Use of food label information by urban consumers in India - a study among supermarket shoppers.

OBJECTIVE: To study consumer knowledge and use of food labels. DESIGN: A cross-sectional study employing both quantitative and qualitative methods. Intercept interviews were conducted with 1832 consumers at supermarket sites selected using a stratified random sampling procedure. This information was triangulated with twenty-one focus group discussions. SETTING: New Delhi and Hyderabad, two metro-cities from north and south India. SUBJECTS: Adolescent (10-19 years), adult (20-59 years) and elderly (≥60 years) consumers. RESULTS: While the national urban literacy rate is 84 %, about 99 % of the study participants were educated. About 45 % reported that they buy pre-packaged foods once weekly and about a fifth buy them every day. Taste, quality, convenience and ease of use are the main reasons for buying pre-packaged foods. Although 90 % of consumers across the age groups read food labels, the majority (81 %) looked only for the manufacturing date or expiry/best before date. Of those who read labels, only a third checked nutrition information and ingredients. Nutrient information on labels was not often read because most consumers either lacked nutrition knowledge or found the information too technical to understand. About 60 % read quality symbols. A positive association was found between education level and checking various aspects of food labels. Women and girls concerned about 'fat' and 'sugar' intake read the nutrition facts panel. CONCLUSIONS: The intention of promoting healthy food choices through use of food labels is not being completely met. Since a majority of people found it difficult to comprehend nutrition information, there is a need to take up educational activities and/or introduce new forms of labelling.

Overweight/obesity, pre-diabetes, diabetes and its association with hypertension and other factors among rural adults (≥18 years) in India.

BACKGROUND: Non-communicable diseases are important causes of morbidity and mortality throughout the world. METHODS: A community-based cross-sectional study conducted in 10 Indian states using multi-stage random sampling procedures. Information was collected on socio-economic and demographic particulars, anthropometric measurements such as height, weight and waist circumference, fasting blood glucose and blood pressure was measured. One day 24-h dietary recall was done for foods and nutrient intakes. Bivariate and multivariate step-wise logistic regression analyses was done. RESULTS: The prevalence of overweight/obesity among rural adults was 23.4 % (95 % CI: 22.9-23.9), while age adjusted prevalence of pre-diabetes was 8.4 % (95 % CI: 8.1-8.7) and diabetes was 6.8, (95 % CI 6.7-7.1), respectively. The prevalence of diabetes was lowest in Uttar Pradesh, West Bengal and Odisha (3-4%) and higher in Kerala and Tamil Nadu (12-15 %). The odds of diabetes was 5.5 times more among elderly, 1.3 times higher among Christians and among high income groups, and 2 times among overweight (CI: 1.50-2.50), obese (CI: 1.61-2.76) and abdominal obesity (OR; 1.57; CI: 1.29-1.91) and 1.6 times more among hypertensives. The odds of diabetes were high among those consuming the lower tertiles of carbohydrates, pulses, milk and milk products and folic acid. CONCLUSION: the age-adjusted prevalence of diabetes and pre-diabetes was 6.8 % and 8.4 % respectively and the odds of diabetes was high among elderly, among high socio-economic groups, overweight/obese subjects and among hypertensives. Also, knowledge about symptoms of diabetes was low. There is a need to improve awareness for early diagnosis and treatment for control of diabetes and hypertension.

Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey.

BACKGROUND: Hypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India. METHODS: A community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22. RESULTS: The prevalence of pre-hypertension was 45.3% (95% CI: 44.6-46.0) and hypertension was 22% (95% CI: 21.5-22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2-23.0) as per Asian cut offs (BMI≥23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16-19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2-3 times higher among overweight (CI: 1.87-2.25) and obese (2.65-3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI = 1.02-1.41) and zinc (CI = 1.11-1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment. CONCLUSIONS: Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

Dietary and nutritional change in India: implications for strategies, policies, and interventions.

Despite the global transition to overnutrition, stunting affected approximately 159 million children worldwide in 2014, while an estimated 50 million children were wasted. India is an important front in the fight against malnutrition and is grappling with the coexistence of undernutrition, overnutrition, and micronutrient deficiencies. This report summarizes discussions on trends in malnutrition in India, its evolution in the context of economic growth, intrahousehold aspects, infant and young child feeding practices, women's status, maternal nutrition, and nutrition policymaking. The discussion focuses on a review of trends in malnutrition and dietary intakes in India in the context of economic change over the past four decades, identification of household dynamics affecting food choices and their consequences for family nutritional status in India, and effective malnutrition prevention and treatment interventions and programs in India and associated policy challenges.

Assessing Differences in Risk Perceptions About Obesity Among "Normal-Weight" and "Overweight" Adolescents--A Qualitative Study.

OBJECTIVES: To assess the differences in risk perceptions of overweight/obese and normal-weight adolescents about obesity and associated risk factors. DESIGN: Qualitative study using focus group discussions (FGDs). SETTINGS: Five randomly selected schools from the South Indian city of Hyderabad. PARTICIPANTS: Seventy-nine adolescents (ages 11-14 years) participated in 10 FGDs (5 each with overweight/obese and normal-weight groups). PHENOMENON OF INTEREST: Whether obesity-related risk perceptions differ with actual weight status or not. ANALYSIS: FGDs were recorded, transcribed, and manually coded for thematic analysis. Results were presented according to 6 themes. At each stage of coding and analysis, reports were read independently by 2-3 researchers and the inter-coder reliability was high (ratio of number of agreements against the sum of agreements plus disagreements was over 90%). RESULTS: Adolescents across the groups had limited understanding of nutrition during adolescence as well as causes and consequences of obesity. The optimistic bias that they were less vulnerable compared to others to the risks of obesity was evident from perceptions of overweight groups. While overweight adolescents argued that obesity was hereditary, the normal-weight participants perceived "faulty food habits" and laziness as the reasons. Adolescents across the groups considered fruits and vegetables as healthy foods. CONCLUSIONS AND IMPLICATIONS: There were clear differences in perceptions of adolescents of different weight status. Employing the risk perception analysis framework, this study identified the following adolescent traits: responsive, avoidance, and indifference, which may be useful for developing nutrition communication programs.

Influence of feeding practices and associated factors on the nutritional status of infants in rural areas of Madhya Pradesh state, India.

A community based cross-sectional study was undertaken in rural Madhya Pradesh (MP). The nutritional status of infants was assessed using WHO Child Growth Standards. Only 26% of infants received breast-feeding within 1 hour of birth. About 57% of children 6 to 11 months old received complementary feeding (CF). The prevalence of underweight, stunting, and wasting was 41%, 29%, and 33%, respectively. Multivariate analysis showed that the risk of underweight and stunting was 1.4 times higher among children belonging to scheduled castes and scheduled tribes compared with others, 1.4 to 1.6 times among children from households with the lowest wealth index, and 1.5 times among children of illiterate mothers. Hygienic practices, birth weight, home delivery, and CF practices were also significantly (P < .01) associated with undernutrition in multivariate analysis. Undernutrition is an important health problem in MP, and urgent steps are required to formulate policies and strategies to improve infant and young child feeding practices, socioeconomic conditions, and literacy and encouraging institutional delivery and personal hygiene.