Scientists are studying how diet, incomes, and diseases are correlated in India

Plate half full.
Plate half full.
Image: REUTERS/Rupak De Chowdhuri
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You are what you eat goes the old adage. In India, it could mean many things.

For one, dietary habits, like dialects and customs, change every few hundred kilometres. Then income inequality vastly impacts what people eat and where they derive nutrition from: Amidst acute malnutrition and anaemia, India also has the world’s second-highest number of diabetics.

To unpack this conundrum, a team of researchers has developed a data-driven research tool to understand India’s dietary universe. A group from Queen’s University, Belfast, collaborated with one from New Delhi’s All India Institute of Medical Sciences to capture data that can eventually establish a correlation between diet and disease.

Through this new tool, questions about food intake and habits will be worked into population surveys. The responses will then be mapped to understand health care and mould policy. “We hope this measure will capture dietary data and provide a foundation for innovative and rigorous studies of diet-disease to inform policy and health care planning cross-nationally, and reduce the high socioeconomic burden of disease, especially among those who are most vulnerable,” Dr Claire McEvoy, lecturer at Queen’s University’s School of Medicine, Dentistry, and Biomedical Sciences, told Quartz during an interview.

She also spoke about the challenges India faces with an ageing population, under- and over-nutrition, and the need for more investment in public health care in the country. Edited excerpts: 

How did this project come about? 

This collaboration brings together experts from a range of disciplines (nutrition, public health, ageing, academics, and clinicians) who are interested in how food choice influences the risk of developing a disease as we get older. India is one of the fastest ageing populations in the world and dietary risks are major drivers of increasing rates of non-communicable diseases like diabetes, heart disease, and stroke. Dietary surveillance data are critically needed in India to inform public health policies and interventions to reduce disease. However, until now nutrition research has been largely under-resourced and understudied in India.

How does this tool exactly work? Who will be using it?

Dr Claire McEvoy
Dr Claire McEvoy
Image: Queen's University Belfast

Our goal is to embed the dietary assessment measure into population studies and surveys so we can study diet-disease relations. Ultimately, we aim to generate evidence-based dietary recommendations for public health and reduce the high socioeconomic burden associated with diet-related illness.

We ask people to report their typical frequency of intake of a list of over 100 foods, drinks, and spices covering all the major food groups ranging from cereals to fruit to beverages. We also ask them for additional details on the vitamins they take as well as their household intake of salt, sugar, oils, etc.

How does your research take India’s diverse cultural and financial nuances into account?

The interplay between sociocultural factors, diet, and disease has not been comprehensively investigated in India. There are wide variations in dietary practices between Indian states and between geographical regions as well as other factors that influence food choice, including income, religious, and cultural beliefs. We worked with local dietetic expertise to develop the dietary measure and tested its feasibility in both urban and rural populations in three states in the north and south of India. We hope to extend the validation of the dietary measure to other Indian states. 

Is India prepared to handle an ageing and aged population? What are some of the biggest hurdles you anticipate? 

It’s good that people are living longer but invariably this means that healthcare systems will need vast resources to treat chronic diseases that can largely be prevented by targeted public health approaches. India needs more investment in public health for disease prevention.

Culturally, how has attitude to nutrition changed in India? Are people less insecure about food and famine, and thus have their eating habits changed? Or is that true for only a small demographic?

The rapid pace of economic growth, urbanisation, and increasing life expectancy in India has fuelled a double-burden of under- and over-nutrition and diet-related disease. On one hand, nutrient deficiencies remain widespread, especially among young children and women, while non-communicable diseases are rapidly escalating and contributing to high levels of disability and even premature death. 

Does it also have specific aspects related to diabetes, a leading lifestyle disorder in India? 

The population survey in India captures data on current and medical history, educational attainment, social and cultural factors as well as measurements of health and wellbeing in older adults. Future studies will be able to investigate whether eating patterns are related to risk of disease in the population and help inform policies to reduce preventable disease.

How far along are you in the research process? When do you expect this research to present its first set of findings? 

It took almost a year to develop this tool. We then carried out training with fieldworkers and pilot-tested the diet questionnaire in Haryana, Delhi, and Chennai. We are conducting preliminary dietary data analysis but we would like to conduct further validation studies of the questionnaire before we publish the findings.