Piyush Gupta1, Dheeraj Shah2, Praveen Kumar3, Nidhi Bedi4, Hema Gupta Mittal5, Kirtisudha Mishra6, Sumaira Khalil7, K E Elizabeth8, Rupal Dalal9, Rekha Harish4, Upendra Kinjawadekar10, Kristin Indumathi11, Sheetal S Gandhi12, J P Dadhich13, Niranjan Mohanty14, Ajay Gaur15, A K Rawat16, Srikanta Basu3, Raghavendra Singh17, R Remesh Kumar10, Bakul Jayant Parekh10, Santosh T Soans10, Digant Shastri10, H P S Sachdev18. 1. Department of Pediatrics, UCMS and GTB Hospital, Dilshad Garden, New Delhi. Correspondence to: Dr Piyush Gupta, Chairperson, Pediatric and Adolescent Nutrition Society (Nutrition Chapter), Indian Academy of Pediatrics; and Professor and Head, Department of Pediatrics, University College of Medical Sciences, Delhi 110 095, India. prof.piyush.gupta@gmail.com. 2. Department of Pediatrics, UCMS and GTB Hospital, Dilshad Garden, New Delhi. 3. Department of Pediatrics, Lady Hardinge Medical College, New Delhi. 4. Department of Pediatrics, Hamdard Institute of Medical Sciences and Research, New Delhi. 5. Department of Pediatrics, Ram Manohar Lohia Hospital, New Delhi. 6. Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi. 7. Department of Pediatrics, Safdarjang Hospital, Delhi. 8. Department of Pediatrics, Sree Mookambika Institute of Medical Sciences, Kanyakumari, Tamil Nadu. 9. Department of CTARA, IIT and Shrimati Malati Dahanukar Trust, Mumbai. 10. Indian Academy of Pediatrics, Mumbai. 11. SUT Hospital, Thiruvananthapuram, Kerala. 12. Consultant Pediatrician, Solapur, MS. 13. Breastfeeding Promotion Network of India, Delhi. 14. SCB Medical College, Urkal University, Bhubaneswar, Odisha. 15. Gajra Raje Medical College, Gwalior, MP. 16. Consultant Pediatrician, Bhopal, MP. 17. Maulana Azad Medical College, New Delhi. 18. Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Sciences and Research, New Delhi.
Abstract
JUSTIFICATION: In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juices and drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential to increase this problem in children and adolescents. OBJECTIVES: To review the evidence and formulate consensus statements related to terminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks; and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents. PROCESS: A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review of literature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing the guidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and a consensus document was finalized. CONCLUSIONS: The Group suggests a new acronym 'JUNCS' foods, to cover a wide variety of concepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beverages is associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adverse cardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleep disturbances. The Group recommends 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. The Group recommends intake of regional and seasonal whole fruits over fruit juices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age <2y), whereas for children aged 2-5 y and >5-18 y, their intake should be limited to 125 mL/day and 250mL/day, respectively. The Group recommends that caffeinated energy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCS foods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. The Group supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisements of all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggests communication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumption of the JUNCS foods.
JUSTIFICATION: In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juices and drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential to increase this problem in children and adolescents. OBJECTIVES: To review the evidence and formulate consensus statements related to terminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks; and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents. PROCESS: A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review of literature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing the guidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and a consensus document was finalized. CONCLUSIONS: The Group suggests a new acronym 'JUNCS' foods, to cover a wide variety of concepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beverages is associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adverse cardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleep disturbances. The Group recommends 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. The Group recommends intake of regional and seasonal whole fruits over fruit juices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age <2y), whereas for children aged 2-5 y and >5-18 y, their intake should be limited to 125 mL/day and 250mL/day, respectively. The Group recommends that caffeinated energy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCS foods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. The Group supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisements of all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggests communication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumption of the JUNCS foods.
Authors: Sineide Freitas de Souza; Maria Ester Pereira da Conceição-Machado; Priscila Ribas de Farias Costa; Carla de Magalhães Cunha; Valterlinda Alves de Oliveira Queiroz; Mônica Leila Portela de Santana; Luana de Oliveira Leite; Ana Marlúcia de Oliveira Assis Journal: Einstein (Sao Paulo) Date: 2022-05-16