New Nature Medicine study finds 62% of Indian calories come from carbohydrates
Refined cereals, milled grains and sugar raise diabetes risk by up to 14%
21 states exceed national sugar intake guidelines
Protein intake remains suboptimal, with most coming from plant sources
Researchers say cutting carbs and boosting plant or dairy protein is key to lowering risk
India’s rapidly shifting eating habits — characterised by high carbohydrate and sugar consumption — are fuelling a dramatic rise in diabetes and obesity, according to new evidence from the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.
Carbohydrate intake among Indians is among the highest in the world, with 62 per cent of total calories derived from carbs. Much of this energy comes from low-quality sources such as white rice, milled whole grains and added sugars. Researchers found that higher calorie intake from carbohydrates was linked to a 14 per cent greater likelihood of newly diagnosed type 2 diabetes.
Type 2 diabetes occurs when the human body becomes resistant to insulin or doesn’t produce enough. It is often linked to lifestyle factors such as being overweight, physical inactivity and poor dietary choices.
The findings, published on September 30, 2025 in the journal Nature Medicine, are based on a cross-sectional survey conducted in collaboration with the Madras Diabetes Research Foundation (MDRF). The survey covered a nationally representative sample of 121,077 adults from urban and rural areas across 36 states, Union Territories and the National Capital Territory of Delhi.
Detailed dietary information from every fifth participant was used to profile eating patterns across regions and assess inter-and intra-regional differences in macronutrient intake and associated metabolic risks. The results showed consistent links between carb-heavy diets and diabetes risk.
Another alarming trend was excessive sugar intake. In 21 states and UTs, sugar consumption exceeded the national recommendation of less than 5 per cent of daily energy intake.
A meta-analysis of dietary patterns in six major regions, north, south, east, west, central and north-east, found refined cereals, milled whole grains and added sugars were associated with 13 per cent, 9 per cent and 14 per cent higher odds of type 2 diabetes, respectively.
Vasudevan Sudha, joint first author and senior scientist and head of MDRF’s Department of Foods, Nutrition and Dietetics Research, said similar metabolic risks were observed across all regions, regardless of the main carbohydrate sources.
While average total fat intake stayed within national guidelines (less than or equal to 30 per cent of daily energy), saturated fat consumption exceeded the recommended limit for metabolic health (less than 7 per cent of daily energy) in all but four states (Jharkhand, Chhattisgarh, Arunachal Pradesh and Manipur). Intake of healthier fats such as monounsaturated and omega-3 polyunsaturated fats remained low across the country.
Protein consumption was also found to be inadequate, averaging just 12 per cent of daily energy intake. The highest intake was recorded in the north-east (14 per cent), while the bulk of protein across India came from plant-based sources like cereals, pulses and legumes. Dairy and animal proteins contributed just 2 per cent and 1 per cent of total daily energy, respectively.
A modelled substitution analysis showed that replacing 5 per cent of daily calories from carbohydrates with plant or dairy proteins could significantly lower the risk of developing diabetes and prediabetes. In contrast, substituting carbs with red meat protein or fats did not offer the same protective effect.
“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,” said Ranjit Mohan Anjana, lead author of the study and president of the Madras Diabetes Research Foundation.
The solution is not simply switching from white rice to wheat or millets. Unless total carbohydrate intake is reduced and more calories come from plant or dairy proteins, the risk remains high, she said.
Replacing 50 grams of refined cereals with the same quantity of whole wheat or millet flour was not associated with lower metabolic risk, the paper found. However, replacing 5 per cent of daily energy intake from carbs with protein derived from plants, dairy, eggs or fish was linked to a lower likelihood of developing type 2 diabetes and prediabetes.