Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India
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Research Article Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India: A Case Study of the Food Environments of Rural Villages and an Urban Slum Vidhu Gupta, MSc1; Shauna M. Downs, PhD2; Suparna Ghosh-Jerath, PhD, APD1; Karen Lock, PhD3; Archna Singh, PhD, MPH4 ABSTRACT Objective: To describe the food environment in rural villages and an urban slum setting in India with reference to commercially available unbranded packaged snacks and street foods sold by vendors, and to analyze the type and quantity of fat in these foods. Design: Cross-sectional. Setting: Two low-income villages in Haryana and an urban slum in Delhi. Participants: Street vendors (n ¼ 44) were surveyed and the nutritional content of snacks (n ¼ 49) sold by vendors was analyzed. Main Outcome Measures: Vendors’ awareness and perception of fats and oils, as well as the type of snacks sold, along with the content and quality of fat present in the snacks. Analysis: Descriptive statistics of vendor survey and gas chromatography to measure fatty acid content in snacks. Results: A variety of snacks were sold, including those in unlabeled transparent packages and open glass jars. Mean fat content in snacks was 28.8 g per 100-g serving in rural settings and 29.6 g per 100-g serving in urban settings. Sampled oils contained high levels of saturated fats (25% to 69% total fatty acids) and trans fats (0.1% to 30% of total fatty acids). Conclusions and Implications: Interventions need to target the manufacturers of oils and fats used in freshly prepared products to improve the quality of foods available in the food environment of low- socioeconomic groups in India. Key Words: trans fatty acids, fatty acids, food environment, snacks, low- or middle-income country (J Nutr Educ Behav. 2016;-:1-11.) Accepted November 28, 2015. INTRODUCTION ronment.1 The food environment is nutrition labeling, offering healthier one of the major domains in which foods, setting standards in public insti- What people eat depends not only on policies can intervene to improve the tutions, using economic tools to individual and cultural factors but availability, affordability, and accept- address food affordability, restricting also on their surrounding food envi- ability of healthier food.2 By improving food advertising, improving the qual- ity of the food supply, and setting in- centives and rules to create a healthy 1Indian Institute for Public Health–Delhi, Public Health Foundation of India, Haryana, India retail environment, the food environ- 2Menzies Centre for Health Policy, University of Sydney, Sydney, Australia ment can better support consumers to 3London School of Hygiene and Tropical Medicine and Leverhulme Centre for Integrative make healthier food choices.2 Research on Agriculture and Health, London, United Kingdom Most research on food environ- 4Indian Institute for Public Health–Delhi, Public Health Foundation of India and All India ments has been conducted in the US Institute of Medical Sciences, Delhi, India and other high-income countries.1 In Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online the US, studies have shown that lower- with this article on www.jneb.org. socioeconomic communities tend to Address for correspondence: Shauna M. Downs, PhD, Menzies Centre for Health Policy, be characterized by the high availabil- Victor Coppleson Bldg (D02), University of Sydney, Sydney NSW 2006, Australia; Phone: ity of convenience and energy-dense þ(1 347) 431 5630; E-mail: [email protected] foods of little nutritional value and Ó2016 The Authors. Published by Elsevier, Inc. on behalf of the Society for Nutrition the low availability of fresh produce Education and Behavior. This is an open access article under the CC BY license (http:// and other nutritious foods.3,4 Barriers creativecommons.org/licenses/by/4.0/). to access can make it difficult for http://dx.doi.org/10.1016/j.jneb.2015.11.006 people to choose healthy food.5-7 How- Journal of Nutrition Education and Behavior Volume -, Number -, 2016 1 2 Gupta et al Journal of Nutrition Education and Behavior Volume -, Number -, 2016 ever, there is a paucity of research deficient in key nutrients20 while eat snacks and street foods sold by assessing the food environments of consuming high intakes of trans fatty vendors; and (2) analyze the type and low-socioeconomic status (SES) set- acids (TFAs) from hydrogenated oils.21 quantity of fat in these foods to under- tings in low-income (defined as those These dietary TFAs have adverse effects stand the exposure to the population. with a gross national income per cap- on blood lipoprotein profiles and coro- ita of # $1,045 in 2013) and middle- nary heart disease risk affecting indi- income countries (defined as those viduals and populations. The adverse METHODS with a gross national income per cap- effects on coronary heart disease are This study analyzed the retail food ita of > $1,045 but < $12,746) (LMICs). mediated by increases in plasma con- environment in terms of the snacks Therefore, it is important to examine centrations of low-density lipoprotein and street foods available and sampled the situation in LMICs, because little cholesterol and lipoprotein A, and re- from the vendors in the low-SES set- is known about the nature of their ductions in high-density lipoprotein tings in North India. The researchers food environments. cholesterol, promotion of inflamma- determined the snack sampling strat- Many LMICs worldwide are currently tion, and endothelial dysfunction.22 egy using data obtained from the undergoing a nutrition transition: a Many Indian snacks have been found consumer-level study. This included a shift from traditional dietary patterns to be high in TFA ($2% of total fatty survey of the dietary intake patterns toward a more Western diet consist- acids).23,24 The Government of India with an emphasis on snacking patterns ing of energy-dense foods high in recently took steps to limit the amo- conducted in low-SES HHs (260 HH in fat, sugar, and salt.8-10 The transition, unt of TFA in foods by publishing a each community). The HH surveys which has been linked to a rise in regulation setting an upper limit of included a dietary intake questionnaire diet-related noncommunicable dis- 10% TFA in partially hydrogenated as well as 2 24-hour dietary recalls, eases, is rooted in globalization.11 As vegetables oils (PHVOs). This regu- which were conducted on 2 consecu- a result, many countries now face a lation was subsequently revised to a tive days. The dietary questionnaire, double burden of diet-related diseases 5% limit that will come into effect in in addition to the 24-hour recalls, pro- in which undernutrition and overnu- August, 2016, in addition to requiring vided information regarding consump- trition coexist, even within the same that TFA be labeled on packaged tion of commercially prepared snacks, household (HH).12-14 foods.25,26 However, it is unclear to which was then subsequently used to Although the dietary intakes of what extent this regulation will be en- determine the snack sampling strategy. lower-socioeconomic groups in LMICs forced and what substitutions vendors Only unbranded (unlabeled, open, or are often limited by the scarcity of will make to keep consumers satisfied freshly prepared) snacks from all ven- food, it may no longer be the main fac- and maintain product demand despite dors willing to participate were sampled tor affecting energy intakes in some the changes. (details are provided subsequently). settings; instead, the availability of There is currently limited informa- Therefore, snacks sampled from the cheap, energy-dense foods, including tion about the food retail environ- vendors were those consumed (if repo- those from street vendors, may result ments of low-socioeconomic groups rted in the 24-hour recall) by participants in increased energy intake.15 Street in LMICs, particularly those living in in the HH survey. The authors ob- and snack foods have become a signif- rural areas and urban slums. Creating tained ethics approval for the study icant source of food for many people healthy public policies and supportive from the Public Health Foundation of in LMICs as people migrate from food environments can facilitate access India's Institutional Ethics Committees. rural to urban areas.16 In particular, to safe, affordable, nutritious food.27 To low-income populations often depend identify which policies might be the almost exclusively on food prepared most effective in specific settings, it is Setting by street vendors.16 Unfortunately, important to gain a thorough under- many vendors sell food of suboptimal standing of the existing food environ- The researchers examined the food en- nutritional quality.15 A study conduct- ment. Thus, a project was designed vironments of 3 purposively selected ed in India found that migrant and ur- that aimed to examine awareness of settings, which included 2 rural vil- ban men consumed a higher proportion and use of TFAs and the feasibility of lages (Sundh and Hasanpur) in the Me- of energy from fat and saturated fat their removal from the Indian food wat district of Haryana and an urban than do rural men, which suggests a supply chain by integrating perspec- slum (Chanderpuri) in the northeast shift toward a lower-quality diet after tives from 3 levels: manufacturers, re- district of Delhi. These communities migration.17 In the absence of a diver- tailers, and consumers. The current were selected specifically to examine sified, nutrient-dense diet, there may study, which is part of the larger proj- snacking patterns (through the HH be a propensity for overconsumption ect, describes the retail food environ- survey) in low-SES settings in 2 adja- leading to overweight and obesity ment with a focus on unbranded cent states that typically consume but a simultaneous failure to meet mi- packaged products and street foods in vanaspati (PHVO high in TFA) and cronutrient requirements.18 rural and urban low-SES settings of 2 unbranded snacks made using PHVOs.