Alleviation: An International Journal of Nutrition, Gender & Social Development, ISSN 2348-9340, Volume 9, Number 9 (2022):1-8
© Arya PG College (College with Potential for Excellence Status by UGC) & Business Press India Publication, Delhi
http://apcjournals.com, www.aryapgcollege.ac.in
Paradigm Shift in the Dietary Pattern and Relationship to Diabetes and Coronary Heart Diseases in Asian Indians
Anjali Dewan
Formerly Associate Professor and Head
Department of Home Science
St. Bede’s College, Shimla
(Himachal Pradesh), India
Email: dewananjali2014@gmail.com
Abstract
The economic transition in India has brought forward a great change in the lifestyle, which is mainly seen in the nutritional transition. The economic status of an average Asian Indian belonging to the middle socio-economic stratum has improved and the life expectancy has increased. The migration from villages and smaller towns has changed in the recent years. This has resulted in overcrowding in the urban areas. The food systems are undergoing changes. The main reasons for such a metamorphosis are urbanization, increased per capita income, and capital flow and market liberalization. The physical activity has gone down due to increasing industrialization, watching television, internet usage and enhanced job pressure. Many of these factors are causing nutritional imbalance, stress and increased intake of alcohol and tobacco. There has been tremendous rise in lifestyle and diet related non-communicable diseases (NCD’s) like Type 2 Diabetes mellitus, hypertension, obesity, insulin resistance syndrome, and coronary heart disease while at the same time, the communicable diseases have decreased. Changing food systems and dietary patterns affect health and nutrition of populations. Diet related factors such as cholesterol, low fruit and vegetable intake and iron, zinc and vitamin a deficiency rank among the major risk factors for increased disability and incidence of diseases.
Keywords: Coronary Heart Diseases, Dietary Intake, Diabetes, Non-Communicable Diseases Physical Activity.
Introduction
India is a developing country with diverse people, religions and diets. Over last decade, economic transition in India has brought forth a vast variety of changes in the lifestyle, which is primarily reflected in nutritional transition. The economic status of an average Asian Indian belonging to middle socio-economic stratum has improved and the life expectancy has increased. The migration from villages and smaller towns has increased in the recent years. This has brought changes in the profile of the urban population and has led to overcrowding in the urban areas. The food systems are changing, resulting in greater availability of diverse foods. The main reasons for such changes are urbanization, increased per capita income, and capital flow and market liberalization. The physical activity has decreased due to increasing mechanization, television viewing, internet usage and increased job pressure. Many of these factors are responsible for causing nutritional imbalance, stress and increased intake of alcohol and tobacco.
Many demographic and economic shifts in India over the last decade had important bearing on the lifestyle and diet related non-communicable diseases (NCD’s) like type 2 diabetes mellitus, hypertension, obesity, insulin resistance syndrome, and coronary heart disease while at the same time, the communicable diseases are showing a downward trend. These diet related NCD’s are much more prevalent in Asian Indians and South Asians than in any other ethnic groups worldwide. It is also predicted that these NCD’s will reach alarming proportions in the next twenty years.
Diet Related to Non-Communicable Diseases in India
India has been witnessing a steady increase in the prevalence of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Many reports have suggested that South Asians have an unusually high predisposition to develop NCD’s. Obesity is consistently increasing in urban areas and current reports suggest almost 40 per cent of adults and 15 per cent of children are overweight. About 1/4th of urban population is suffering from diabetes mellitus. A more worrisome factor is the frequent development of insulin resistance in children and adolescents, making them easy targets for the occurrence of T2DM and CHD. During the last three decades, the prevalence of T2DM has doubled both in rural and urban areas and it is expected to rise even further. There is also a steep rise in the cases of CHD in both rural and urban areas. CHD is more severe in Asian Indians and also leads to more mortality.
Heterogeneity in Dietary Profile and Secular Trends in the Consumption of Dietary Nutrients in Asian Indians Diets in India are extremely diverse and influenced by local, cultural and religious factors. Unfortunately, the Indian diets are not subjected to intensive research. About 60-70 per cent of the population in India is vegetarian. In general, the vegetarian diets contain a large amount of vegetables and spices in addition to a large amount of carbohydrates despite the geographical heterogeneity. The energy intake from carbohydrate diets is higher in Asian Indians than diets from other populations but has shown a decreasing trend over the years. The energy derived from carbohydrates alone accounted to be 2168 kcals. In 1975, it was reduced to 1948 Kcals. in 1995 in rural India. The intake of sugar and jaggery was around 2/3rd of the recommended dietary allowance (RDA). The consumption of sugar in 11 out of 20 states was found to be above the ICMR norms and was found to vary between 74 and 98 per cent of the requirement. For the urban India as a whole, from 1987-1988 to 1999-2000, consumption of rice and wheat has declined marginally (Govt of India 2001).
Dietary Fats
Fat intake in India varies among different groups depending upon the socio-economic status and region of the country. It is reported that a mere 5 percent of the affluent population consumes nearly 30 per cent of the available fat. Visible fat intake in the lower socio-economic strata in both rural and urban areas is quite low, the daily intake being less than 10gm. The percentage of energy obtained from fats has considerably risen over time from 14 per cent in 1989 to 19 per cent in 2000. According to India nutritional profile, when fat intake is compared among different states of India, highest fat consumption is in Kerala and lowest is in Orissa. A study conducted by Misra and Vikram (2004) on adolescent children of Delhi showed that the 25 per cent of total energy was derived from fat out of which saturated fat formed 10 percent of the total intake while MUFA and PUFA formed 6.39 percent and 7.40 percent respectively.
Nutritional Transition
The process of diet transformation in India due to affluence has driven diet diversification and diet globalization. In the stage of diet diversification, the economic gains cause consumers to afford a more varied diet, which differs from traditional frugal diets. Gradually, there is adoption of globalized diets replacing the traditional diets to a large extent.
For the urban India as a whole, from 1987-1988 to 1999-2020, a substantial increase over the three time periods is seen in the consumption of eggs, tea, biscuits, salted refreshments, prepared sweets, edible oils, sugar and jaggery. While consumption of traditional cereal based diets (low saturated fat, low simple sugars and high fiber) has shown an upward trend in urban areas and diets in cities are a mix of traditional and westernized diets.
Young people increasingly prefer energy dense fast foods due to demanding job schedule and easy availability of such foods around the schools, colleges and their workplace. Particularly noticeable is the rapid increase in the number of western ‘fast foods’ outlets and the sale of aerated sweet drinks. This is even observed in small cities and semi-urban areas. The dietary habits of migrant south Asians have changed as well, depending upon the duration of stay in the country of residence. Consumption of margarine, juice, chips, fruits, cola, alcohol and fast foods were shown to be increased while consumption of some traditional foods had decreased in migrant Asian Indians in USA.
South Asian Diets, Insulin Resistance and NCD’s
Changing food systems and dietary patterns affect health and nutrition of populations. Diet related factors such as cholesterol, low fruit and vegetable intake; and iron, zinc and vitamin A deficiency rank among the major risk factors for decreased disability adjusted life years (WHO 2002). The deaths caused in India due to communicable and non-communicable diseases are nearly equal in South East Asia. WHO and FAO have also shown concern about the increased prevalence of chronic NCD’s linked to diet including diabetes mellitus, cardiovascular diseases, hypertension, strokes and some types of cancer. India and China are predicted to have the highest global burden at 57.2 and 37.6 million cases in the coming years.
Dietary consumption pattern with cardiovascular mortality in different states in India found positive univariate relationship with the prevalence of overweight and dietary intake of fats, sugars and jaggery. There is a negative correlation of fruit and vegetable intake. Reponses to the Asian Indians consuming n-6 enriched high fat diet with elevated n-6/n-3 ratio in dietary lipids have increased prevalence of insulin resistance and its disorders including dyslipidemia.
The WHO Global Strategy
WHO has formulated global strategies for the prevention of NCD’s such as diabetes mellitus and heart disease with the following objectives:
1) To reduce the risk factors of NCD’s that arise from unhealthy diets and physical inactivity by means of essential public health action and measures that promote health and prevent diseases.
2) To increase the overall awareness and understanding regarding the influences of unhealthy diet and physical inactivity on health and the positive impact of preventive interventions.
3) To encourage the development, strengthening and implementation of sustainable and comprehensive global, regional, national and community policies and action plans to improve diets and increase physical activity that actively engage all sectors, including civil society, the private sector and the media.
4) To monitor the scientific data and key influences on diet and physical activity that support research in broad spectrum of relevant areas, including evaluation of interventions; strengthening the human resources needed in this domain to enhance and sustain good nutritional status.
What Needs to be Done?
Established scientific evidence suggests that there are major metabolic benefits in following the dietary guidelines given below:
1) Eating more fruit and vegetables as well as nuts and whole grains.
2) Transition from saturated animal fats to unsaturated vegetable oil-based fats.
3) Reducing the amount of fried, salty and sugary foods in the diet.
4) Increase in the amount of dietary fibre.
5) Increase in the intake of n-3 fatty acids.
6) Maintaining a normal body weight with the BMI (Body Mass Index) being in the range of 18.5 to 23Kg/m2.
7) All the above guidelines should be enforced from a young age.
References
1) Brady LM, Williams CM and Lovegrove JA (2004) Dietary PUFA and the Metabolic Syndrome in Indian Asians Living in U.K. Proc. Nutr. Soc. 63(1): 115-125.
2) Ghafoorunissa (1998) Requirements of Dietary Fats to Meet Nutritional Needs and Prevent the Risk of Atherosclerosis-an Indian Perspective. Indian J. Med. Res. 108: 191-202.
3) Gopalan C (2001) Rising Incidence of Obesity, Coronary Heart Disease and Diabetes in Indian Urban Middle Class. Possible Role of Genetic and Environmental Factors. World Rev. Nutr. Diet 90: 127-143.
4) Govt of India (2001) Consumption of Some Important Commodities in India, 1999–2000. National Sample Survey Organization. New Delhi: GOI.
5) Mahajan D and Bermingham MA (2004) Risk Factors for Coronary Heart Disease in Two Similar Indian Population Groups, One Residing in India and the Other in Sydney, Australia. Eur. J. Clin. Nutr. 58 (5): 751-760.
6) Misra A, Gulati S and Dutta R (2006) Asian Indian Diets: Nutrient Composition and Relationship to Diabetes and Coronary Heart Disease. Nutr. Update: 1-5.
7) Misra A, Sharma R, Pandey RM and Khanna N (2001) Adverse Profile of Dietary Nutrients, Anthropometry and Lipids in Urban Dwellers in Northern India. Eur. J. Clin. Nutr. 55:727-734.
8) Misra A and Vikram NK (2004) Insulin Resistance Syndrome (Metabolic Syndrome) and Obesity in Asian Indians: Evidence and Implications, Nutr Review 20 (5): 482-491.
9) Nayar D, Kapil Umesh, Joshi YK, Sundaram KR, Srivastava SP and Shukla NK (2000) Nutritional Risk Factors in Esophageal Cancer. J. Assoc. Physicians India 48:781-787.
10) Popkin BM, Horton S, Kim S Mahal A and Shuigo J (2001) Trends in Diet, Nutritional Status and Diet-Related Non-Communicable Diseases in China and India: The Economic Costs of the Nutrition Transition. Nut. Rev. 59:379-390.
11) Shetty PS (2002) Nutrition Transition in India. Pub. Health Nutr. 5:175-182.
12) Vijayaraghavan K and Rao DH (1998). Diet and Nutrition Situation in Rural India. Ind. J. Med. Res 108: 243-253.
13) World Health Organization (WHO) (2003) Diet, Nutrition and the Prevention of Chronic Diseases: A Report of a Joint WHO/FAO Expert Consultation. Geneva: WHO.
