Dietary Guidelines for Indians - A Manual

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It is now more than a decade since this valuable publication was first prepared. It was compiled by a team of experienced nutrition scientists at the National Institute of Nutrition, Hyderabad, under the leadership of Dr. Kamala Krishnaswamy. It has received wide appreciation from the general public as well as from students of nutrition, medicine, home science, nursing and allied subjects, and has been reprinted several times. It has also been widely disseminated through outreach activities undertaken by the National Institute of Nutrition, in the form of lectures, exhibitions and distribution of materials in various local languages.

In the intervening years, there have been notable socio-economic changes in India. It was thought necessary to update the guidelines in the light of new developments and fresh information.

The most notable change has been in the overall economic scenario in the country, with a robust growth rate. There have also been some important government initiatives in the fields of health and nutrition and poverty alleviation, including the launching of MGNREGA and overhauling of the ICDS. Globalisation has resulted in the opening of multinational fast food chains in Indian cities, including the smaller cities. Lifestyles and dietary patterns that had started giving early warning signals towards the end of the previous century, when these guidelines were first published, are continuing to follow a trend that promotes obesity and the attendant non communicable diseases.

The improvement in the overall economy at the macro level and concomitant improvements in purchasing power (though unevenly distributed) among households have not led to the expected levels of improvement in the nutritional status of Indians. The latest findings of the National Family Health Survey, NFHS-3 showed virtually no improvement in parameters as compared to NFHS-2, and recent surveys by the National Nutrition Monitoring Bureau have thrown more light on the growing problem of the 'double burden' of undernutrition and overnutrition. These data should serve as a wake-up call to nutritionists and policy makers. There is very obviously an 'awareness and information deficit', even among the more affluent sections of the population, about good dietary practices and their linkage with good health. This deficit should be narrowed and eliminated by harnessing all traditional as well as modern technological vehicles of communication.

This updated version of DGI from India's premier nutrition institute, National Institute of Nutrition, should serve as a valuable source of concise, accurate and accessible information, both for members of the general public and those who are involved in dissemination of nutrition and health education.

The first edition of 'Dietary Guidelines' was published in 1998, and since then many changes have taken place in the country. The economic transition has transformed the way people live. Changing lifestyles of people both in rural and urban areas are seen to alter the very structure of our society at a rapid pace today. The shift from traditional to 'modern' foods, changing cooking practices, increased intake of processed and ready-to-eat foods, intensive marketing of junk foods and 'health' beverages have affected people's perception of foods as well as their dietary behaviour. Irrational preference for energy-dense foods and those with high sugar and salt content pose a serious health risk to the people, especially children. The increasing number of overweight and obese people in the community and the resulting burden of chronic non-communicable diseases necessitate systematic nutrition educational interventions on a massive scale. There is a need for adoption of healthy dietary guidelines along with strong emphasis on regular physical exercise.

Today, the multiple sources of health and nutrition related information tend to create unnecessary confusion among people. This book makes an attempt to inform us on matters of everyday nutrition in a user friendly manner and thus, aims to influence our dietary behavior. These guidelines deal with nutritional requirements of people during all stages of their life, right from infancy to old age.

We earnestly hope that readers will enjoy reading the book and benefit from it and also spread the valuable information among those around them.

Nutrition is a basic human need and a prerequisite to a healthy life. A proper diet is essential from the very early stages of life for proper growth, development and to remain active. Food consumption, which largely depends on production and distribution, determines the health and nutritional status of the population. The recommended dietary allowances (RDA) are nutrient-centred and technical in nature. Apart from supplying nutrients, foods provide a host of other components (non-nutrient phytochemicals) which have a positive impact on health. Since people consume food, it is essential to advocate nutrition in terms of foods, rather than nutrients. Emphasis has, therefore, been shifted from a nutrient orientation to the food-based approach for attaining optimal nutritional status. Dietary guidelines are a translation of scientific knowledge on nutrients into specific dietary advice. They represent the recommended dietary allowances of nutrients in terms of diets that should be consumed by the population. The guidelines promote the concept of nutritionally adequate diets and healthy lifestyles from the time of conception to old age.

Formulation of dietary goals and specific guidelines would help in providing required guidance to people in ensuring nutritional adequacy. The dietary guidelines could be directly applied for general population or specific physiological or high risk groups to derive health benefits. They may also be used by medical and health personnel, nutritionists and dietitians. The guidelines are consistent with the goals set in national policies on Agriculture, Health and Nutrition.

The dietary guidelines ought to be practical, dynamic and flexible, based on the prevailing situation. Their utility is influenced by the extent to which they reflect the social, economic, agricultural and other environmental conditions. The guidelines can be considered as an integral component of the country's comprehensive plan to reach the goals specified in the National Nutrition Policy.

The major food issues of concern are insufficient/ imbalanced intake of foods/nutrients. The common nutritional problems of public health importance in India are low birth weight, protein energy malnutrition in children, chronic energy deficiency in adults, micronutrient malnutrition and diet-related non- communicable diseases. However, diseases at the either end of the spectrum of malnutrition (undernutrition and overnutrition) are important. Recent evidences indicate that undernutrition in utero may set the pace for diet-related chronic diseases in later life. Population explosion, demographic changes, rapid urbanization and alterations in traditional habits contribute to the development of certain unhealthy dietary practices and physical inactivity, resulting in diet-related chronic diseases.

The dietary guidelines emphasize promotion of health and prevention of disease, of all age groups with special focus on vulnerable segments of the population such as infants, children and adolescents, pregnant and lactating women and the elderly. Other related factors, which need consideration are physical activity, health care, safe water supply and socio-economic development, all of which strongly influence nutrition and health.

In this document, food-related approaches, both in qualitative and quantitative terms, have been incorporated. Emphasis is on positive recommendations which can maximize protective effects through use of a variety of foods in tune with traditional habits. The higher goals set with respect to certain food items such as pulses, milk and vegetables/fruits are intended to encourage appropriate policy decisions. Suitable messages for each of these guidelines have been highlighted.

A variety of foods, which are available and are within the reach of the common man, can be selected to formulate nutritionally adequate diets. While there are only four accepted basic food groups, in India, there are a variety of food preparations and culinary practices. Different cereals/ millets are used as staple food, apart from a variety of cereal/ millet/ pulse combinations in different regions of India. The cooking oils and fat used are of several kinds. The proposed guidelines help to formulate health promoting recipes and diets which are region- and culture- specific. It is difficult to compute standard portion sizes, common to all regions of India. Nevertheless, attempts are made to give portion sizes and exchanges.

Translation of knowledge into action calls for the coordinated efforts of several government and non-government organizations. The fifteen guidelines prescribed, herein, stress on adequacy of intake of foods from all food groups for maintenance of optimal health. Effective IEC strategies and other large-scale educational campaigns should be launched to encourage people to follow the dietary guidelines. Such efforts should be integrated with the existing national nutrition and health programs.