India's diabetes driver is different from the rest of Asia: Study explains why
A new Asia-wide analysis has identified low fruit intake as a major dietary driver of type 2 diabetes in India and South Asia. The finding sharpens calls for local dietary advice that also focuses on foods people are missing.
The study, published in Diabetes Research and Clinical Nutrition, analysed data from the Global Burden of Disease (GBD) Study 2023 across 34 Asian countries and found that dietary risks were responsible for nearly 10 million disability-adjusted life years (DALYs) – a measure combining years lost to illness and premature death - and 214,810 deaths from type 2 diabetes across Asia in 2023 alone.
Among all dietary risks examined, a diet low in fruit emerged as the single largest contributor, accounting for 3.6 million DALYs and nearly 86,000 deaths across the continent.
More importantly, the study highlights that Asia's diabetes epidemic is far from uniform.
While countries such as China, Japan and several Central Asian nations are increasingly battling the consequences of diets high in red and processed meat, South Asia-and India in particular- faces a very different nutritional challenge.
Researchers found that diets low in fruit and whole grains were the dominant dietary drivers of type 2 diabetes across South Asia, pointing to a distinct regional pattern that calls for prevention strategies tailored to local eating habits rather than one-size-fits-all dietary advice.
Commenting on the finding, Mumbai-based diabetes expert Dr Shashank Joshi pointed out that the country had its own data as well to suggest this.
It is estimated that about 10.1 crore Indians have full-blown diabetes while another 13.6 crore people have prediabetes, a precursor to the metabolic condition that triggers many complications as it progresses.
An important research from the Madras Diabetes Research Foundation (MDRF) and the Indian Council of Medical Research (ICMR)-INDIAB study that came out last year revealed that Indians derive about 62 percent of their calories from carbohydrates, largely from refined grains like white rice and added sugars.
INDIA’S UNIQUE CHALLENGE
The findings reinforce a growing body of Indian research suggesting that the country's diabetes epidemic is driven as much by nutritional deficiencies as by unhealthy excesses.
India today has the second-largest population of people living with diabetes in the world, and experts have increasingly argued that the disease cannot be explained simply by rising sugar consumption or obesity.
In an ICMR-Madras Diabetes Research Foundation (MDRF) study in 2024, researchers found that fried foods, baked foods and ultra-processed foods are contributing significantly to India's growing diabetes burden.
But the study also underscored another uniquely Indian problem: diets that are disproportionately high in refined carbohydrates and deficient in protective foods such as fruits, vegetables, whole grains and quality proteins.
The new analysis complements those findings by showing that the absence of fruit itself has become the largest diet-related contributor to diabetes burden in South Asia.
That may appear counterintuitive in a country where many people diagnosed with diabetes are routinely advised – or choose on their own – to avoid fruit because of its natural sugar content.
Experts say that misconception may actually be depriving people of foods rich in fibre, vitamins, antioxidants and bioactive compounds that improve metabolic health.
Veteran diabetologist and MDRF chairman Dr V. Mohan said the findings are consistent with years of research from India.
"This directly supports our work over the last several years. We have published in Nature Medicine showing that carbohydrates are a main driver of the diabetes epidemic in India, coupled with low protein intake and low fibre intake," he told India Today.
He added that the quality of dietary fat also matters.
"Healthy fats containing monounsaturated fats, such as nuts and seeds, olive oil, groundnut oil and mustard oil – are protective. In contrast, saturated fats such as ghee, coconut oil and palm oil increase the risk not only of diabetes but also of metabolic syndrome."
According to Dr Mohan, the new study's findings on fruit and whole grains fit well with existing Indian evidence.
"I am not surprised. It is well known that if you consume less fibre and fewer whole-grain cereals containing bran, you are more prone to diabetes. In India, polished rice, from which the bran has been removed, has been linked to diabetes. That is what we showed in our ICMR-INDIAB study," he said.
DIFFERENT FROM ASIA
One of the study's most striking observations is how sharply diabetes drivers differ across Asia.
In East Asia, including China, diets high in unprocessed red meat contributed the largest share of diabetes burden. In high-income Asia-Pacific countries such as Japan, processed meat emerged as the leading dietary risk. Across Central Asia, the combined consumption of red and processed meat accounted for the greatest burden.
South Asia, however, stood apart.
Rather than excessive meat consumption, inadequate intake of fruits and whole grains emerged as the defining dietary risk.
That distinction has important implications for public health messaging.
Many diabetes awareness campaigns have traditionally focused on what people should eliminate from their diets. But the latest findings suggest that, at least in India, equal attention must be paid to foods people are not eating enough of.
The findings also expose what may be described as India's "missing fruit" paradox.
Despite being one of the world's largest producers of fruits and having year-round access to diverse seasonal produce, fruit consumption remains well below recommended levels for a significant section of the population.
Cost, accessibility, changing food habits, urbanisation and misconceptions surrounding fruit intake among people with diabetes all contribute to the gap.
The authors argue that region-specific dietary strategies are essential if countries hope to reduce the growing diabetes burden. For South Asia, that means encouraging greater consumption of whole fruits and replacing refined grains with whole grains.
The researchers suggest these findings could help primary care physicians prioritise simple, evidence-based dietary counselling rather than relying solely on generic advice to reduce sugar.
The study also arrives amid growing concern over India's rapidly rising diabetes numbers.
More than 60 per cent of people with diabetes globally now live in Asia, with India, China and Pakistan accounting for the largest absolute numbers.
The study, published in Diabetes Research and Clinical Nutrition, analysed data from the Global Burden of Disease (GBD) Study 2023 across 34 Asian countries and found that dietary risks were responsible for nearly 10 million disability-adjusted life years (DALYs) – a measure combining years lost to illness and premature death - and 214,810 deaths from type 2 diabetes across Asia in 2023 alone.
Among all dietary risks examined, a diet low in fruit emerged as the single largest contributor, accounting for 3.6 million DALYs and nearly 86,000 deaths across the continent.
More importantly, the study highlights that Asia's diabetes epidemic is far from uniform.
While countries such as China, Japan and several Central Asian nations are increasingly battling the consequences of diets high in red and processed meat, South Asia-and India in particular- faces a very different nutritional challenge.
Researchers found that diets low in fruit and whole grains were the dominant dietary drivers of type 2 diabetes across South Asia, pointing to a distinct regional pattern that calls for prevention strategies tailored to local eating habits rather than one-size-fits-all dietary advice.
Commenting on the finding, Mumbai-based diabetes expert Dr Shashank Joshi pointed out that the country had its own data as well to suggest this.
It is estimated that about 10.1 crore Indians have full-blown diabetes while another 13.6 crore people have prediabetes, a precursor to the metabolic condition that triggers many complications as it progresses.
An important research from the Madras Diabetes Research Foundation (MDRF) and the Indian Council of Medical Research (ICMR)-INDIAB study that came out last year revealed that Indians derive about 62 percent of their calories from carbohydrates, largely from refined grains like white rice and added sugars.
INDIA’S UNIQUE CHALLENGE
The findings reinforce a growing body of Indian research suggesting that the country's diabetes epidemic is driven as much by nutritional deficiencies as by unhealthy excesses.
India today has the second-largest population of people living with diabetes in the world, and experts have increasingly argued that the disease cannot be explained simply by rising sugar consumption or obesity.
In an ICMR-Madras Diabetes Research Foundation (MDRF) study in 2024, researchers found that fried foods, baked foods and ultra-processed foods are contributing significantly to India's growing diabetes burden.
But the study also underscored another uniquely Indian problem: diets that are disproportionately high in refined carbohydrates and deficient in protective foods such as fruits, vegetables, whole grains and quality proteins.
The new analysis complements those findings by showing that the absence of fruit itself has become the largest diet-related contributor to diabetes burden in South Asia.
That may appear counterintuitive in a country where many people diagnosed with diabetes are routinely advised – or choose on their own – to avoid fruit because of its natural sugar content.
Experts say that misconception may actually be depriving people of foods rich in fibre, vitamins, antioxidants and bioactive compounds that improve metabolic health.
Veteran diabetologist and MDRF chairman Dr V. Mohan said the findings are consistent with years of research from India.
"This directly supports our work over the last several years. We have published in Nature Medicine showing that carbohydrates are a main driver of the diabetes epidemic in India, coupled with low protein intake and low fibre intake," he told India Today.
He added that the quality of dietary fat also matters.
"Healthy fats containing monounsaturated fats, such as nuts and seeds, olive oil, groundnut oil and mustard oil – are protective. In contrast, saturated fats such as ghee, coconut oil and palm oil increase the risk not only of diabetes but also of metabolic syndrome."
According to Dr Mohan, the new study's findings on fruit and whole grains fit well with existing Indian evidence.
"I am not surprised. It is well known that if you consume less fibre and fewer whole-grain cereals containing bran, you are more prone to diabetes. In India, polished rice, from which the bran has been removed, has been linked to diabetes. That is what we showed in our ICMR-INDIAB study," he said.
DIFFERENT FROM ASIA
One of the study's most striking observations is how sharply diabetes drivers differ across Asia.
In East Asia, including China, diets high in unprocessed red meat contributed the largest share of diabetes burden. In high-income Asia-Pacific countries such as Japan, processed meat emerged as the leading dietary risk. Across Central Asia, the combined consumption of red and processed meat accounted for the greatest burden.
South Asia, however, stood apart.
Rather than excessive meat consumption, inadequate intake of fruits and whole grains emerged as the defining dietary risk.
That distinction has important implications for public health messaging.
Many diabetes awareness campaigns have traditionally focused on what people should eliminate from their diets. But the latest findings suggest that, at least in India, equal attention must be paid to foods people are not eating enough of.
The findings also expose what may be described as India's "missing fruit" paradox.
Despite being one of the world's largest producers of fruits and having year-round access to diverse seasonal produce, fruit consumption remains well below recommended levels for a significant section of the population.
Cost, accessibility, changing food habits, urbanisation and misconceptions surrounding fruit intake among people with diabetes all contribute to the gap.
The authors argue that region-specific dietary strategies are essential if countries hope to reduce the growing diabetes burden. For South Asia, that means encouraging greater consumption of whole fruits and replacing refined grains with whole grains.
The researchers suggest these findings could help primary care physicians prioritise simple, evidence-based dietary counselling rather than relying solely on generic advice to reduce sugar.
The study also arrives amid growing concern over India's rapidly rising diabetes numbers.
More than 60 per cent of people with diabetes globally now live in Asia, with India, China and Pakistan accounting for the largest absolute numbers.
