By Sumi Sukanya Dutta

Nutrition advocates urge for stricter cut-offs for sugar in packaged foods. Demand transparency and accountability in food labelling.

The Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN) — the country’s apex nutrition authority — has updated its dietary guidelines, advising against sugar for children under two years of age.
The guidelines released this week, which come after a 13-year hiatus, also recommend that individuals over two years old should limit their sugar intake to just 5 percent of their daily caloric intake.
Aligned with the World Health Organization’s (WHO) 2015 sugar intake recommendations, these guidelines highlight a stark contrast with India’s current food policies regarding sugar content in food products.
Recent scrutiny has fallen on Nestlé, the global food conglomerate, for adding sugar to its powdered baby food products, such as Cerelac, in lower-income countries like India, while omitting it in wealthier nations.
This revelation has prompted the Food Safety and Standards Authority of India (FSSAI) to reevaluate its regulations on sugar in packaged foods.
Notably, a joint investigation by Public Eye and the International Baby Food Action Network (IBFAN) released last month, showed that “in India, where sales of Cerelac (powdered baby food for 6-24 months age group) surpassed $250 million in 2022, all Cerelac baby cereals contain added sugar, on average nearly 3 grams per serving”.
In its defense, Nestlé India issued a statement that it has reduced added sugars by up to 30 percent, depending on the variant, in its infant cereals portfolio (milk cereal-based complementary food).
“We regularly review our portfolio and continue to innovate and reformulate our products to further reduce the level of added sugars without compromising quality, safety and taste,” the food company said.
Meanwhile, speaking to ThePrint, a senior FSSAI official said that, in the background of the Nestlé controversy, one of its scientific panels was examining the case and could recommend a policy change, if deemed required.
In response to a query to its chief executive officer G. Kamala Vardhan Rao to understand the authority’s official stand, FSSAI shared its FSS (Foods for Infant Nutrition) regulations.
It said that lactose and glucose polymers — types of carbohydrates — “shall be the preferred carbohydrates for food for infant nutrition. The regulation also says that sucrose and/or fructose shall not be added unless needed as a carbohydrate source, and provided the sum of these does not exceed 20 percent of total carbohydrate.”
However, nutrition experts such as Dr Arun Gupta, national convenor of the nutrition think-tank Nutrition Advocacy in Public Interest (NAPi) pointed out that there are clear-cut loopholes in the existing norms in India, which companies exploit.
He underlined that the WHO offers specific advice for a healthy diet for infants and children saying that from 6 months of age, breast milk should be complemented with a variety of adequate, safe and nutrient-dense foods, and salt and sugars should not be added to complementary foods.
Despite this, India’s 2020 Food Safety and Standards (Foods for Infant Nutrition) Regulations permit the addition of sucrose and/or fructose up to 20 percent of total carbohydrates or 13.6 grams of sugar per 100 grams of serving.
In fact, Gupta said, no packaged food with added sugar should be permitted at all for infants. Moreover, considering India’s escalating non-communicable disease crisis, he added that the products for older children and adults should also come up with clear-cut Front-of-the Packet Label (FoPL) warnings stating if they are high in fat, sugar, and salt (HFSS).
Damage caused by sugar
In India, 56.4 percent of the disease burden is directly linked to diet, the 148-page guidelines by ICMR-NIN highlighted.
Another study by the ICMR, in collaboration with Madras Diabetes Research Foundation released last year found that one in four Indians is diabetic, pre-diabetic, or obese — conditions tied to dietary habits and sedentary lifestyles.
Moreover, there is also enough evidence to establish that feeding infants and young children with food products laden with added sugar puts them at a higher risk of early childhood obesity and non-communicable diseases in later life.
Additionally, the American Heart Association advises that adult women should consume no more than 6 teaspoons (approximately 25 grams) and men no more than 9 teaspoons (approximately 38 grams) of added sugar daily.
Despite these guidelines and warnings, many packaged foods, including unexpected ones, contain added sugars like sucrose and high fructose corn syrup (HFCS).
Dr Tushar Tayal, lead consultant, department of internal medicine, CK Birla Hospital, Gurugram, explained that the liver is the only organ that can metabolise sugar in significant amounts.
“When your liver gets overloaded, it turns the sugar into fat. Some of that fat can lodge in your liver, contributing to fatty liver. High sugar consumption is also linked to insulin resistance, metabolic syndrome, obesity, and type 2 diabetes,” he said.
Additionally, it promotes oxidative stress, inflammation, higher serum uric acid levels, hypertriglyceridemia and higher systolic blood pressure. Also, high sugar causes leptin hormone resistance, Tayal highlighted.
Leptin is a hormone that sends signals to your brain when you need food or when you’re satiated. Leptin resistance on the other hand makes you feel hungry and eat more even though your body has enough fat stored.
Worse still, as refined sugar is an already digested form of sugar, it causes a rapid spike in sugar levels, which is extremely harmful to diabetics, experts said.
Scientifically, added sugar in food products can cause more harm to health compared to natural sugar as they contribute excess calories without providing essential nutrients, explained Seema Gulati, head of the nutrition research group at a Delhi-based non-profit National Diabetes, Obesity, and Cholesterol Foundation.
Gulati added that natural sugars found in fruits and dairy products come packaged with fibre, vitamins, and minerals, which can mitigate some of their negative effects when consumed in moderation.
Meanwhile, the ICMR-NIN guidelines addressed the rise in highly processed food consumption, sedentary lifestyles, and limited access to diverse foods, contributing to micronutrient deficiencies and increasing obesity rates in India.
The guidelines also highlighted concerns with aggressive advertising and marketing of these unhealthy foods through different media channels, including social media, which influence dietary preferences among children and adults, leading to detrimental long-term effects.
Given this context, Gupta pointed out that there are hardly any instances when FSSAI has penalised food companies for misleading advertisements. He also expressed disappointment in the delay in implementing the FOPL policy, which, he said, would at least inform consumers and aid their decision-making on choosing what they eat.
‘Need scientific cut-offs for sugar, salt, fat’
Several nutrition experts insist that scientific “cut-offs” for salt, sugar and fats in processed foods are mandatory if India wants to curb the raging pandemic of lifestyle diseases.
According to Gulati, there are gaps in enforcement or limitations in the scope of food regulation. “It is essential for regulatory bodies to continuously review and strengthen regulations related to added sugar, salt, trans fat, and other harmful ingredients to protect public health. Collaboration between government agencies, health experts, and industry stakeholders is crucial to address these issues effectively,” she stressed.
Meanwhile, Ashim Sanyal, chief operating officer (COO) and secretary at Consumer Voice, a Delhi-based consumer advocacy group, pointed out the regulatory void in controlling high levels of sugar, salt, and fat in packaged foods, which have become a daily staple for many.
“The FOPL policy has been on hold likely due to industry pressure,” he alleged, adding that more sugar, salt or saturated fats are addictive and convenient to use.
While the experts highlighted concerns surrounding food regulations, evidence linking ultra-processed food (UPF) food with non-communicable diseases, including cancers, has also been growing in the country over the last few years.
A WHO report from 2023 indicated that India’s UPF sector, encompassing chocolate, sugar confectionery, salty snacks, beverages, ready-to-eat meals, and breakfast cereals, experienced a compound annual growth rate (CAGR) of 13.37 percent in retail sales value from 2011 to 2021.
Moreover, according to the Nova Food Classification System — a widely-used system that rates food based on degree of processing — UPF comprises eatables of mainly industrial origin, made mostly or entirely from substances derived from foods and additives using a series of processes and containing minimal whole foods.
According to Sanyal, the least FSSAI can do is to warn consumers by introducing FOPL so that they can make decisive choices based on their health concerns. “Consumers often encounter food products that do not even mention the nutrition content on their packaging,” he highlighted.
As a result, consumers have little guidance to help them make informed choices about sugary and refined products, Sanyal told ThePrint, emphasising that: “It should be mandatory even for restaurants and home chefs to mention the basic nutrient values of their products.”
(Edited by Richa Mishra)

Courtesy: The Print