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DIETARY GUIDELINES
FOR INDIANS
-A Manual
NATIONAL INSTITUTE OF NUTRITION
Hyderabad – 500 007, INDIA
First Published
Reprinted
Second Edition
.....
.....
.....
1998
1999, 2003, 2005, 2007
2011
ATTENTION READERS
Readers can download the soft copy of the “Dietary Guidelines for Indians” free of cost for their own use and also for
dissemination of information for the benefit of the society on nonprofit basis. Readers are not supposed to either reproduce / copy / reprint the same for commercial purpose. If the information is used in some context, the source of information with proper
acknowledgement to the National Institute of Nutrition,
Hyderabad should be mentioned. Usage of the information should be intimated to the Director, NIN in advance and approval should be sought. All copyrights are reserved with NIN.
WORKING GROUP OF THE FIRST EDITION
National Institute of Nutrition
Hyderabad
Chairperson
Dr.Kamala Krishnaswamy
Director
Members
Dr.Bhaskaram P.
Deputy Director (Sr. Grade)
Dr.Bhat RV.
Deputy Director (Sr. Grade)
Dr. Ghafoorunissa
Deputy Director (Sr. Grade)
Dr. Raghuram TC.
Deputy Director (Sr. Grade)
Dr. Raghuramulu N.
Deputy Director (Sr. Grade)
Dr. Sivakumar B.
Deputy Director (Sr. Grade)
Dr.Vijayaraghavan K.
Deputy Director (Sr. Grade)
Assistance rendered by Dr.Damayanthi K,
Mr. Pulkit Mathur, Ms. Sujatha T, Ms. Uma Nayak
Dr. Vasanthi S and Dr. Vijayalakshmi K, in the
preparation of Annexures is gratefully acknowledged.
EXPERT ADVISORY GROUP OF THE FIRST EDITION
Dr. Achaya KT.
CSIR Emeritus-Scientist
Bangalore
Dr. Rajammal P Devadas
Chancellor
Avinashalingam deemed University
Coimbatore
Dr. Bamji. Mahtab S.
Former Director-Grade Scientist, NIN
ICMR Emeritus scientist
Hyderabad
Dr. Ramachandran A.
Diabetes research Centre
Chennai
Dr. Bhan MK.
Additional Professor
All India Institute of Medical Sciences
New Delhi
Dr. Rao MV
Former Vice-Chancellor
A.P.Agricultural University
Hyderabad
Dr. Leela Raman
Former Deputy Director (Sr.Grade), NIN
Hyderabad
Dr. Srinath Reddy K.
Prof. Cardiology
All India Institute of Medical Sciences
New Delhi
Dr. Mary Mammen
Chief Dietitian
Christian Medical College & Hospital
Vellore
Dr. Subhadra Seshadri
Head, Dept. of Food & Nutrition
M.S. University
Baroda
Dr. Narasinga Rao BS.
Former Director, NIN
Hyderabad
Dr. Sushma Sharma
Reader in Nutrition
Lady Irwin College
New Delhi
Dr. Pralhad Rao N.
Former Deputy Director (Sr.Grade), NIN
Hyderabad
Dr. Vinodini Reddy
Former Director, NIN
Hyderabad
Dr. Prema Ramchandran
Adviser (Health)
Planning Commission
New Delhi
WORKING GROUP OF THE SECOND EDITION
National Institute of Nutrition
Hyderabad
Dr. Kamala Krishnaswamy ..
Chairperson
Former Director, NIN
Dr.B.Sesikeran
..
Co-Chairperson
..
Convener
..
Member Secretary
Director, NIN
Members
Dr.A.Laxmaiah
Dr.A.Vajreswari
Dr.B.A.Ramalaxmi
Mr.Anil Kumar Dube
Dr.D.Raghunatha Rao
Dr.Ghafoorunissa
Dr.GNV.Brahmam
Dr.J.Padmaja
Dr.Arjun L. Khandare
Dr.Bharathi Kulkarni
Dr.K.Damayanthi
Dr.KV.Radhakrishna
Dr. M. Radhika
Dr.N.Arlappa
Dr. Kalpagam Polasa
Dr.Rita Saxena
Dr.V.Sudershan Rao
Dr.Y.Venkataramana
Assistance rendered by the artist Mr. S. Devendran in designing the revised edition; Mr.P.S. Ramarao for technical assistance; Mr. B. Omprakash, Mr. N. Satyanarayana and Mr. V. Bhuvaneswaran of the Printing Division, NIN is gratefully acknowledged.
Acknowledgments
We are thankful to
Food and Nutrition Security Community
Solution Exchange Group
and
Dr. Anura Kurpad,
Dean, St. John’s Research Institute, Bangalore
for their valuable comments and inputs.
CONTENTS
Page
Foreword
i
Preface
ii
Introduction
1
Current Diet and Nutrition Scenario
3
Dietary Goals
9
Dietary Guidelines
10
Guideline 1
11
Guideline 2
21
Guideline 3
25
Guideline 4
29
Guideline 5
34
Guideline 6
40
Guideline 7
45
Guideline 8
52
Guideline 9
56
Guideline 10
60
Guideline 11
63
Guideline 12
67
Guideline 13
70
Guideline 14
75
Guideline 15
79
Annexures
1. Approximate Calorific Value of Nuts, Salads and Fruits
85
2. Balanced Diet for Adults - Sedentary/Moderate/Heavy Activity
86
2a. Sample Meal Plan for Adult Man (sedentary)
87
2b. Sample Meal Plan for Adult Woman (sedentary)
88
3. Recommended Dietary Allowances
Macronutrients
89
Micronutrients
90
4. Balanced Diet for Infants, Children and Adolescents
91
5. Anthropometric Standards
92
6. Low Calorie Vegetables and Fruits (< 100 Kcal)
104
7. Vegetable and Fruits with High Calorie Value (> 100 Kcal)
105
8. Approximate Calorific Value of Some Cooked Preparations
106
9. ALA Content of Foods (g/100g)
110
10.Glycemic Index of Common Foods
111
11.Exercise and Physical Activity
112
12.Removal of the Pesticide Residues from the Food Products
114
13.Drinking Water Standards
116
14.Portion Sizes and Menu Plan
117
15.Some Nutrient-rich Foods
118
BOOKS FOR FURTHER READING
121
GLOSSARY
123
FOREWORD
- Dr. C. GOPALAN
Founder President
Nutrition Foundation of India
It is now more than a decade since this valuable publication was first prepared. It was compiled by a team of experienced nutrition scientists at the National Institute of Nutrition, Hyderabad, under the leadership of Dr. Kamala Krishnaswamy. It has received wide appreciation from the general public as well as from students of nutrition, medicine, home science, nursing and allied subjects, and has been reprinted several times. It has also been widely disseminated through outreach activities undertaken by the National Institute of Nutrition, in the form of lectures, exhibitions and distribution of materials in various local languages. In the intervening years, there have been notable socio-economic changes in India. It was thought necessary to update the guidelines in the light of new developments and fresh information.
The most notable change has been in the overall economic scenario in the country, with a robust growth rate. There have also been some important government initiatives in the fields of health and nutrition and poverty alleviation, including the launching of MGNREGA and overhauling of the ICDS. Globalisation has resulted in the opening of multinational fast food chains in Indian cities, including the smaller cities. Lifestyles and dietary patterns that had started giving early warning signals towards the end of the previous century, when these guidelines were first published, are continuing to follow a trend that promotes obesity and the attendant non communicable diseases.
The improvement in the overall economy at the macro level and concomitant improvements in purchasing power (though unevenly distributed) among households have not led to the expected levels of improvement in the nutritional status of Indians. The latest findings of the National Family Health Survey, NFHS-3 showed virtually no improvement in parameters as compared to NFHS-2, and recent surveys by the National Nutrition Monitoring Bureau have thrown more light on the growing problem of the 'double burden' of undernutrition and overnutrition. These data should serve as a wake-up call to nutritionists and policy makers. There is very obviously an 'awareness and information deficit', even among the more affluent sections of the population, about good dietary practices and their linkage with good health. This deficit should be narrowed and eliminated by harnessing all traditional as well as modern technological vehicles of communication.
This updated version of DGI from India's premier nutrition institute, National Institute of Nutrition, should serve as a valuable source of concise, accurate and accessible information, both for members of the general public and those who are involved in dissemination of nutrition and health education.
PREFACE
The first edition of 'Dietary Guidelines' was published in 1998, and since then many changes have taken place in the country. The economic transition has transformed the way people live. Changing lifestyles of people both in rural and urban areas are seen to alter the very structure of our society at a rapid pace today. The shift from traditional to 'modern' foods, changing cooking practices, increased intake of processed and ready-to-eat foods, intensive marketing of junk foods and 'health' beverages have affected people's perception of foods as well as their dietary behaviour. Irrational preference for energy-dense foods and those with high sugar and salt content pose a serious health risk to the people, especially children. The increasing number of overweight and obese people in the community and the resulting burden of chronic non-communicable diseases necessitate systematic nutrition educational interventions on a massive scale. There is a need for adoption of healthy dietary guidelines along with strong emphasis on regular physical exercise.
Today, the multiple sources of health and nutrition related information tend to create unnecessary confusion among people. This book makes an attempt to inform us on matters of everyday nutrition in a user friendly manner and thus, aims to influence our dietary behavior. These guidelines deal with nutritional requirements of people during all stages of their life, right from infancy to old age. We earnestly hope that readers will enjoy reading the book and benefit from it and also spread the valuable information among those around them.
ii
INTRODUCTION
Nutrition is a basic human need and a prerequisite to a healthy life. A proper diet is essential from the very early stages of life for proper growth, development and to remain active. Food consumption, which largely depends on production and distribution, determines the health and nutritional status of the population. The recommended dietary allowances (RDA) are nutrient-centred and technical in nature. Apart from supplying nutrients, foods provide a host of other components (non-nutrient phytochemicals) which have a positive impact on health. Since people consume food, it is essential to advocate nutrition in terms of foods, rather than nutrients. Emphasis has, therefore, been shifted from a nutrient orientation to the food-based approach for attaining optimal nutritional status. Dietary guidelines are a translation of scientific knowledge on nutrients into specific dietary advice. They represent the recommended dietary allowances of nutrients in terms of diets that should be consumed by the population. The guidelines promote the concept of nutritionally adequate diets and healthy lifestyles from the time of conception to old age.
Formulation of dietary goals and specific guidelines would help in providing required guidance to people in ensuring nutritional adequacy. The dietary guidelines could be directly applied for general population or specific physiological or high risk groups to derive health benefits. They may also be used by medical and health personnel, nutritionists and dietitians. The guidelines are consistent with the goals set in national policies on Agriculture, Health and Nutrition. The dietary guidelines ought to be practical, dynamic and flexible, based on the prevailing situation. Their utility is influenced by the extent to which they reflect the social, economic, agricultural and other environmental conditions. The guidelines can be considered as an integral component of the country's comprehensive plan to reach the goals specified in the National Nutrition Policy.
The major food issues of concern are insufficient/ imbalanced intake of foods/nutrients. The common nutritional problems of public health importance in India are low birth weight, protein energy malnutrition in children, chronic energy deficiency in adults, micronutrient malnutrition and diet-related noncommunicable diseases. However, diseases at the either end of the spectrum of
malnutrition (undernutrition and overnutrition) are important. Recent evidences indicate that undernutrition in utero may set the pace for diet-related chronic diseases in later life. Population explosion, demographic changes, rapid urbanization and alterations in traditional habits contribute to the development of certain unhealthy dietary practices and physical inactivity, resulting in diet-related chronic diseases.
The dietary guidelines emphasize promotion of health and prevention of disease, of all age groups with special focus on vulnerable segments of the population such as infants, children and adolescents, pregnant and lactating women and the elderly. Other related factors, which need consideration are physical activity, health care, safe water supply and socio-economic development, all of which strongly influence nutrition and health.
In this document, food-related approaches, both in qualitative and quantitative terms, have been incorporated. Emphasis is on positive recommendations which can maximize protective effects through use of a variety of foods in tune with traditional habits. The higher goals set with respect to certain food items such as pulses, milk and vegetables/fruits are intended to encourage appropriate policy decisions. Suitable messages for each of these guidelines have been highlighted. A variety of foods, which are available and are within the reach of the common man, can be selected to formulate nutritionally adequate diets. While there are only four accepted basic food groups, in India, there are a variety of food preparations and culinary practices. Different cereals/millets are used as staple food, apart from a variety of cereal/millet/pulse combinations in different regions of India. The cooking oils and fat used are of several kinds. The proposed guidelines help to formulate health promoting recipes and diets which are region- and culturespecific. It is difficult to compute standard portion sizes, common to all regions of India. Nevertheless, attempts are made to give portion sizes and exchanges. Translation of knowledge into action calls for the coordinated efforts of several government and non-government organizations. The fifteen guidelines prescribed, herein, stress on adequacy of intake of foods from all food groups for maintenance of optimal health. Effective IEC strategies and other large-scale educational campaigns should be launched to encourage people to follow the dietary guidelines. Such efforts should be integrated with the existing national nutrition and health programs.
2
CURRENT DIET AND NUTRITION SCENARIO
Health and nutrition are the most important contributory factors for human resource development in the country. India has been classified by the World Bank as a country with a lower middle income, with per capita GNP of US $ 996-39451. It ranks 160th in terms of human development among 209 countries. Among the Indian population, about 28% in the rural and 26% in the urban areas are estimated to be below the poverty line2, which is defined as the expenditure needed to obtain, on an average, 2400 Kcal per capita per day in the rural areas and 2100 Kcal in urban areas. Long-term malnutrition leads to stunting and wasting, non-communicable chronic diet related disorders, increased morbidity and mortality and reduced physical work output. It is a great economic loss to the country and undermines development.
Common Nutrition Problems
Protein Energy Malnutrition (PEM), micronutrient deficiencies such as vitamin A deficiency (VAD) , Iron Deficiency Anemia (IDA), Iodine Deficiency Disorders(IDD) and vitamin B-complex deficiencies are the nutrition problems frequently encountered, particularly among the rural poor and urban slum communities. Undernutrition starts as early as during conception. Because of extensive maternal undernutrition (underweight, poor weight gain during pregnancy, nutritional anaemia and vitamin deficiencies), about 22% of the infants are born with low birth-weight (Prevalence
Infants and Preschool children (%)
Low birth weight
22
# Kwashiorkor/Marasmus
Iodine deficiency disorders (IDD)
Goitre (millions)
54
Cretinism (millions)
2.2
Still births due to IDD (includes neo natal deaths)
90,000
4
Prevalence of chronic diseases Over weight/obesity (BMI>25) (%) # Rural Adults
Men
7.8
Women
10.9
Tribal Adults
Men
2.4
Women
3.2
Men
Urban Adults
36.0
Women
40.0
Hypertension
Urban
35.0
# Rural
25.0
Men
25.0
Women
24.0
Tribal
24.0
Men
25.0
Women
23.0
Diabetes Mellitus (%) (year 2006)
Urban
16.0
# Rural
5.0
9
Coronary Heart Disease (%)
Urban
7-9
# Rural
3-5
10
Cancer incidence Rate (Per 100,000)
Men
113
Women
123
* Iodine deficiency disorders (IDD) are very common among large sections of population in several parts of the country. About 167 million are estimated to be living in IDD endemic areas. Iodine deficiency causes goiter (enlargement of thyroid gland in the neck), neonatal hypothyroidism, cretinism among new borns, mental retardation, delayed motor development, stunting, deaf-mutism and neuromuscular disorders. The most important consequence of iodine deficiency in mothers is cretinism in which the children suffer from mental and growth retardation right from the birth. About 90,000 still-births and neonatal deaths occur every year due to maternal iodine deficiency. Around 54 million persons are estimated to have goiter, 2.2 million have cretinism and 6.6 million suffer from mild psycho-motor handicaps7. India is passing through the phase of economic transition and while the problem of undernutrition continues to be a major problem, prevalence of overnutrition is emerging as a significant problem, especially in the urban areas. The prevalence of overweight/ obesity is higher among the women (10.9%) compared to men (7.8%) in rural areas4. The prevalence of Diabetes Mellitus8 and Coronary Heart Disease (CHD)9 is also higher in urban areas as compared to their rural counterparts. The incidence rate of cancer is comparatively higher among women (123) compared to men (113 for 100,000)10.
Food availability and consumption
The overall production of food grains (cereals/millets/pulses) recorded a significant increase from about 108 million tones in 1970-71 to a little over 230 million tones during 2007-200811,12. Though the production of cereals and millets appears to be adequate, production of pulses, the source of protein for the rural poor, actually shows a decline. Total Production of vegetables is about 30% less than the demand of 100 million tones13. The total production of milk during 2006-2007 was about 100.9 million tones, corresponding to about 245 g per caput per day, which is lower than the world average of 285 g per day14. Though the per capita availability of various foods stuffs is comparable to RDA, the distribution of foods, both within the community and the family, may be unfavorable to some vulnerable groups due to low income and purchasing power. In view of the high cost of milk, a large proportion of the Indian population subsists on diets consisting mostly of plant foods with low nutrient bio-availability (Table 2).
5
Table 2. Food availability (per caput/g/day)
Year
Food Group
RDA
1990
2000
2001
2002
2003
2004
2006/07
Per
CU
Per
caput*
Cereals
431.5
422.7
386.2
458.7
408.5
426.9
412.1
460
400
Pulses
41.1
31.8
30.0
35.4
29.1
35.8
32.5
40.0
35
Milk
176
220
225
230
231
232
245
150
131
-
-
-
-
-
-
210
60
52
Vegetables
Oils
17.8
26.0
27.9
23.6
NA
NA
NA
20
17
Meat
12.6
13.7
14.0
14.2
NA
NA
NA
-
-
25
36
38
39
40
41
-
-
-
Eggs
no.s / head / annum
*0.87 CU (Consumption Unit) per caput . Source: Ref Nos. 2,15,16,17,18 & 19
National Nutrition Monitoring Bureau (NNMB) surveys4 indicate that the daily intake of all foods except cereals and millets (396g) in Indian households is lower than the Recommended Dietary Allowances or RDA (Table 3). The average consumption of pulses and legumes like green gram, bengal gram and black gram, which are important source of protein was less than 50% of RDA. Consumption of green leafy vegetables (Vegetables
49
43
300
Oils
14
12
30
400
* Source: National Nutrition Monitoring Bureau, 2006.
# Source: RDA -2010 for moderately active person
The proportion of households with energy inadequacy was about 70%, while that with protein inadequacy was about 27%. Thus, in the cereal/millet-based Indian dietaries, the primary bottleneck is energy inadequacy and not the protein, as was earlier believed. This dietary energy gap can be easily reduced by the poor by increasing the quantities of habitually eaten foods.
6
On the other side of the spectrum of malnutrition, diet-related non-communicable diseases are commonly seen. With increasing urbanization, energy-rich diets containing higher amount of fat and sugar, which also provide less dietary fibre and complex carbohydrates, are being frequently consumed, particularly by highincome groups. In addition, the urban population is turning to be more sedentary with little physical activity. Consumption of alcohol, providing empty calories, and tobacco use is also common among them. Hence, prevalence of disorders like obesity, heart disease, hypertension (high blood pressure) diabetes and certain types of cancers is on the increase.
Determinants of Malnutrition
Widespread malnutrition is largely a result of dietary inadequacy and unhealthy lifestyles. Other contributing factors are poor purchasing power, faulty feeding habits, large family size, frequent infections, poor health care, inadequate sanitation and low agricultural production. Population living in the backward and drought-prone rural areas and urban slums, and those belonging to the socially backward groups like scheduled castes and tribal communities are highly susceptible to undernutrition. Similarly, landless labourers and destitutes are also at a higher risk.
The most rational, sustainable and long-term solution to the problem of malnutrition is ensuring availability, accessability and consumption of adequate amounts of foods. Dietary guidelines help to achieve the objective of providing optimal nutrition to the population.
References
1.
2.
3.
4.
5.
6.
World Bank Development Indicators database, World Bank, revised, 10-Sep 2008. National Health profile 2007, GoI, Central Bureau of Health Intelligence, Directorate General of Health services, Ministry of Health and family welfare, Nirman Bhavan, New Delhi -110011.
National Family Health Survey-3, International Institute for population on sciences (2005-06); Mumbai.
Diet and Nutritional status of population and prevalence of Hypertension among adults in rural areas. NNMB Technical Report No: 24, NNMB, NIN,ICMR, Hyderabad-2006. Prevalence of Micronutrient Deficiencies. NNMB, Technical Report No.22, NIN, ICMR, Hyderabad, 2003.
Health Information of India, 2004 GoI, Central Bureau of Health Intelligence, Directorate General of Health services, Ministry of Health family welfare, Nirman Bhavan, New Delhi-110011.
7
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Current Status of IDD in selected Districts of Southern Region of the country (2003). NIN, ICMR, HYD -7.
Mohan, V, Mathur, R and Deepa, M. ital. Urban rural difference in prevalence of self reported diabetes in India WHO- ICMR Indian NCD risk factor surveillance in Elsevier Website.
Bela Shah and Prashant Mathur (2005).
Risk factor surveillance for NonCommunicable Disease (NCDs): The multi – site ICMR- WHO collaborative initiative. Presentation made at forum 9, Mumbai, India. 12-16 September. Time trends in incidence rates of cancer: 1988-2005. National Cancer Registration Programme, 2009.
All India Area, production and yield of food grains from 1950-51 to 2006-2007 along with percentage coverage under irrigation.
www.ficciagroindia.com/general/agriculture_statistics
India produced record 231 Million Tonne food grains in 2007-2008. www.icar.org.in/news/record.production.foodgrains.html
India's vegetable production falls a short of Demand.
www.expressindia.com/news/ie/dailly/19990101/0015023/html
Milk production reaches 111 million tonnes by 2010.
http://news.webindia123.com/news/articles/india/20080917/1055522.html\ Estimates of production and per capita availability of Milk – All India, 1950 - 51 to 2004-05.
www.kashvet.org/pdf/milk_prdn_year_wise. pdf
10.1: Net availability of food grains (per day) in India from 1951 to 2005. http://dacnet.nic.in/eands/10.1
1.19 Per capita availability of certain important articles of consumption. Economic survey 2007-2008; Economic survey
http://indiabudget.nic.in/es2007-08/esmain.html
Meat consumption: per capita
http://earthtrends.wri.org/text/agriculture_food/variable_193.html Estimates of production and per capita availability of Egg
www.Kashvet.org/pdf/egg_prdn.pdf
8
DIETARY GOALS
1. Maintenance of a state of positive health and optimal
performance in populations at large by maintaining
ideal body weight.
2. Ensuring adequate nutritional status for pregnant
women and lactating mothers.
3. Improvement of birth weights and promotion of growth
of infants, children and adolescents to achieve their full
genetic potential.
4. Achievement of adequacy in all nutrients and
prevention of deficiency diseases.
5. Prevention of chronic diet-related disorders.
6. Maintenance of the health of the elderly and increasing
the life expectancy.
9
DIETARY GUIDELINES
Right nutritional behavior and dietary choices are needed to achieve dietary goals. The following 15 dietary guidelines provide a broad framework for appropriate action:
1. Eat variety of foods to ensure a balanced diet.
2. Ensure provision of extra food and healthcare to pregnant and lactating women.
3. Promote exclusive breastfeeding for six months and encourage breastfeeding till two years or as long as one can.
4. Feed home based semi solid foods to the infant after six months. 5. Ensure adequate and appropriate diets for children and
adolescents, both in health and sickness.
6. Eat plenty of vegetables and fruits.
7. Ensure moderate use of edible oils and animal foods and very less use of ghee/ butter/ vanaspati.
8. Avoid overeating to prevent overweight and obesity.
9. Exercise regularly and be physically active to maintain ideal body weight.
10. Restrict salt intake to minimum.
11. Ensure the use of safe and clean foods.
12. Adopt right pre-cooking processes and appropriate cooking methods.
13. Drink plenty of water and take beverages in moderation.
14. Minimize the use of processed foods rich in salt, sugar and fats. 15. Include micronutrient-rich foods in the diets of elderly people to enable them to be fit and active.
10
Guideline 1
Eat variety of foods to ensure a balanced diet
Rationale: Nutritionally adequate diet should be consumed through a wise choice from a variety of foods
v
Nutrition is a basic prerequisite to sustain life.
v
Variety in food is not only the spice of life but also the essence of nutrition and
health.
v
A diet consisting of foods from several food groups provides all the required
nutrients in proper amounts.
v
Cereals, millets and pulses are major sources of most nutrients. v
Milk which provides good quality proteins and calcium must be an essential
item of the diet, particularly for infants, children and women. Oils and nuts are calorie-rich foods, and are useful for increasing the energy v
density and quality of food.
v
Inclusion of eggs, flesh foods and fish enhances the quality of diet. However,
vegetarians can derive almost all the nutrients from diets consisting of cereals, pulses, vegetables, fruits and milk-based diets.
v
Vegetables and fruits provide protective substances such as vitamins/
minerals/ phytonutrients.
v
Diversified diets with a judicious choice from a variety food groups provide the
necessary nutrients.
Why do we need nutritionally adequate food?
Nutrients that we obtain through food have vital effects on physical growth and development, maintenance of normal body function, physical activity and health. Nutritious food is, thus needed to sustain life and activity. Our diet must provide all essential nutrients in the required amounts. Requirements of essential nutrients vary with age, gender, physiological status and physical activity. Dietary intakes lower or higher than the body requirements can lead to undernutrition (deficiency diseases) or overnutrition (diseases of affluence) respectively. Eating too little food during certain significant periods of life such as infancy, childhood, adolescence, pregnancy and lactation and eating too much at any age can lead to harmful consequences. An adequate diet, providing all nutrients, is needed throughout our lives. The nutrients must be obtained through a judicious choice and combination of a variety of foodstuffs from different food groups (Figure 1). 11
EAT SPARINGLY
EAT MODERATELY
EAT LIBERALLY
CONSUME ADEQUATELY
Carbohydrates, fats and proteins are macronutrients, which are needed in large amounts. Vitamins and minerals constitute the micronutrients and are required in small amounts. These nutrients are necessary for physiological and biochemical processes by which the human body acquires, assimilates and utilizes food to maintain health and activity.
Carbohydrates
Carbohydrates are either simple or complex, and are major sources of energy in all human diets. They provide energy of 4 Kcal/g. The simple carbohydrates, glucose and fructose, are found in fruits, vegetables and honey, sucrose in sugar and lactose in milk, while the complex polysaccharides are starches in cereals, millets, pulses and root vegetables and glycogen in animal foods. The other complex carbohydrates which are resistant to digestion in the human digestive tract are cellulose in vegetables and whole grains, and gums and pectins in vegetables, fruits and cereals, which constitute the dietary fibre component. In India, 70-80% of total dietary calories are derived from carbohydrates present in plant foods such as cereals, millets and pulses.
Dietary fibre delays and retards absorption of carbohydrates and fats and increases the satiety value. Diets rich in fibre reduce glucose and lipids in blood and increase the bulk of the stools. Diets rich in complex carbohydrates are healthier than low-fibre diets based on refined and processed foods.
Proteins
Proteins are primary structural and functional components of every living cell. Almost half the protein in our body is in the form of muscle and the rest of it is in bone, cartilage and skin. Proteins are complex molecules composed of different amino acids. Certain amino acids which are termed “essential”, have to be obtained from proteins in the diet since they are not synthesized in the human body. Other nonessential amino acids can be synthesized in the body to build proteins. Proteins perform a wide range of functions and also provide energy (4 Kcal/g). Protein requirements vary with age, physiological status and stress. More proteins are required by growing infants and children, pregnant women and individuals during infections and illness or stress. Animal foods like milk, meat, fish and eggs and plant foods such as pulses and legumes are rich sources of proteins. Animal proteins are of high quality as they provide all the essential amino acids in right proportions, while plant or vegetable proteins are not of the same quality because of their low content of some of the essential amino acids. However, a combination of cereals, millets and pulses provides most of the amino acids, which complement each other to provide better quality proteins.
13
Fats
Oils and fats such as butter, ghee and vanaspathi constitute dietary visible fats. Fats are a concentrated source of energy providing 9 Kcal/g, and are made up of fatty acids in different proportions. Dietary fats are derived from two sources viz. the invisible fat present in plant and animal foods; and the visible or added fats and oils (cooking oil). Fats serve as a vehicle for fat-soluble vitamins like vitamins A, D, E and K and carotenes and promote their absorption. They are also sources of essential polyunsaturated fatty acids. It is necessary to have adequate and good quality fat in the diet with sufficient polyunsaturated fatty acids in proper proportions for meeting the requirements of essential fatty acids (Refer chapter 7). The type and quantity of fat in the daily diet influence the level of cholesterol and triglycerides in the blood. Diets should include adequate amounts of fat particularly in the case of infants and children, to provide concentrated energy since their energy needs per kg body weight are nearly twice those of adults. Adults need to be cautioned to restrict intake of saturated fat (butter, ghee and hydrogenated fats) and cholesterol (red meat, eggs, organ meat). Excess of these substances could lead to obesity, diabetes, cardiovascular disease and cancer.
Vitamins and minerals
Vitamins are chemical compounds required by the body in small amounts. They must be present in the diet as they cannot be synthesized in the body. Vitamins are essential for numerous body processes and for maintenance of the structure of skin, bone, nerves, eye, brain, blood and mucous membrane. They are either watersoluble or fat-soluble. Vitamins A, D, E and K are fat-soluble, while vitamin C, and the B-complex vitamins such as thiamin (B1),
riboflavin (B2), niacin, pyridoxine (B6), folic
acid and cyanocobalamin (B12) are watersoluble. Pro-vitamin like beta-carotene is converted to vitamin A in the body.
Fat-soluble vitamins can be stored in
the body while water-soluble vitamins
are not and get easily excreted in urine.
Food Groups
Vitamins B-complex and C are heat
labile vitamins and are easily destroyed
by heat, air or during drying, cooking
and food processing.
Minerals are inorganic elements
found in body fluids and tissues. The
important macro minerals are sodium,
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potassium, calcium, phosphorus, magnesium and sulphur, while zinc, copper, selenium, molybdenum, fluorine, cobalt, chromium and iodine are micro minerals. They are required for maintenance and integrity of skin, hair, nails, blood and soft tissues. They also govern nerve cell transmission, acid/base and fluid balance, enzyme and hormone activity as well as the blood- clotting processes. Approximate calorific value of nuts, salads and fruits are given in annexure 1. What is a balanced diet?
A balanced diet is one which provides all the nutrients in required amounts and proper proportions. It can easily be achieved through a blend of the four basic food groups. The quantities of foods needed to meet the nutrient requirements vary with age, gender, physiological status and physical activity. A balanced diet should provide around 50-60% of total calories from carbohydrates, preferably from complex carbohydrates, about 10-15% from proteins and 20-30% from both visible and invisible fat.
In addition, a balanced diet should provide other non-nutrients such as dietary fibre, antioxidants and phytochemicals which bestow positive health benefits. Antioxidants such as vitamins C and E, beta-carotene, riboflavin and selenium protect the human body from free radical damage. Other phytochemicals such as polyphenols, flavones, etc., also afford protection against oxidant damage. Spices like turmeric, ginger, garlic, cumin and cloves are rich in antioxidants. Balanced Diet for Adults - Sedentary/Moderate/Heavy Activity is given in annexure 2 and figures 3 & 4. Also, sample menu plans for sedentary adult man and woman are given in annexure 2a and 2b respectively.
What are food groups ?
Foods are conventionally grouped as :
1.Cereals, millets and pulses
2.Vegetables and fruits
3.Milk and milk products, egg, meat and fish 4.Oils & fats and nuts & oilseeds However, foods may also be classified according to their functions (Table 4). What are nutrient requirements and recommended dietary allowances (RDA)? Requirements are the quantities of nutrients that healthy individuals must obtain from food to meet their physiological needs. The recommended dietary allowances (RDAs) are estimates of nutrients to be consumed daily to ensure the requirements of all individuals in a given population. The recommended level depends upon the bioavailability of nutrients from a given diet. The term bioavailability indicates what is absorbed and utilized by the body. In addition, RDA includes a margin of safety, to cover variation between individuals, dietary traditions and practices. The RDAs are 15
suggested for physiological groups such as infants, pre-schoolers, children, adolescents, pregnant women, lactating mothers, and adult men and women, taking into account their physical activity. In fact, RDAs are suggested averages/day. However, in practice, fluctuations in intake may occur depending on the food availability and demands of the body. But, the average requirements need to be satisfied over a period of time (Annexure-3).
Our diet must provide adequate calories, proteins and micronutrients to achieve maximum growth potential. Therefore, it is important to have appropriate diet during different stages of one’s life (Figure 2). There may be situations where adequate amounts of nutrients may not be available through diet alone. In such high risk situations where specific nutrients are lacking, foods fortified with the limiting nutrient(s) become necessary. A good example of such fortified foods is the salt fortified with iron and iodine.
Table – 4 Classification of foods based on function
MAJOR NUTRIENTS
ENERGY
RICH FOODS
BODY
BUILDING
FOODS
PROTECTIVE
FOODS
OTHER NUTRIENTS
Carbohydrates & fats
Whole grain cereals, millets
Protein, fibre, minerals, calcium,
iron & B-complex vitamins
Vegetable oils, ghee, butter
Fat soluble vitamins, essential fatty
acids
Nuts and oilseeds
Proteins, vitamins, minerals
Sugars
Nil
Proteins
Pulses, nuts and oilseeds
B-complex vitamins, invisible fat, fibre
Milk and Milk products
Calcium, vitamin A, riboflavin, vitamin B12
Meat, fish, poultry
B-complex vitamins, iron, iodine, fat
Vitamins and Minerals
Green leafy vegetables
Antioxidants, fibre and other
carotenoids
Other vegetables and fruits
Fibre, sugar and antioxidants
Eggs, milk and milk products
and flesh foods
Protein and fat
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POINTS TO PONDER
v
Choose a variety of foods in amounts appropriate for age, gender, physiological status and physical activity.
v
Use a combination of whole grains, grams and greens. Include jaggery or sugar and cooking oils to bridge the calorie or energy gap. v
Prefer fresh, locally available vegetables and fruits in plenty. v
Include in the diets, foods of animal origin such as milk, eggs and meat, particularly for pregnant and lactating women and children.
v
Adults should choose low-fat, protein-rich foods such as lean meat, fish, pulses and low-fat milk.
v
Develop healthy eating habits and exercise regularly and move as much as you can to avoid sedentary lifestyle.
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Figure 2
IMPORTANCE OF DIET DURING
DIFFERENT STAGES OF LIFE
For being physically
active and healthy.
Nutrient- dense low
fat foods.
For maintaining health,
productivity and prevention of
diet-related disease and to
support pregnancy/lactation.
Nutritionally adequate diet
with extra food for child
bearing/rearing
For growth spurt, maturation and bone
development.
Body building and protective foods.
For growth, development and to fight infections.
Energy-rich, body building and protective foods
(milk, vegetables and fruits).
For growth and appropriate milestones.
Breastmilk, energy-rich foods (fats, Sugar).
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Figure 3
BALANCED DIET FOR ADULT MAN (SEDENTARY)
FATS/OILS
*5g X 5**
3
* Portion Size.
** No. of Portions
Elderly man: Reduce 3 portions of cereals and millets and add an extra serving of fruit
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Figure 4
BALANCED DIET FOR ADULT WOMAN (SEDENTARY)
4
* Portion Size.
** No. of Portions
Extra Portions:
Pregnant women
Lactating women
: Fat/Oil-2, Milk-2, Fruit-1, Green Leafy Vegetables-1/2.
: Cereals-1, Pulses-2, Fat/Oil-2, Milk-2, Fruit-1, Green Leafy Vegetables-1/2
Between 6-12 months of lactation, diet intake should be gradually brought back to normal. Elderly women
: Fruit-1, reduce cereals and millets-2.
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Guideline 2
Ensure provision of extra food and healthcare to
pregnant and lactating women
Rationale: Additional food and extra care are required during pregnancy and lactation
Pregnancy is physiologically and nutritionally a highly demanding period. Extra ?
food is required to meet the requirements of the fetus.
?
A woman prepares herself to meet the nutritional demands by increasing her
own body fat deposits during pregnancy.
?
A lactating mother requires extra food to secrete adequate quantity/ quality of
milk and to safe guard her own health.
Why additional diet is required during pregnancy and lactation ? Pregnancy is a demanding physiological state. In India, it is observed that diets of women from the low socioeconomic groups are essentially similar during prepregnant, pregnant and lactating periods. Consequently, there is widespread maternal malnutrition leading to high prevalence of low birth weight infants and very high maternal mortality. Additional foods are required to improve weight gain in pregnancy (10-12 Kg) and birth weight of infants (about 3 Kg).
What are the nutrients that require special attention ?
The daily diet of a woman should contain an additional 350
calories, 0.5 g of protein during first trimester and 6.9 g during second trimester and 22.7 g during third trimester of
pregnancy. Some micronutrients are specially required in
extra amounts during these physiological periods. Folic acid, taken throughout the pregnancy, reduces the risk of
congenital malformations and increases the birth weight. The mother as well as the growing fetus needs iron to meet the high demands of erythropoiesis (RBC formation). Cal...