ICMR Counted 101 Million Indians With Diabetes, and Its Own Diet Survey Found Millet Flour Supplies Just 1.4 Percent of What They Eat

In June 2023 The Lancet Diabetes & Endocrinology published the results of ICMR-INDIAB-17, a survey of 113,043 adults, urban and rural, that the Indian Council of Medical Research had carried out in stages between 2008 and 2020. The authors counted diabetes in 11.4 percent of adults, about 101 million people (10.1 crore). Prediabetes, the stage before it, stood at 15.3 percent, about 136 million. Hypertension was 35.5 percent (about 315 million), generalised obesity 28.6 percent, and abdominal obesity 39.5 percent (about 351 million).

The authors wrote that “the prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated.” NCDs are non-communicable diseases, the ones you cannot catch from anyone.

The national figures hide a gap of more than five to one. Goa recorded diabetes in 26.4 percent of adults and Uttar Pradesh in 4.8 percent. Punjab had the highest hypertension rate, 51.8 percent, and Puducherry the highest generalised obesity, 53.3 percent. The states were surveyed in different years, so the map compares different moments as well as different places.

People looking for a culprit often point at the chilli, the tomato and the potato, the crops that crossed the Atlantic after 1492. The surveys below point at white rice and refined flour, edible oil, packaged food, and a run of government decisions about what India should grow.

A second survey, three years on

On 29 May 2026 the Health Ministry released the fact sheets of the sixth National Family Health Survey, fielded in 2023 and 2024 by the International Institute for Population Sciences in Mumbai. The ministry’s own note gives the adult nutrition trend. Among women aged 15 to 49, the share overweight or obese was 20.6 percent in NFHS-4, 24.0 percent in NFHS-5 and 30.7 percent in NFHS-6. Among men it went from 18.9 to 22.9 to 27.3 percent.

The survey also records “high blood sugar.” For women it rose from 13.5 to 17.8 percent between NFHS-5 and NFHS-6, and for men from 15.6 to 20.9 percent. The ministry’s note describes this as an indicative point prevalence of diabetes among people over 15 “at the time of survey.”

One number went the other way. Elevated blood pressure fell, from 21.3 to 19.4 percent among women and from 24.0 to 22.1 percent among men. The note also counts 420 million screenings for hypertension and 418 million for diabetes at the health and wellness centres set up from 2018. The note’s summary of the adult trend reads: “Adult obesity is rising rapidly, creating a dual burden of undernutrition and overnutrition.”

What is on the plate

A national count of what Indians eat comes from the same ICMR team. In Nature Medicine on 30 September 2025, the ICMR-INDIAB survey-21 reported the diets of 18,090 adults. Carbohydrate supplied 62.3 percent of their energy. Refined cereals, meaning white rice, refined wheat flour (maida), semolina and polished millet, supplied 28.5 percent. Milled whole grains, such as whole wheat ground into atta, supplied 16.2 percent. Protein supplied about 12 percent.

The mix differs by region. The paper reports refined rice as the main cereal for 99 percent of people in the Northeast, 87 percent in the South and 78 percent in the East, while whole wheat ground into flour led in the North (90 percent) and the Centre (70 percent). Whole millet flour was eaten by more than a third of people only in Karnataka (47.7 percent), Gujarat and Maharashtra (35 percent each).

The paper’s abstract says: “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.”

The authors then compared people by how much carbohydrate they ate. Those in the highest group had higher odds of newly diagnosed type 2 diabetes than those in the lowest, with an odds ratio of 1.30. An odds ratio of 1.30 means odds about 30 percent higher. The study is a survey taken at one moment, so it shows an association and cannot show what happens to a person who changes what they eat.

A second result concerns atta. The authors modelled replacing refined cereals with whole wheat or millet flour without cutting the total amount of carbohydrate. That swap “was not associated with lower risk” of type 2 diabetes, with an odds ratio of 0.94 and a wide confidence interval of 0.57 to 1.56. Modelled swaps that replaced carbohydrate with plant, dairy, egg or fish protein were linked to lower odds, from 0.89 for dairy to 0.91 for egg. In that analysis, moving from white rice or maida to atta or millet flour at the same total carbohydrate showed no detectable difference.

Where the millet went

The government’s Press Information Bureau put the history in a 2023 briefing for the International Year of Millets. Millets were traditionally eaten in India, it said, but “due to the push given to food security through Green Revolution in the 1960s, millets were rendered as ‘orphan crops’.” Before the Green Revolution, the briefing says, millets made up around 40 percent of all cultivated grains. The share has since dropped to around 20 percent. The same briefing calls millets “nutritionally superior to wheat and rice owing to their higher levels of protein with a more balanced amino acid profile.” That is a claim about the grain. The INDIAB-21 swap test described above grouped millet flour with whole wheat flour, and the grouped swap showed no detectable difference in diabetes odds.

Two economists, Lipsa Moharana and Alli Pandiyathuray, set out the numbers in a Frontiers in Environmental Economics paper in July 2026. Millet available per person fell from 32 kg a year in 1960-61 to about 9 kg in 2020-21. These are availability estimates and not a measured intake. The area sown to millets shrank from 37 million hectares to 13.5 million over the same years. In the National Sample Survey, jowar, bajra and ragi made up nearly 36 percent of the cereals a rural household consumed per person in the early 1960s and 23 percent in urban homes. By 2011-12 the shares were 6.9 percent rural and 3.0 percent urban.

They place the cause in policy. The Green Revolution, they write, brought “governmental investment of billions of rupees into developing rice and wheat fields.” From the 1960s a procurement system for rice and wheat grew around the Food Corporation of India and the public distribution system, “while providing little or no assistance concerning other cereals or grains such as millets.” The tilt persists. Under the National Food Security Act in 2022-23, millets were 2 percent of the grain distributed, and rice and wheat were over 93 percent.

Foodgrain output was 50.82 million tonnes in 1950, according to a Press Information Bureau factsheet. The Agriculture Ministry’s final estimate for 2024-25 was 357.73 million tonnes, a record. The cost that Moharana and Pandiyathuray point to is variety in the fields and on the plate.

White rice, measured

The Prospective Urban Rural Epidemiology (PURE) study followed 132,373 people in 21 countries for a mean of 9.5 years. Its authors reported in Diabetes Care in 2020 that people who ate 450 grams or more of white rice a day had a hazard ratio of 1.20 for developing diabetes, against people who ate under 150 grams. A hazard ratio of 1.20 means a 20 percent higher rate of new cases in the follow-up period. The association was strongest in South Asia, where the ratio was 1.61. During the follow-up 6,129 of the participants developed diabetes, and South Asian participants were reported to eat a median of about 630 grams of white rice a day.

The Chennai Urban Rural Epidemiology Study looked at one city. Its 2009 paper in Metabolism covered 2,042 adults. Refined grain averaged 333 grams a day and 46.9 percent of calories. People in the top quarter of refined grain intake were far more likely to have the metabolic syndrome, a cluster of high blood pressure, high blood sugar, extra waist fat and abnormal blood fats, than people in the bottom quarter. The odds ratio was 7.83. The top quarter also had a fasting blood glucose 7.9 percent higher and insulin resistance 13.6 percent higher than the bottom quarter, after the authors adjusted for age, sex, body mass index, activity and total energy intake.

The authors concluded that “higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets.” Both studies are observational, and neither can say that rice caused a given person’s diabetes. Both point the same way for South Asian eaters.

Oil, and the fat inside it

Business Standard reported in April 2025 that apparent edible oil consumption had risen from 8.2 kg a person a year in 2001 to about 24 kg. Apparent consumption is supply divided by population, so it counts oil used in restaurants and factories as well as home kitchens. INDIAB-21 also looked at fat. Nearly every state exceeded the 7 percent of energy limit for saturated fat, the exceptions being Jharkhand, Chhattisgarh, Arunachal Pradesh and Manipur. In February 2025 the Prime Minister asked Indians to cut the oil they use by 10 percent, a call the Health Ministry repeats in its NFHS-6 note.

Vanaspati, the hydrogenated cooking fat, carried a particular problem. The Centre for Science and Environment (CSE) tested brands in 2009 and found, in its own words, “trans fats in all vanaspati (partially hydrogenated vegetable oils) brands to be 5-12 times higher than the standard of Denmark,” which allowed 2 percent of total fat.

India’s food regulator, FSSAI, set a limit of 10 percent in 2013, according to CSE, and cut it to 5 percent from August 2016. A regulation notified on 2 February 2021 set 2 percent from January 2022. FSSAI said, citing 2017 estimates, that more than 1.5 million deaths a year in India are attributed to coronary heart disease, nearly 5 percent of them (71,000) to trans fat intake.

The packet

In August 2023 the World Health Organization’s South-East Asia office and the research institute ICRIER published The growth of ultra-processed foods in India. Ultra-processed foods are factory products made from refined ingredients and additives, such as sweet biscuits, packaged snacks and sweetened drinks. The report put their retail sales at ₹723 billion in 2011 and ₹2,535 billion in 2021, a compound annual growth rate of 13.37 percent. Those are current prices, not adjusted for inflation. Salty snacks grew by 16.78 percent a year. The report’s authors recommended that the regulator, in their words, “should come up with a clear and transparent definition of High Fat Sugar Salt (HFSS) food,” and that India consider taxes tied to the nutrient content of a product.

The same report contains a number that cuts the other way. Ultra-processed foods were 43 percent of all processed food sales by value in 2011 and 36 percent in 2021, because processed essential foods, the other part of the total, grew faster.

Sugar has its own article, India gave the world sugar, and the habit of sweet tea has another, how Britain taught India to drink tea. INDIAB-21 names added sugar as one of the low-quality carbohydrates in Indian diets, and found it above the 5 percent of energy recommendation in 21 states and union territories.

Household spending shows the packet reaching poorer homes. A 2024 working paper for the Economic Advisory Council to the Prime Minister found that packaged processed food rose from 1.8 percent to 3.1 percent of total spending in the poorest fifth of rural households between 2011-12 and 2022-23. The same paper found cereal spending falling, and it credits free grain for part of that: the government’s PMGKAY scheme gives free foodgrains to about 800 million people. Those are shares of spending, which is not the same as what was eaten. The Statistics Ministry’s household survey for 2023-24 says beverages, refreshments and processed food have the major expenditure share in the food basket in both rural and urban India.

Chilli, potato, tomato

Portuguese ships brought the chilli to India around 1542, as Europe went looking for India’s pepper recounts, and what India cooked before it has its own article. A large study of chilli and health comes from China. In BMJ in 2015, Lv and colleagues followed 487,375 adults aged 30 to 79 in the China Kadoorie Biobank. People who ate spicy food six or seven days a week had a hazard ratio for death of 0.86, a 14 percent lower risk, than people who ate it less than once a week. The study’s authors cautioned: “This is an observational study so no definitive conclusions can be drawn about cause and effect.” It measured mortality in China and says nothing about diabetes in India.

The potato study points at the frying. In August 2025 The BMJ published an analysis of three American cohorts of more than 205,000 health professionals followed between 1984 and 2021, with 22,299 cases of type 2 diabetes. Three servings a week of French fries were linked to a 20 percent higher risk. Baked, boiled or mashed potatoes showed no substantially raised risk. Swapping potatoes for whole grains lowered risk by 8 percent, and swapping them for white rice raised it. The researchers wrote that “the association between potato intake and type 2 diabetes risk depends on the specific foods used as replacement.”

That study did not test samosas or aloo tikki. Both are fried potato, so the French fry result is the nearest evidence, and carrying it over to them is an inference. How the potato reached India is told in how potato and tomato came to India. The editors found no study linking tomato consumption to diabetes.

Physical activity belongs in the account too. The Lancet Global Health reported in 2024, in work led by Tessa Strain at the University of Edinburgh, that nearly half of Indian adults were insufficiently physically active in 2022, 57 percent of women and 42 percent of men.

Shorter lives, fewer diabetics

Earlier generations had a different problem. A 2021 working paper from the International Institute for Population Sciences in Mumbai found, drawing on earlier estimates, that average life expectancy in India was only around 25 years for males between 1881 and 1920, and 25.6 years for females in 1901 to 1911. Infant mortality ran above 200 deaths per thousand live births, and the authors say fluctuations in the population were mostly due to epidemics and famines, the kind this site covers in Lytton’s Madras famine of 1877 and Bengal in 1943. The Sample Registration System put life expectancy at 69.8 years for 2017 to 2021, as Down To Earth reported in February 2026. Part of the reason chronic disease is hard to find in the records of that time may be that few people lived to the ages when it usually appears, and nothing like INDIAB existed to count it.

India now carries both burdens. NFHS-6 found child stunting down from 35.5 percent to 29.3 percent between the fifth and sixth rounds, while the adult figures above went up. In a note on the survey published on 18 June 2026, Manisha Dhulipala, writing for CDPP, said: “India is now trapped in a dangerous pincer movement: we are simultaneously fighting the residual battles of severe undernutrition in early childhood and the escalating costs of cardiovascular disease, stroke, and diabetes in adulthood.”

How a body ends up diabetic, and what a mother’s diet can do to her child’s risk, are the subject of the next piece in this series.

What ICMR now tells Indians to eat

In May 2024 ICMR and its National Institute of Nutrition in Hyderabad released revised Dietary Guidelines for Indians. A balanced diet, they say, “should provide not more than 45% calories (energy) from cereals and millets” and up to 15 percent from pulses, beans and meat. The guidelines recommend 50 to 55 percent of calories from carbohydrate. INDIAB-21 found 62.3 percent.

The guidelines also carry two large claims, which belong to ICMR-NIN and should be read as its estimates. They state: “Estimates show that 56.4% of total disease burden in India is due to unhealthy diets.” The passage where it appears gives no calculation for it. They add that healthy diets and physical activity can prevent up to 80 percent of type 2 diabetes.

India has taken millets to the United Nations. Millets were notified as “Nutri-cereals” in April 2018. India’s proposal for an International Year of Millets was supported by 72 countries, and the United Nations General Assembly declared 2023 the year in March 2021. India produces about 20 percent of the world’s millet, according to the Press Information Bureau’s 2023 briefing, which cites FAO figures for 2021.

In ICMR’s own diet survey, published in September 2025, millet flour supplied 1.4 percent of the energy that Indians eat.