 2) is crucial for ensuring proper growth and development, and for preventing various forms of malnutrition and obesity.
• The Comprehensive National Nutrition Survey 2019 highlighted alarming rates of lifestyle-related conditions among children and adolescents, including overweight or obesity, diabetes, and pre-diabetes.
• The survey revealed that approximately 5% of children aged 5-9 and 6% of adolescents were overweight or obese.
• Around 2% of children and adolescents were diagnosed with diabetes, while another 10% had pre-diabetes.
• High levels of bad cholesterol (LDL and triglycerides) were observed in 37.3% of children aged 5-9 and 19.9% of pre-teens and teens aged 10-19. Additionally, a significant portion exhibited low levels of good cholesterol.

Dual nutrition challenge faced by India

Micronutrient Deficiencies:

• Incidence of micronutrient deficiencies, including zinc, iron, and vitamins, is prevalent among children aged 1 to 19, with rates ranging from 13% to 30%.
• Anaemia remains a significant concern, with prevalence rates of 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19, respectively.

Persistence of Undernutrition and Emergence of Overnutrition:

• While severe forms of undernutrition like marasmus and kwashiorkor have decreased, anaemia persists, indicating ongoing nutritional challenges.
• Despite the prevalence of undernutrition, there has been a significant increase in obesity over the last 30 years, highlighting the emergence of overnutrition-related issues.

Importance of Dietary Guidelines

• The guidelines issued by NIN emphasize the importance of adopting healthy dietary practices, including reducing salt intake and limiting consumption of highly processed foods such as packaged snacks, sugary treats, and processed meats.
• Addressing micronutrient deficiencies and promoting balanced macronutrient intake are essential components of the dietary recommendations to combat malnutrition and NCDs.
• Recognizing the diverse nutritional needs of different population groups, the guidelines provide specific recommendations tailored to pregnant and lactating women, infants, children, and the elderly.
• Emphasis is placed on consuming a variety of nutrient-dense foods from different food groups to ensure adequate intake of essential nutrients and promote overall health and well-being.

General dietary principles:

Diverse Food Groups:

• Aim to obtain essential nutrients from at least eight food groups, including:
  • Vegetables
  • Leafy vegetables
  • Roots and tubers
  • Dairy products
  • Nuts
  • Oils

Restriction of Cereals:

• Limit the consumption of cereals, which are a staple in Indian meals, to contribute only 45% of the total energy intake. This is lower than the current range of 50-70%.
• Instead, increase the intake of proteins from sources such as:
  • Pulses
  • Meat
  • Poultry
  • Fish
• Proteins should make up 14% of the total daily energy intake, higher than the current range of 6-9%.

Incorporation of Essential Fatty Acids and B12 for Vegetarians:

• Vegetarians may face challenges in obtaining adequate levels of essential polyunsaturated fatty acids (PUFA) and vitamin B12.
• Recommendations include consuming sources rich in PUFA such as flax seeds, chia seeds, walnuts, vegetables, and greens.

Salt Restriction:

• Limit salt consumption to 5g per day to reduce the risk of hypertension and other related health issues.

Avoidance of Highly Processed Foods:

• Strongly discourage the consumption of highly processed foods that are high in fats, salt, and sugar. These foods contribute to various health problems, including obesity, cardiovascular diseases, and diabetes.

Specific dietary recommendations:

Pregnant Women:

• Dietary Recommendations:
  • Consume small, frequent meals to alleviate nausea and vomiting.
  • Increase consumption of fruits and vegetables, particularly those rich in iron and folate, to support maternal and fetal health.
• Key Nutrients:
  • Iron and folate are essential for preventing anemia and supporting fetal development.

Infants and Children:

• Dietary Recommendations:
  • Exclusively breastfeed infants for the first six months, without giving honey, glucose, or diluted milk.
  • Avoid giving water, even during hot months, as breast milk provides adequate hydration.
  • Introduce complementary foods after six months of age to meet growing nutritional needs.
• Key Nutrients:
  • Breast milk provides essential nutrients and immune protection for infants, while complementary foods should be introduced gradually to ensure a balanced diet.

Elderly:

• Dietary Recommendations:
  • Consume foods rich in proteins, calcium, micronutrients, and fiber to support overall health and well-being.
  • Include a variety of foods such as pulses, cereals (with at least one-third as whole grains), low-fat milk or milk products, nuts and oilseeds, and ample servings of vegetables and fruits.
• Key Nutrients:
  • Protein helps maintain muscle mass and strength, while calcium supports bone health.
  • Micronutrients and fiber are essential for overall health and digestive function.
• Exercise: Regular physical activity is crucial for maintaining bone density and muscle mass, promoting mobility and independence in older adults.

Misleading information presented on packaged food labels:

Misleading Health Claims:

• Products labeled as "sugar-free" may contain hidden sugars, fats, and refined cereals, resulting in high glycemic index and calorie content.
• Food products claiming to be "all-natural" may still contain added flavors or substances, despite minimal processing.
• Claims of being a "good source of protein" or other nutrients may not accurately reflect the quantity of these nutrients relative to daily requirements.

Organic Food Claims:

• Not all organic food claims guarantee the absence of artificial additives or pesticides. Consumers should look for the "Jaivik Bharat" logo approved by the Food Safety and Standards Authority of India (FSSAI) for assurance of organic authenticity.

Fruit Content in Products:

• Products claiming to contain real fruit may have minimal fruit content, often as low as 10%, with added sugars and additives.

Fat Claims:

• All oils are 100% fat and should be consumed in moderation. Claims of being cholesterol-free or heart-friendly may not indicate overall healthiness.

Dietary Guidelines:

• Consumers are encouraged to read food labels to make informed choices and minimize consumption of high-fat, high-sugar, high-salt, and ultra-processed foods.
• The guidelines recommend reducing sugar consumption to less than 5% of daily caloric intake, and ideally eliminating added sugars altogether.
• Long-term consumption of sugar substitutes like aspartame and saccharin may lead to obesity, diabetes, hypertension, and other non-communicable diseases.
• Fortification of ultra-processed foods does not make them inherently healthy.
• Excessive protein intake, especially through supplements, is cautioned against, as it may not contribute significantly to muscle building and can lead to health issues.

Sources:

DownToEarth

PRACTICE QUESTION Q.  The complex nature of the nutrition challenge in India, which requires comprehensive efforts to address both undernutrition and overnutrition and promote healthier dietary patterns among the population. Discuss in the context of the Dietary Guidelines for India 2024. (250 words)