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ICMR’s Dietary Guidelines for Indians

Table of contents

Dietary Guidelines for Indians

  • Released by: National Institute of Nutrition of Indian Council of Medical Research (ICMR-NIN), Department of Health Research under Ministry of Health and Family Welfare, Government of India.
  • In India, severe forms of undernutrition such as marasmus, kwashiorkor and keratomalacia have largely disappeared, yet subclinical manifestations of undernutrition and anaemia persist.
  • Kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats.
  • Xerophthalmia is a term for a group of eye problems caused by not getting enough vitamin A.
  • Keratomalacia involves drying, clouding and softening of the cornea and is one of the conditions grouped under xerophthalmia due to undernutrition.
  • Estimates show that 56.4% of the total disease burden in India is due to unhealthy diets.
  • Healthy diets and physical activity can reduce a substantial proportion of coronary heart disease (CHD) and hypertension (HTN) and prevent up to 80% of type 2 diabetes.

Guideline 1: Eat a variety of foods to ensure a balanced diet

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‘My Plate for the Day’

  • Recommended by ICMR-NIN.
  • It includes sourcing macronutrients and micronutrients from a minimum of eight food groups, with vegetables, fruits, green leafy vegetables, roots, and tubers forming essentially half the plate.
  • Cereals and millets make up the other major portion, followed by pulses, flesh foods, eggs, nuts, oil seeds, and milk/curd.
  • Carbohydrates, fats and proteins are ‘macronutrients,’ which are needed in large amounts. Vitamins, minerals and phytonutrients constitute the ‘micronutrients’ and are required in smaller amounts.

Major food constituents

Carbohydrates

  • Sources: Cereals, millets, grains, pulses (lentils, beans and peas), nuts, milk, fruits and vegetables. All plant foods have carbohydrates.
  • Simple carbohydrates, glucose and fructose are found in fruits, vegetables, and honey. Sucrose and lactose are disaccharides; while lactose is found in milk, sucrose is table sugar.
  • Starches in cereals, millets, pulses and root vegetables and glycogen in animal foods are complex carbohydrates. Cellulose in vegetables and whole grains, and gums and pectins in vegetables are other complex carbohydrates resistant to human digestion.
  • Foods containing sugar or refined carbohydrates have a high glycemic index (GI) and, therefore, promote rapid absorption of glucose and increase glycemic load (GL).
  • The glycemic index is used to measure how much a specific food increases blood sugar levels.
Pectins
  • Pectin is a soluble fiber (polysaccharide) found in fruits.
  • It is used as a thickener in cooking (for making jams and jellies) and baking. It is also sometimes used to make medicine.

Fibre

  • Fibre is indigestible part made up of cellulose in vegetables, fruits, whole grains, pulses, nuts & seeds.
  • Delays and retards the absorption of carbohydrates and fats and increases the satiety value.
  • A fibre-rich diet reduces glucose and lipids in the blood and improves insulin sensitivity.

Proteins

  • Proteins are complex molecules composed of 20 different amino acids. Nine of these 20 amino acids are termed ‘essential’. Essential amino acids must be obtained from proteins in the diet since they are not synthesised in the human body.
  • About half the proteins in our body are in muscles, and the rest are in bone, cartilage and skin.
  • Sources: Animal foods like milk, meat, fish and eggs and plant foods such as pulses..
  • Animal proteins are of high quality as they are bioavailable and provide all the essential amino acids in the right proportions, while plant or vegetable proteins have a low content of some of the essential amino acids.
  • Histidine, Isoleucine, Leucine, Lysine, Methionine, Cysteine, Methionine, Cysteine, Threonine, Phenylalanine, Tyrosine, Tryptophan, and Valine are some of the Essential amino acids.
  • Cereals have lower levels of lysine and higher levels of sulphur-containing amino acids (methionine and cysteine). The reverse is true for pulses.

Fats (lipids)

  • Two sources: Invisible fat present in plant and animal foods; Visible/added fats are vegetable oils, butter and ghee.
  • Sources: Animal foods like fatty fish and plant foods such as nuts, oil seeds, and certain beans. Grains and pulses also have fats in low quantities.
  • Fats are a concentrated source of energy, providing 9 kcal/g, and are made up of fatty acids.
  • Important for fat-soluble vitamins vitamins A, D, E & K and carotenes and promote their absorption.
  • They are also sources of essential polyunsaturated fatty acids (PUFA).

‘Visible’ and ‘Invisible’ Fats

  • Fats/oils that are used for cooking (vegetable oils, vanaspati, butter and ghee) or added to foods at the time of consumption/ dressing are termed as ‘visible’ fats.
  • Fats that are present as integral components of various foods (such as nuts, seeds, pulses, cereals and millets) are referred to as ‘invisible’ fats. Cereals contain only 2% – 3% of invisible fat.

Vitamins

  • They are required by the body in small amounts and are not synthesised in the body.
  • They are essential for numerous body processes and for maintaining the structure of skin, bone, nerves, eyes, brain, blood, and mucous membranes.
  • They are either water-soluble or fat-soluble.
    1. Fat-soluble vitamins: Vitamins A, D, E, and K.
    2. Water Soluble vitamins: Vitamin C, B-complex vitamins thiamin (B1), riboflavin (B2), niacin, pyridoxine (B), folic acid (B9), and cyanocobalamin (B12).
  • Fat-soluble vitamins can be stored in the body, while water-soluble vitamins are not stored (except vitamin B12 & folate) and get easily excreted in urine.
  • Pro-vitamin, like beta-carotene, is converted to vitamin A in the body.
  • Vitamins B-complex and C are heat-labile vitamins, easily destroyed by heat and food processing.

Minerals

  • Macrominerals: Sodium, potassium, calcium, phosphorus, magnesium and sulphur,
  • Microminerals: Iron, zinc, copper, selenium, molybdenum, fluorine, cobalt, chromium and iodine.
  • Functions: Maintenance of skin, hair, nails, blood and soft tissues. Govern nerve cell transmission, acid/base and fluid balance, enzyme & hormone activity, and blood-clotting processes.

Important terms

  • Recommended dietary allowances (RDAs): They are estimates of nutrients to be consumed daily to ensure the requirements of all individuals in a given population. The recommended level depends upon the bioavailability of nutrients.
  • Bioavailability: It indicates what is absorbed and utilised by the body.
  • Estimated Average Requirement (EAR): It is the mean of the nutrient requirement distribution. It is used to assess the nutrient adequacy of individuals or population groups and to plan the dietary nutrient requirements for healthy individuals or population groups.

Guideline 2: Extra food and healthcare during pregnancy and lactation

  • Certain nutrients, such as iron, folic acid (to meet the high demands of erythropoiesis, i.e. red blood cell formation and haemoglobin synthesis), B12, iodine, and long-chain n-3 polyunsaturated fatty acids (LCn-3PUFAs), should receive special attention during pregnancy.
  • Folic acid reduces the risk of anaemia.
  • Calcium and vitamin D are essential for the proper formation of bones and teeth of the offspring, for secretion of breast milk that is rich in these nutrients, and to prevent osteoporosis in the mother.
  • Vitamin A, B12 and C rich food is required during pregnancy and lactation to improve child growth and development.
  • LCn-3PUFA, adequate intake of folate-rich foods and iodine are essential for proper growth of the brain of the growing foetus.
  • Intake of oil seeds, nuts, beans and fish consumption must be encouraged to meet the daily needs of the higher fat and EFA requirement of foetus and infants. During these periods, visible fat should be restricted, while TFA should be avoided.
  • The bioavailability of iron can be improved by using fermented and sprouted grains and foods rich in vitamin C, such as guava and oranges, along with meals.
  • Milk is the best source of biologically available calcium but is a poor source of iron.
  • Fatty fish is a good source of LCn-3PUFA. Vegetarians can get LCn-3PUFA from green leafy vegetables, seeds and nuts.

Guideline 3: Ensure exclusive breastfeeding for the first six months

  • Early initiation of breastfeeding (EIBF), i.e. within an hour of birth, is crucial. Colostrum is the first milk secreted during the first 3–4 days after birth; and should be fed to the newborn immediately after birth.
  • Infants should be exclusively breastfed (EBF) for the first six months and to continue breastfeeding till two years and beyond.
  • They should not be given any other feed like honey, glucose, or dilute milk formula, not even water. Feeding water increases the risk of diarrhoea in infants.
  • Breastfeeding should not be discontinued when the milk appears stained with blood as the bloody stains disappear gradually.

Advantages of Breast Milk

  • It is rich in proteins, minerals, vitamins especially vitamin A and antibodies.
  • Adequately hydrates the baby, has a laxative effect and prevents constipation.
  • Lowers risk of certain autoimmune diseases, inflammatory bowel disease, obesity, and related disorders.
  • Leads to better cognitive and brain development in infants.
  • Protects against diarrhoea and upper respiratory tract infections.
  • Breastfeeding helps in birth spacing by delaying further pregnancies.

Breastfeeding for HIV-positive women

  • HIV may be transmitted from mothers to infants through breast milk.
  • In resource-poor regions, exclusive breastfeeding for up to four months, followed by weaning and complete stoppage of breastfeeding at six months, should be followed in order to restrict transmission through breastfeeding.
  • Mixed feeding, i.e., breastfeeding along with other feeds, should be strictly discouraged as it increases the risk of HIV transmission.

Risks associated with not feeding breast milk

  • For infants: Increased incidence of infections, higher risks of childhood obesity, type 1 and type 2 diabetes and leukaemia. In some cases, it can also lead to sudden infant death syndrome.
  • For mothers: Breastfeeding reduces the risk of breast cancer and ovarian cancer, obesity, type 2 diabetes, metabolic syndrome and cardiovascular diseases such as stroke and heart attacks.

Guideline 4: Feeding homemade semi-solid complementary foods to the infant

  • Complementary foods should be introduced soon after six months of age. These can include oil seeds, nuts, milk, vegetables and fruits, flesh foods, eggs, or pulses such as lentils, chickpeas, kidney beans, cowpeas, and black gram.
  • Fruit juices and sugar-sweetened beverages should be avoided.
  • Sugar and Salt should not be added to complementary foods.
  • Diet of liquid consistency (flows in a plate or thali) should not be fed. A semisolid (spreads in a plate or thali) diet is recommended.

Responsive feeding

  • It refers to the mutual interaction between a parent or caregiver and a child while feeding.
  • Involves active interaction and not feeding passively while watching TV or playing with the phone.

Amylase-Rich Foods (ARFs)

  • Flours of germinated cereals, which are rich in the enzyme alpha-amylase, constitute ARFs.
  • ARFs help in increasing the energy density of weaning gruels as well as in reducing bulk.
  • Lactose intolerance occurs due to a deficiency of the enzyme lactase in intestinal cells, which is needed to digest lactose in milk.

Guideline 5: Appropriate diets for children and adolescents

  • Young children below the age of five years should be given less bulky foods, rich in energy, protein, vitamin and minerals such as pulses, nuts, edible oil/ghee milk and egg.
  • Adolescents (10–19 years of age) require more calcium to achieve optimal peak bone mass.
  • Foods high in fats, sugar and salt should be avoided as they calorie-dense and contain low micronutrients and fibre.

Guideline 6: Eat plenty of vegetables and legumes

Microgreens

  • Microgreens are young, tender plants of herbs, vegetables or even grains with just one to two sets of leaves. Harvested within a week to ten days after sowing the seeds.
  • Microgreens are rich sources of nutrients such as amino acids, fatty acids, micronutrients and various bioactive compounds and phytochemicals.
  • These are emerging functional foods that, when consumed even in small quantities, have the potential to prevent various deficiencies and diseases.
  • They are high in aliphatic glycosylates and polyphenols and serve as dietary carriers to provide naturally occurring antioxidant compounds with strong antioxidant capacity, e.g. amaranth, basil, mustard, peas, parsley, beet, coriander, broccoli, celery, etc.
  • The microgreens of red cabbage have been shown to modulate the lipid profile favourably, and that of fenugreek shows anti-diabetic activity.

Polyphenols

  • They are micronutrients that are naturally found in many plant foods, such as fruits, vegetables, herbs, spices, tea, dark chocolate, and wine.
  • They are antioxidants that can neutralize harmful free radicals that can damage cells and increase the risk of conditions like cancer.

Important nutrients and phytonutrients in vegetables and fruits

Iron

  • Iron is essential for the formation of haemoglobin, the red pigment present in red blood cells.
  • Haemoglobin plays an important role in the transportation of oxygen to the tissues.
  • Reduction in haemoglobin in the blood leads to anaemia, a condition characterised by paleness, easy fatigue and increased susceptibility to infections.
  • Iron is available in plenty of green leafy vegetables, but the absorption is limited. Vitamin C-rich foods like guava or orange must be consumed after meals to improve iron absorption.

Vitamin A

  • Carotenoids (precursors of vitamin A) are plentiful in fruits and vegetables that are green or deep yellow / orange in colour like leafy vegetables, carrots, tomatoes, capsicum, orange-flesh, mango, etc.
  • Necessary for clear vision (even in dim light) and the maintenance of the integrity of epithelial tissues.
  • In vitamin A deficiency, the white of the eye (conjunctiva) loses its lustre, becomes dry and could manifest as Bitot’s spots (foamy white patches).
  • In severe vitamin A deficiency, the black area of the eye (cornea) gets ulcerated, leading to irreversible blindness in young children.
  • Vitamin A also has a role in maintaining the resistance of the body to common infections.

Vitamin C

  • Abundantly available in fresh citrus fruits, guava, amla and certain vegetables such as tomatoes.
  • Vitamin C is an essential nutrient required for healthy bones and teeth. Also promotes iron absorption.
  • Vitamin C deficiency is characterised by weakness, bleeding gums and defective bone growth.
  • However, it is very susceptible to destruction by atmospheric oxidation. For this reason, when vegetables become dry and stale, cut and exposed to air, or cooked and consumed, most of the vitamins originally present are destroyed.

Folates / Folic acid / Vitamin B9

  • Green leafy vegetables are good sources of folates. It is essential for the multiplication and maturation of red cells in our body, and its deficiency also leads to anaemia.
  • Prevents neural tube defects in the fetus and promotes the birth weight of infants.
  • Its deficiency increases homocysteine blood levels, increasing the risk of stroke and heart disease.

Dietary fibre

  • Fresh fruits and vegetables are rich sources of dietary fibre. Dietary fibre is important for proper bowel function and reduces constipation and the risk of developing piles.
  • It reduces cholesterol absorption and protects against coronary heart disease, diabetes, and obesity.
  • The protective role of dietary fibre against colon cancer has long been recognised.

Other nutrients

  • Raw and fresh vegetables, such as green leafy vegetables and carrots, and fresh fruits, including citrus and tomatoes, have been identified as good sources of antioxidants. They restrict the damage to cells and cellular components.
  • Root vegetables like carrots, radish, beetroot, knol-kohl, and turnip should be preferred to tubers like potato, yam, colocasia and cassava.
  • Vitamin C and carotenoids that are present in these vegetables are also potential antioxidants.
  • Green and orange-coloured vegetables provide beta-carotene, red vegetables provide lycopene, deep red ones provide battalions, and blue and purple ones provide anthocyanins, etc.
  • Vegetables and fruits play a major role in protecting from certain diseases, such as damage to blood vessels, cancer, inflammatory joint diseases, asthma and diabetes.

Guideline 7: Use oils/fats in moderation

  • Three types of fatty acids (FA) in our diets: Saturated fatty acids (SFA), mono-unsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA).

Type of Fats - Saturated Unsaturated Trans Fat

  • Our body can synthesise SFAs and MUFAs besides obtaining them from the diet.
  • PUFAs, namely, linoleic acid (n-6/omega 6/LA) and alpha-linolenic (n-3/omega 3/ALA), cannot be synthesised. Hence, n-6 and n-3 are termed essential fatty acids (EFAs).
  • Lipids constitute major components of many hormones and cell membranes along with proteins and are involved in many important cell-signalling functions and gene expression.
  • Fats increase the energy density of food as each gram of lipid gives energy of 9 Kcal, while protein or carbohydrates give only 4 Kcal for every gram.
  • Fats increase the palatability of the diet and impart a feeling of fullness and satisfaction, thus, delay the onset of hunger.
  • Dietary fats also contain minor components such as tocopherols, tocotrienols, sterols, etc. Since most of the minor components are antioxidants, they prevent fats from going rancid.
  • Tocotrienols in palm oil & rice bran oil, lignans in sesame oil & oryzanol reduce blood cholesterol.

Hydrogenated fat

  • Prepared by partial hydrogenation of vegetable oils (often referred to as ‘vegetable shortening’).
  • During hydrogenation, the liquid oils become solid because MUFA and PUFA are converted into SFA and isomers called trans fatty acids.

Omega-3 fatty acids

  • Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA).
  • Rich in foods such as marine fish, walnuts, soybeans, and seeds such as flax seed oil and canola oil.

Types

  • EPA (eicosapentaenoic acid): EPA is a “marine omega-3” because it is found in fish.
  • DHA (docosahexaenoic acid): DHA is also a marine omega-3 found in fish.
  • ALA (alpha-linolenic acid): ALA is the form of omega-3 found in plants.

Benefits of Omega-3 fatty acids

  • It lowers blood pressure and helps reduce joint inflammation in rheumatoid disease.
  • It helps prevent and alleviate dementia, depression, asthma, migraine, and diabetes.
  • High doses of EPA and DHA can significantly lower blood triglyceride levels. DHA, in particular, is vital for brain health and cognitive function.
  • It reduces the risk of heart attack and prevents arrhythmias.

Different Fats/oils and their implications on health

Saturated Fatty Acids

  • SFA are known to increase serum total and LDL-cholesterol levels, increase inflammation, reduce insulin sensitivity and enhance the tendency of clot formation (thrombogenicity) and increase the risk of heart attack and stroke.

Trans Fatty Acids (TFA)

  • TFAs are fats produced during the hydrogenation of vegetable cooking oils (for example, vanaspati).
  • TFA consumption alters lipid profile (dyslipidemia) and endothelial dysfunction, decreases insulin sensitivity, and increases the risk of diabetes, breast cancer, colon cancer and disorders of the nervous system and vision in infants.

Cholesterol (lipid from animal source)

  • Cholesterol plays an important role in the fluidity and permeability of the body’s cell membrane.
  • Sources of cholesterol: Butter, ghee, whole milk, cream, fatty cheese and fatty meats.
  • It is also a precursor of many hormones and vitamin D. Cholesterol aids in cell signalling function. It is actively synthesised in the liver whenever required.
  • Cholesterol is found only in animal-source foods. It is synthesised in the liver from carbohydrates and fats in our diet. Liver cholesterol synthesis increases when our cholesterol intake is low, and it is suppressed when our intake is increased.

Lipoproteins

  • Lipoproteins carry cholesterol: Low-density lipoprotein (LDL) & high-density lipoprotein (HDL).
  • High-density lipoproteins (HDL), also called good cholesterol, remove and transport excess cholesterol from the tissues to the liver for degradation and are, therefore, anti-atherogenic.
  • However, high blood levels of LDL cholesterol, also called bad cholesterol, result in the accumulation of lipids in the cells and cause the atherogenic effect.
  • Atherogenesis is a tissue response to injury involving chronic inflammation and repair of the vessel wall and smooth muscle cells, resulting in thickened vessel walls.

Refining oils

  • Refining’ extends the shelf life of vegetable oils and removes odour. It removes undesirable compounds found in crude extracted oils, but the refining process adds several additives, including preservatives, that are not good for human health.
  • Refining oils does not alter fatty acid composition. It modifies the composition of minor components.
    • For e.g, palm oil is extracted from the crude pulp of the fruit of oil palms. The colour of the pulp is red, as it is rich in beta-carotene. These carotenes are lost during the refining of palm oil.

Crude vegetable oils

  • Crude vegetable oils are the vegetable oils extracted from seeds (sunflower, soybean, mustard, sesame, etc.) or fruits like palm and olive by mechanical expelling.
  • These oils are likely to contain several undesirable compounds such as free fatty acids, gums, waxes, mono and diacylglycerides, phospholipids, hydrocarbons, pesticide residues, aflatoxins and allergens.

Virgin oils

  • Virgin oils are produced by mechanical procedures (expeller pressing) and the application of heat. They also contain undesirable compounds similar to crude oil.
  • Nutrients such as antioxidants and phytonutrients are preserved through the use of mechanical procedures that do not alter the nature of the oil.

Cold pressed oils

  • Cold-pressed oils also contain undesirable compounds, similar to crude oil.
  • However, nutrients such as antioxidants and phytonutrients are preserved as they are obtained without altering the nature of the oil by mechanical procedures without the application of heat.

Repeated heating of oils

  • Repeated heating of vegetable oils/fat results in oxidation of PUFA, leading to the generation of compounds that are harmful/toxic and may increase the risk of cardiovascular diseases and cancer.
  • Vegetable oil once used for frying, should be filtered and may be used for curry preparation but using the same oil for frying again should be avoided.

Total Polar Compounds

  • Total Polar Compounds (TPC) serve as key indicators to assess the degradation and overall quality of oils during their usage and storage.
  • TPC testing measures the cumulative content of degradation compounds such as free fatty acids, mono- and di-glycerides, polymerized and oxidized triglycerides within the oil.
  • Elevated levels of TPC can indicate oil deterioration, affecting the taste, nutritional value, and potentially posing health risks due to the formation of harmful compounds.

Palm Oil

  • Palm oil contains saturated fats, which can raise LDL (bad) cholesterol. However, Tocotrienols in palm oil reduce blood cholesterol.
  • Palm oil boasts vitamins A and E, essential for immunity and healthy skin.

Guideline 8: Obtain Protein through an appropriate combination of foods

  • The human body requires only 20 AA. Of the 20, nine amino acids are not synthesised in the body; hence, these should be obtained from dietary sources and are termed essential amino acids (EAA).
  • Of the nine, four amino acids are the ones that are limiting in plant foods.

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Need for good muscle mass

  • Keeps the bones strong.
  • Helps joints move freely, and there is less strain on knee or hip joints; and protects joints from damage.
  • Improves insulin sensitivity and decreases the risk of diabetes, stroke and heart attacks.
  • Delays ageing.

Protein Powders

  • Protein powders are made from either eggs or dairy milk or whey (a byproduct of cheese or paneer) or plant sources such as soyabeans, peas and rice.
  • Protein powders may also contain added sugars, non-caloric sweeteners and additives such as artificial flavouring; hence, they are not advisable to be consumed on a regular basis.
  • Whey protein is rich in branched-chain amino acids (BCAAs). BCAAs may increase the risk of certain non-communicable diseases (NCDs).
  • Prolonged intake of protein supplements can strain kidney function by increasing glomerular filtration rate (eGFR), serum creatinine levels & bone mineral loss due to increased urinary excretion of calcium.
  • Glomerular filtration rate is the rate at which your blood is filtered each minute.

Guideline 9: Adopt a healthy lifestyle to prevent obesity

What is overweight and obesity?

  • Overweight and obesity is based on BMI. According to WHO, a BMI for adults ranging from 18.5 to 25 Kg/M is considered normal.
  • However, for Asians, the BMI should be between 18.5 to 23Kg/M since they tend to have a higher percentage of body fat even at a given BMI compared to Caucasians and Europeans, which leaves them at a higher risk of NCDs.
  • Overweight: BMI ranging from 23 to 27.5 Kg/M is defined as overweight, according to Asian cut-offs.
  • Obesity: BMI above 27.5 Kg/M is defined as obesity as per the Asian cut-offs.
  • Obesity is often associated with increased levels of low-density lipoproteins (‘bad’ cholesterol), and triglycerides, apart from abnormal increase in glucose and insulin resistance.
  • High insulin impairs metabolism, increases adipogenesis and promotes deposition of fat in and around organs.
  • Adipogenesis is the process by which fat-laden cells, that is, adipocytes, develop and accumulate as adipose tissue at various sites in the body.

Central/Abdominal obesity (increased waist circumference)

  • It is indicative of excessive fat in the peritoneum (abdominal cavity) with accumulation of fat in and around the abdomen and internal organs.

Body Mass Index (BMI)

  • BMI is the ratio of weight and height, which estimates total body mass and correlates highly with the percentage of body fat.
  • It is computed by dividing the weight in kilograms by the square of the height in meters.
  • Age and gender-specific BMI scores are used to assess their nutritional status.
  • As age advances, one needs fewer calories each year as the metabolism slows down and lean (muscle) mass decreases.

Guideline 10: Be physically active to maintain good health

  • A combination of physical activities is recommended for overall health and improved cardio-respiratory and muscular fitness.
  • Being physically active can reduce the risk of chronic diseases such as diabetes, high blood pressure, heart disease, osteoporosis, arthritis and certain types of cancer.
  • Types of physical activity:
    1. Structured activities: It is planned and repetitive in nature and includes exercises such as aerobics, stretching and strengthening activities (gym workouts, swimming, jogging, skipping, cycling, etc.).
    2. Incidental activities: It includes a broad range of routine activities such as household chores, walking around for daily tasks, climbing up the stairs, gardening, leisure activities, work place activities, leisure games and sports.

Guideline 11: Restrict Salt intake

Salt Intake

  • Common salt or edible salt is sodium chloride (40% sodium and 60% chloride), which is the major source of sodium in daily diets.
  • Contains some essential trace minerals such as Magnesium, Calcium, Iron, Sulfur and Nitrogen.

Harmful impacts of excess salt intake

  • Increased risk of developing high blood pressure.
  • Affect stomach mucosa and increase the risk of gastritis, atrophy and gastric cancer.
  • Leads to greater calcium excretion, which may result in reduction in bone density.
  • Pink salt is one of the purest forms of salt.
  • Black salt grows darker upon storage. Assorted spices, charcoal, seeds, and tree bark are used to preserve this salt. Both pink salt and black salt are types of rock salt.

Sodium and Potassium

  • Sodium, along with potassium, is essential for water and fluid balance, electrolyte equilibrium, and the electrophysiological functions of all cells.
  • Sodium: Cereals, pulses, vegetables, milk, animal and sea foods.
  • Potassium: Beans, lentils, bananas, dry fruits, coconut water, nuts, flesh foods.
  • Sodium is rapidly absorbed from the gastrointestinal tract, and a positive balance can be achieved with an intake of not more than 5g of salt per day (equivalent to 2g of sodium).
  • While potassium intake has been decreasing gradually, there is a simultaneous increase in sodium intake, either as table salt used while cooking in meals or through processed food.

Guideline 12: Consume safe and clean foods

  • The safety of foods can be compromised due to microbial contamination, chemical contamination, adulteration and natural enzymes present in food.

Common adulterants

  • Non-permitted colors like metanil yellow; non-edible oils like castor oil; extraneous matter like husk, sand and sawdust in spices; and metal contaminants like aluminium foil on sweets or iron filings in tea, sugar syrup in honey.

Guideline 13: Adopt appropriate pre-cooking and cooking methods

  • Avoid repeated washing of food grains like rice and pulses, as this can result in the loss of certain minerals and vitamins.
  • Cutting vegetables into small pieces results in vitamin loss due to oxidation, as it exposes a greater surface area of the food to the atmosphere.
  • Do not use baking soda while cooking pulses and vegetables as it adds to the sodium content (just like salt) of food
  • Steaming is better than blanching of vegetables as the nutrient content is better.

Blanching

  • Blanching involves putting vegetables in boiling water or steam for a short time and cooling them immediately in cold water to stop enzyme actions that could cause loss of flavour, colour, or texture.
  • This process increases the shelf life of the vegetables, but the nutrients might be lost along with water.

Boiling and pressure cooking

  • The concentration of phytic acid in cereals and legumes (which hinders the absorption of minerals) decreases greatly after boiling or pressure cooking, making important minerals like iron, calcium, magnesium, and zinc absorbable upon consumption.
  • Longer cooking causes a drop in the nutritive value of pulses as it results in the loss of lysine.
  • B complex vitamins and vitamin C may be lost if the cooking water after boiling is discarded.

Microwave cooking

  • Minimal nutritional differences occur between foods prepared by conventional & microwave methods.
  • As microwave cooking takes very little time, it is the least likely form of cooking to S.
  • This method retains more vitamins and minerals than any other cooking method, as no leaching occurs.

Grilling and barbecue

  • Polycyclic Aromatic Hydrocarbons (PAHs) are compounds that can be found in foods that have been grilled or barbecued, notably meats.
  • Polycyclic aromatic hydrocarbons (PAHs) are a class of chemicals that occur naturally in coal, crude oil, and gasoline. They also are produced when coal, oil, gas, wood, garbage, and tobacco are burned.
  • The type of heat source used for barbecuing significantly impacts PAH concentrations.
  • Continuous barbecuing of the same charcoal results in higher concentrations of certain carcinogens.
  • A by-product of grilling meats is advanced glycation end products (AGEs), or glycotoxins. As food is grilled, the AGEs multiply, leading to increased inflammation when ingested.

Avoid Non-Stick Cookware

  • Non-stick pans use chemicals like perfluororootonic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) to produce non-stick coatings such as Teflon (polytetrafluoroethylene (PTFE)) (made up of carbon and fluorine).
  • When heated, non-stick cookware releases toxic fumes into the air, which can lead to respiratory problems, thyroid disorders, and certain types of cancer if inhaled.
  • PFOA belongs to a larger class of chemicals known as per- – and polyfluoroalkyl substances (PFAS). While PFOA is largely phased out, other PFAS compounds may still be present in some cookware.
  • Many PFAS, including perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA), are a concern because they:
    • Do not break down in the environment,
    • Can move through soils and contaminate drinking water sources,
    • Build up (bioaccumulate) in fish and wildlife.

Environmental impacts of PFAS

  • Chemicals used in non-stick coatings, such as PTFE, are persistent in the environment and can accumulate in water and soil, leading to long-term ecological damage.
  • Non-stick coatings have a shorter life span. As coating wears off, pan becomes less effective leading to increased consumer waste.

Eco-friendly alternatives

  • Ceramic cookware: It offers non-stick properties similar to traditional non-stick cookware but without the use of harmful chemicals. It is also durable, scratch-resistant and safe for use at high temperatures.
  • Cast iron cookware: It is free from synthetic coatings and chemicals
  • Stainless steel cookware: it is made from durable and recyclable materials, free from harmful chemicals, resistant to corrosion and staining.

Guideline 14: Drink adequate quantity of water

Water

  • Water accounts for 70% of our body weight. It is a constituent of blood and other vital body fluids.
  • Water plays a key role in eliminating body wastes and regulating body temperature. The body loses water through sweat, urine, and faeces.
  • A normal, healthy person needs to drink eight glasses (two litres) of water, including beverages, daily.
  • Boiling of water kills all disease-causing organisms and also removes temporary hardness. However, boiling will not remove chemical impurities.

Fluorosis

  • Fluorosis is a disease that causes bone deformities and dental problems from drinking water containing an excess of fluoride over long periods.
  • Generally, a concentration of 1–1.5 mg of fluoride per litre of drinking water is considered safe.

Soft drinks

  • Soft drinks are non-alcoholic beverages either carbonated or non-carbonated, and may contain sugar or artificial sweetening agents, edible acids (malic acid, citric acid or vinegar, etc.)
  • Carbonated beverages contain phosphoric acid and may damage the enamel of teeth, and affect appetite.
  • Consumption of soft drinks or commercially available fruit juices increases one’s sugar and salt intake and hence must be avoided.
  • Sugarcane juice is high in sugar (13–15g/100 ml), so its consumption should be minimized.

Tea and coffee

  • ICMR advises abstaining from tea or coffee consumption at least an hour before and after meals.

Impact of tea and coffee consumption

Negative
  • Tea and coffee contain caffeine, which stimulates the central nervous system and induces physiological dependence.
  • Additionally, tea and coffee contain tannins, which inhibit iron absorption as they bind to iron in the stomach, potentially leading to iron deficiency and anaemia.
  • Excessive consumption of coffee increases blood pressure and causes abnormalities in the heartbeat.
Positive
  • Tea (green or black) also contains theobromine and theophylline, which are known to relax arteries and thereby promote blood circulation.
  • Flavonoids and other antioxidant polyphenols present may reduce the risk of coronary heart disease and stomach cancer.

Alcoholic beverages

  • Alcohol intake increases the risk of cancers of the mouth, larynx, oesophagus, prostate and breast in women.
  • Excessive alcohol intake weakens the heart muscle (cardiomyopathy) and also causes fatty liver, damages the liver (cirrhosis), brain and peripheral nerves.

Guideline 15: Minimize the consumption of high fat, sugar, salt (HFSS) and ultra-processed foods (UPFs)

High-Fat Sugar Salt (HFSS)

  • HFSS foods are defined as a food or diet that contains >15 % of energy from any cooking vegetable oils or ghee, butter (visible or added oil/fat) etc.
  • HFSS foods are classified into three categories.
    • Category 1 indicates energy, fat, sugar and salt within normal level from 100 grams food eaten.
    • Categories 2 & 3 indicate higher levels of energy and fats or sugar or both along with excessive salt. Categories 2 and 3 fall under HFSS foods.
  • They are energy-dense (high-calorie foods and poor in vitamins, minerals & fibre). They cause inflammation and affect the gut microbiota.

Natural Sugars

  • Naturally occurring simple sugars refer to those that are inherently present in the food.
    • E.g. monosaccharides are simple sugars with single sugar molecules such as glucose or fructose in fruits. Disaccharides are two simple sugar molecules like sucrose (sugar) or lactose in milk.

Added sugars

  • Added sugars refer to sugars and sugar syrups added to foods and drinks during processing and preparation, and they include sucrose (table sugar), jaggery, honey, glucose, fructose, dextrose, etc.
  • Adding sugar over and above what is naturally/ inherently present in foods increases the total calorie intake, but adds no nutritive value. Refined extracted sugars have no vitamins or minerals.

Processed foods

  • Depending upon the extent of processing, they have been classified into various categories – primary, secondary, tertiary, minimally processed and ultra-processed foods.
  • Primary processing: Basic cleaning, grading and packaging, as in the case of fruits and vegetables;
  • Secondary processing: This involves altering the basic product to a stage just before the final preparation (as in the milling of paddy into rice).
  • Tertiary processing: Leads to almost ready-to-eat foods like bakery products, instant foods etc..
  • Minimally processed foods are those that are slightly altered for the main purpose of preservation but do not substantially change the nutritional content.

Ultra-processed foods (UPFs)

  • UPFs refer to food and beverage products that have undergone extensive industrial processing and contain a high number of additives such as preservatives, sweeteners, flavourings and emulsifiers.
  • The extensive processing involved often results in the depletion of fibre and micronutrients, rendering them unhealthy for regular consumption.
  • Fast foods are those that are cooked within minutes of order for consumption. Most of these are fresh and do not fall under UPF.

Guideline 16: Include nutrient-rich foods in the diets of the elderly

  • An elderly person is an individual of 60 years and over.
  • Elderly people require less energy but more micronutrient rich foods such as vegetables, fruits, beans, nuts, eggs and fish.

Guideline 17: Read information on food labels

  • Food labels display the name of the food, a list of the ingredients, the net weight, brand name, name and address of the manufacturer, date of manufacture, use-by/expiry dates, storage instructions, allergen declaration, and shelf life of the food.
  • For imported foods, the country of origin, complete address of the importer, and packing premises are provided.
  • The ingredient declaration informs of all the ingredients that are in the food product, displayed in descending order, with the ingredient that is highest in quantity appearing first.
  • Mandatory nutrition information to display: Energy (in Kcal), protein (in grams), carbohydrates, sugar and fat (in grams), sodium, dietary fibre, vitamins, Recommended Dietary Allowances (RDAs), minerals, saturated fats, trans fats and the amount of any other nutrient the product claims to contain.
  • Recommended Dietary Allowances (RDAs): Food labels display nutrient contents as a proportion of the RDAs. i.e. the percentage of the nutrients in relation to a 2000 Kcal/day recommendation.

A chart of food information Description automatically generated with medium confidence

Various terms and symbols used on labels

Name Symbol What it means

FSSAI (Food Safety and Standards Authority of India)

Ensures basic food safety and hygiene standards.

ISI (Bureau of Indian Standards)

Indicates compliance with specific quality and safety parameters set by the government.

Agmark (Agricultural Mark)

Identifies agricultural and processed food products meeting government quality standards.

Fortified

Added essential vitamins and minerals to the food.

Veg/Non-Veg

Denotes vegetarian or non-vegetarian origin.

Jaivik Bharat (Organic)

Produced organically without synthetic fertilisers or pesticides.

Vegan

No animal products are used in the food.

Gluten-Free

Contains no gluten, suitable for celiac disease or gluten sensitivity. (gluten is protein in wheat, barley, & rye that can cause health problems in people with celiac disease or gluten sensitivity).
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