Overview of Indian Diet 

• India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fats, simple sugars, salt, and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity, diabetes, metabolic syndrome, and cardiovascular disease (CVD).

• Diet is a difficult risk factor to compare among populations, because of considerable variation within and between South Asian countries. In general, the average Indian diet tends to be high in carbohydrates, saturated fat, trans fat (mostly related to the widespread use of vanaspati), and low in protein, cholesterol, monounsaturated fat (MUFA), and polyunsaturated fat (n-3 PUFA), and fiber.¹

• However, there is wide variation in the total and saturated fat intake with the affluent consuming 3 times more fat than the rural poor in India. These nutritional imbalances are associated with insulin resistance, diabetes, and, dyslipidemia (high triglyceride and low HDL) leading to CVD in South Asians.¹ Asian Indians and South Asians are prone to develop insulin resistance and metabolic syndrome at a young age.

• In general, Asian Indians are more likely to be vegetarians and use high saturated fat dairy products and high trans fat fried foods. Unlike western vegetarians who consume liberal amounts of fish and chicken, Indian vegetarians do not consume these foods.

• Ghee (clarified butter) is used in large quantities by the affluent in most regions of South Asia (See Contaminated Vegetarianism).² Vegetarianism often results in reduced consumption of omega-3 fatty acids, which are found in fish products and are thought to be cardioprotective. Conversely, the penchant for fried food and liberal use of vegetable ghee results in very high consumption of trans fat.

• Beef consumption is negligible and the portion size of meat is 50g as opposed to 100g in western countries. The frequency of consumption of meat is also low─ a few times a month. High fat beef is not available. Furthermore, beef is not consumed by more than 90% of the Indians due to religious practices. The cow is considered a sacred animal by certain religions.

• Cultural differences likely pose barriers to lower CVD risk in a number of areas. Traditional cuisine might not include a lot of fruits and vegetables in some regions, whereas overcooking and frying practices can lead to reduced nutrient levels in vegetables.

• The recently published consensus dietary guidelines calls for a reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats,  reduction in trans fats, slightly higher protein intake, lower intake of salt, and restricted intake of sugar than was previously recommended.³

• Asian Indians are known to have high triglycerides and low HDL and this may be due in part to the high carbohydrate intake or high glycemic load. Higher intake of carbohydrate is associated with higher fasting glucose, higher triglycerides (24mg/dl) and lower HDL (5mg/dl).

• Energy-adjusted carbohydrate intake in Canada is highest among South Asians, lowest among Chinese and intermediate among Europids.

• Reducing the frequency of intake of sugar-containing soft drinks, juices, snacks and white rice may be beneficial.⁴

• Higher intakes of unhealthy saturated fat, trans fat have been reported in South Asians.^{1, 5, 6} Such a diet can lead to dangerous dyslipidemia (abnormal blood lipids). Although 50% or more of Indians are vegetarian, fiber intake is low in this population.

• Indians have a low consumption of the highly beneficial n-3 PUFA and MUFA compared to Europids.^{7, 8}

• South Asians (adults, children, and even pregnant women) consume less fruits, vegetables, and fiber than Europids although more than half of Indians are vegetarians.^9-11 Eating a diet high in fresh fruits and vegetables promotes heart health, whereas low intake of fruits contribute to the development of diabetes and heart disease. Low fruit and vegetable intake accounts for about 20% of cardiovascular disease worldwide.¹²

• In the CADI study, involving Indian physicians and their family members, the average energy intakes from carbohydrates, total fats, and saturated fats were 56%, 32%, and 8% respectively. High total fat intake was associated with obesity and high carbohydrate intake (>280grams per day) was associated with high TG levels. Leisure-time activity averaged 136 minutes/week and negatively correlated with total plasma cholesterol level and low-density lipoprotein cholesterol level.¹³

• Both total carbohydrates and dietary glycemic load intake are inversely associated with plasma HDL-C concentrations among Asian Indians, with dietary glycemic load having a stronger association.¹⁴

• Dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. ¹

Sources

1. Misra A, Khurana L, Isharwal S, Bhardwaj S. South Asian diets and insulin resistance. The British journal of nutrition. Oct 9 2008:1-9.

2. Jacobson MS. Cholesterol oxides in Indian ghee: possible cause of unexplained high risk of atherosclerosis in Indian immigrant populations. Lancet. Sep 19 1987;2(8560):656-658.

3. Misra A, Sharma R, Gulati S ea. Consensus dietary guidelines for healthy living and prevention of obesity, the metabolic syndrome, diabetes, and related disorders in asian indians. Diabetes Technol Ther. 2011;13:683-694.

4. Merchant AT, Anand SS, Kelemen LE, et al. Carbohydrate intake and HDL in a multiethnic population. Am J Clin Nutr. Jan 2007;85(1):225-230.

5. Enas EA, Senthilkumar A, Chennikkara H, Bjurlin MA. Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations. Indian heart journal. Jul-Aug 2003;55(4):310-338.

6. Enas EA. Cooking oils, cholesterol and CAD: facts and myths. Indian heart journal. Jul-Aug 1996;48(4):423-427.

7. McKeigue PM, Marmot MG, Adelstein AM, et al. Diet and risk factors for coronary heart disease in Asians in northwest London. Lancet. 1985;2(8464):1086-1090.

8. Miller GJ, Kotecha S, Wilkinson WH, et al. Dietary and other characteristics relevant for coronary heart disease in men of Indian, West Indian and European descent in London. Atherosclerosis. 1988;70(1-2):63-72.

9. Pushpamma P., Geervani P, Rani MU. Food intake and nutrient adequacy of rural population of Andhra Pradesh, India. Hum Nutr Appl Nutr. Aug 1982;36A(4):293-301.

10. Panwar B, Punia D. Food intake of rural pregnant women of Haryana State, northern India: relationship with education and income. Int J Food Sci Nutr. May 1998;49(3):243-247.

11. Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. Jama. Jan 17 2007;297(3):286-294.

12. Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916: Diet, Nutrition and the Prevention of Chronic Diseases Geneva: World Health Organization 2003.

13. Yagalla MV, Hoerr SL, Song WO, Enas E, Garg A. Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States. J Am Diet Assoc. 1996;96(3):257-261.

14. Radhika G, Ganesan A, Sathya RM, Sudha V, Mohan V. Dietary carbohydrates, glycemic load and serum high-density lipoprotein cholesterol concentrations among South Indian adults. European journal of clinical nutrition. Nov 7 2007.