Indians are a long way away from an ideal diet

The new recommendations were published last week by The Lancet as the result of a three-year commission involving a global team of experts, assimilating the latest research to arrive at a consensus on the best mix of foods for the health of individuals and the planet. The commission recommends a 2,500 Kcal per day diet with a focus on whole grain instead of processed flour, a mix of animal and plant proteins, a reduction of sugar intake and of dairy-based fats and saturated fats. Universal adoption of a diet similar to the reference diet would prevent 10.9 million deaths per year or 22·4% of adult deaths (from coronary heart disease, stroke, type-2 diabetes mellitus, some cancers, and other non-communicable lifestyle diseases) the authors estimate.

Using The Lancet commission’s reference diet, the actual consumption and the nutritional value of the same items for average rural and urban Indians can be calculated using 2011-12 consumption expenditure survey data from the National Sample Survey Office (NSSO).The food categories used by Lancet in its recommendations do not correspond precisely with the carbohydrate/ protein/ fats categories used by the NSSO. But the diet from the Lancet report can be recreated by using daily per capita intake information from the Household Consumption of Various Goods and Services in India (2011-12) report, and the per unit nutritional information from the Nutritional Intake in India (2011-12) report.

By building up from each individual item in this way, the total quantity of calories consumed daily adds up to around 29-30 Kcal per day less than the total NSSO estimates for daily consumption. This is on account of the nutritional information for some food items being impossible to calculate owing to data shortcomings.

The comparison shows that the average Indian, whether rural or urban, consumes more carbohydrates in the form of cereals than The Lancet commission recommends. On the other hand, the average Indian consumes far less protein than is necessary in a healthy diet.

While the developed world consumed far more red meat than is good for their health or is environmentally sustainable (North Americans consume 6.5 times the daily recommended quantity), Indians ate too little, at half the recommended levels. Upping protein intake in India is vital: In low-income populations in which the majority of energy comes from starchy carbohydrates, the addition of meat or other major protein sources is likely to mitigate micronutrient deficiencies and have metabolic benefits by reducing the impact on blood sugar, the commission observes. Not just animal proteins, Indians consume too little of plant proteins as well. As against the recommendation of 50 grams of lentils and 25 grams of soy foods per day, Indians consume just half the amount of lentils and no soy foods, the NSSO data shows.

Additionally, Indians eat too few fruit and vegetables and not enough unsaturated oils, while consuming dairy fat (like ghee) which the commission recommends restricting, although it is worth noting that the debate on saturated and unsaturated fats is not yet settled with some researchers disputing the mainstream consensus on the harmful effects of saturated fats.

Indians also consume between 200 and 300 Kcal every day of foods that the commission says are harmful for individual and planet health. This includes junk food and eating out.

Since the early 1980s, the total calories consumed by Indians fell as their levels of physical activity dropped, but in 2011-12 the nutritional intake recovered slightly. Over time the share of calorific intake that comes from cereals has dropped. However, protein intake has also fallen on average although there are significant difference among the rich and the poor on this.

As Indians get richer, they consume more fruits and vegetables, but they also begin to consume far more dairy, fat and sugar than is recommended. Meanwhile, the consumption of pulses does not rise substantially among the richest 5% of people, and the consumption of meat still lags the recommended average. Instead, the consumption of junk food skyrockets with rising incomes. Even the richest Indians eat less of protein than recommended.

The EAT-Lancet commission recommends a diverse diet with a focus on whole foods over processed foods. Roughly 20% of rural Indians and 23% of urban Indians are still undernourished, NSSO data shows. However around 18% are in what the NSSO calls the “over-nourished end". Even Indians with the economic means to eat a more diverse diet choose more unhealthy processed foods rather than more healthy whole foods, the NSSO data shows.

Rukmini S. is a Chennai-based journalist.