Review | Published:

Interventions and public health nutrition

Abdominal obesity and type 2 diabetes in Asian Indians: dietary strategies including edible oils, cooking practices and sugar intake

European Journal of Clinical Nutrition volume 71, pages 850857 (2017) | Download Citation


Obesity and type 2 diabetes are increasing in rural and urban regions of South Asia including India. Pattern of fat deposition in abdomen, ectopic fat deposition (liver, pancreas) and also low lean mass are contributory to early-onset insulin resistance, dysmetabolic state and diabetes in Asian Indians. These metabolic perturbations are further exacerbated by changing lifestyle, diet urbanization, and mechanization. Important dietary imbalances include increasing use of oils containing high amount of trans fatty acids and saturated fats (partially hydrogenated vegetable oil, palmolein oil) use of deep frying method and reheating of oils for cooking, high intake of saturated fats, sugar and refined carbohydrates, low intake of protein, fiber and increasing intake of processed foods. Although dietary intervention trials are few; the data show that improving quality of carbohydrates (more complex carbohydrates), improving fat quality (more monounsaturated fatty acids and omega 3 polyunsaturated fatty acids) and increasing protein intake could improve blood glucose, serum insulin, lipids, inflammatory markers and hepatic fat, but more studies are needed. Finally, regulatory framework must be tightened to impose taxes on sugar-sweetened beverages, oils such as palmolein, and dietary fats and limit trans fats.


Obesity and metabolic syndrome, not known to be prevalent previously in South Asians due to generally labour intensive lifestyle and frugal diets, are increasing in urban and semi-urban regions of South Asia.1, 2 These are prime determinants of type 2 diabetes, and cardiovascular disease.3 In general, despite some differences, similar secular trends have been seen in all South Asian countries, including India, Afghanistan, Bangladesh, Bhutan, Pakistan, Maldives, Sri Lanka and Nepal.4

In this review, we intend to discuss impact of obesity patterns, changing dietary practices and cooking methods, nutrient manipulations and intervention in context of obesity, insulin resistance, metabolic syndrome and cardiovascular risk factors in Asian Indians, with some reference to South Asians.

A literature search was conducted of studies on obesity specifically abdominal obesity and trends in changing dietary pattern with respect to carbohydrates, fats and protein from 1966 to January 2017 in the medical search database of PubMed (National Library of Medicine, Bethesda, MD, USA) and Google Scholar. We carried out a literature search using the terms ‘obesity, abdominal obesity’, ‘trends in the consumption of: carbohydrates, fats, protein’, ‘consumption of processed food’, ‘dietary interventions’, ‘sugar tax’ and ‘fat tax’ in the Indian context. The Data have also been extracted from references known to authors, and from following websites of the World Health Organization (WHO), National Sample Survey Organization (NSSO India), the Food and Agricultural Organization (FAO), and industries related to sugar and edible oil production.

Abdominal obesity, ectopic fat and diabetes

Increasing trend of obesity, abdominal obesity and metabolic syndrome is particularly worrisome since Asian Indians develop diabetes and atherogenic dyslipidemia at lower levels of body mass index and waist circumference.5, 6 These data have necessitated lower cutoffs for definitions of overweight and obesity vs whites.7 Onset of dyslipidemia and metabolic syndrome are early contributing factors to onset of diabetes.8

It is important to understand pattern of fat deposition and lean mass in various parts of body of South Asians, since these impact metabolism (Table 1). The data show a number of differences in comparison to white Caucasians. While intra-abdominal visceral adipose tissue is higher in South Asians,9 specifically in those with diabetes,10 these observations were not shown in women residing in USA.11 In particular, there is excess of truncal and abdominal subcutaneous adiposity. Specifically, deep subcutaneous abdominal adipose tissue (deep SCAT) may have more metabolic activity, and its expansion may adversely affect insulin resistance and cardiovascular risk12 in South Asians who have thicker abdominal subcutaneous adipose tissue,13 with excess deep SCAT. Further, hepatic fat accumulation is ~2-folds higher in the Asian Indians compared with all other ethnic groups, associated with heightened insulin resistance. Such excess hepatic fat is also associated with increased pancreatic volume (surrogate of ‘fatty pancreas’). Specifically, in non-obese patients with diabetes, pancreatic volume and liver span (a surrogate of excess fat deposition in liver) were increased by 26.6 and 10.8%, respectively, as compared to non-obese non-diabetic Asian Indians.14 Interestingly, increased fat deposition in liver and pancreas in Asian Indians, in a preliminary cross-sectional data, have potential of predicting diabetes.15 Fatty pancreas appears to be a particularly interesting pathological entity, and may have potential to reflect both insulin resistance and insulin secretory defect, and needs further research in this ethnic group. Interestingly, abdominal subcutaneous adipocyte area is increased in South Asians.13 Adjustment for adipocyte area attenuated the ethnic differences in insulin and adiponectin levels and liver fat in South Asians. Further, the subcutaneous adipocyte size was inversely correlated to glucose disposal rate in South Asians, independent of intra-peritoneal fat.16 These authors opined that heightened insulin resistance in South Asians appears to be related more to increased truncal subcutaneous fat and adipose tissue dysfunction than to excess intra-abdominal visceral fat.

Table 1: Adiposity and lean mass in South Asians: impact on metabolism

A less investigated issue is skeletal muscle mass and its impact on metabolism in South Asians. The comparative data suggest lower skeletal muscle mass in South Asians vs white Caucasians;13 possible explanations being low physical activity, low-protein diets and genetic make-up in the former.17 In particular, thigh muscle area is lower in South Asians, in both genders, and associated with diabetes and coronary heart disease.18 In a study done on limited sample of South Indians, 39.5% of patients had pre-sarcopenia independently associated with diabetes.19 Another facet of muscle composition is accumulation of intra-myocellular triglycerides, which are higher in Asian Indians with type 2 diabetes,20 but did not have significant correlation with insulin sensitivity as compared to white Europeans.21 This issue of ‘fatty muscles’ and low skeletal muscle mass, in South Asians, needs more research with focus on protein intake and genetic determinants, including myostatin gene.17

Much of the above discussion must be taken in context of nutrition and physical activity. Various issues pertaining to nutrition, oil intake and dietary habits vis-à-vis obesity and type 2 diabetes will be discussed in subsequent sections.

Nutrition transition in India: impact of open market economy

Rapid urbanization, mechanization, changing lifestyle and trade liberalization over past three decades has led to changes in dietary consumption patterns, including processed foods in India. Foreign direct investment (FDI) has become increasingly important since the mid-1980s, enabling production, distribution and consumption of highly processed foods, and has attracted foreign investment.22 In India, there is increasing demand for processed food products since they can be prepared easily and are reasonably priced.23 The national policy aims to increase the level of food processing from 10 (2010) to 25% in 15 years and this market is growing at 14% per annum.24, 25

Cooking methods: impact on oil composition

The traditional cooking practice adopted in India involves the cooks (home, restaurants) and roadside food vendors who heat and reheat fats and oils in a large karahi (a deep, thick, circular pot used for open-air deep frying) at high temperatures and almost always reuse of such oils to cut costs.34 These processes promote neo-formed contaminants (NFCs) such as advanced glycation end-products (AGEs) and trans-fatty acids (TFAs).35, 36 TFAs are also formed during the frying, during partial hydrogenation of vegetable oils and in small amounts during refining of vegetable oils.37 The formation of TFAs during food frying is increased in high temperature frying and reuse of same oils.38 It is proposed that high heat/frying as cooking methods may be important contributor to CVD in South Asians.39 Bhardwaj et al34 researched formation of TFAs when oils/fats as used in Indian cooking, are constantly heated at high temperature and underwent deep frying. These procedures resulted in high levels of TFAs and SFAs at the cost of cis-unsaturated fatty acids. Further, TFA formation after heating/frying was even observed for three oils that had undetectable amounts of TFA (refined soybean oil, refined groundnut oil and refined olive oil) before heating. Increased consumption of TFAs may occur with increasing use of PHVO, repeated heating of fats/oils for preparation of popular and frequently consumed traditional fried snacks.40

Increasing intake of refined carbohydrates, non-home-cooked foods and processed foods

Consumption of refined carbohydrates is high in Asians Indians/South Asians. Noodles, vermicelli and refined flour breads, kulchas (a type of leavened bread made from refined wheat flour), pao bread (a small loaf of bread made from refined wheat flour) are being increasingly consumed instead of whole wheat flour chapatis (unleavened flat bread made from whole wheat flour), millet chapatis and chilas (pancake made from gram flour). Refined carbohydrates are mainly rapidly digesting starches, which lead to higher postprandial glucose peak, a reported problem with Asian Indians.

The NSSO lists processed foods into two categories: those served in restaurants, dhabas (roadside restaurants), snack bars and so on, and those which are bought and consumed at home. Taken together, beverages and processed foods accounted for 7.9% (1.75 USD) of consumer expenditure in rural India and 9% (3.66 USD) in urban India.

The data from 68th round of National Sample Survey Organization (NSSO)26 show that there is a substantial increase in the consumption of ‘misc. foods’ (which includes processed foods), in both rural (2.4–7.04%) and urban areas (5.6–8.6%) from 1993 to 2012. Further, the snacks (mostly potato based) market in India is worth 220 million USD with rapid annual growth.41 The National level data show that consumption of salted refreshments (savory) has increased from 0.04 kg per capita per month to 15.08 kg per capita per month in 2012.26 Importantly, carbonated drinks sales in India is US$ 1.5 billion, while the fruit juice and fruit juice-based drink sales are US$ 0.25 billion. Growing at a rate of 25%, the fruit-drinks category is one of the fastest growing segments in the beverages market.41

Traditionally a higher priority has always been given to fresh foods rather than the purchase of convenience foods in India, but these are changing now.42 In a study conducted in four cities of India in 2011, about 88% of the children felt that home-cooked food was healthy but 40% of the children felt that home-cooked food was ‘old fashioned’.43 Importantly, younger Indians are more willing to opt for novel food products and they have an innate tendency of perceiving imported foods to be of ‘high quality’ in comparison to locally produced products.43, 44 NSSO data show a clear increase in the percent share of calories from ‘misc. foods’ from 2.32 and 5.52% in 2000 to 8.61 and 9.01% in 2012 in rural and urban areas, respectively. Interestingly, along with an increased consumption of modern processed foods from transnational food companies (TFCs), which are high in carbohydrates, fats, sugars and salt, India is also creating processed versions of traditional dishes; ready-to-eat dals (soups prepared from pulses), parathas (shallow fried unleavened flat breads of wheat flour), pulaos (rice cooked with vegetables and spices) and so on.)

Sugar intake in Asian Indians, obesity and diabetes

Sugar intake leads to the several adverse metabolic events; accumulation of body fat and intra-abdominal fat, excess liver fat, increased insulin resistance, hypertriglyceridemia, increased free fatty acids, hyperuricemia and diabetes.45, 46 It is important to note that India is the second largest (after Brazil) producer and largest consumer of sugar globally.47 Further, India is the largest producer of khandsari and gur (other forms of locally produced ‘traditional’ sugar in India).48 Interestingly, while intake of these ‘traditional sugars’ has declined, intake of sugar from sugar-sweetened beverages (SSBs) has increased. It is interesting to note that when consumption from jaggery/khandsari and SSBs are added to that of white sugar,49, 50, 51, 52 the ‘total’ sugar intake in Indians is around 25.17 Kg per annum, exceeding the per capita global consumption of 23.7 kg per annum.53 Finally, consumption of traditional sweets, which have high concentration of sugar and fat, is high in India.

Specifically, increased risks for obesity, diabetes, and heart disease is closely associated with consumption of sugar-sweetened beverages (SSBs).54 Since 1998, sales of SSBs have increased by 13% per year in India and these are easily available in rural and urban areas.52

Protein intake in Asian Indians and sarcopenia

Protein intake in Asian Indians has been more discussed in context of under-nutrition and poor growth, rather than obesity and diabetes. National data show relatively lower intake of protein in Asian Indians (10.8% in rural and 10.9% in urban population) vs north Americans in USA (nearly 16%).55, 56 Protein intake has not changed much over past one decade in both rural and urban India and there is hardly any difference in the protein intake of rural and urban populations (Figure 1).

Importantly, when protein digestibility-corrected amino acid score (PDCAAS), using lysine as the first limiting amino acid, is considered, all population segments in India, particularly rural and tribal, have an inadequate quality of their protein intake.57 Besides these data, research studies are few. In a study done on 1236 subjects (607 males, 629 females) aged 13–25 years from schools and colleges of New Delhi, intake of protein was 11% of energy intake, while a small study showed higher protein intake (14% males and 12% females) in immigrant Asian Indians in Michigan, USA.58 Low protein intake may be more marked in vegetarians.59

Overall protein intake and its quality are lower in Asian Indians and may impact the skeletal muscle mass and sarcopenia.

Evidence of benefits of nutrient manipulation for South Asians

To curb rising prevalence of obesity and type 2 diabetes in Asian Indians, simple and cost-effective strategies are needed. It is important, therefore, to focus on interventions that can improve insulin sensitivity and decrease adiposity, and also target ectopic fat (including liver fat). Low intake of monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs) and fiber, and high intake of saturated fats, TFAs and carbohydrates60 are some of the imbalances in nutrition of Asian Indians/South Asians, and these could be targeted for metabolic benefits. Intervention trials with nutrition are few, pertinent ones are summarized below.


While there are studies which show that decreasing carbohydrates in diets may help in reducing weight and improving insulin sensitivity, it is not always possible in South Asians, because of their tendency to eat largely carbohydrate based diets. In STARCH (Study To Assess the dietaRy CarboHydrate) study, it was observed that carbohydrates constitute 64.1% of the total energy in Indian patients with type 2 diabetes.61 Cereals are staple foods and contribute about two-thirds of the total carbohydrates consumed.62 It may, however, be feasible to alter quality of carbohydrates so as to have metabolic benefits. Mohan et al63 in a randomized cross over trial on 15 non-diabetic Asian Indians, compared white rice with brown rice and brown rice with legumes. The percentage difference in 5-day average incremental area under the curve was 19.8% lower in the brown rice group than in the white rice group (P=0.004). Brown rice with legumes intake further decreased the glycemic response (22.9% lower compared with white rice, P=0.02). The authors concluded that 24-h glucose and fasting insulin responses among overweight Asian Indians can be reduced by consumption of brown rice in place of white rice.63 Given importance of carbohydrates in diets consumed by Asian Indians, more research is needed.


There is a paucity of intervention trials on protein intake, muscle strength and diabetes in Asian Indians. In view of low efficiency protein of vegetarian diet in Asian Indians, trials using higher dietary protein, and in particular for lysine and leucine are needed. In a 8-week trial in healthy men, high lysine diets (80 mg/kg per day) had a positive effect, albeit small, on muscle strength.64 In a well-characterized birth cohort (n=1446, 32% females, born near Hyderabad, India, in 29 villages from 1987 to 1990), adult lean body mass (LBM) and muscle was assessed after long-term nutrition program. Multivariable regression analyses showed that adult LBM and muscle strength has positive association with physical activity levels and energy intake. This study could not detect a ‘programming’ effect of early nutrition supplementation on adult LBM and muscle strength.65 In a randomized trial, 60 sedentary osteoporotic women (mean age 54.55 years) were assigned to three groups: soy + exercise group, soy isolate protein (Group A), and control group. Significant muscle performance changes, after intervention were evident in 60 osteoporotic sedentary postmenopausal women.66 Although high protein intake was associated with diabetes in a study with limited number of immigrant Asian Indians, the findings need to be substantiated.67

Increasing protein in diets may also lead to weight loss with multiple metabolic benefits. In a randomized controlled parallel arm open label study on obese Asian Indians (n=122), intervention with diet high in protein (29% of total energy) and low in carbohydrates (47%) against a control diet of 60% carbohydrates and 15% protein over a period of 3 months has shown significant reduction in body weight, waist circumference, blood pressure, fasting blood glucose, serum insulin, lipids, hs-CRP and liver aminotransferases.68 Possible mechanisms of weight loss with high-protein diets include increased thermogenesis and satiety.69, 70 Satiety is influenced by the postprandial amino acid concentrations, through stimulation of gastrointestinal hormones cholecystokinin, Peptide YY (PYY) and glucagon-like peptide-1 (GLP-1).71, 72, 73

MUFA-rich diets


Dietary intake of MUFAs increase insulin sensitivity while regulating postprandial glucose levels, minimizing increases in blood TC and LDL-C and promoting elevated HDL-C levels.74 In a randomized controlled parallel arm open label study in Asian Indians with the metabolic syndrome (n=60), intervention high-MUFA diet, which included unsalted pistachio nuts (20% of total energy) for 6 months resulted in beneficial effects on waist circumference, fasting blood glucose, lipid parameters, adiponectin, free fatty acids, hs-CRP and oxidative stress.75

In another study in Asian Indian subjects with type 2 diabetes (n=63), supplementation with almonds (20% of total energy) for 6 months led to significant reduction in waist circumference, waist-to-height ratio, TC, LDL-C, serum triglycerides, glycosylated hemoglobin and hs-CRP.76

Edible oils

In randomized controlled trial, interventions with the olive or canola cooking oils (20 g per day) vs oils low in MUFAs for 6 months in Asian Indians with non-alcoholic fatty liver (n=93) improved grading of fatty liver, fasting blood glucose, serum triglycerides high-density lipoprotein cholesterol and serum insulin was reported.77

Such interventions with MUFA-rich diets are important for South Asians because of their impact on abdominal obesity, metabolic syndrome and subclinical inflammation. Clearly, more experiments with dietary MUFAs are needed in Asian Indians.

Omega 3 polyunsaturated fatty acids

It has been hypothesized the prevalence of metabolic abnormalities among Asian Indians may be related to an imbalance in dietary PUFAs intake,78 specifically the higher intake of n-6 PUFAs in combination with the lower intake of long-chain (LC) n-3 PUFAs. However, only a few intervention studies with n-3 PUFAs are available for South Asians. In this context, Indu & Ghafoorunissa showed supplementation of oral intake of n-3 PUFAs on serum triglycerides and decrease platelet aggregation in a limited number of subjects.79 A randomized, double-blind, placebo-controlled, parallel, fish-oil intervention study by Lovegrove et al.,80 where 44 Europeans and 40 Indo-Indian Sikhs were randomly assigned to receive either 4.0 g fish oil (1.5 g eicosapentaenoic acid (EPA) and 1.0 g docosahexaenoic acid (DHA)) or 4.0 g olive oil (control) daily for 12 weeks showed a significant decrease in plasma triacylglycerol, plasma apolipoprotein B-48 and platelet phospholipid arachidonic acid concentrations in Indo-Asians with fish oil intervention but insulin sensitivity remained unchanged.

These interventions highlight the need for dietary modifications for Asian Indians who have the higher propensity for developing metabolic perturbations. The potentially important dietary intervention among Asian Indians are listed in Table 3.

Table 3: Proposed changes in macro and micronutrient intake focusing on obesity, insulin resistance and diabetes in Asian Indians based on literature review

Regulation of harmful foods in south Asians: possible benefits

Sugar-sweetened beverages

Increasing taxation on sugar, SSBs and edible fats are part of public health nutrition approach to curb obesity and diabetes.81 A strategic controlling of price can be instrumental in lowering the consumption of unhealthy foods which can minimize the negative effects of the nutrition transition.82 A study by Ford et al83 in the US showed that price increases of 10%, 15, and 20% on SSBs were associated with fewer purchases of juice drinks. Basu et al.51 suggest that a 20% soda tax may lead to a reduction of 3% in obesity (or prevent 11.2 million new cases), and a 1.6% decrease in prevalence of T2DM (or prevent 400 000 cases), over the decade 2014–2023 in India. These compelling data should lead to reformulation of strategies for curbing non-communicable diseases by enhancing taxation on SSBs.

Palm oil

As stated previously, consumption of palm oil is high in India. Basu et al30 in a modeling study proposed that 20% tax on palm oil purchases in India was projected to avert approximately 363 000 deaths from cardiovascular disease (myocardial infarction and stroke; 1.3% reduction in cardiovascular deaths) over the period 2014–23.

Trans fatty acids

Standards for TFAs in India are being debated since 2004 by the Union Ministry of Health and Family Welfare. In 2009, Center for Science and Environment (CSE) had released a study that found that the quantity of trans fats in all vanaspati brands was 5–12 times higher than the standards for Denmark, that is, 2% of the total fat content. In 2010, the National Institute of Nutrition (NIN) conducted a national consultation which concluded that the levels of trans fats in vanaspati should be below 10%. The Food Safety and Standards Authority of India (FSSAI) had drafted regulations for TFA limits at 10 per cent (by weight) in 2010, and proposed to bring it to five per cent in three years. However, it still is not implemented.

Importantly, labelling for TFA poses a major challenge in India Considering the negative effects of TFA on health (specifically in Asian Indians with high propensity to develop CVD) and increase in formation of TFA on repeated use of oils, it should be mandatory to carry out laboratory analysis of the TFA content of each batch of fats/oils used for frying. Finally, stringent policies regarding quality of edible fats/oils should be developed for India.34

Fat tax

Recently, in July, 2016 a ‘fat’ tax (tax on burgers, pizzas and other junk food) of 14.5% is introduced in the state of Kerala, India. It is estimated that tax would add 100 million rupees (1.53 million USD) annually to state’s funds and also make people more conscious of their food choices.84

Other governmental interventions

Policy evidence from existing food tax implementation suggests that taxes need to be paralleled by subsidies on healthier foods like fruits and vegetables and other interventions to encourage healthy eating.85 Such dual methods would be helpful for in changing consumer behavior and improved nutrition outcomes.


Dietary pattern is rapidly changing in India owing to changing lifestyle, and is contributing to increasing numbers of obesity, diabetes and cardiovascular disease. The National data show increasing consumption of sugar, fats and processed foods in India. There is strong need to curtail the consumption of these foods by implementation of policies such as increased taxation. Also strategies like improving the carbohydrate quality, correct choice of cooking oils, increasing protein intake, increasing MUFA and n-3 fatty acids in the diet, while cutting down intakes of sugar and SSBs and saturated and trans fats could be helpful in preventing abdominal adiposity, ectopic fat deposition, hyperglycemia, and atherosclerosis.


  1. 1.

    , . Obesity and dyslipidemia in South Asians. Nutrients 2013; 5: 2708–2733.

  2. 2.

    , , , , . Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC Public Health 2017; 17: 101.

  3. 3.

    , , , , . Diabetes in South Asians. Diabet Med 2014; 31: 1153–1162.

  4. 4.

    , , , , . Obesity, diabetes and cardiovascular diseases in India: public health challenges. Curr Diabetes Rev 2016; 13: 65–80.

  5. 5.

    , , , , . Metabolic cardiovascular risk factors worsen continuously across the spectrum of body mass index in Asian Indians. Indian Heart J 2012; 64: 236–244.

  6. 6.

    , , , , , et al. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi cross-sectional studies. PLoS One 2014; 9: e90813.

  7. 7.

    , , , , , et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163–170.

  8. 8.

    , , , , , et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009; 9: 28.

  9. 9.

    , , , . Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab 2001; 86: 5366–5371.

  10. 10.

    , , , , , et al. Estimation of liver span using MRI for prediction of type 2 diabetes in non-obese Asian Indians. J Diabetes Sci Technol 2017; 11: 446–447.

  11. 11.

    , , , , . Fat distribution and insulin resistance in young adult nonobese Asian Indian women. Metab Syndr Relat Disord 2012; 10: 326–330.

  12. 12.

    , , , , , et al. Structural and functional properties of deep abdominal subcutaneous adipose tissue explain its association with insulin resistance and cardiovascular risk in men. Diabetes Care 2014; 37: 821–829.

  13. 13.

    , , , , , et al. Adipocyte hypertrophy, fatty liver and metabolic risk factors in South Asians: the molecular study of health and risk in ethnic groups (mol-SHARE). PLoS One 2011; 6: e22112.

  14. 14.

    , , , , , . Body fat patterning, hepatic fat and pancreatic volume of non-obese asian indians with type 2 diabetes in north india: a case-control study. PLoS One 2015; 10: e0140447.

  15. 15.

    , , , , . Diabetes risk prediction model for non-obese Asian Indians residing in North India using cut-off values for pancreatic and intra-abdominal fat volume and liver span. J Diabetes 2016; 8: 729–731.

  16. 16.

    , , , , , et al. Insulin resistance and body fat distribution in South Asian men compared to Caucasian men. PLoS One 2007; 2: e812.

  17. 17.

    , , , , , et al. Association of the Myostatin gene with obesity, abdominal obesity and low lean body mass and in non-diabetic Asian Indians in north India. PLoS One 2012; 7: e40977.

  18. 18.

    , , , , , et al. Thigh fat and muscle each contribute to excess cardiometabolic risk in South Asians, independent of visceral adipose tissue. Obesity (Silver Spring) 2014; 22: 2071–2079.

  19. 19.

    , , , , , . The prevalence of presarcopenia in Asian Indian individuals with and without type 2 diabetes. Diabetes Technol Ther 2013; 15: 768–775.

  20. 20.

    , , , , , et al. Proton magnetic resonance spectroscopy and biochemical investigation of type 2 diabetes mellitus in Asian Indians: observation of high muscle lipids and C-reactive protein levels. Magn Reson Imaging. 2009; 27: 94–100.

  21. 21.

    , , , , , et al. Relation of triglyceride stores in skeletal muscle cells to central obesity and insulin sensitivity in European and South Asian men. Diabetologia 1999; 42: 932–935.

  22. 22.

    , , . Food processing industry in India: S&T capability, skills and employment opportunities. J Food Process Technol 2013; 2013.

  23. 23.

    . Selling to India’s Consumer Market. Quorum books: Greeenwood Publishing Group: Westport, Connecticut, London, 1997 , pp 145–210.

  24. 24.

    Directorate of Economics and Statistics, Department of Agriculture, Cooperation and Farmers Welfare. Agricultural situation in India, 2016, Ministry of Agriculture and Farmers Welfare, Government of India. Available at: (accessed on 31 March 2017).

  25. 25.

    Ministry of Food Processing Industries, Draft National Food Processing Policy, Government of India 2017. Available at: (accessed on 31 March 2017).

  26. 26.

    National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Nutritional Intake in India, 2011-12, NSS 68th Round; National Sample Survey Organization, GOI: New Delhi, India, 2014. Available at: (accessed on 12 December 2016).

  27. 27.

    National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Nutritional Intake in India, 1999-2000, NSS 55th Round Report No. 471; National Sample Survey Organization, GOI: New Delhi, India, 2001. Availble at: (accessed on 2 December 2016).

  28. 28.

    National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Nutritional Intake in India, 2004–2005, NSS 61st Round Report No. 513; National Sample Survey Organization, GOI: New Delhi, India, 2007. Available at: (accessed on 2 December 2016).

  29. 29.

    National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Nutritional Intake in India, 2009–2010, NSS 66th Round Report No. 540; National Sample Survey Organization, GOI: New Delhi, India, 2012. Available at (accessed on 2 December 2016).

  30. 30.

    , , , , , et al. Edible Oilseeds Supply and Demand Scenario in India. Implications for Policy. Available at (accessed on 2 June 2017).

  31. 31.

    Department of Food and Public Distribution. Ministry of Consumer Affairs, Food and Public Distribution. Government of India.Sugar & Vegetable Oils. Available at: (accessed on 13 December 2016).

  32. 32.

    Department of Food and Public Distribution. Ministry of consumer affairs, food and public distribution; Government of India. Sugar and vegetable oils. Available at: (accessed on 12 December 2016).

  33. 33.

    , , Edible Oilseeds Supply and Demand Scenario in India. Implications for Policy. Available at Demand _Scenario_in_India.pdf (accessed on 30 December 2016).

  34. 34.

    , , , , , et al. Effect of heating/reheating of fats/oils, as used by Asian Indians, on trans fatty acid formation. Food Chem 2016; 212: 663–670.

  35. 35.

    , , , , , et al. Intake of fried foods is associated with obesity in the cohort of Spanish adults from the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2007; 86: 198–205.

  36. 36.

    , , , , , et al. Hypertension is related to the degradation of dietary frying oils. Am J Clin Nutr 2003; 78: 1092–1097.

  37. 37.

    , , , , , et al. The analysis of trans fatty acid profiles in deep frying palm oil and chicken fillets with an improved gas chromatography method. Food Control 2014; 44: 191–197.

  38. 38.

    , , , , . Determination of thermally induced trans-fatty acids in soybean oil by attenuated total reflectance fourier transform infrared spectroscopy and gas chromatography analysis. J Agric Food Chem 2012; 60: 10709–10713.

  39. 39.

    , , , . Urbanized South Asians' susceptibility to coronary heart disease: The high-heat food preparation hypothesis. Nutrition 2017; 33: 216–224.

  40. 40.

    , . Levels of trans fats in diets consumed in developing economies. J AOAC Int 2009; 92: 1277–1283.

  41. 41.

    Government of India, National Productivity Council Productivity & Competitiveness of Indian Manufacturing. Food Processing Sector: New Delhi, India, 2009.

  42. 42.

    , , . Western style prepared foods blaze trail in Indian market. Marketing News 1999; 33: 14.

  43. 43.

    , , , , , et al. Dietary intakes and familial correlates of overweight/obesity: a four-cities study in India. Ann Nutr Metab 2013; 62: 279–290.

  44. 44.

    , . Asia bites back. Asian Business 1997; 33: 58–60.

  45. 45.

    , . Effect of L-carnitine on skeletal muscle lipids and oxidative stress in rats fed high-fructose diet. Exp Diabetes Res 2007; 2007: 72741.

  46. 46.

    , , , . Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014; 100: 65–79.

  47. 47.

    USDA Foreign Agricultural Service report 2014. Available at: (accessed on 4 December 2016).

  48. 48.

    , Industrial and policy issues and export potential of jaggery and khandsari. Proceedings of National seminar on 'Status, problems and prospects of jaggery and khandsari industries of India. Lucknow 1999.

  49. 49.

    , The gur & khandsari industry & its practical impact on Indian sugar consumption level. In Proceedings of World Assocaition of Beet and Cane Growers, New Delhi, India, 25 March 2013. Available at: (accessed on 10 December 2016).

  50. 50.

    Sugar Year book. 2012 International sugar organization. Available at: (accessed on 4 December 2016).

  51. 51.

    , , , , , . Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. PLoS Med 2014; 11: e1001582.

  52. 52.

    Euromonitor International Passport Global Market Information Database. Euromonitor: New York, NY, USA, 2013.

  53. 53.

    , . Sugar intake, obesity, and diabetes in India. Nutrients 2014; 6: 5955–5974.

  54. 54.

    , , , , , . Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010; 33: 2477–2483.

  55. 55.

    National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India. Nutritional Intake in India, 2011–2012, NSS 68th Round Report No. 560; National Sample Survey Organization, GOI: New Delhi, India, 2014. Available at: (accessed on 2 December 2016).

  56. 56.

    US Department of health and human services. Centers for disease control and prevention. National center for health statistics. Health United States, 2014. May 2015. DHHS publication no.2015-1232. Available at: (accessed on 5 December 2016).

  57. 57.

    , , . Protein intakes in India. Br J Nutr 2012; 108 (Suppl 2), S50–S58.

  58. 58.

    , . Nutrient intake, body composition, blood cholesterol and glucose levels among adult Asian Indians in the United States. J Immigr Minor Health 2007; 9: 171–178.

  59. 59.

    , , , , , et al. Nutritional profile of Indian vegetarian diets—the Indian Migration Study (IMS). Nutr J 2014; 13: 55.

  60. 60.

    , , , , , et al. Imbalanced dietary profile, anthropometry, and lipids in urban Asian Indian adolescents and young adults. J Am Coll Nutr 2010; 29: 81–91.

  61. 61.

    , , , , , et al. Results from a dietary survey in an Indian T2DM population: a STARCH study. BMJ Open 2014; 4: e005138.

  62. 62.

    , , , , , et al. Dietary profile of urban adult population in South India in the context of chronic disease epidemiology (CURES–68). Public Health Nutr 2011; 14: 591–598.

  63. 63.

    , , , , , et al. Effect of brown rice, white rice, and brown rice with legumes on blood glucose and insulin responses in overweight Asian Indians: a randomized controlled trial. Diabetes Technol Ther 2014; 16: 317–325.

  64. 64.

    , , , , , et al. The effect of a controlled 8-week metabolic ward based lysine supplementation on muscle function, insulin sensitivity and leucine kinetics in young men. Clin Nutr 2012; 31: 903–910.

  65. 65.

    , , , , , et al. The association of early life supplemental nutrition with lean body mass and grip strength in adulthood: evidence from APCAPS. Am J Epidemiol 2014; 179: 700–709.

  66. 66.

    , , . Effect of soy isolate protein and resistance exercises on muscle performance and bone health of osteopenic/osteoporotic post-menopausal women. J Women Aging 2013; 25: 183–198.

  67. 67.

    , , . Higher protein intake is associated with diabetes risk in South Asian Indians: the metabolic syndrome and atherosclerosis in South Asians living in America (MASALA) study. J Am Coll Nutr 2010; 29: 130–135.

  68. 68.

    , , , , , . Effect of high-protein meal replacement on weight and cardiometabolic profile in overweight/obese Asian Indians in north India. BMJ 2017 (in press).

  69. 69.

    , , . Dietary protein - its role in satiety, energetics, weight loss and health. Br J Nutr 2012; 108 (Suppl 2), S105–S112.

  70. 70.

    , , , , . Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr 2008; 87: 44–55.

  71. 71.

    , , , , , . Protein, weight management, and satiety. Am J Clin Nutr 2008; 87: 1558S–1561SS.

  72. 72.

    , , , , , et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab 2001; 86: 5992.

  73. 73.

    , , , . Cholecystokinin and stomach distension combine to reduce food intake in humans. Am J Physiol Regul Integr Comp Physiol 2003; 285: R992–R998.

  74. 74.

    , , , , , et al. A MUFA-rich diet improves posprandial glucose, lipid and GLP-1 responses in insulin-resistant subjects. J Am Coll Nutr 2007; 26: 434–444.

  75. 75.

    , , , , . Effects of pistachio nuts on body composition, metabolic, inflammatory and oxidative stress parameters in Asian Indians with metabolic syndrome: a 24-wk, randomized control trial. Nutrition 2014; 30: 192–197.

  76. 76.

    , , . Effect of almond supplementation on glycemia and cardiovascular risk factors in Asian Indians in North India with type 2 diabetes mellitus: a 24-week study. Metab Syndr Relat Disord 2017; 15: 98–105.

  77. 77.

    , , , , , et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther 2014; 16: 255–261.

  78. 78.

    . Requirements of dietary fats to meet nutritional needs & prevent the risk of atherosclerosis-An Indian perspective. Indian J Med Res 1998; 108: 191–202.

  79. 79.

    . n-3 fatty acids in Indian diets—Comparison of the effects of precursor (alpha-linolenic acid) Vs product (long chain n-3 poly unsaturated fatty acids). Nutr Res 1992; 12: 569–582.

  80. 80.

    , , , , , et al. Moderate fish-oil supplementation reverses low-platelet, long-chain n− 3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians. Am J Clin Nutr 2004; 79: 974–982.

  81. 81.

    , , , , , . Taxes on sugar-sweetened beverages to reduce overweight and obesity in middle-income countries: a systematic review. PLoS ONE 2016; 11: e0163358.

  82. 82.

    , , . Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue. Prev Med 2011; 52: 413–416.

  83. 83.

    , , . Targeted beverage taxes influence food and beverage purchases among households with preschool children. J Nutr 2015; 145: 1835–1843.

  84. 84.

    Tax on junk food in Kerala leaves Indians with a bitter taste. July.2016. Available at: (accessed on 10 December 2016).

  85. 85.

    , . Guest commentary: fat and other taxes, lessons for the implementation of preventive policies. Prev Med 2015; 77: 204–206.

  86. 86.

    , , . Adipose tissue collagen and inflammation in nonobese Asian Indian men. J Clin Endocrinol Metab 2013; 98: E1360–E1363.

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  1. Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India

    • S Gulati
    •  & A Misra
  2. Diabetes Foundation (India), SDA, New Delhi, India

    • S Gulati
    •  & A Misra
  3. Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India

    • A Misra


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