Owing to nutrition transition, faulty eating habits (increased consumption of sugar and salt, diet high in energy, fat, refined grains, and other processed foods, sweets, and savoury snacks) and physical inactivity, there is a rapid rise in NCDs in India [1].

Excess salt consumption is a leading cause of high blood pressure and has been reported as the seventh leading cause of mortality worldwide, responsible for an estimated 1.65 million deaths each year. The World Health Organization's (WHO) global action plan for the prevention and control of non-communicable diseases identifies a 25% reduction in premature mortality from cardiovascular disease, a 25% reduction in raised blood pressure, and a 30% reduction in mean population salt intake as targets for 2025. In addition, the WHO recommends maximum dietary salt intake of 5 g/day for adults [2-5].

India is world's highest consumer of sugar with one of the highest salt consumption per day. Increased sugar intake is directly linked to increased risk of obesity, fatty liver disease, and metabolic syndrome. Also, increased sugar intake may be indirectly related to the increased risk of type 2 diabetes. There is no safe limit of sugar consumption, as the human body can produce its own glucose. Being nature's gift to mankind, there is no harm in moderate consumption of salt and sugar, however, modest reduction in the consumption of both can substantially reduce the burden of non-communicable diseases [6].  

Animal fats like ghee, butter and cheese contain large amounts of saturated fats and cholesterol. These lead to the deposition of harmful material on the walls of our blood vessels and may lead to blockage or haemorrhage. Excessive consumption of rich fatty foods may lead to excessive weight gain, heart disease and several other health problems in adult age and among elderly individuals. We should thus limit the use of these fats, especially in adult and old age [7].

A number of studies have done in different parts of the India to see the pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption; such studies are limited in hilly areas of District Shimla. Thus the present study was developed to evaluate the pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption among adult population of District Shimla.

Objectives of the Study

To evaluate the pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption among adult population of District Shimla.

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Shimla

• Study duration- between September 2021- October 2021 

• Study population- Adults population aged between 18-60 years

• Sample size- 400 adults assuming 50% adults have adequate knowledge regarding Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption, 5% absolute error, 95% confidence level, and 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption was created

• Inclusive Criteria- who were willing to participate in the study

• Exclusion Criteria: who were not willing to participate in the study

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin. Responses were then recorded in a Google Excel spreadsheet, the information from which was used to generate graphical display

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc.

• Ethical Considerations- Participants confidentiality and anonymity was maintained

Present study was developed to evaluate the pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption among adult population of District Shimla. A total of 400 respondents including 194 (48.5%) females and 206 (51.5%) males from district Shimla were participated in the study. Among the participants of the majority 189 (47.3%) were in age group of 31-40 years, 159 (39.8%) were in Govt Job,338(84.5%) were graduate & above, 235 (58.8%)were from urban area and 387 (96.8%) were belong to Hindu Religion (Table 1).

Table 1: Socio-demographic characteristics of study participants

Table 2: Pattern of visible salt consumption in a family 

Table 3: Pattern of visible salt consumption/ person/day according to gender and area

Table 4: Pattern of visible sugar consumption in a family 

Table 5: Pattern of visible sugar consumption/person/day according to gender and area

Among the total 400 study participants, majority of their family 149 (37.3%) were taking 1 Kg of salt in a month (Table 2).

Among the total 400 study participants, mean salt consumption per person per day was 8.74± 5.592 gm. In males salt consumption was lower (8.66± 5.889 gm) than females (8.81±5.272 gm). But there was no statistically difference between males & females. Similarly salt consumption was lower in rural areas (8.47± 5.424 gm) as compared to urban areas (8.92± 5.711 gm). But there was no statistically difference between rural and urban areas (Table 3). 

Among the total 400 study participants, majority of their family 124 (31.0%) were taking 2 Kg of sugar in a month (Table 4).

Among the total 400 study participants, mean sugar consumption per person per day was 20.23± 13.035 gm. In males sugar consumption was statistically higher (22.13± 14.637gm) than females (18.21±10.759 gm). Similarly sugar consumption was statistically higher in rural areas (23.44± 14.580 gm) as compared to urban areas (17.97± 11.327gm) (Table 5).

Among the total 400 study participants, majority of their family 125 (31.3%) were taking 1 Kg of visible fat (oil, ghee, butter) in a month (Table 6).

Among the total 400 study participants, mean visible fat (oil, ghee, butter) consumption per person per day was 19.19± 12.170 gm. In males visible fat (oil, ghee, butter) consumption was statistically higher (20.58±13.222 gm)

Table 6: Pattern of visible Fat (oil, ghee, butter) consumption in a family 

Table 7: Pattern of visible Fat (oil, ghee, butter) consumption/person/day according to gender and area

than females (17.72±10.784 gm). Similarly visible fat (oil, ghee, butter) consumption was statistically higher in rural areas (21.00± 13.985 gm) as compared to urban areas (17.92± 10.562 gm) (Table 7).
 

In the present study, among the total 400 study participants, majority of their family 149 (37.3%) were taking 1 Kg of salt in a month. Mean salt consumption per person per day was 8.74± 5.592 gm. In males salt consumption was lower (8.66± 5.889 gm) than females (8.81±5.272 gm). Similarly salt consumption was lower in rural areas (8.47± 5.424 gm) as compared to urban areas (8.92± 5.711 gm). A number of population surveys assessing dietary salt consumption in India have estimated mean intake as >5 g/day. Recent data on salt intake levels in India show consumption is around 11 g per day, higher than the World Health Organization’s (WHO) recommended intake of 5 g per day. National salt intake recommendations are between 5g and 8g of salt/day (sodium 2000–3200 mg) [8-10]. Similarly in the study done by sachdeva A et al in shimla city Per capita salt consumption was found to be 8.98±2.35 gm [11].

Among the total 400 study participants, majority of their family 124 (31.0%) were taking 2 Kg of sugar in a month. Mean sugar consumption per person per day was 20.23± 13.035 gm. In males sugar consumption was statistically higher (22.13± 14.637gm) than females (18.21±10.759 gm). Similarly sugar consumption was statistically higher in rural areas (23.44± 14.580 gm) as compared to urban areas (17.97± 11.327gm). The American Heart Association (AHA) has issued a scientific statement recommending that no more than 100 kcal/day for women and no more than 150 kcal/day for men from added sugars. The mean percentage of energy from total free sugars in India is higher than the WHO goal. Data from the India sugar trade industry shows that India is the second largest (after Brazil) producer and largest consumer of sugar in the world [12-15]. The per capita consumption of sugar in India is 20.2 kg. It is lower than the global average of 24.8 kg, but consumption of sugar in India is growing more rapidly than the global average. In the last 50 years, sugar consumption in India has raised from 5% of the global production to 13% [16]. The National Institute of Nutrition recommends an added sugar intake of not more than 20 to 25g a day for normal adults. The Consensus Dietary Guidelines for Indians recommend less than 10% of total calories from free sugars per day [16].

Among the total 400 study participants, majority of their family 125 (31.3%) were taking 1 Kg of visible fat (oil, ghee, butter) in a month. Mean visible fat (oil, ghee, butter) consumption per person per day was19.19± 12.170 gm. In males, visible fat (oil, ghee, butter) consumption was statistically higher (20.58±13.222 gm) than females (17.72±10.784 gm). Similarly visible fat (oil, ghee, butter) consumption was statistically higher in rural areas (21.00± 13.985 gm) as compared to urban areas (17.92± 10.562 gm). It is estimated that about 15- 25 g of visible fat meets both the requirements of essential fatty acids and 3 -6% of the total energy needs. In a country like India, even a rural diet which is primarily cereal based, the amount of invisible fat that is present is about 15 g and this is able to contribute nearly 6% of total energy requirements. A level of 22 g visible fat per person per day, is the recommendation to meet health needs [17].

Salt, sugar and visible fat consumption in Shimla is well above the World Health Organization recommendation. Salt, sugars, oil, ghee & butter, though an integral part of daily diets, can be used as cautious, owing to their strong association with the risk of various NCDs. Being nature’s gift to mankind, there is no harm in their moderate consumption. The measures to limit their intake provide comprehensive, accessible, community‑based, preventive, curative, and rehabilitative measures for NCDs.

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