1. “Handling 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

2. Science for Health , Diet and Life style
Four healthy lifestyle factors
No smoking
Maintaining a healthy weight
Exercising regularly
Healthy diet
Together appear to be associated with as much as an 80 percent reduction in the risk of developing the most common and deadly chronic diseases

3. Early awareness
The roots of these factors often originate during the formative stages of life, it is especially important to start early in teaching the important lessons concerning healthy living.
Schools should be a priority

4. Indians have sweet tooth!
Almost 75% of the sugar available in the open 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 domestic consumption increasing more than 4 % annually.

5. Consumption of sugar 2005- 2006 – 19 million tons
Per capita consumption of sugar:
Rural – 2.2 kg/ month/ household
Urban – 5.11 kg/month/household
Sugar consumption in India has more than doubled in 20 years .

6. PER CAPITA CONSUMPTION OF SUGAR IN URBAN INDIA
States
Kgs. Per annum
Punjab
71.5
Haryana
68.5
Maharashtra
40.9
Gujarat
Kerala
41.5
Uttar Pradesh
35.2
Tamil Nadu
29.1
Karnataka
23.3
All India
31.5

7. Incidence of Obesity
On an average 5 % of Indian population is obese but when seen in urban settings the numbers are amazingly high .
Punjab : 30.3 % Males, 37.5 % Females Kerala : 24.3 % Males, 34.0 % Females Goa : 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 in private schools.

8. 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% = %

9. Prevalence (%) of Abdominal Obesity in 14-18 y old Asian Indian Adolescents: 5 City Data
Age (y)
New Delhi
(n = 4997)
Mumbai
(n = 435)
Agra
(n = 4415)
Jaipur
(n = 2646)
Allahabad
(n = 3379)
Overall
(n = 15872) 14
26.8
51.9
18.3
15.1
22.9
23.1 15
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
28.8
31.3
13.9
13.7
29.1 20
Diabetes Foundation ( INDIA) - Ongoing trial

10. Consumption of Energy-dense Foods
Eating Habit
Public
Schools
Gov.
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
 25
Eating pizzas, >1 d/week 15
 12
Eating noodles, >1 d/week 44 50
Drinking colas, >1 d/week 36
 35
65 % of Children in class X and XII are sedentary

11. Un healthy Eating Habits
Erratic eating habits
Frequent fast and fried food consumption
Excess intake of colas
Excess consumption of refined foods
Not consuming enough fruits and vegetables

12. 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

13. 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

14. Causes of Obesity - WHO
Energy imbalance between calories consumed on one 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 to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.
Urbanization , sedentary life styles and excessive consumption of sugary foods along with increased fat consumption specially saturated fats is leading India to obesity . Obesity being the primary factor of type II Diabetes is leading India to become the diabetic capital of the world by 2030.

15. Incidence of Life style Diseases
Heart disease : Rural: 5 – 6%
                     Urban: 9-10%.
Hypertension : Rural :5-8 %.
                     Urban : 15%
Diabetes         : – 12 %

18. Satisfying Sweet tooth
Craving for sugar often translates into a tug-of-war; the urge to satisfy a sweet tooth versus the urge to resist empty calories.
Artificial sweeteners are avoiding this .Indias artificial sweetener industry (estimated at Rs 60 crore) is also growing at a healthy 20 per cent annually.
The Government of India has allowed the use of artificial sweeteners in around 25 food items. The items include carbonated water, soft drink concentrate, sugar/sugar free confectionery, chewing gums, biscuits, breads, cakes and pastries and some traditional sweets. ...

19. 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 be completely diabetic-safe.

20. Low calorie sweeteners
Sweetos is a low calorie, high intensity sweetener made from Fructo-Oligo-Saccharide and Sucralose.
It is approved as a soluble fibre and helps to reduce serum LDL Cholesterol Levels.
Fructo-Oligo-Saccharide is a very good Prebiotic, 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

21. 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 several thousand times sweeter than sugar.
Because of their intense sweetening power, these sweeteners are used in very small amounts and thus add only a negligible amount of calories to foods and beverages.

22. Sweeteners and weight Management
Non-nutritive sweeteners play a crucial role in weight management strategies. It is a difficult task to cut down 500 calories in a weight reduction diet. A reduction 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 lost approximately 1 kg in weight.
Improves the adherence to the diet program. Hence, the artificial sweeteners play a very important role in obesity as well as diabetes management.

23. Artificial Sweetener intake
Obese
Over weight
Diabetics Type 2
Middle income group = %
High Income group = %
Equal, Sugar free, Saccharin
Ms Swapna Chaturvedi , Dept of Dietetics
All India Inst of Medical sciences , New Delhi

24. Food supplements share in the market
In food supplements, the major share is held by food products and supplements (artificial sweetener, meal replacers, 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 products 5% are valued at Rs 0.56 billion, Rs 0.23 billion and Rs 0.23 billion respectively. (Source: Cygnus Business Consulting & Research 2008)

25. Food supplements

26. World Health Organization (WHO)
Nutrient and energy requirements vary between individuals and are related to a person's age, sex, level of physical activity
In India % of person's dietary energy is coming from carbohydrates including sugars .
The calories from sugar are termed hollow calories as they lack proteins , vitamins and minerals .
Healthy eating concept should reduce refined carbohydrates especially sugars and select healthy foods with whole grains and fiber .
Fibre is important for gut function, and helps to reduce the risk of heart disease and some cancers and acts as a filler for weight reduction.
Many studies have also shown that fruit and vegetables have beneficial effects on health. WHO recommends consuming around 400 g (five or six portions) a day.

27. 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 calories with 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.

28. Dietary guidelines for lifestyle modification-NIN
Polyunsaturated fat should not exceed 8% of the total calories.
P/S ratio should be between
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.

29. Per capita calorie Intake
Calories K cals/Day
Rural Urban
NSS
NSS Report –

30. 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
Exercises
Moderate intensity
Vigorous intensity
Type of physical activity
Modality
Duration
Frequency/ days per week
Duration/ repetitions
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 (Pull ups)
1-3 sets of 8-12 repetitions targeting major muscle groups
2-3
Resistance training, curls, presses, anti gravity exercise, isometric exercise
Children- Body weight activity (Pull ups)
>3 sets of >12 repetitions targeting major muscle groups
2-3 days

31. Thank You