Slide 1: Nutrition Transition in India: The Pandemic of Cardiometabolic Disorders
NUTRITION TRANSITION IN INDIA: THE PANDEMIC OF CARDIOMETABOLIC DISORDERS Shilpa N Bhupathiraju, PhD Research Associate, Department of Nutrition, Harvard School of Public Health, Boston, MA
Slide 2: Defining Nutrition Transition in India
Defining Nutrition Transition in India Westernization of the traditional diet Easy access to a variety of processed foods and fast foods
Slide 3: Fast Food Nation
FAST FOOD NATION era AMA ENE swastdste( DP eration Groure Areal sa | Kamala nef Golege ews “as Disc: Pak: Shier Sports Comatex IWCld Ce nous GKTh Bloc ck = + ya
Slide 4: Defining Nutrition Transition in India
Defining Nutrition Transition in India Westernization of the traditional diet Easy access to a variety of processed foods and fast foods Shift back to a healthier diet and lifestyle
Slide 5: Possible causes of the nutrition transition
Possible causes of the nutrition transition Adapted from Martorell and Stein, 2001 and Popkin, 1994.
Slide 6: The Double Burden of Disease
Trends in Malnutrition Among Ever-married Women 15-49 Years Percent NFHS-2. mi NFHS-3 53 3 -—7z 11 Too thin Overweight/obese Normal weight
Slide 7: Age-standardized Rates and Trends among Women who are Overweight or Obese
Age-standardized Rates and Trends among Women (18-49 y) who are Overweight or Obese Source: Popkin et al, Nutr Rev, 2012, 70(1):3-21.
Slide 8: Type 2 Diabetes: A Disease on the Rise
Type 2 Diabetes: A Disease on the Rise 2013 cases of diabetes among 2035 projected cases ages 20-79 China 142.7 million China 98.4 million India 109.0 India 65.1 US US 29.7 24.4 Source: IDF
Slide 9: Nutrition Transition in India
Nutrition Transition in India • Refined • Coarse grains carbohydrates • Legumes • Added sugars • Fruits • Fats • Vegetables • Sodium • Animal source foods
Slide 10: Trends in Cereal Intake
TRENDS IN CEREAL INTAKE
Slide 11: Trends in Cereal Intake
Trends in Cereal Intake Consumption of cereals has declined in the past few decades despite reductions in cost. Changes depend on income level.
Slide 12: Trends in Cereal Intake
Trends in Cereal Intake Reductions in consumption of traditional whole grains and increases in refined grain consumption Source: FAO Food Balance Sheets data
Slide 13: Refined grain intake and markers of glucose tolerance – CURES
Refined grain intake and markers of glucose tolerance – The Chennai Urban Rural Epidemiology Study (CURES) Source: Radhika et al, Metabolism. 2009 May;58(5):675-81
Slide 14: Higher intakes of refined grains associated with higher odds of metabolic syndrome
Higher intakes of refined grains associated with higher odds of metabolic syndrome Source: Radhika et al, Metabolism. 2009 May;58(5):675-81
Slide 15: Brown rice and type 2 diabetes risk: a randomized cross-over study
Brown rice and type 2 diabetes risk: a randomized cross-over study • 5 day trial in overweight Indians without type 2 diabetes, aged 40-59 y • Test meals were identical except for rice and legumes (50 g) • Effects of BR – ↓ Glucose IAUC (19.8%) – ↓ Glycemic response (22.9%) – ↓ % change in insulin (
Slide 16: Trends in Starchy Roots and Tubers
TRENDS IN STARCHY ROOTS AND TUBERS
Slide 17: Trends in Starchy Roots and Tubers
Trends in Starchy Roots and Tubers Source: FAO Food Balance Sheets data
Slide 18: French fries are now one of the largest selling snacks
French fries are now one of the largest selling snacks in modern retail and in the frozen food section. Canadian firm McCain Foods, the world's largest maker of French fries and assorted potato snacks, says fries along with potato smiles are its fastest moving products in India.
Slide 19: Changes in potato consumption and subsequent weight gain
Changes in potato consumption and subsequent weight gain Source: Mozzafarian et al, 2011, N Engl J Med, 23;364(25):2392-404.
Slide 20: Trends in Sugar Intake
TRENDS IN SUGAR INTAKE
Slide 21: Trends in Sugar Consumption: A Sweet Tooth Nation
Trends in Sugar Consumption A Sweet Tooth Nation Source: India’s Sugar Policy and the World Sugar Economy, FAO International Sugar Conference, Fiji, August 2012
Slide 22: Sources of added sugar in the Indian diet
Sources of added sugar in the Indian diet • Traditional sweets • Cakes, cookies, biscuits • Sugar-sweetened beverages
Slide 23: Soda consumption across the globe
Soda consumption across the globe An untapped market
Slide 24: An untapped market
An untapped market • Soft drink industry - $50 bn • Annual growth rate of 6%- 7% • Penetration into rural areas (40% sales) – Outlets growing exponentially since 2001 – Expand distribution infrastructure – Increasing coolers in each outlet offers – Increasing awareness of hygiene
Slide 25: Soft drink consumption and global overweight, obesity, and type 2 diabetes
Soft drink consumption and global overweight, obesity, and type 2 diabetes A 1% rise additional 0.3 diabetic adults/100 A 1% rise additional 4.8 overweight adults/100 Data Sources: • Euromonitor Global Market Information • WHO • IDF Source: Basu et al Am J Public Health. 2013;103:2071–2077
Slide 26: Trends in Fat Intake
TRENDS IN FAT INTAKE
Slide 27: Trends in Fat Intake
Trends in Fat Intake • Vegetable oil supply doubled • Animal fats increased 3-fold • Supply of ghee increased 4-fold Source: FAO Food Balance Sheets data
Slide 28: TFA of common Indian foods
TFA of common Indian foods Denmark trans fat ban Source: Agrawal A et al, 2008, Nutrition & Food Science, Vol. 38 Iss: 6, pp.564 - 569
Slide 29: Regulation of trans fats in India
Regulation of trans fats in India Current Regulations Proposed Regulations • Foods with TFA should declare • Level of TFA in on the label “Hydrogenated vanaspati/PHVO be fixed vegetable fats or shortening at 10% maximum and used – contains trans fats” brought down to 5% in 3 • Health claim of trans
Slide 30: Salt Consumption
SALT CONSUMPTION
Slide 31: Dietary Salt: Current intake
Dietary Salt • Current intakes continue to be high Current intake • Urban rural differences WHO • Higher with NIN increasing income
Slide 32: Dietary salt intake and HTN risk in an Indian cohort
Dietary salt intake and HTN risk in an Indian cohort Source: Radhika et al 2007, J Assoc Physicians India;55:405-11.
Slide 33: Dietary salt in processed foods
Dietary salt in processed foods
Slide 34: Impact of dietary salt reduction over a 30-year period
350,000 MIs/year Impact of dietary salt reduction of 3 g/d over a 30-y period on future MI, stroke, and mortality 81,000 deaths/year 48,000 strokes/year Source: Basu et al (2012) PLoS ONE 7(9): e44037.
Slide 35: Next Steps: Multi-pronged Approach
NEXT STEPS: MULTI-PRONGED APPROACH • Understanding the feasibility and acceptability of simple dietary interventions • Mechanistic studies to understand the lower age of onset of type 2 diabetes • Effect of educational campaigns • Effect of policy changes such as soda taxes
Slide 36: Questions?
QUESTIONS? Email: sbhupath@hsph.harvard.edu
Slide 37: Basic Copyright Notice & Disclaimer
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