t is well recognised that dietary intake in
school-age children plays a major role in defining nutritional and
health status not only during childhood and adolescence but also during
adulthood. Surveys carried out by the National Nutrition Monitoring
Bureau between 1972 and 1997 showed that low dietary intake,
undernutrition and anemia were major public health problems in
school-age children [1]. The school mid-day meal program was initiated
in 1995 to reduce class room hunger and undernutrition [2]. In the last
two decades, research studies – mostly from urban areas – highlighted
the emerging problem of overnutrition, especially among affluent urban
segments.
Fourth District Level Household Survey (DLHS-4) [3]
and Clinical, Anthropometric and Biochemical (CAB) component of Annual
Health Survey [4] provided for the first time, country-wide, district-
and state-specific data on nutritional status of school-age children.
Data from these surveys showed that school-age children across the
country faced triple burden of malnutrition; but there were substantial
differences between districts and states in prevalence of these
problems.
India currently has the largest number of
undernourished and anemic children in the world because of the high
prevalence of undernutrition (20-30%) and anemia (70-87%) [5].
Therefore, the ongoing programs to combat undernutrition and anemia will
have to be continued and effectively implemented. Data from these
surveys show that if body mass index (BMI)-for-age is used as the
parameter for assessment of nutritional status, over 70% of school age
children in India were normally nourished [5]. Every effort should be
made to ensure that they continue taking appropriate diet, undertake
adequate physical activity, and remain normally nourished.
Prevalence of overnutrition in Indian school children
is among the lowest (0.6 to 5.2%) in the world [5], but because India is
a population billionaire, the country is the home to the largest number
of overnourished school-age children. Data from research studies
indicate that increasingly sedentary lifestyle is the most important
factor leading to overnutrition. Increasing physical activity at school
and at home is the critical intervention needed to prevent rise in
overnutrition.
Almost all studies on overnutrition in school-age
children have reported an association between overnutrition and habitual
consumption of energy-dense but micronutrient-poor food stuffs. The
unhealthy food stuffs come from different sources – from increasing use
of oil at home for preparing easy-to-cook fried food, relatively
inexpensive tasty street foods (samosas, kachoris, vadas), readily
available ultra-refined industrially processed food containing sugar,
oil, fat, salt (variously called HFSS food, fast food, junk food), and
sugar-sweetened beverages (fruit juices and drinks, carbonated drinks,
energy drinks). Vigorous nutrition and health education campaigns
highlighting the hazards associated with habitual consumption of
unhealthy food stuffs is being undertaken by all agencies. It is
expected that the increasingly aware, literate population will take
steps first to prevent further increase, and then to reduce consumption
of unhealthy food stuffs.
In this context, the development of Guidelines on the
Fast and Junk Foods, Sugar-sweetened Beverages, Fruit Juices and Energy
Drinks by the Indian Academy of Pediatrics (IAP) [6] is timely. The
Nutrition Chapter of the IAP had constituted a National Consultative
Group with a mandate to:
• review the evidence and formulate consensus
statements related to terminology, magnitude of problem and possible
ill effects of junk foods, fast foods, fruit juices, sugar-sweetened
beverages and carbonated drinks; and
• formulate recommendations for limiting
consumption of these foods and beverages in Indian children and
adolescents.
The Group after review of all available data and
discussions:
• recommended use of a new acronym for unhealthy
food – JUNCS food (Junk foods, Ultra-processed foods,
Nutritionally-inappropriate foods, Caffeinated/colored/carbonated
foods/beverages, and Sugar-sweetened beverages);
• concluded that consumption of these JUNCS foods
and beverages is associated with higher energy intake leading to
higher body mass index and possibly adverse cardio-metabolic
consequences in children and adolescents;
• recommended avoiding consumption of the JUNCS
by all children and adolescents as far as possible and limit their
consumption to not more than one serving per week;
• advised that no fruit juices/drinks should be
given to infants and young children (age <2 yrs); intake should be
restricted to 125 mL/day and 250 mL/day, in children aged 2-5 yrs
and >5-18 yrs, respectively;
• supported the ban on sale of JUNCS foods in
school canteens and in near vicinity, and suggested efforts to
ensure availability and affordability of healthy snacks and foods.
• supported traffic light coding of food
available in school canteens;
• recommended legal ban of screen/print/digital
advertisements of all the JUNCS foods; and
• suggested communication, marketing and
policy/taxation strategies to promote consumption of healthy foods,
and limit availability and consumption of the JUNCS foods.
India has some major advantages while initiating
interventions first to contain and then to reverse the overnutrition
epidemic in children. Current per capita consumption of processed food
and sugar-sweetened beverages in India are lowest in Asia [7]; efforts
are being made to ensure that the country retains this enviable position
in the coming decades. There is a growing recognition across all
segments of population in the country that healthy diets and lifestyles
w ith adequate physical activity are essential for optimal nutrition and
health. India identified overnutrition early in the course of the
epidemic and initiated programs to prevent further rise in overnutrition.
Given these advantages, the country can be expected to achieve the
Sustainable development goal for prevention and reduction of
overnutrition and associated non-communicable diseases.
1. National Nutrition Monitoring Bureau (NNMB).
Twenty-five Years of NNMB (1972-1997). Available from:
http://nnmbindia.org/NNMB-PDF%20FILES/Reports-for%20
the%2025%20years(1972-97).pdf. Accessed August 30, 2019.
2. Ramachandran P. School mid-day meal programme in
India: Past, present, and future. Indian J Pediatr. 2019;12:1-6.
3. International Institute of Population Sciences.
District Level Household and Facility Survey (DLHS-4) 2014. Available from:https://data.gov.in/.../district-level-household-and-facility-survey-dlhs-4.
Accessed August 28, 2019.
4. Office of the Registrar General and Census
Commissioner of India. Clinical, Anthropometric and Biochemical (CAB)
2014. Annual Health Survey CAB Component: CAB State Fact Sheets.
Available from:
http://www.censusindia.gov.in/2011census/hh-series/cab.html.
Accessed August 28, 2019.
5. Ramachandran P, Kalaivani K. Nutrition transition
in India: Challenges in achieving global targets. Proceedings of the
Indian National Science Academy. 2018;84:821-33.
6. Gupta P, Shah D, Kumar P, Bedi N, Mittal HG,
Mishra K, et al; for Pediatric And Adolescent Nutrition Society
(Nutrition Chapter) of Indian Academy of Pediatrics. Indian Academy of
Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened
Beverages, Fruit Juices, and Energy Drinks. Indian Pediatr.
2019;56:849-63.
7. Baker P, Friel S. Food systems transformations,
ultra-processed food markets and the nutrition transition in Asia. Glob
Health. 2016;12:80.
