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Table 2 Tobacco use, diet and physical activity recommendations and their implementation

From: Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

Year Recommendations Implementing agency
TOBACCO USE
2003 Cigarettes and Other Tobacco Products Act (COTPA) 2003: The Department of Health and Family Welfare in each state is primarily responsible for implementation in coordination with other departments, authorised officers and various other stakeholders.
  - Prohibition of smoking in public places  
  - Prohibition of advertisement of cigarettes and other tobacco products  
  - Prohibition of sale of tobacco products to minors (below 18 years of age)  
  - Prohibition of sale of tobacco products by minors  
  - Prohibition of sale of tobacco products within 100 yards of the educational institutions  
  - Specified health warnings on tobacco products  
  - Testing of tobacco products for their harmful contents and emissions  
2007-2012 Programme components of National Tobacco Control Programme (NTCP): NTCP to support implementation with national, state and district level actions and actors
  National level:  
  - Mass media campaigns to create public awareness  
  - Establishment of tobacco testing labs  
  - Mainstreaming the programme components as part of the health delivery mechanism under the overall NRHM framework  
  - Mainstreaming research and training on alternate crops and livelihoods and monitoring and evaluation including surveillance  
  State level:  
  - Establishment of a tobacco control cell  
  District level:  
  - Tobacco control centres  
  - Information, Education and Communication activities  
  - Training of professionals  
DIET
2008 (pilot phase) Guidelines by National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke (NPDCS)* Ministry of Health and Family Welfare, Govt. of India
  - Increase intake of green leafy vegetables and fresh fruits.  
  - Consume less salt; avoid adding or sprinkling salt to cooked and uncooked food.  
  - Preparations that are high in salt and need to be moderated are: Pickles, chutneys, sauces and ketchups, papads, chips and salted biscuits, cheese and salted butter, bakery products and dried salted fish.  
  - Restrict all forms of free sugars and refined carbohydrates for example biscuits, breads, naan, kulchas, cakes, and so on.  
  - Steamed and boiled food should be preferred over fried food.  
  - Have fresh lime water instead of carbonated drinks.  
  - Avoid eating fast or junk foods and aerated drinks. Instead of fried snacks, eat a fruit.  
  - In practice, it is best to use mixture of oils. Either buy different oils every month or cook different food items in different oils. Oils that can be mixed and matched are mustard oil, soya bean oil, groundnut oil, olive oil, sesame oil, and sunflower oil.  
  - Ghee, vanaspati, margarine, butter and coconut oil are harmful and should be moderated.  
  - If you are a non-vegetarian, try to take more of fish and chicken. They should not be fried. Red meat should be consumed in small quantities and less frequently.  
  - Eat variety of foods to ensure a balanced diet  
2010 Guidelines by National Institute of Nutrition (NIN) These guidelines were proposed by the National Institute of Nutrition, Hyderabad which works under the aegis of Indian Council of Medical Research, Ministry of Health and Family Welfare, Govt. of India
  - Combine different food groups to obtain a well-balanced diet. Recommended balanced diet for adults with moderate physical activity (for reference men and women weighing 60 and 55 kg respectively): net energy (kcal/day): 2730 (men), 2230 (women); Fats and oils (visible fat): 5gX6 (men), 5gX5 (women); Sugar: 5gX6; Milk and milk products: 100gX3; Pulses: 30gX3 (men), 30gX2.5 (women); Vegetables (excluding roots and tubers): 100gX3; Fruits: 100gX1; Cereals and millets: 30gX15 (men), 30gX11 (women).  
  - Ensure provision of extra food and healthcare to pregnant and lactating women.  
  - Promote exclusive breastfeeding for six months and encourage breastfeeding till two years.  
  - Feed home based semi-solid foods to the infant after six months.  
  - Ensure adequate and appropriate diets for children and adolescents in health and sickness.  
  - Ensure moderate use of edible oils and animal foods and less use of ghee, vanaspati, and so on.  
  - Overeating should be avoided to prevent overweight and obesity.  
  - Restrict salt intake to minimum, should not exceed 6 g per day.  
  - Ensure safe and clean foods and practice right cooking methods and healthy eating habits.  
  - Drink plenty of water and take beverages in moderation. A normal healthy person needs to drink about 8 glasses (2 litre) of water per day.  
  - Minimize the use of processed foods rich in salt, sugar and fats. The intake of trans-fatty acids should not exceed 2% of energy intake.  
  - Include micronutrient rich foods in the diets of elderly people for them to be fit and active.  
  - Eat plenty of vegetables and fruits.  
  - Exercise regularly and be physically active to maintain ideal body weight.  
PHYSICAL ACTIVITY
2008 (pilot phase) Guidelines by the NPCDCS* Ministry of Health and Family welfare, Govt. of India with WHO collaboration
  - Physical activity is a key determinant of energy expenditure.  
  - Regular exercise is important for promoting weight control or weight loss.  
  - Exercise regularly (moderate to vigorous) for 5–7 days per week; start slowly and work up gradually.  
  At least 30 min (accumulated) of physical activities per day for cardiovascular disease protection.  
  45 min/day (accumulated) for fitness.  
  60 min/day (accumulated) for weight reduction.  
  - Discourage spending long hours in front of television.  
  - Encourage outdoor activities like cycling, gardening and so on.  
  - A minimum 30–45 min brisk walk/physical activity of moderate intensity improves overall health.  
  - Include ‘warm-up’ and ‘cool- down’ periods, before and after exercise regimen.  
2010 Guidelines by NIN Guidelines were proposed by the National Institute of Nutrition, Hyderabad which works under the aegis of Indian Council of Medical Research, Ministry of Health and Family Welfare, Govt. of India
  - Physical activity is essential to maintain ideal body weight by burning excess calories and is of vital significance for health and prevention of diseases.  
  - Physical activity is essential for the reduction of morbidity and mortality due to several chronic diseases and may reduce the risk of falls and injuries in the elderly.  
  - Exercise is a prescriptive medicine.  
  - Move your body as much as you can.  
  - Physical activity is a major modifiable risk factor in reduction of non-communicable chronic diseases.  
  - Recommended to carry out at least 45 min of moderate intensity activity, which may reduce the risk of chronic diseases.  
  - To lose weight 60 min of moderate to vigorous intensity physical activity may be taken for most of the days in a week.  
  - Children and teenagers need at least 60 min of physical activity every day. In the case of pregnant women 30 min or more of moderate-intensity physical activity every day is recommended.  
  1. * The programme was launched in 10 states (including Kerala) and 10 districts as National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke (NPDCS) in 2008. In 2010–11, when it was scaled up to 21 states and 21 districts, a cancer component was added and its name was changed to National Programme for Prevention and Control of Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS).