NEW DELHI: India’s rapidly changing eating habits with high consumption of refined carbohydrates like wheat and white rice and saturated fat are fuelling a dramatic rise in diabetes and obesity, a latest ICMR study said.
The study by the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) recommended that Indians should replace these diets with plant, milk and animal-based proteins.
The study, published in Nature Medicine, also revealed that while there was significant diversity in nutrient intakes across the states, most Indians get a staggering 62% of their calories from carbohydrates, one of the highest rates in the world.
The cross-sectional survey, conducted in collaboration with the Madras Diabetes Research Foundation (MDRF), also found that a significant portion of carbohydrates comes from low-quality sources, such as white rice, milled whole grains, and added sugar.
While white rice dominates diets in the South, East, and Northeast, wheat is more common in the North and Central regions.
The study, which surveyed 1,21,077 Indian adults from urban and rural areas of 36 states, found that high carbohydrate calories and their primary food sources were associated with increased metabolic risk like diabetes, prediabetes and obesity.
Speaking with TNIE, Dr V. Mohan, senior author of the paper and Chairman, MDRF, said, “Replacing just 5% of daily calories from carbohydrates with plant or dairy proteins significantly lowers risk of developing diabetes and prediabetes.”
“Importantly, replacing carbs with red meat protein or fats did not have the same protective effect,” he said.
"More than sugar, it is the rice and wheat which is eaten in excess and which are fuelling NCDs, especially diabetes."
Dr RM Anjana, lead author and President of MDRF, said that their findings clearly show that typical Indian diets, which are 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.”
The study, which is the most exhaustive study linking various dietary factors to diabetes, obesity, and their prevalence across the country, state by state, and region by region, also found that most protein in Indian diets comes from plant-based foods, such as cereals, pulses, and legumes.
However, the intakes of dairy and animal protein varied widely but remained low nationwide.
Sudha, joint first author and Senior Scientist and Head of the Department of Foods, Nutrition, and Dietetics Research at MDRF, noted that similar metabolic risks were observed across all regions, regardless of the primary carbohydrate sources.
“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, said 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.”
The study found that millets, as a main staple, are consumed in only three states: Karnataka, Gujarat, and Maharashtra, with primary types including finger millet (ragi), sorghum (jowar), and pearl millet (bajra).
Highlighting high sugar intake, the study found that 21 states and union territories exceeded the national recommendations of less than 5%E for added sugar intake.
A recent ICMR-INDIAB study, conducted from November 2008 to December 2020, found the prevalence of type 2 diabetes and prediabetes of 11.4% and 15.3%, respectively. The prevalence of generalised obesity and abdominal obesity was also high at 28.6% and 39.5%, respectively. NCDs account for 6.3 million (68%) of all deaths in India.
By 2060, the economic costs of overweight and obesity are projected to reach $839 billion (2.47% of the nation’s GDP).
“Given the enormous public health burden of NCDs and their associated economic costs, it is crucial to identify cost-effective, practical strategies for reducing NCD risk,” Dr Mohan said.
What to eat
Plant protein includes cereals, pulses, legumes, fruits, vegetables, including roots and tubers, nuts and oilseeds
Dairy protein includes fermented dairy protein (Indian style yoghurt (curd), buttermilk, lassi) and non-fermented dairy protein - all types of milk, milk added to coffee and tea, paneer
Animal protein includes red meat, poultry, fish and egg, and does not include dairy protein
What Indians are eating
High intakes of low-quality carbohydrates like white rice, milled whole grains and added sugar
High levels of saturated fat – ghee in the North, and use of subsidised palm oil and coconut oil in the South
Palmolein oil is used due to its lower cost compared to other vegetable oils
It is also widely used in the food industry and in processed foods
Low intakes of protein