Handling Sugar and Sweeteners Intakes - Indian Experience by

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³Handling 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 styleFour healthy lifestyle factors

No smoking

Maintaining a healthy weight

Exercising regularly

Healthy diet

Together appear to be associated withas much as an 80 percent reduction inthe risk of developing the mostcommon and deadly chronic diseases



Early awareness

The roots of these factors often

originate during the formative stages of

life, it is especially important to startearly in teaching the important lessons

concerning healthy living.

Schools should be a priority



Indians have sweet tooth!

Almost 75% of the sugar available in theopen 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 domesticconsumption increasing more than 4 %annually.



Consumption of sugar

2005- 2006 ± 19 million tons

2007 ± 2008 ± 22 million tons

2008 ±

2009 ±

23million ton

Per capita consumption of sugar:

Rural ± 2.2 kg/ month/ household

Urban ± 5.11 kg/month/household

Sugar consumption in India has morethan doubled in 20 years .



States Kgs. Per annum

Punjab 71.5

Haryana 68.5Maharashtra 40.9

Gujarat 40.9

Kerala 41.5

Uttar Pradesh 35.2

Tamil Nadu 29.1

Karnataka 23.3

All India 31.5

PER CAPITA CONSUMPTION OF

SUGAR IN URBAN INDIA



Incidence of Obesity

On an average 5 % of Indian population isobese but when seen in urban settings thenumbers are amazingly high .

Punjab : 30.3 % Males, 37.5 % FemalesKerala : 24.3 % Males, 34.0 % FemalesGoa : 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 inprivate 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% Delhi, DST trial , 2002

Post menopausal (52 years) = 62 % Delhi, DBT trial, 2006

Hypertension >140/90 mm Hg = 43%

Hyperlipidaemia Cholesterol > 200 mg = 47%

Diabetes Blood sugar >126 mg% = 4 %

Osteoporosis (T-score < -2.5) = 22%

4,621( >35 years) overweight urban areas= 64 % DST trial in 6 cities,2009

rural areas = 36 %Hypertension >140/90 mm Hg = 50%

Hyperlipidaemia Cholesterol > 200 mg = 25%

Diabetes Blood sugar >126 mg% = 3 - 14 %



Age (y) New

Delhi (n = 4997)

Mumba

i (n = 435)

Agra(n = 4415)

Jaipur (n = 2646)

Allahaba

d (n = 3379)

Overall (n = 15872)

14 26.8 51.9 18.3 15.1 22.9 23.115 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

Overall 28.8 31.3 13.9 13.7 29.1 20

Diabetes Foundation ( INDIA) - Ongoing trial

Prevalence (%) of Abdominal Obesity in 14-18 y

old Asian Indian Adolescents: 5 City Data



E ating Habit Public

Schools

Gov.

Schools

Eating out, >1 d/week 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

Consumption of Energy-dense Foods

65 % of Children in class X and XII are sedentary



Un healthy Eating Habits

Erratic eating habits

Frequent fast and fried food

consumption

Excess intake of colas

Excess consumption of refinedfoods

Not consuming enough fruits and

vegetables



Sedentary Life style

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 onone 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 tothe increasingly sedentary nature of many forms of work, changing modes of transportation, andincreasing urbanization.

Urbanization , sedentary life styles and excessiveconsumption of sugary foods along with increasedfat consumption specially saturated fats is leadingIndia 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

H eart disease : Rural: 5 ± 6%

Urban: 9-10%.

Hypertension : Rural :5-8 %.

Urban : 15%

Diabetes : 6 ± 12 %









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 becompletely diabetic-safe.



Low calorie sweeteners

Sweetos is a low calorie, high intensitysweetener made from Fructo-Oligo-Saccharide and Sucralose.

It is approved as a soluble fibre and helps toreduce serum LDL Cholesterol Levels.

Fructo-Oligo-Saccharide is a very goodPrebiotic, 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 severalthousand times sweeter than sugar.

Because of their intense sweetening power,

these sweeteners are used in very small

amounts and thus add only a negligibleamount 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 cutdown 500 calories in a weight reduction diet. Areduction 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 lostapproximately 1 kg in weight.

Improves the adherence to the diet program. Hence,the artificial sweeteners play a very important role inobesity 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 foodproducts and supplements (artificial sweetener, mealreplacers, 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 products5% are valued at Rs 0.56 billion, Rs 0.23 billion and Rs0.23 billion respectively. (Source: Cygnus BusinessConsulting & Research 2008)



Food supplements



World Health Organization (WHO)

Nutrient and energy requirements vary betweenindividuals and are related to a person's age, sex,level of physical activity

In India 70- 80 % of person's dietary energy iscoming from carbohydrates including sugars .

The calories from sugar are termed hollow caloriesas they lack proteins , vitamins and minerals .

Healthy eating concept should reduce refinedcarbohydrates especially sugars and select healthyfoods with whole grains and fiber .

Fibre is important for gut function, and helps to

reduce the risk of heart disease and some cancersand acts as a filler for weight reduction.

Many studies have also shown that fruit andvegetables have beneficial effects on health. WHOrecommends 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 calorieswith 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



Exercises

Moderate intensity

Vigorous 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(4-

7m/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, anti-

gravity

exercise,

isometric

exercise

Children-Body

weight

activity (Pullups)

1-3 sets of 8-12

repetitions

targeting

major

muscle

groups

2-3 Resistance

training,

curls,

presses,

anti gravity

exercise,

isometric

exercise

Children- Body

weightactivity

(Pull u s

>3 sets of >12

repetitio

ns

targetin

g major

muscle

groups

2-3 days

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



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Handling Sugar and Sweeteners Intakes - Indian Experience by