North Indian diet high on salt, low on potassium, proteins: study

A recent study of the north Indian diet has raised a host of red flags. The study found that their diet does not conform to recommended guidelines for salt, and nutrients such as potassium and proteins. The population’s salt intake is very high and potassium intake is low, increasing the risk of developing hypertension, cardiovascular disease and chronic kidney disease (CKD).

Consumption of protein is also below the recommended figure, according to researchers. Unsurprisingly, women were not getting sufficient nutrients compared to men. The study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, and the George Institute for Global Health, India.

Dietary variations

The Indian diet is varied and differs from region to region. In the south if the population predominantly eats rice, then in the northern parts people consume wheat. It is thus challenging for policymakers to come up with an allencompassing guideline for the entire country.

To find ways to prevent CKD the researchers decided to assess the intake of nutrients such as sodium, potassium, protein and phosphorus. They included two groups of adults — one that was healthy and another of persons with stage 2 to 4 chronic CKD. The healthy population was drawn from among the family members of those with CKD.

Of the 404 adults who participated, 182 were healthy and 222 had CKD. The mean age of the group was 47 years. An equal number of men and women were enrolled for the study. While 71 (32%) of the subjects were in stage 4 of CKD, 127 (57%) persons were in stage 3 and another 24 (11%) persons were in stage 2 of the disease.

“We analysed sodium, protein, potassium and phosphorus intakes using onetime 24hour urinary excretion. Dietary intake was also analysed in subgroups based on sex, body mass index, blood pressure and abdominal obesity,” the researchers, Prabjot Kaur et al wrote in their research article published in the peerreviewed journal Frontiers in Nutrition.

The Institute of Medicine of the National Academy of Medicine recommends a dietary allowance of 700mg/day of phosphorus and 0.80gm/kg/day of protein. The actual phosphorus and protein intake in the western population is around 1,0561,617 mg/day and 1.301.40g/kg/day respectively, the researchers said. The intake of sodium was calculated at around 2 gm a day. They explained that dietary manipulation is an important strategy to manage patients with noncommunicable diseases, including CKD. The participants’ 24hour urinary excretion was analysed to assess their nutrient intake.

High salt intake

In the first of its kind study the researchers said they found that more than twothirds of the subjects studied took salt higher than recommended levels. The amount of salt intake was lower in the study as compared to earlier studies done across the country, it acknowledged, attributing the reason for fall in salt consumption to bet

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ter awareness after being educated on the benefits of a lowsalt diet.

Healthy individuals consumed substantially less than 3.50g/day of potassium that is recommended for healthy population, and 24gm for those with earlystage CKD as per the Kidney Disease Outcome Quality Initiative 2020 guidelines. The diet contained just around 39.5g/kg/day of protein among the healthy population. The authors pointed out the diet reflected the low dietary diversity in the population whereas a balanced diet requires nuts, green vegetables and fruits, considered the main source of potassium. The collective intake combination of higher than recommended sodium and lower than recommended potassium raises cardiovascular disease risk, the authors pointed out.

“A poornutrition diet is a major risk element for noncommunicable diseases (NCD), which are of considerable public health concern. In India, people eat different foods, so it is important to know exactly what nutrients they are getting to help prevent and manage these diseases. The high salt intake and low potassium intake point to the need to develop interventions targeted to individuals and societies.” said Vivekanand Jha, lead author of the study. He is also the executive director, The George Institute for Global Health, India and a kidney health specialist.

Reducing risk of NCD

The authors said the study highlighted the need for personalised changes in diet to reduce the risks of common noncommunicable diseases. It also emphasised the importance of accurate dietary assessments to provide personalised advice and develop effective policies.

Dr. Jha said, “The study shows that it is important to have dietary guidelines that are specific to the local area. We need to take action to fix imbalances in nutrients and encourage people to eat more healthily by increasing diversity.” The project was supported with funding from the Department of Biotechnology, the India Science and Engineering Research Board and the Department of BiotechnologyWelcome Trust, India Alliance.

(sujatha.r@thehindu.co.in)