Banning unhealthy foods in school premises in India: Its implications and future recommendations

Maternal-child consumption of ultra-processed foods and sugar-sweetened beverages in informal settlements in Mumbai, India

BACKGROUND

The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition.

METHODS

This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay-milk, soda, tea with sugar, sweets, and chips/biscuits-using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups.

RESULTS

Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with children's frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store.

CONCLUSION

Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal-child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit children's consumption of unhealthy foods and beverages from an early age.

Assessing Obesogenic School Environments in Sibiu County, Romania: Adapting the ISCOLE School Environment Questionnaire

The impact of the school environment on childhood weight status has garnered significant attention in recent years. This study aimed to adapt and validate the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) School and Environment questionnaire in order to assess the potential obesogenic impact of school environments in Sibiu County, Romania. The ISCOLE questionnaire was chosen for its rigorous methodology. It was derived from a comprehensive study conducted across 12 countries which aimed to capture multifaceted influences on childhood weight while emphasizing educational settings in the collection of data. To guide the translation and adaptation of the questionnaire, a multidisciplinary committee was assembled which comprised experts in teaching and school administration to ensure target responder relevance, experts in clinical research to ensure methodological robustness, experts in language adaptation to preserve the original intent of the survey, and experts in public health to steer the interpretation of the results, with potential policy implications. The data were analyzed by distinguishing between urban and rural settings, and a two-step cluster analysis was implemented to identify potential intervention targets. To assess the validity of the adapted tool, the questionnaire's construct validity and internal consistency were explored. A response rate of 71.2% of the approached schools in Sibiu County was achieved. Of the 84 responding school representatives, 37 (44%) were from a rural setting. The rural schools had significantly more limited access to gymnasiums, secured lockers, showers, and bicycle racks, and exhibited more serious problems regarding the inadequate disposal of garbage in the school vicinity. A two-step cluster analysis revealed distinct school categories, providing opportunities for public policy interventions. One of these primarily concerned rural schools with limited infrastructure but with proactive practices and policies which were termed "unable but willing"; on the opposing spectrum, the category "able but unwilling" mainly comprised urban schools which had available facilities but lacked local proactive initiatives. The findings emphasize the urgent need for targeted measures to bridge these discrepancies by investing in infrastructure in rural schools and promoting active school practices and policies in urban settings. The assessment of obesogenic school environments in Sibiu County provides a pilot model for broader applications due to the diverse school landscape and supportive local authorities. The results, which were achieved using low-cost methods, can guide future educational policies, health promotion initiatives, and preventive interventions.

Dietary salt consumption pattern as an antecedent risk factor for hypertension: Status, vision, and future recommendations

Multiple salt reduction strategies have been devised from time to time, addressing the issues of hypertension without considering the other essential factors, like the variability of salt sensitivity from the person to person. In this paper, we discuss how high salt consumption is one modifiable risk factor associated with hypertension among Indians, and there needs to be updated cut-off values. A thorough literature search on salt consumption articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic database revealed a paucity of data in this field for India. Several studies revealed that the mean salt intake among the Indian populations ranges between 5.22 and 42.30 g/day. Moreover, among other risk factors analysed, salt intake (≥ 5 gm/day) was significantly associated with the development of hypertension. Although the need to address reduced salt intake for primordial prevention of hypertension and related cardiovascular diseases (CVDs) in India is well acknowledged by the key stakeholders, social and cultural beliefs, unorganized food retail sector and lack of existing food policing are some of the potential barriers that affect the progress and employment of such effective strategies. Some multinational food companies have already research is warranted to evaluate the contextual barriers and facilitators and to adopt effective strategies to improve awareness among consumers, to encourage the endorsement of salt reduction by the food industry, and to facilitate the adoption of countrywide consumer-friendly food labelling. We concluded that salt consumption is high in India, although this assessment has been done primarily by subjective methods in India. People all across are recommended the same cut-off value of dietary salt consumption regardless of the diversity in dietary patterns and environmental conditions across the country. There is an urgent need to address these issues through evidence-based population research.

Effects of diet on hypertensive disorders during pregnancy: A cross-sectional study from a teaching hospital

Background:

Pregnancy is a positive, fulfilling experience for many, but it can put the mother at the risk of suffering ill-health, disability, or even maternal death. The common causes of maternal death include pregnancy-induced hypertension (PIH) or gestational hypertension or hypertensive disorders in pregnancy (HDP), post-partum hemorrhage, and pulmonary embolism. Modifications in lifestyle and diet have been widely advocated as a cost-effective strategy to prevent PIH.

Objectives:

To assess the role of dietary factors in PIH attending antenatal care services at a teaching hospital.

Materials and Methods:

Pregnant women who were attending the antenatal clinic who were diagnosed with hypertension in pregnancy and normotensive before the pregnancy were included in the study. As per the protocol, informed written consent, demographic details with clinical data were obtained from the patients. A total of 225 antenatal cases having hypertension in pregnancy were included in our study.

Results:

Majority of the study subjects (81.8%) were taking mixed diets, 50.2% consumed additional salt in their diet, the intake history of visible fat was given by 25.3% and 96.4% consumed tea while 52.9% had a history of consuming junk food. Among the 41 vegetarian study subjects with hypertension in pregnancy, the maximum subjects (73.1%) had preeclampsia followed by gestational hypertension in 23.6% the subjects. The relation between the type of diet and hypertension in pregnancy was found to be statistically insignificant. The relation between visible fat consumption and hypertension in pregnancy was found to be statistically significant.

Discussion:

The association of dietary factors with HDP could be explained by several factors. One being the high-calorie intake by women with known HDP and those without HDP. The imbalance between the energy intake and expenditure is a potential risk factor and leads to overweight or obesity.

Conclusion:

The consumption of additional salt in the diet, visible fat, and obesity was found to be associated with HDP in our study.

Food environment in and around schools and colleges of Delhi and National Capital Region (NCR) in India

Background

Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents.

Methods

Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data.

Results

The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools.

Conclusion

It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11778-6.

Optimizing the impact of health and related programmes / policies to address the issue of Childhood Obesity in India----A narrative review

Non-communicable diseases are already acknowledged as a double burden, and now childhood obesity is putting extra strain on our health system. The current paper aimed to analyze the ongoing health and related programmes/policies in India, and we discussed the existing opportunities in the programmes to address the issue of childhood obesity in India. We searched the "MEDLINE," "PsycINFO," "Scopus," "Web of Science," and "Google Scholar" databases using the following keywords: ("overweight") and ("obesity"), ("childhood obesity"), ("nutritional programmes in India"), ("Health policies in India"), ("malnourished children in India") in combination with each other and in truncated form. All the relevant articles and policy documents (MOHFW, INDIA) available in the public domain were included to support the argument for this narrative review. We found that we have programme gaps like guidelines issues by Food Safety Standards Authority of India to tackle childhood obesity and it has not been strictly implemented due to multiple reasons. School health programme has an opportunity to address the issue of childhood obesity, but at the ground level the outcomes are not very promising. The National Nutrition Mission have only focussed on undernutrition and anemia problem, ignoring the overweight/childhood obesity. Primary care physicians are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke is dealing with health promotion and prevention, early diagnosis, and management of all ages, except children. Diet provided in Integrated Child Development Scheme is calculated based on calories, not by the quality which is a concern to us. The breastfeeding promotion programme named Mothers Absolute Affection programme has not been implemented with letter and spirit. Other than health programmes, we assume that Ministry of Urban Planning, Foreign Direct Investment policy, Advertisement Council of India and many more sector/policy/programme are indirectly responsible for the increasing burden of childhood obesity in India. Lack of awareness and wrong perception also responsible for the development of childhood obesity. We have multiple National Health Programmes and Policies to address the childhood malnutrition, but are focussing the undernutrition component only, ignoring overnutrition problem in the children, which is emerging as quadruple burden to our health system. Appropriate actions and inclusion of suggestions provided in this study for the improvement of the programmes at the practical level needs to be considered by the policy makers to halt the ever-rising trend of childhood obesity and primary care physicians should play a leadership role.

Identifying the risk factors for the prevention of hypertensive disorders in pregnancy in a tertiary care hospital: A cross-sectional study

INTRODUCTION

Hypertensive disorders in pregnancy accounts for maternal morbidity and mortality globally.

AIM AND OBJECTIVES

We conducted this study to know the demographic profile and risk factors pertaining to lifestyle and behavioral aspects for hypertension among the pregnant women.

METHODOLOGY

It was a hospital-based cross-sectional study. During the routine antenatal checkups, those antenatal cases found hypertensive, were included in the study after taking written consent. A semi-structured questionnaire was prepared and pretested before conducting the actual study. Statistical analysis was done by SPSS (version 17) software. Participants' sociodemographic characteristics were described using descriptive statistics. Results are presented using graphs, tables, mean, percentages, standard deviation, frequency, and significance.

RESULTS

We observed that most of the study subjects 110 (48.9%) were educated up to secondary level followed by primary level 47 (20.9%) while 25 (11.1%) of the subjects were illiterate. We also found that 113 (50.2%) of the study subjects consumed additional salt in their diet and 57 (25.3%) of the study subjects had a history of intake of visible fat. Among 225 study subjects, 174 (77.3%) did not consume tobacco in any form. Among the 225 study subjects, 142 (60.9%) did not have a family history of hypertension. It was observed that 121 (53.77%) subjects had normal BMI while 16 (7.11%) subjects were underweight while 51 (22.6%) subjects were pre-obese. A total of 32 (14.22%) subjects were obese class 1 followed by 5 (2.22%) subjects who were obese class 2. It was observed that among 225 study subjects, 155 (68.9%) subjects had mild hypertension while 70 (31.1%) subjects had severe hypertension.

DISCUSSION

The scarcity of data regarding hypertension in pregnancy in low and middle income countries despite this, a comparatively high prevalence of hypertension in pregnancy was observed due to behavioral risk factors, which is mostly preventable at the primary care level.

RECOMMENDATIONS

It is possible to prevent PIH by eliminating behavioral risk factors through education and counseling to the pregnant ladies, at the primary care level by family physicians or primary care physicians which will reduce maternal mortality to a great extent.