India, as a country, suffers from a unique triple burden of Malnutrition – Gross Undernutrition, Gross Obesity and Lean Obesity with Micronutrient Malnutrition. This observation cuts across age groups and socio-economic strata in India. What became a stark truth during the pandemic was that individuals in each shade of the canvas of malnutrition suffered and succumbed not only because of the lack of Food in terms of Quantity but also due to the gross ignorance about Quality Nutrition in Food.
The basic concept of Quality Nutrition (QN) stems from the nutrient density of foods. In other words, what is the total nutrients (which includes the Macros – Carbohydrates, Proteins, Fats and the Micros- Vitamins and Minerals and the Non- Nutrients- Dietary Fiber and Phytochemicals) per calorie of a given food. In other words, QN refers to those foods which give ‘More Nutrients in Less Quantity’.
The ‘Why’ of QN
The triple burden of malnutrition in India can be simply addressed ‘nutritionally’ if we pay attention to the following key nutrients on priority:
- Quality carbohydrates are dense in dietary fibre, proteins, good quality fats, minerals and phytonutrients.
- Plant protein sources provide not only protein but are fibre dense and good sources of good quality fats, important vitamins and minerals.
- Good quality fats through nuts and oilseeds. This group is also a powerhouse of cardio-metabolic risk protective nutrients.
- Fruits and vegetables that are locally available, specifically seasonal green leafy and coloured vegetables and fruits, which are rich in antioxidants and dietary fibre.
The Format of Quality Intake will address the major problems of the Indian population which predispose them to early onset of malnutrition, non-communicable diseases and infections which are appended below:
- Decreased spike in blood sugars after a meal which is the major cause of insulin resistance and hypertriglyceridemia – a major prerequisite to rising prediabetes and increased cardiometabolic risk factors.
- Increased Dietary Fiber Intake would improve gut microflora which impacts metabolic health and inflammation in the body which is the beginning of the story of all problems across age groups and Socioeconomic Strata.
- Increased protein intake and rationed carbohydrates coupled with physical activity will go a long way in addressing preventing malnutrition, diabetes and sarcopenia in Indians.
Improved micronutrients and antioxidant intake will boost immunity and the ability to fight infections which has immense relevance in the present pandemic times.
Quality carbohydrates
India is a ‘Carb Country’ and thus it is most important that we look for food choices of carbohydrate-rich foods which are nutrient dense.
As a country, we need to invest in our cultural and local heritage of coarser grains which are millets and look at all aspects of making it viable to reach the Indian consumer across socioeconomic strata. The nutrient density of millets needs to be maximised to its fullest for the benefit of the Indian population.
The White Paper on Millets submitted to the Government of India- NITI Aayog, by the Working Committee constituted by Indian Agricultural Research Institute (ICAR) – Indian Institute of Millets Research (IIMR), 2021 is the starting point in this direction. This white paper is a culmination of inputs from all experts, organisations and stakeholders starting from Farm to Fork and its integration to formulate One Wholesome approach …..a great work in progress with India approaching to significantly contribute to the International Year of Millets 2023.
The second food group which needs to be emphasised for QN is the Pulses and Legumes of India. The nutrient density of this powerhouse of nutrients needs to reach all the people across age groups and socioeconomic strata.
The ‘How’ of QN
One of the suggestions here can be- making locally grown dals and pulses available through the public distribution system, through midday meals, Integrated Child Development Services (ICDS) centres to reach the underprivileged in adequate quantity and on the other hand bring in innovation on pulse-based preparations with variety to reach all age groups in the middle and higher socioeconomic strata.
In addition to this, a continuous effort towards nutrition literacy is needed. It is heartening to see that the Food Safety and Standards Authority of India (FSSAI), and the Government of India, through its ‘Eat Right India’ Initiatives are doing a fabulous job, especially by leveraging social media like Facebook, Twitter and Instagram to reach the lay population with scientific and credible information in innovative formats.
Here again, the FSSAI is working very closely with NetProFaN which is the amalgamation of seven important professional associations in India- Indian Dietetic Association (IDA), Nutrition Society of India (NSI), Association of Food Scientists & Technologists AFSTI (AFSTI), Indian Medical Association (IMA), Indian Association of Analytical Communities (IAOAC), Indian Chefs Association and Indian Institute of Public Health). This network further empowers and leverages the reach of each association through its network to every part of this diverse country.
QN from nuts and oilseeds
India is native to a variety of nuts and oilseeds. All of them are known to have nutrient density. There is a lot of Indian research which has been generated through Randomized Control Trials in the recent past on the adult population and Type 2 diabetics through the dietary intervention of nuts to demonstrate benefits to lower Glycosylated Hemoglobin, LDL levels and other cardiometabolic risk factors.
A recent randomised control done by our Institutional Research Cell from Sir Vithaldas Thackersey College of Home Science (Autonomous), Shreemati Nathibai Damodar Thackersey Women’s University (SNDTWU), Mumbai in collaboration with Kasturba Health Research Society and Medical Research Centre, Mumbai in adolescents and young adults with prediabetes in Mumbai city demonstrated that two handfuls of almonds in a day when used in the diets for 90 days lowered the HbA1c, LDL, high insulin levels and inflammatory markers in three months.
Seasonal coloured vegetables and fruits
India’s diversity in its ‘local variety of vegetables and fruits is immense and needs further maximisation of its nutritional awareness to people at large so that the common people are made aware of the nutritious vegetables and fruits which are seasonally and locally available in their geographic regions. The most important aspect here is that they are available and also affordable.
A scientifically validated resource generated by the National Institute of Nutrition – Indian Council of Medical Research, (NIN -ICMR) 2017- Indian Food Composition Tables’ needs to be converted into a simple, vernacular and easy to comprehend format which should be made available to people at large and disseminated widely across the country through different mediums. This will be an important step towards nutrition literacy to improve Diet Diversity across Socioeconomic strata.
Thus, Quality Nutrition for India can be achieved through Nutrition-Sensitive Agriculture and Plant-Based Diets which are native to India considering that a majority of the Indian population is vegetarian. This needs to be supported by a strong mass movement towards nutrition literacy which should be an essential prerequisite for each Indian across socioeconomic strata. The nutrition and dietetics fraternity of this country is committed to realising this dream.
Dr Jagmeet Madan, National President, Indian Dietetic Association (IDA), Mumbai