Dietary profiles and associated metabolic risk factors in India from the ICMR–INDIAB survey-21

Rapid dietary transitions in India have been associated with an alarming rise in cardiometabolic diseases. Using data from the national Indian Council of Medical Research-India Diabetes survey (18,090 adults), we examined India's dietary profile and the effect of isocaloric substitution of carbohydrates with other macronutrients on metabolic risk. Indian diets are characterized by high intakes of low-quality carbohydrates (white rice, milled whole grains and added sugar), high levels of saturated fat and low intakes of protein. Compared to those with the least carbohydrate intakes, those with the highest intakes had higher risk of newly diagnosed type 2 diabetes (T2D; odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14,1.47), prediabetes (OR = 1.20, 95% CI = 1.06,1.33), generalized obesity (OR = 1.22, 95% CI = 1.07,1.37) and abdominal obesity (OR = 1.15, 95% CI = 1.01, 1.30). Replacing refined cereals with whole wheat or millet flour without decreasing overall carbohydrate quantity was not associated with lower risk for T2D (OR = 0.94, 95% CI = 0.57, 1.56) or abdominal obesity (OR = 1.08, 95% CI = 0.66, 1.76). Modeled isocaloric substitution of carbohydrates for plant, dairy, egg or fish protein was associated with lower likelihood of T2D (ranging from OR = 0.89, 95% CI = 0.83, 0.95-for dairy to OR = 0.91, 95% CI = 0.82, 0.99-egg) and prediabetes (ranging from OR = 0.82, 95% CI = 0.72, 0.92-for dairy to OR = 0.94, 95% CI = 0.89, 0.99-for fish). Public health strategies that reduce overall carbohydrates and saturated fat while increasing intake of plant and dairy proteins could mitigate the risk of metabolic diseases in India.