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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
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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
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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
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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.
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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 .
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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
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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.
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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 %
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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
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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
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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
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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
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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
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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.
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Incidence of Life style Diseases
H eart disease : Rural: 5 ± 6%
Urban: 9-10%.
Hypertension : Rural :5-8 %.
Urban : 15%
Diabetes : 6 ± 12 %
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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.
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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
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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.
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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.
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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
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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)
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Food supplements
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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.
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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.
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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.
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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
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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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