Indian studies on the consumption of ultra-processed foods are few and are focused on limited foods. The present study assesses the contribution of ultra-processed foods to the macronutrient intake in diets of adolescents (aged 12-16 year) from low- and middle-income families in Delhi.

The study was conducted in one purposively selected private and government/government-aided school each from North, South, East and West zones of Delhi between July, 2014 and July, 2016. Children from government schools belonged to low-income group and children from private schools belonged to middle-income group, which was verified using Kuppuswamy scale of socio-economic status (SES) classification [7]. Adolescents aged 12-16 years were enrolled by random selection of one section each from 7-11 grades in the respective schools.

A diet survey was carried out by using a pre-tested food frequency questionnaire and a 24-hour food record. The respondents were asked to record their frequency of consumption in the questionnaire, and actual consumption of foods and beverages for three days i.e. two working days and one holiday, in a food record. Intake of a food at least three times or more per week was considered as frequent consumption. The amount of food products consumed was assessed by using three and two-dimensional food models of standardized plates, glasses, spoons, ladles and bowls. For foods like chips, ready-to-serve beverages and confectionery, pack sizes were noted in order to assess the child’s dietary intake for that food product. Ethical clearance was taken from the institutional ethics committee of Lady Irwin college. Written consent was taken from parents and assent from the school children.

Nutrient intake was calculated by using dietary assessment software, Diet Cal Version 5 (Profound Tech Solutions Pvt. Ltd., Delhi, India) utilizing the nutrient composition data given by National Institute of Nutrition [8]. The contribution of all ultra-processed foods to the macronutrient intake in day’s diet was assessed and compared across the income groups using an independent t-test or Mann-Whitney U test. P values less than 0.05 were considered as statistically significant.

Out of 1200 children recruited, 1030 (86%) adolescents (46% from private schools) were present on the day of collection of forms and provided completed forms.

The majority of adolescents (92%) consumed ultra-processed food items frequently. The mean daily intake of ultra-processed foods across income groups is shown in Web Table I. It was higher in middle-income group than low-income group. The contribution for macronutrients from ultra-processed foods across income groups was higher in middle-income group as compared to low-income group Table I. About 11-19% of daily macronutrient intake was from ultra-processed foods. The maximum contribution to energy intake from ultra-processed foods was by bakery products, followed by beverage concentrates.

Table I  Contribution of Ultra-processed Foods to Total Macronutrient Intake of Adolescents 

The present study shows high intake of ultra-processed foods in the majority of adolescents, which was higher in middle-income group than low-income group. Intake of few ultra-processed food products has been reported in literature [2,5,9-13]. The mean consumption of carbonated beverages, fruit juices, ice creams and ready to serve fruit beverages was higher in a study [10] from developed countries than the present study. Previous studies [5,12] have reported lower mean intake of carbonated beverages than the present study. Data show a higher consumption of aerated drinks and chips regularly in school children in Delhi than the present study. This may be due to the difference in sample, age and income group studied.

Data from Comprehensive National Nutritional Survey [2] and National Nutrition Monitoring Bureau [13] reported that the intake for macronutrients and micronutrients was less than the recommended dietary intake (RDA) (10-19 year old children). Similar findings were reported in a study done in Delhi [9]. The present study did not look at the nutritional status of participants. However, a high consumption of ultra-processed foods, most of which are high in fat, salt and sugar and lacking in micronutrients, is disturbing. The fact that half the sample size was from low socio-economic groups shows that income is not a limiting factor and ultra-processed foods have penetrated all segments of society.

A limitation of the study was the difficulty in assessing portion sizes when respondents did not eat a full packet of the packaged product (e.g. chips) or a full portion size (e.g. piece of cake rather than a defined slice). Assessing the nutritional status of the respondents would have added more information.

Many reasons have been proposed for the high consumption of ultra-processed foods by children [2,5,13-15]. Consumption of these foods in excess could increase the risk of obesity and associated co-morbidities at a younger age. Attention needs to be given to availability of energy dense and HFSS ultra-processed foods in the home and school food-environment so that these foods do not replace fresh home cooked meals. Early introduction to the concept of healthy food choices in schools could help in ensuring better eating habits among growing children. The food industry also needs to pitch in by making available healthier food and beverage options which improve the nutritional quality of the diets of children of this country.

Contributors: AJ: design of study, data collection, data analysis and interpretation, writing paper; PM: design of study, data interpretation, writing and review of paper.

Ethics clearance: Institutional Ethics Committee of Lady Irwin College; ECR/12/INDT/DL/2014 dated May 06, 2014.

Funding: Senior research fellowship by University Grants Commission Government of India (AJ); Competing interest: None stated.

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