Mrs. SONYA GODWIN

1

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR

DISSERTATION

Mrs. SONYA GODWIN

FIRST YEAR M.SC (NURSING)

PAEDIATRIC NURSING

YEAR 2009-2011

RAJIV GANDHI COLLEGE OF NURSING,

Opp.MEENAKSHI TEMPLE, NATIONAL PARK ROAD,

BANGALORE – 560 076

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR

DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Soft Drinks Are Far From Soft” -Perez Escamilla.

In the new era of urbanization and westernization of lifestyle in our country the need of our hour is faster and automated services. The busy lifestyle gave way to the development of vending machines for quick provision of fast foods, soft drinks, snacks and candies, which can be made available at any corner, especially in school compounds. Children and youngsters consume soft drinks in breath taking quantities and are often unaware of the health hazards of the excess consumption.

Beverages like colas, sparkling water, iced tea, lemonade, squash and fruit punch are among the most common types of soft drinks43. The children who are unable to decide the right food habits and were falling prey to the combined effect of fancy advertisement and easily available drinks at their disposal.

Soft drinks have no nutritive value. Themain preservatives found in the soft drink packets are:

During the last few decades, soft drink consumption by children steadily increased. Research suggests that children who drink a lot of soft drinks have risk to become fat, weak bones, dental caries and caffeine addicted.(Luo et al 200526,Sayegh et al452002 ,,Hardling et al 200312,Al Majed et al 20021 ,Johansson et al 1996 19 )

The mineral, calcium is needed for bone and teeth development and for various physiological processes in our body.99% calcium stored in bones50. The large amounts of sugar bubbles caused by carbon dioxide and phosphoric acid, which are found in soft drinks, remove nutrition, minerals from bones allowing them to become weak and increasing risk of breakage28.Substituting soft drinks for milk and eating away from home are the barriers of adequate calcium intake and metabolism.30

The work of Nicklas TA (2003) on calcium intake trends and health consequences showed thatthe increased soft drink consumption and decreased dietary consumption affects the calcium intake31.

The increasing prevalence of childhood obesity is a global problem. There are varieties of environmental factors that may be contributing the increase of obesity. One such factor is the consumption of excess soft drink4. The sugar in the soft drink is the source of extra calories. This have high energy intake and more likely to become overweight. The work of Virtanen (2007) on health effects of soft drink consumption confirmed that there is a clear association of soft drink consumption, increased energy and body weight54.

The amount of sugar and acid content in the soft drinks are associated with the dental caries. Soft drink PH has been shown a causative factor of dental erosion. The artificial sugars in the soft drinks also cause dental erosion40. Research work of Jain and Poonam regarding the relation between soft drinks and enamel erosion confirmed that prolonged exposure to soft drinks can lead to significant enamel loss.17The infant and young children ate more sweets and who drinks at bed time are susceptible to early childhood carie41..

In addition cola drinks also contain large amounts of caffeine. About 60% of the soft drink contains caffeine, a mildly active chemical as a flavouring agent. A study (2007) on caffeine in the soft drinks reported that caffeine has no flavouring activity and it will induce a physiologic and psychological desire to consume drinks21.

The acceptance of western life style especially in the developing country like India will be harmful to our own existence. It is the time to realise that prevention is better than cure. So we want to forget about the soft drinks. There by we can construct a healthy India and a healthy world.

6.1 NEED FOR THE STUDY

“In order to neutralise a glass of cola, it takes 32 glasses of high ph alkaline water” –WILLIAM FRAZIER.

Problems are the part of our life. For every problem there is a solution. And the problems having a quest for answer until it resolved. The need for the study is to find solution to solve the problem. Soft drink consumption among children is an existing problem in the world.

In 2008 The international Beverage division reported that 9% volume growth of soft drink consumption rates in middle east china, Argentina, RussiaTheEurope, middleeast, and African region grew 11%, the Asian pacific region grew 9% and the Latin American grew 7%.According to WHO some countries now suffer a “double burden” of child hood obesity and mal nutrition due to soft drinks. The soft drinks displace healthier food from children’s diet9.

The Indian market research report shows that the market for soft drinks in India increased between 2000-2005 growing at an average annual rate of 5.3%.The market of soft drinks in India increased between 2001-2006 growing at an average annual rate of 8.1%.And the market of soft drinks in India increased between 2002-2007, growing at an annual rate of 10.8%.Also shows that 75% of the soft drink consumers are children and young adults. It pointed out that cola drinks have main market in metro cities and states of Utter Pradesh, Haryana, and Punjab etc.Orange flavoured drinks are popular in southern states16.

`The Global Dump soft drink campaign (2007) demands cease all marketing of sugar –sweetened beverages to children under 16, including print and broad cast advertising, product placement, the internet, mobile phones, athletic events and sponsorship and other means, the sugary beverages should include rotating nutritional education such as “High sugar-drink only occasionally or For occasional consumption”etc.The campaign suggested thatpaying of a modest value added tax on soft drinks will reduce its demand9.

The consumer organization in Delhi celebrated the National consumer day in New Delhi on 24th December 2007.In that occasion Mr.Bejonmisra, executive director of consumer voice said, “we have to encourage children and ourselves to reduce consumption of soft drinks in India as it has been proved that excessive use of soft drinks leads to obesity, disease and unhealthy life style. The per capita consumption in India is less than 15, and needs our attention because it is steadily increasing in India and the soft drink multinationals are targeting India to increase their sales. Also the multinationals focus our teenagers and young adults. They are the 75%of their consumers in India14.”

Survey of Indian health services and nutrition (2007) shows that consumption of soft drinks and fast food can cause 60-65% of health problems in Indian children, adolescents and adults. Further the health and the family welfare minister has requested health minister of all states and Minister of human resource development to consider issuing withdrawal of soft drinks from Indian schools and colleges39.

A study released by centre for science and environment (CSE), Delhi on August 2006 found pesticides in 11 soft drink brands. The high lights of 2006 CSE study on pesticides in soft drinks brands are:

• A cocktail 3-6 pesticide was present in all samples.
• Lindane (a confirmed carcinogen) level was over 54 times above the Bureau of Indian standard (BIS).
• Chlorpyrifos level 47 times higher in 4-5 brands.
• Heptachlor, banned in India was found in 70% of samples at levels 4 times higher than BIS standards.
• Average amount of pesticide residues found in all samples was 11.85 parts/billion.24 times greater than BIS standards.38

In August 2006 after the controversial news report about the presence of pesticides in soft drinks sold in India, many state governments have issued a ban of the sale of soft drinks in school. Kerala has issued a complete ban on the sale or manufacture of soft drinks altogether. The other states starts banning soft drinks are Gujrat, Punjab, Haryana, Andrapredash, and Deihi37.

On December 2006 the Karnataka government re imposes ban on soft drinks in schools, colleges, in the interest of children’s health. The government re impose the ban after the controversy over the products containing a high level of pesticides. However, the state governments are not empowered to impose such a ban but they are taking the necessary steps, judicial authority is also doing its work into the matter20.

Indian dental association and Paediatric association (2008) showed that soft drink consumption among children could cause dental caries and childhood obesity.75% of children aged between 8-19 years suffered from one of these problems15.Recent Indian health service survey (2008) on oral health showed that 79% of Indian children aged 5-15 years have tooth decay and the main cause is the continuous exposure to sweets and weak acids seen in soft drinks and candies.

Most health problems are related to poor hygienic practices, unhealthy food habits. This focuses the importance of health education.Haej; CaineBish proved the effectiveness of a student information class on a healthy dietary choices and bad effect of soft drink on health11.

Now a day the soft drink manufacturing companies mainly focus children. Literatures shows that 75% of soft drink consumers are childrens.Most of children and parents are unaware about the ill effects of soft drink consumption. This study mainly focuses to help the students to develop a favourable knowledge and attitude regarding ill effects soft drink consumption. The increasing focus on the ill effects of soft drinks and the need for research will help in the development of preventive and promotional health programmes in the community.

.6.2 REVIEW OF LITERATURE

Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to research project. Before any research can be started a review of previous studies and experiences related to proposed investigations should be done. A literature review helps to determine what is known and unknown about a subject, determine gaps, consistencies, inconsistencies in literature, help to discover unanswered questions about subjects, and help to determine appropriate research design data collection and analysis methods.

For the present study the review of literature is organised under the following headings.

1. Review of literature related to the preservatives of soft drinks which cause ill effect to the health.
2. Review of Literature related to the association between soft drink consumption and childhood health problems
3. Review of literature related to soft drink consumption and its ill effects on health.

1. Review of literature related to the preservatives of soft drinks which cause ill effect to the health.

A study conducted by centre for science and environment, Delhi on August 2006 to find out the pesticide residue in soft drinks. The study found that an average pesticide residue of 11.85 parts/billion in 57 samples of 11 soft drink brands produced in 12 Indian states. It is 24 times greater than Bureau of Indian standards.The common pesticides found are Lindane, chlorpyrifos ,heptachlor etc38.

The Indian university (2007) conducted tests on soft drinks to find out the chemicals used in it and the effect of these chemicals. This study proved that it contain excessive amount of chemicals namely phosphoric acid, citric acid, carbonic acid and caffeine which harms the teeth bones and also leads to obesity, diabetes mellitus, rapid heart rate, low pressure, calcium depletion, malnutrition etc52.

A research study conducted by Dr. Mangoshadha(2007) Delhi university, to find out the preservatives of soft drinks. The study founded that in 36 soft drink samples manufactured in India contain pesticides.4 commonly found pesticides detected in soft drink samples were Lindane,DDT and its metabolites’Malathion,andChlorpyrifos.The study concluded that the health impact of the pesticides are damage to human liver,kidney,neural and immune system,cancer,death and include birth defects27.

A research study done by Peterpiper (2007) from Sheffield University in England, found that the use of Sodium Benzoate as a preservative in the soft drinks could switch off the vital part of the DNA, causing serious cell damage in human. The study concluded that soft drink consumption could lead to disease such as Parkinsonism, osteoporosis, obesity and tooth decay36.

Keast Russell (2007) performed a study to find out the role of caffeine in soft drinks. The study found that about 60% of soft drinks contain caffeine, a mild psycho active chemical as a flavouring agent. They concluded that caffeine in the soft drinks has no flavour activity and it will induce a physiologic and psychological desire to consume drinks. And excess amount could cause some psychological problems21.

2. Review of Literature related to the association between soft drink consumption and childhood health problems

Sandretto AM et al, (2005) conducted a study on obesity in African-American preschool children to find out the relation between obesity and sugar sweetened beverages.Structured questionnaire was administered to a total of 365 low income preschool children and collected the dietary information. The children were examined for 4 years. The result of the study concluded that the prevalence of overweight was 12.9% baseline and increased to 18.7% after 2 years. Prevalence of obesity increased from 10.3%-20.4% during the same period. And the consumption of sweetened beverages was significantly associated with the increased risk of obesity44.

RohitAnand,Dabuyshahipraha (2008),Sardar Patel post graduation Institute Of Dental and Medical science,Lucknow India conducted a study to find out the effect of soft drink on plaque ph in two groups. Two groups based on caries experience of 12 child patients each aged 12-16 years were included in the study and the groups were randomly allocated for soft drinks. The endogenous ph of soft drinks and plaque were collected at base line and after consumption of drinks by digital phmeter. The study revealed that the soft drinks were acidic and reduces the plaque pH. Soft drink consumption increases the development of dental caries40.

Sheetal mongers (2008) conducted a study to find out the association between change in diet and childhood obesity in Indian children. The studyconcluded that 6.22% of children were obese and 8.24% were overweight in India. More sugar content and extra calories are the main cause of childhood obesity. The fast foods, soft drinks are the main causes47

Berky, Catherine et al, (2004) conducted a prospective cohort study regarding the relationship between sugar added soft drinks and weight gain among adolescents in America. Study include >10,000 9-14 years boys and girls. They completed the questionnaire in 1996, 97 and 1998.the findings of the study concluded that children who drank 1 serving\day of sugar added soft drinks gained more weight than children drink none. Children who increased intakes by 2 or more servings \day from the prior year gained weight and the consumption of sugar added soft drinks were contributed to weight gain among adolescents5.

Al Majed (2007) conducted a study to find out the risk factor for dental erosion in 5-6 years and 12-14 years boys in India.354 boys aged 5-6 years and 862 boys aged 12-14 years were included as sample. Questionnaire was administered. The study result shows that dental erosion was seen in 34% of 5-6 years old and 26% 12-14 years old. The study findings concluded that consumption of soft drink, poor oral hygiene, more sweet consumption were associated with the development of dental erosion and caries in children1.

Olivia Love MC Cord et al, (2003) performed a study to describe the relationshipbetween body mass index and soft drink consumption among adolescents. A structured questionnaire was administered to a total of 225 children from a school in Utah country. The findings of the study concluded that those who were in the highest soft drink consumption category had a higher mean BMI than those in other soft drink categories. The study findings concluded that soft drink consumption is related to high BMI among adolescents34..

Waterhouse et al, (2008) conducted a study on diet and dental erosion in children in Tres, coracoes, southeast Brazil. The objective of the study was to investigate the association between dental erosion and consumption of acidic beverages and foods. A questionnaire survey was conducted among 458 school students. The findings of the study concluded that the frequency of sugared carbonated drinks was the only variable independently associated with erosive process56.