Why India Needs To Take A Cue From The New US Dietary Guidelines

18/01/2016 8:23 AM IST | Updated 15/07/2016 8:25 AM IST
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The United States Department of Agriculture (USDA) published the Dietary Guidelines 2015 this month. These guidelines tell Americans, and in a large way to others in the world, what an ideal diet to keep oneself healthy is. These dietary recommendations are crucial for they eventually determine the nutrition policy in schools, nudge the food industry to meet norms, and most importantly set a benchmark for individuals.

In the 1970s, when cardiac ailments began rising in the US, the government decided to recommend an ideal diet. These guidelines since their first release in 1977 as "Dietary Goals", have become a five-yearly affair. Every five years, based on emerging research, largely epidemiologic studies, a revision to the dietary guidelines is made. The current guidelines have made a departure from previously held views and have both been lauded and criticised for the recommendations it makes.

The NIN report, which pegs India's overweight or obese population at 30-50%, also states that 33% of Indian men and 36% women have chronic energy deficiency.

For the first time, the guidelines have set a cap on "added sugar" in the diet, recommending that it should comprise no more than 10% of daily calorie needs. Fructose, sucrose, corn syrup and honey, all of which are found in significant quantity in packaged drinks are all added sugars. For a person with a moderately active lifestyle who would need about 2000 kcal/day, one can of a soft drink is enough to meet a full day's requirement.

A major criticism of the USDA's Dietary Guidelines is that they are based on epidemiological studies which establish association but not causation. Another critique is that by pushing for a low-fat diet they have encouraged high carbohydrate consumption, which is widely understood to be a major cause of obesity. The current guidelines diverge from this convention.

Another significant departure has been eliminating the "villain" tag from cholesterol by removing the previously recommended cap of 300 mg/day (about two egg yolks). Research has delinked dietary cholesterol with blood cholesterol, thereby leading to such a change. However treading a cautious path, the advisory regarding cholesterol has been to limit intake to "as little as possible".

A controversial feature has been the removal of a cap on red meat consumption, which the American Cancer Society believes is a risk factor for cancer. Much has been blamed on the lobby of the meat processing industry, an industry that carries much financial and political weight, in establishing such a guideline.

An important feature of the new guidelines has been the absence of a chapter on the oft dreaded word 'fat'. The current guidelines have removed a cap on total fat intake. This has stemmed from studies which have shown that low-fat diets do not significantly help in better heart health. In putting a cap of 2300 mg/day on salt, where 75-80% salt content in US is in packaged food, the USDA has hit the nail in the right place.

Indian Dietary Guidelines - missing the mark

The National Institute of Nutrition (NIN), Hyderabad has been publishing dietary guidelines for Indians since 1998 with the latest being in 2011. It identifies, albeit with not much nutrition research or consultation with various stakeholders, that a shift from traditional to "modern" foods, intake of processed and ready-to-eat foods, increased consumption of energy-dense food with high salt and sugar pose a serious health risk.

The NIN report offers only rudimentary recommendations regarding fat consumption... it does not take into account recent scientific findings, especially those concerning the benefits of good fat.

The NIN report offers only rudimentary recommendations regarding fat consumption. The suggested intake, which is pegged at 20-30% of total energy needs per day, does not take into account recent scientific findings especially those concerning the benefits of good fat. Sweeping statements like "take just enough fats" are of little use to readers. The report while approaching a paternalistic approach on alcohol consumption does not specify what drinking in moderation is.

The NIN report, which pegs India's overweight or obese population at 30-50%, also states that 33% of Indian men and 36% women have chronic energy deficiency. These facts underline the Indian paradox where the battle is on two drastically opposite fronts. These are just a few drops of issue in the ocean of nutrition which warrants extensive and detailed dietary guidelines.

Significance of dietary guidelines

In the 1980s and 90s saturated fat was found to be correlated with heart diseases. A cap on its consumption by the USDA and a requirement to mention the amount of it in labels pushed food manufacturers to cut on saturated fat content which led to positive results over the years. Diet and disease are closely related with a huge burden of NCDs (Non Communicable Diseases) directly attributable to diet. Any recommendation should be based on solid scientific evidence and USDA, despite various criticisms, does a good job.

Nutrition policymaking is a much neglected sector. On one hand there is no significant research in the Indian context, and on the childhood obesity and non-communicable diseases are on the rise, burdening the already fragile healthcare system. NIN or any other competent body needs to undertake an exercise like the USDA, free from the lobbying of food giants. Keeping local sensibilities in mind, it must come up with dietary guidelines in order to chart a healthy path for Indians.

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