Comprehensive Guidelines on the Diet of Vulnerable Groups

What’s in today’s article?

• Why in News?
• What are Noncommunicable Diseases (NCDs)?
• Status of Non-Communicable Diseases (NCDs) in India
• Initiatives of the Indian Government to Reduce Prevalence of NCDs in the Country
• The Comprehensive Guidelines on the Diet of Vulnerable Groups

Why in News?

• India’s premier nutrition research institute - National Institute of Nutrition (NIN), has published comprehensive guidelines on the diet of vulnerable groups, including pregnant and lactating women, and children and the elderly.
• This comes as the noncommunicable diseases (NCDs) such as cardiovascular disease, cancers, diabetes, etc., are rising among adolescents and even children.

What are Noncommunicable Diseases (NCDs)?

• Also known as chronic diseases, NCDs tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.
• The main types of NCD are -
  • Cardiovascular diseases (CVDs) (such as heart attacks and stroke),
  • Cancers,
  • Chronic respiratory diseases (CRDs) (such as chronic obstructive pulmonary disease and asthma) and
  • Diabetes.
• NCDs disproportionately affect people in low- and middle-income countries, where more than three quarters of global NCD deaths (31.4 million) occur.
• In line with Sustainable Development Goal 3, the global ambition is to reduce premature mortality from NCDs by one-third by 2030.

Status of Non-Communicable Diseases (NCDs) in India:

• According to the “India: Health of the Nation's States” report by Indian Council of Medical Research (ICMR), the proportion of deaths due to Non-Communicable Diseases in India have increased from 37.9% in 1990 to 61.8% in 2016.
  • This has now increased to 63% (of all deaths in India).
• The human impact of NCDs in India is most severe among those over 30 years old, with CVDs being the leading cause of NCD-related deaths at 27%, followed by CRDs (11%), cancers (9%), diabetes (3%), and other (13%).
• The four major NCDs (mentioned above) share four behavioural risk factors - unhealthy diet, lack of physical activity, and use of tobacco and alcohol.
• Also, the NCDs are expected to cost India $3.55 trillion in lost economic output between 2012 and 2030.

Initiatives of the Indian Government to Reduce Prevalence of NCDs in the Country:

• Rebranded and expanded NPCDCS to NP-NCD:
  • The National Program for Prevention and Control of Cancer, Diabetes, CVDs & Stroke (NPCDCS, launched in 2010) has been rebranded into the National Programme for Prevention and Control of NCDs (NP-NCD).
  • Also, its scope has been broadened to include Chronic Obstructive Pulmonary Disease (COPD) and Asthma, Chronic Kidney Disease (CKD), and Non-Alcoholic Fatty Liver Disease (NAFLD).
• Revised operational guidelines of NP-NCD: It underscores the growing financial burden of NCDs on individuals and the economy, a situation that's driving a focus on primary and secondary prevention to improve the quality-of-care services.
• Providing standard care: The union health ministry is aiming to provide standard care to 75 million people with hypertension and diabetes by 2025, representing the world's largest coverage of NCDs in primary healthcare.
• National Institute of Nutrition (NIN):
  • It was founded by Sir Robert McCarrison in the year 1918 as ‘Beri-Beri’ enquiry unit and emerged as a full-fledged institute (under ICMR and located in Hyderabad) in 1967.
  • It has attained global recognition for its pioneering studies on various aspects of nutrition research, with special reference to protein energy malnutrition (PEM).

The Comprehensive Guidelines on the Diet of Vulnerable Groups:

• Key highlights of the guidelines:
  • The guidelines say an estimated 56.4% of India’s total disease burden can be attributed to unhealthy diets.
  • A healthy diet and physical activity can prevent 80% of Type 2 diabetes cases, and significantly reduce the burden of heart disease and high blood pressure.
• Key focus areas of the guidelines - Children:
  • Optimal nutrition for mother and child from conception till the age of 2 years is linked to proper growth and development.
  • It can prevent all forms of undernutrition, including micronutrient deficiencies, and obesity.
  • The report quotes the Comprehensive National Nutrition Survey 2019, which showed high prevalence of lifestyle conditions even in children.

• India is facing the dual nutrition challenge (both micronutrient deficiencies and diseases of overnutrition):
  • Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19.
  • While severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country, manifestations such as anaemia continue.
  • The faulty dietary pattern in which unhealthy, highly processed, high-fat, sugar and salt (HFSS) foods have become more affordable and accessible, contributes to deficiencies in iron and folic acid.
• Recommendations of the guidelines:
  • The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
  • Consumption of cereals should be restricted and more proteins (pulses, meat, poultry, fish) should be consumed.
  • Achieving adequate levels of essential polyunsaturated fatty acids (PUFA) and B12 is a challenge for vegetarians.
    • The guidelines recommend consumption of flax seeds, chia seeds, walnuts, vegetables, and greens.
  • The report says salt consumption should be restricted to 5g a day, and strongly recommends against consuming highly processed foods that are typically high in fats, salt, and sugar.
• Age/group-specific recommendations:
  • Pregnant women: The guidelines recommend consumption of lots of fruit and vegetables, especially those high in iron and folate content.
  • Infants and children: For the first six months, infants should only be breastfed, and after age 6 months complementary foods must be included.
  • Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fibre. Exercise is important in order to maintain bone density and muscle mass.

Q.1. What is the Noncommunicable Diseases (NCDs) Global Monitoring Framework (GMF)?

The GMF for the prevention and control of NCDs was adopted in the 2013 World Health Assembly. It aims to reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being by 2030.

Q.2. What is the National Health Mission (NHM)?

The NHM was launched by the government of India in 2005 subsuming the National Rural Health Mission and National Urban Health Mission. It envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

Source: Meeting nutrition challenge: What new guidelines prescribe | Mint | PIB