According to the latest evidence from the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study published in Nature Medicine, India’s changing eating habits are contributing to rising cases of diabetes and obesity.
The cross-sectional survey was conducted in collaboration with the Madras Diabetes Research Foundation (MDRF) and included 1,21,077 Indian adults from urban and rural areas of 36 states, union territories, and the National Capital Territory (NCT)-Delhi. Dietary data from every fifth participant was analysed to profile India’s food consumption patterns and examine inter- and intra-regional differences in macronutrient intakes and associated metabolic risk.
Carbohydrate intake
The study found that most Indians obtain 62 per cent of their calories from carbohydrates, one of the highest levels globally. Much of this comes from white rice, milled whole grains, and added sugar.
White rice is the dominant staple in the South, East, and Northeast, while wheat is more common in the North and Central regions. Millets, including finger millet (ragi), sorghum (jowar), and pearl millet (bajra), are consumed as staples only in Karnataka, Gujarat, and Maharashtra.
Added sugar intake exceeded the recommended threshold of less than 5 per cent of energy intake in 21 states and union territories.
Fat intake
While average total fat consumption remained within national guidelines (≤30 per cent of energy), saturated fat intake exceeded the recommended level (<7 per cent of energy) in all but four states: Jharkhand, Chhattisgarh, Arunachal Pradesh, and Manipur.
The intake of monounsaturated and omega-3 polyunsaturated fats was found to be low across all regions.
Protein intake
Protein intake in India was found to be suboptimal, averaging 12 per cent of daily calories. The Northeast region had the highest protein intake at 14 per cent of daily calories.
Most of the protein consumed came from plant-based foods such as cereals, pulses, and legumes (9 per cent of daily calories). Dairy protein and animal protein consumption remained low nationwide, at 2 per cent and 1 per cent of daily calories respectively.
Carbohydrates and metabolic risk
High carbohydrate intake from white rice, milled whole grains, and added sugar was associated with increased metabolic risk, including diabetes, prediabetes, and obesity.
Substitution analysis showed that replacing 5 per cent of daily calories from carbohydrates with plant or dairy proteins significantly reduced the risk of developing diabetes and prediabetes. Replacing carbohydrates with red meat protein or fats did not have the same protective effect.
Expert comments
Dr R.M. Anjana, lead author and President of the Madras Diabetes Research Foundation, said: “Our findings clearly show that typical Indian diets, heavy in carbohydrates from white rice or whole wheat flour, and low in quality protein are putting millions at risk. Simply switching from white rice to whole wheat or millets is not enough unless total carbohydrate intake decreases and more calories come from plant or dairy proteins.”
Sudha, joint first author and Senior Scientist & Head, Department of Foods Nutrition & Dietetics Research, MDRF, stated that similar metabolic risks were observed across all regions, regardless of the main carbohydrate sources.
Dr V. Mohan, senior author and Chairman of the Madras Diabetes Research Foundation, said, “These nationwide findings should inspire policy reforms, especially regarding food subsidies and public health messaging to help Indians shift towards diets richer in plant-based and dairy proteins, and lower in carbohydrates and saturated fats.”
Dr Shilpa Bhupathiraju, co-senior author, noted, “Reducing saturated fat remains a challenge. Encouraging healthier oils and more pulses and legumes could make a major difference to the health of the Nation.”
Dr V. Mohan added that dietary changes could help reverse current nutrition trends, address widespread protein gaps, and improve overall diet quality. He further said that as healthcare is a state matter, the findings will be relevant for state governments in considering healthier food subsidies. He emphasised that “this certainly requires a multisectoral approach – across health, agriculture, food processing and welfare sectors – to realign food subsidies and public messaging.”
The ICMR-INDIAB study was funded by the Indian Council of Medical Research and the Ministry of Health and Family Welfare, Government of India. The study was conducted over 15 years with MDRF as the national coordinating centre.