Dietary Guidelines for Indians (DGIs) By NIN

Context

Recently, the Hyderabad-based National Institute of Nutrition (NIN) under the apex health research body the Indian Council of Medical Research (ICMR) has released the revised Dietary Guidelines for Indians (DGIs). 

The Lancet Study and State of Food Security and Nutrition in the World (SOFI) Report 2023

• A study on malnutrition published in The Lancet earlier this year said undernutrition continues to be high in India, but obesity has increased significantly over the last 30 years.
• As per State of Food Security and Nutrition in the World (SOFI) Report 2023 (published by Food and Agriculture Organization), 74% people in India can not afford a healthy diet.

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Crucial Insights on the Dietary Guidelines for Indians, Released by the Indian Council of Medical Research (ICMR)

Issued Dietary Guidelines for Indians: Seventeen guidelines have been listed in it to meet the requirements of essential nutrients and prevent non-communicable diseases (NCDs). It also prescribed general principles such as reducing consumption of salt and highly processed foods (such as packaged chips, cookies, bread, ketchup, candy, etc.).

• The report quotes the Comprehensive National Nutrition Survey 2019, which showed high prevalence of lifestyle conditions even in children. 
  • Around 5% of children of ages 5-9, and 6% of adolescents, were overweight or obese, almost 2% of children and adolescents were found to have diabetes, and another 10% had pre-diabetes.

About Healthy Diet

According to the Food and Agriculture Organization (FAO), a healthy diet is one that meets the nutritional needs of individuals at different stages of life and promotes overall health. 

• Nutrition: It is the science of food and nutrients and their action on our health.
• Physiological State: It refers to the state when nutrient needs increase because of normal physiological events such as pregnancy and lactation. 
• Components: According to WHO, components of a healthy diet are as follows:
• • Breastfeed: Exclusively breastfeed babies for the first 6 months and continue breastfeeding until 2 years and beyond. 
  • Energy: The intake of energy should balance energy expenditure. Eat at least 400g of fruits and vegetables a day.
  • Fat: Keep total fat intake to less than 30% of total energy intake, with a shift in fat consumption away from saturated fats to unsaturated fats, and towards the elimination of industrial trans fats. 
  • Sugar: Limit intake of free sugars to less than 10% (or even less than 5%) of total energy intake. 
  • Salt: Keep salt intake to less than 5 g/day. 

• Balanced Diet: A balanced diet is one form of a healthy diet, since it consists of all the essential nutrients that would be optimal for overall functioning. 
  • It is thus common to use ‘balanced’ and ‘healthy’ diets interchangeably.
• Significance of a Balanced Diet:
  • Prevent Deficiencies: A balanced diet prevents nutrient deficiencies that can lead to various health problems. 
    • Examples: Lack of vitamin C can cause scurvy and is essential for collagen production  and iron deficiency leads to anaemia.
  • Prevent from Diseases: A balanced diet reduces the risk of chronic diseases like diabetes, cardiovascular diseases, and certain cancers.
  • Optimal Function: Different nutrients perform specific functions and their appropriate quantity is desirable for optimal functions of the body. 
    • Examples: Calcium is necessary for bone health and potassium is required for maintaining normal blood pressure.
  • Weight Management: A balanced diet helps maintain a healthy weight by providing the right mix of macronutrients and preventing overconsumption of unhealthy foods.

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Raised Concerns

• High Disease Burden: The guidelines say an estimated 56.4% of India’s total disease burden can be attributed to unhealthy diets. 
  • The prolonged intake of large amounts of protein powders or consumption of high protein concentrate has been associated with potential dangers such as bone mineral loss and kidney damage.
• Cholesterol Level: The survey found high levels of bad cholesterol (LDL and triglycerides) in 37.3% of children ages 5-9, and 19.9% of pre-teens and teens ages 10-19.
  • Levels of good cholesterol were low in a fourth of all children and adolescents.
• Dual Nutrition Challenge: Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. 
  • While severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country, anaemia is prevalent at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
• Faulty Dietary Pattern: The “faulty dietary pattern” in which unhealthy, highly processed, high-fat, sugar and salt (HFSS) foods have become more affordable and accessible than healthier alternatives, “contributes to deficiencies in iron and folic acid, resulting in anaemia and in the higher prevalence of overweight and obesity among population groups.
  • As per WHO estimates that by 2025, approximately 167 million people, adults and children will become less healthy because they are overweight or obese.
• Availability & Impact: Due to the limited availability and high cost of pulses and meat, a significant proportion of the Indian population relies heavily on cereals, resulting in poor intake of essential macronutrients (essential amino acids and essential fatty acids) and micronutrients.
  • Low intake of essential nutrients can disrupt metabolism and increase the risk of insulin resistance and associated disorders from a young age.

Way Forward

• Avoid Unhealthy Practices: To avoid protein supplements for building body mass and restrict salt intake, minimise sugar and ultra-processed foods and read information on food labels to make informed and healthy food choices.
• Adopt General Dietary Principles: The recommended ideal diet charts for various groups of people takes into account both micronutrient deficiencies and diseases of overnutrition.
  • The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils. 
  • Consumption of cereals should be restricted, so they contribute only 45% of the total energy (instead of the 50-70% now). 
  • Instead, more proteins (pulses, meat, poultry, fish) should be consumed, making up 14% of the total daily energy (instead of only 6-9% now).
  • Salt consumption should be restricted to 5g a day, and strongly recommends against consuming highly processed foods that are typically high in fats, salt and sugar.
  • Sugar should be less than 5% of total energy intake and a balanced diet should provide not more than 45% calories from cereals, and millets and up to 15% of calories from pulses, beans and meat. 
  • Total fat intake should be less than or equal to 30% energy.
  • Achieving adequate levels of essential polyunsaturated fatty acids (PUFA) and B12 is a challenge for vegetarians. The guidelines recommend consumption of flax seeds, chia seeds, walnuts, vegetables, and greens.
• Follow Group-Specific Guidelines:
  • Pregnant Women: Small frequent meals for those experiencing nausea and vomiting. The guidelines recommend consumption of lots of fruit and vegetables, especially those high in iron and folate content.
    • Focus on Children, Mothers: For mother and child, optimal nutrition from conception till the age of 2 years is linked to proper growth and development. It can prevent all forms of undernutrition, including micronutrient deficiencies, and obesity.
  • Infants and Children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. There is no need to give water, even during hot months. After age 6 months, complementary foods must be included.
  • Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients and fibre. 
    • Apart from pulses and cereals, with at least one-third as whole grains, at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed. 
• Adopt a Healthy Lifestyle: A significant proportion of premature deaths can be averted by following a healthy lifestyle. 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.
  • Exercise is important in order to maintain bone density and muscle mass.
  • Sustainable Nutrition and Agriculture: Nutrition is linked to the health of our planet. Sustainable agricultural practices are crucial for ensuring nutritious food while minimising environmental impacts.
    • Farmers’ Markets intervention is also required to increase the availability of fresh, locally sourced foods through farmers’ markets supporting both local agriculture and access to nutritious options.
• Education and Awareness: Nutrition education is the cornerstone of change.
  • In Schools: Nutrition education programs in schools need to be held to foster healthy habits from an early age. 
  • In Communities: It can include cooking classes, community gardens, and workshops on reading food labels to create nutritional and good health awareness.
  • In Healthcare Centres: Healthcare professionals need to provide guidance on managing chronic conditions through diet, ensuring patients understand how nutrition impacts their health.
• Policy Formulations & Strict Enactments: To address nutrition-related concerns, there is a need for a multi-pronged approach, in which governments and organisations need to play their crucial roles.
  • • Examples: Food Fortification programs to address specific nutrient deficiencies, such as, fortifying salt with iodine helps combat iodine deficiency disorders.
  • School Feeding Programs: Providing nutritious meals in schools to ensure children access to healthy food and also supports their learning and overall development.
  • Regulations on Food Labeling: Need for more clear and informative food labels to make healthier and more informed choices by consumers. 
  • Subsidised Healthy Food Programs: Government programs that provide financial assistance for purchasing nutritious foods is significant and desirable to bridge the gap for individuals facing economic challenges.
• Addressing Nutrition Disparities: Initiatives such as Community Gardens provide low-income communities with opportunities to grow their own fresh produce, promoting healthy eating habits and self-sufficiency.

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