High-Carb, Low-Protein Diets Driving Diabetes and Obesity Surge in India, ICMR–INDIAB Study Finds

🧪 ICMR–INDIAB analysis links dietary imbalances to rising diabetes and obesity across India

A comprehensive national dietary analysis from the ICMR–INDIAB survey has brought renewed urgency to India’s spiralling diabetes and obesity crisis. The study, published in Nature Medicine, evaluates the dietary profiles of 18,090 adults across 30 states and union territories and confirms India’s high intake of low-quality carbohydrates—particularly white rice, refined wheat, and added sugars—is a significant contributor to the development of type 2 diabetes, prediabetes, and obesity.

However, perhaps more critically, the findings challenge several commonly held assumptions about healthy eating, grain substitutions, and the role of protein in the Indian diet. Most notably, switching from refined cereals to milled whole wheat or millets without reducing overall carbohydrate intake did not lower metabolic risk. Instead, isocaloric substitution with plant or dairy protein was shown to reduce the likelihood of glycaemic disorders significantly.

“This is not just about rice vs. wheat or rural vs. urban diets. The core issue is an excess of low-quality carbohydrates and a chronic protein gap, particularly from high-quality sources like dairy,” said the authors.

🔬 Key NutIndia’s Findings: What’s Really on India’s Plate?

• 62.3% of daily energy intake came from carbohydrates—among the highest globally.
• Most of this came from refined cereals (28.5%), milled grains (16.2%), and added sugar.
• Total protein intake was only 12%, with dairy protein contributing just 2.1%.
• Fat intake stayed within guidelines, but saturated fat exceeded metabolic risk thresholds in all but four states.

📉 Risk Associations: Not All Grains or Carbs Are Equal

• High carbohydrate intake (69% of energy) increased the odds of:
  1. Type 2 diabetes by 30%
  2. Prediabetes by 20%
  3. Generalised obesity by 22%
  4. Abdominal obesity by 15%
• Replacing 5% of daily calories from carbs with:
  1. Dairy protein reduced diabetes risk by 11%
  2. Plant protein reduced risk by 10%
  3. Egg and fish protein also showed benefits
  4. Red meat or fat replacements showed no benefit

Notably, milled whole wheat or millets did not offer protective effects, likely due to glycaemic spikes from fine milling, which negates the fibre and micronutrient advantages of whole grains.

🥛 The Dairy Angle: A Crucial, Underutilised Nutritional Ally

The role of dairy protein—both fermented (curd, buttermilk, lassi) and non-fermented (milk, paneer)—stood out as a protective macronutrient, especially when substituting carbohydrates.

States like Haryana, Delhi, and Gujarat led in dairy protein intake (~3–4% of energy), while most Northeastern and Eastern states lagged below 1%. The study thus presents a compelling case for increased dairy consumption as a public health strategy to combat metabolic diseases.

🌍 Regional Nuances: One Nation, Many Diets

• White rice was dominant in the South, Northeast, and East (95%+ of cereal calories)
• Whole wheat ruled the North and Central belts, but mostly in milled form
• Millets, while gaining policy attention, were only substantially consumed in Karnataka, Gujarat, and Maharashtra

Even though I” state consuming more “traditional” grains, benefits were blunted due to processing methods (milling, sieving), underscoring the need for intact whole grain consumption.

🧭 Policy Takeaways: From Public Distribution to Protein Subsidy

The study recommends a multisectoral roadmap for reshaping Indian diets:

1. Reduce high-refined carb intake, including added sugars.
2. Enhance the availability and affordability of plant and dairy proteins through subsidies.
3. Reform the Public Distribution System (PDS) to include pulses, legumes, and dairy-based staples.
4. Implement state-specific dietary policies tailored to regional consumption patterns.
5. Promote nutritional labelling, especially for sugars and fats in the informal food sector.

🧠 Conclusion: Carbohydrates Are Not the Enemy—But Balance Is Key

While Indian diets have become increasingly calorific, the composition of those calories is the genuine concern. The research underscores the urgency of rebalancing macronutrients—reducing reliance on refined carbohydrates while increasing protein intake, especially from sustainable, locally available sources such as milk, curd, and pulses.

With 83% of adults in the study having at least one metabolic risk factor, the case for transforming India’s dietary landscape is not just compelling—it is existential.