A high intake of carbohydrates is associated with a higher risk of type 2 diabetes, prediabetes, and other metabolic conditions, and 80% of Indians are susceptible to at least one of these, the study said.
The findings were based on the dietary profile of 18,090 adults from a larger 15-year study of 113,043 adults conducted by the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB) between October 2008 and December 2020.
Cereal killers
The study shows that much of Indians’ carb intake is primarily low-quality carbohydrates such as refined cereals, milled whole grains, and added sugar. Refined cereals, led by white rice, accounted for 28.5% of daily calorie intake, followed by milled whole grains such as wheat and millet flour (16.2%). The study defined ‘refined cereals’ as meals or snacks prepared with white rice, maida, refined millet grains/flour, rava and vermicelli.
Simultaneously, Indians’ protein intake is suboptimal, accounting for just 12% of total calorie intake, below the recommended threshold of 15%. Within proteins, plant sources such as cereals and legumes contributed to the bulk at 8.9% of total energy. Dairy and animal protein (poultry, eggs and fish) accounted for barely 1-2%.
After carbs, fats are the biggest concern, accounting for 25.2% of daily energy intake. While the figure is within the ICMR’s recommended limit of 30%, the quality of fats consumed is usually poor. Foods rich in saturated fats—considered an unhealthy type of fat—account for nearly 9% of energy intake. “Intakes of saturated fat were above national dietary recommendations of <10%E (greater than 10% total daily calorie intake) for the general population in 10 states,” the report said.
Shape shifters
While high-carb diets are a common across India, the sources of these carbs vary by region. White rice, whole wheat flour, and millet flours are key sources of carbs in Indian diets. White rice is most dominant in the north-east and south India, with 99% and 87% of the respective populations consuming it, the study said. In north India, 90% of the population consumes whole wheat flour in form of rotis, but only 8% eats rice.
Consumption of millet-based flours is the highest in south India, at 11% of the population. At the country level, 60.8% of Indians consume white rice, while 34.3% consume whole wheat flour.
To be sure, not all carbs are unhealthy. The main culprit is refined or processed carbs. R. M. Anjana, the lead author of the study and managing director of Dr. Mohan’s Diabetes Specialities Centre, pointed out that “there’s a lot of refining of carbohydrates, which causes loss of nutrients, leading to blood sugar spikes”.
Sugar high
Sugar is a natural part of many foods. However, the consumption of added sugar—another processed carb—beyond the recommended level has been linked with several health risks.
And Indians do consume a lot of added sugar: it is alarmingly high in 19 states and union territories, where it accounts for more than 6% of total calorie intake, against the recommended level of 5%. This study took into account sugar added during cooking, at the table, and in processed foods that label it (such as soft drinks, juices and chocolates). As such, actual consumption may be higher.
There is also substantial variation by region. Only the north-east consumes sugar within permissible limits. The median intake is lowest in this region at 2.1%, and highest in the northern states at 7.9%. State-wise data shows that Haryana (11%), Odisha (10.7%) and Delhi (10.4%), topped the sugar consumption charts. Apart from the north-eastern states (barring Meghalaya), Tamil Nadu (4.8%) is the only other state that controls its sugar cravings.
Action, reaction
Eating a high-carb diet over a long period poses serious health risks, and the study bore this out. A staggering 83% of participants surveyed already had at least one metabolic risk (defined as the presence of either newly diagnosed type 2 diabetes, prediabetes, dyslipidaemia, obesity or hypertension).
The paper also noted that individuals whose carbohydrate consumption exceeded 56% of total calorie count, regardless of grain type, had a 14-30% higher chance of developing these cardiometabolic diseases. Even small changes in diet can help combat this. Switching just 5% of daily calories from carbohydrates to protein significantly lowers the risk of diabetes and prediabetes, it said.