CHENNAI: Facing a serious dearth of quality data that in turn hampers formulation of policy and legislation on dealing with non-communicable diseases, the Indian Council of Medical Research (ICMR) is planning to conduct a National Comprehensive Health and Nutrition Survey that would look into the dietary pattern of what the people are eating, ICMR director general Dr Soumya Swaminathan told Express.
“This will be aligned with the National Family Health Survey (NFHS) - 5, which will begin in early 2018,” said Dr Swaminathan, adding that the authorities are considering making this a periodical survey. Expressing concern over the absolute lack of data on trans fats, she said a specific study on trans fats, including its levels in blood would also be done. “It will also look into parameters like blood lipid levels and urinary salt excretion among others,” she said.
Having such data is important to formulate a policy that would guide not just production but publicity and consumption as well. In 2013, the WHO had released a report advocating against the food industry’s marketing strategies that target children. To save younger generations, the organisation endorsed strict regulation of such gimmicks.
India, too, has taken some baby steps in this direction. “The Centre is also working with several State governments to bring about some policy changes as well as transforming the way the system is looking at chronic diseases like diabetes and hypertension,” Dr Swaminathan said. To start with, the Centre would launch a pilot effort in coordination with five or six States.
Non-communicable diseases like cardiovascular diseases, diabetes, hypertension and cancer form the major chunk of causes of death in India, the risk factors for which include high intake of fat, sugar and salt. This makes understanding the dietary pattern and the effect of these on the Indian population critical to form any policy.
To assist the governments in policy making on FSS, the National Institute of Nutrition, Hyderabad, an ICMR institution, would set up a Centre for Public Health Nutrition, which would analyse the available data and identify the gaps, Dr Swaminathan said. At present, there are no institutions that look into these factors comprehensively.
The dearth of quality data on FSS was revealed as recently as 2016, when the Food Safety and Standard Authority of India (FSSAI) constituted an 11-member panel of eminent experts from the fields of medicine, nutrition and dietetics from reputed medical research and academic institutions to address the issue of high fat, sugar and salt in food. The team, however, could not find even a single comprehensive Indian study on this.
They then collated all possible data from published and unpublished, region-specific, urban, rural and multi-centric studies from India and found 4,223 articles. But removing duplications, there were only 58 studies in all — 23 of them on fats, 16 on sugar and 19 on salt.
But these were far from being desirable. Experts found that dietary assessment was not the primary objective in most of these studies and thus felt the link between FSS and the various conditions may not be fully revealed. Another important limitation was their unreliable quality.
Most studies mentioned carbohydrate, not actual sugar, intake. In the absence of fractions and details about simple and complex carbohydrate intake, the team could not derive many inferences. Also, these studies largely recruited diabetic patients which compromised the data.
The studies on salt did discuss the link between high intake and hypertension but a majority of them did not report the 24-hour urinary sodium levels, which is considered the gold standard for sodium/salt intake estimation.
They showed that the intake of total and saturated fats was higher than recommended, though did not report these facts separately.
Observing that a meta-analysis could not be undertaken, the experts recommended that the country urgently needed long-term cohort studies with more emphasis on intervention trials for good quality data on public health nutrition.