Comprehensive Guidelines on the Diet of Vulnerable Groups

Comprehensive Guidelines on the Diet of Vulnerable Groups

Context: Comprehensive guidelines on the diet of vulnerable groups, including pregnant and lactating women, children, and the elderly, have been published by Indias premier nutrition research institute, the National Institute of Nutrition (NIN). This initiative has been undertaken in response to the increasing prevalence of noncommunicable diseases (NCDs) such as cardiovascular disease, cancers, and diabetes among adolescents and even children.

Non-Communicable Diseases in India

• NCDs, also known as chronic diseases, are characterized by long duration and result from a combination of genetic, physiological,
environmental, and behavioral factors. The main types of NCDs include:
o Cardiovascular diseases (CVDs) such as heart attacks and stroke.
o Cancers.
o Chronic respiratory diseases (CRDs) such as chronic
obstructive pulmonary disease (COPD) and asthma.
o Diabetes.
• Global Impact of NCDs:
o NCDs disproportionately affect people in low- and middle income countries, where over three quarters of global NCD deaths (31.4 million) occur.
o The global ambition, aligned with Sustainable Development Goal 3, is to reduce premature mortality from NCDs by one-third by 2030.

• Status of NCDs in India:
o According to the “India: Health of the Nations States” report by the Indian Council of Medical Research (ICMR), the proportion of deaths due to NCDs in India increased from 37.9% in 1990 to 61.8% in 2016.
o Currently, NCDs account for 63% of all deaths in India.
o The human impact of NCDs is most severe among those over 30 years old, with the leading causes of NCD-related deaths being:
o Cardiovascular diseases (CVDs) at 27%.
o Chronic respiratory diseases (CRDs) at 11%.
o Cancers at 9%.
o Diabetes at 3%.
o Other NCDs at 13%.

• Behavioral Risk Factors Associated with NCDs:
o The four major NCDs share common behavioral risk factors, including:
o Unhealthy diet.
o Lack of physical activity.
o Tobacco use.
o Alcohol consumption.

• Economic Impact of NCDs on India:
• It is estimated that NCDs will cost India $3.55 trillion in lost economic output between 2012 and
2030, highlighting the substantial economic burden associated with these diseases.

Government Initiatives:

The Comprehensive Guidelines on the Diet of Vulnerable Groups:

• Key Highlights of the Guidelines:

o Unhealthy diets contribute to approximately 56.4% of India’s total disease burden.
o A healthy diet combined with physical activity can prevent 80% of Type 2 diabetes cases and reduce the burden of heart disease and high blood pressure.

• Key Focus Areas of the Guidelines - Children:
o Optimal nutrition from conception to age 2 is crucial for proper growth and development, preventing all forms of undernutrition including micronutrient deficiencies and obesity.
o The Comprehensive National Nutrition Survey 2019 highlighted a high prevalence of lifestyle-related conditions in children.

• Dual Nutrition Challenge in India:
o Micronutrient deficiencies (zinc, iron, vitamins) affect 13% to 30% of children aged 1 to 19.
o While severe forms of undernutrition like marasmus and kwashiorkor have reduced, anaemia remains prevalent.
o Faulty dietary patterns with increased consumption of unhealthy, highly processed, high-fat, sugar, and salt (HFSS) foods contribute to deficiencies in iron and folic acid.

• Recommendations of the Guidelines:
o Consume nutrients from at least eight food groups including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
o Restrict consumption of cereals and increase intake of proteins (pulses, meat, poultry, fish).
o Vegetarians should focus on sources of essential polyunsaturated fatty acids (PUFA) and Vitamin B12 like flax seeds, chia seeds, walnuts, vegetables, and greens.
o Limit salt consumption to 5g per day and avoid highly processed foods high in fats, salt, and sugar.

• Age/Group-Specific Recommendations:
o Pregnant Women: Consume plenty of fruits and vegetables rich in iron and folate.
o Infants and Children: Exclusively breastfeed for the first six months and introduce complementary
foods thereafter.
o Elderly: Consume foods rich in proteins, calcium, micronutrients, and fiber; engage in regular exercise to maintain bone density and muscle mass.

These guidelines emphasize the critical role of nutrition in preventing diseases and promoting overall health across
different vulnerable groups in India, advocating for balanced diets, limited consumption of unhealthy foods, and
specific nutritional needs based on age and physiological status.