Transcript Handling sugar and sweeteners Intakes –Indian Experience”

“Handling Sugar and Sweeteners
Intakes – Indian Experience”
Rekha Sharma R.D
Director, Clinical Nutrition and Dietetics
Diabetes Foundation ( INDIA)
Former Chief Dietician
All India Institute of Medical Sciences ,New Delhi, INDIA
Science for Health , Diet and
Life style
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Four healthy lifestyle factors
No smoking
Maintaining a healthy weight
Exercising regularly
Healthy diet
Together appear to be associated with
as much as an 80 percent reduction in
the risk of developing the most
common and deadly chronic diseases
Early awareness
• The roots of these factors often
originate during the formative stages of
life, it is especially important to start
early in teaching the important lessons
concerning healthy living.
• Schools should be a priority
Indians have sweet tooth!
• Almost 75% of the sugar available in the
open market is consumed through bakeries,
candy makers, sweet makers, ice cream and
soft drink manufacturers
• Gur, an unrefined form of sugar, is mostly
consumed in rural areas .
• India is currently the world’s largest
consumer of sugar with domestic
consumption increasing more than 4 %
annually.
Consumption of sugar
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2005- 2006 – 19 million tons
2007 – 2008 – 22 million tons
2008 – 2009 – 23 million ton
Per capita consumption of sugar:
Rural – 2.2 kg/ month/ household
Urban – 5.11 kg/month/household
• Sugar consumption in India has more
than doubled in 20 years .
PER CAPITA CONSUMPTION OF
SUGAR IN URBAN INDIA
States
Kgs. Per annum
Punjab
71.5
Haryana
68.5
Maharashtra
40.9
Gujarat
40.9
Kerala
41.5
Uttar Pradesh
35.2
Tamil Nadu
29.1
Karnataka
23.3
All India
31.5
Incidence of Obesity
• On an average 5 % of Indian population is
obese but when seen in urban settings the
numbers are amazingly high .
• Punjab : 30.3 % Males, 37.5 % Females
Kerala : 24.3 % Males, 34.0 % Females
Goa
: 20.8 % Males, 27.0 % Females
• Diabetes Foundation ( INDIA) on going trial in
7 major cities of India and has found 24 %
school children to be over weight and obese
, where the numbers are much higher in
private schools.
Incidence of obesity & Related disorders
• Young Women (18 – 25 years) = 13.2%
Delhi, DST trial ,2000
• Urban slum ( 35 years)
= 40.2%
European Journal of Clinical Nutrition ,2001
• Urban Slum (30-60)
= 28.2%
• Post menopausal (52 years)
= 62 %
Hypertension
>140/90 mm Hg
Hyperlipidaemia Cholesterol > 200 mg
Diabetes Blood sugar >126 mg%
Osteoporosis (T-score < -2.5)
Delhi, DST trial , 2002
Delhi, DBT trial, 2006
= 43%
= 47%
=4%
= 22%
• 4,621( >35 years) overweight urban areas= 64 %
rural areas = 36 %
Hypertension
>140/90 mm Hg
Hyperlipidaemia Cholesterol > 200 mg
Diabetes Blood sugar >126 mg%
DST trial in 6 cities,2009
= 50%
= 25%
= 3 - 14 %
Prevalence (%) of Abdominal Obesity in 14-18 y
old Asian Indian Adolescents: 5 City Data
Age (y)
New
Delhi
Mumba
i
(n = 4997)
(n = 435)
Agra
Jaipur
(n = 4415)
(n = 2646)
Allahaba
d
(n = 3379)
Overall
(n = 15872)
14
26.8
51.9
18.3
15.1
22.9
23.1
15
26.2
35.9
18.5
13.5
23.9
18.9
16
31.6
17.6
5.3
14.0
37.3
20.4
17
34.0
17.2
8.7
14.3
35.8
19.5
Overal
28.8
l
31.3
13.9
13.7
29.1
20
Diabetes Foundation ( INDIA) - Ongoing trial
Consumption of Energy-dense Foods
Public
Schools
Gov.
Schools
39 %
33%
Eating chips, >1 d/week
53
48
Eating French
fries, >1d/week
20
15
Eating burgers, >1 d/week
20
25
Eating pizzas, >1 d/week
15
12
Eating noodles, >1 d/week
44
50
Drinking colas, >1 d/week
36
35
Eating Habit
Eating out, >1 d/week
65 % of Children in class X and XII are sedentary
Un healthy Eating Habits
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Erratic eating habits
Frequent fast and fried food
consumption
Excess intake of colas
Excess consumption of refined
foods
Not consuming enough fruits and
vegetables
Sedentary Life style
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Low physical activity
No participation in active sports
activities
Long hours devoted to TV,
computer, video games
Sitting in canteens/coffee shops
Taking automated vehicles for
nearby destinations
Sedentary causes
• Hectic pace of life- long hours – desk jobs
• A major culprit is time spent in front of the
television and computers.
• Increase in vehicles
• Reduced play areas and walking space
• Sedentary behaviour – school onwards
• House wives- more help
Causes of Obesity - WHO
• Energy imbalance between calories consumed on
one hand, and calories expended on the other hand.
• A global shift in diet towards increased intake of
energy-dense foods that are high in fat and sugars
but low in vitamins, minerals and other
micronutrients
• A trend towards decreased physical activity due to
the increasingly sedentary nature of many forms of
work, changing modes of transportation, and
increasing urbanization.
• Urbanization , sedentary life styles and excessive
consumption of sugary foods along with increased
fat consumption specially saturated fats is leading
India to obesity . Obesity being the primary factor of
type II Diabetes is leading India to become the
diabetic capital of the world by 2030.
Incidence of Life style Diseases
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Heart disease :
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Hypertension :
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Diabetes
:
Rural: 5 – 6%
Urban: 9-10%.
Rural :5-8 %.
Urban : 15%
6 – 12 %
Satisfying Sweet tooth
• Craving for sugar often translates into a tug-of-war;
the urge to satisfy a sweet tooth versus the urge to
resist empty calories.
• Artificial sweeteners are avoiding this .Indias
artificial sweetener industry (estimated at Rs 60
crore) is also growing at a healthy 20 per cent
annually.
• The Government of India has allowed the use of
artificial sweeteners in around 25 food items. The
items include carbonated water, soft drink
concentrate, sugar/sugar free confectionery,
chewing gums, biscuits, breads, cakes and pastries
and some traditional sweets. ...
Artificial Sweeteners
• Table sugar to artificial sweeteners (like
aspartame and saccharine) may be one
way of achieving
• Stevia the worlds sweetest natural
sweetener that has zero calories lingering after-taste to this sweet herb.
Stevia and its extracts are said to be
completely diabetic-safe.
Low calorie sweeteners
• Sweetos is a low calorie, high intensity
sweetener made from Fructo-OligoSaccharide and Sucralose.
• It is approved as a soluble fibre and helps to
reduce serum LDL Cholesterol Levels.
• Fructo-Oligo-Saccharide is a very good
Prebiotic, which helps to improve immunity
and is a healthy sweetener for Diabetics sweets, coffee and Tea, Baked Goods, Jams,
Jellies, Sauces, Breakfast Cereals, Syrups,
Soft Drinks and Ice Creams
Intense sweeteners
• When added to food, these low Calorie
sweeteners provide a taste that is similar to
that of table sugar (sucrose), and are
generally several hundred to several
thousand times sweeter than sugar.
• Because of their intense sweetening power,
these sweeteners are used in very small
amounts and thus add only a negligible
amount of calories to foods and beverages.
Sweeteners and weight
Management
• Non-nutritive sweeteners play a crucial role in weight
management strategies. It is a difficult task to cut
down 500 calories in a weight reduction diet. A
reduction in direct sugar i.e. about 100 calories from
the diet - by replacing it with an artificial sweetener
is one-fourth the target achieved.
• Done daily for about 2 months, one has lost
approximately 1 kg in weight.
• Improves the adherence to the diet program. Hence,
the artificial sweeteners play a very important role in
obesity as well as diabetes management.
Artificial Sweetener intake
Obese
Over weight
Diabetics Type 2
• Middle income group =
2%
• High Income group =
70%
Equal, Sugar free, Saccharin
Ms Swapna Chaturvedi , Dept of Dietetics
All India Inst of Medical sciences , New Delhi
Food supplements share in the market
• In food supplements, the major share is held by food
products and supplements (artificial sweetener, meal
replacers, and ginsengs)- 50 %, valued at Rs 5.63 billion
in 2007.
• The next major pie is held by malted beverages- 30 %
valued at Rs 3.38 billion.
• The third major segment is fruit-based products- 6% ,
valued at Rs 0.68 billion.
• Paediatric nutrition (Lactogen, Lactodex, Dexolac,
Pediasure),5% valued at Rs 0.56 billion.
• Protein powder, sports products, and clinical products
5% are valued at Rs 0.56 billion, Rs 0.23 billion and Rs
0.23 billion respectively. (Source: Cygnus Business
Consulting & Research 2008)
Food supplements
World Health Organization (WHO)
• Nutrient and energy requirements vary between
individuals and are related to a person's age, sex,
level of physical activity
• In India 70- 80 % of person's dietary energy is
coming from carbohydrates including sugars .
• The calories from sugar are termed hollow calories
as they lack proteins , vitamins and minerals .
• Healthy eating concept should reduce refined
carbohydrates especially sugars and select healthy
foods with whole grains and fiber .
• Fibre is important for gut function, and helps to
reduce the risk of heart disease and some cancers
and acts as a filler for weight reduction.
• Many studies have also shown that fruit and
vegetables have beneficial effects on health. WHO
recommends consuming around 400 g (five or six
portions) a day.
Dietary guidelines for lifestyle
modification-NIN
• Calories should be sufficient to maintain appropriate
body weight for a given height.
• Carbohydrate should constitute 55-65% of calories
with emphasis on complex carbohydrates.
• Proteins should provide around 10-15% of the total
calories.
• Total fat intake should be between 15-30% of total
calories.
• Cholesterol should not exceed 300mg/day in the diet.
• Saturated fat should be less than 10% of the total
calories.
Dietary guidelines for lifestyle
modification-NIN
• Polyunsaturated fat should not exceed 8% of the
total calories.
• P/S ratio should be between 0.8-1.0.
• Linoleic acid (N6) should range between 3-7% of the
calories.
• Alpha-Linoleic acid (N3) should not be less than 1%
of calories.
• LA/ALNA ratio should be between 5-10.
• Sugars should be less than 10% of total calories and
should be kept minimum.
• Salt intake should be between 5-7 g/day.
• Dietary fibre should be around 40g/day.
Per capita calorie Intake
Calories K cals/Day
Rural
Urban
1983 - NSS
2221
2089
1993-1994
2153
2071
1999-2000
2149
2156
2004-2005
2047
2020
NSS Report – 513 - 2004 - 2005
Physical Activity Prescription for Aerobic and Muscle Strengthening Exercises
Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for
Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management
JAPI • VOL. 57 • FEBRUARY 2009 www.japi.org
Exercises
Vigorous intensity
Moderate intensity
Type of
physical
activity
Modality
Duration
Frequency/
days
per
week
Modality
Duration/
repetiti
ons
Frequency/week
Aerobic
physical
activity
Brisk walking, stair
climbing,
jogging(47m/sec),
cycling,
treadmill and
swimming
30 min
5
Football,
badminton,
basketball,
running,
rope
jumping,
dancing
20 min
3 days
Muscle
strengthening
activity
Resistance weight
training, curls,
presses, antigravity
exercise,
isometric
exercise
Children-Body
weight
activity (Pull
ups)
1-3 sets of 8-12
repetitions
targeting
major
muscle
groups
2-3
Resistance
training,
curls,
presses,
anti gravity
exercise,
isometric
exercise
Children- Body
weight
activity
(Pull ups)
>3 sets of >12
repetitio
ns
targetin
g major
muscle
groups
2-3 days