Region-specific nutritious, environmentally friendly, and affordable diets in India

Abstract

•Current diet of most Indian states is deficient in 11 out of 25 essential nutrients•Sustainable diet will cost 1.5 times more than current diet in most states•Shift to sustainable diet will massively reduce food-related GHG emissions•Filling the yield gaps of crops can ensure the sufficient domestic supply of food Over half of India's ice-free land is devoted to agriculture, employing over half of the country's population. Food production for human consumption is a large contributor to greenhouse gas emissions, freshwater scarcity, air pollution, water pollution, and several other environmental problems. Still, India is one of the most malnourished countries in the world as the daily diet of most people is lacking in essential micronutrients, such as vitamins and minerals. We present the daily intake amounts of 111 food items that need to increase or decrease in each of the 35 states for diets to be sustainable. Our quantitative findings can guide individuals in changing their food consumption behaviors as well as policymakers in taking the next steps for discouraging the production of foods that are low in nutrition and high in environmental impact, incentivizing the production of sustainable food items and ensuring the supply of nutritious food at affordable prices for its poor population. In recent times, there has been an increased international interest in India's food systems. There is a concern that, with rising population and incomes, India's adoption of unsustainable dietary patterns could have disastrous consequences not only for public health but also for the environment, locally and globally. This in turn can seriously threaten the progress toward achievement of the United Nations global Sustainable Development Goals. Identifying and informing stakeholders of sustainable dietary behaviors is thus essential. Here, using a non-linear optimization algorithm, we identify a sustainable diet for each of India's 35 states. These diets meet daily recommendations for 29 nutrients, exist within five environmental planetary boundaries, including greenhouse gas emissions, freshwater use, cropland use, nitrogen, and phosphorus application, and satisfy several cultural acceptability constraints. Results reveal that, while such a sustainable diet is possible, it will cost 50% more than current diets in most Indian states. Our results offer optimistic news that India's nutrition problem can be solved without jeopardizing the environment. In recent times, there has been an increased international interest in India's food systems. There is a concern that, with rising population and incomes, India's adoption of unsustainable dietary patterns could have disastrous consequences not only for public health but also for the environment, locally and globally. This in turn can seriously threaten the progress toward achievement of the United Nations global Sustainable Development Goals. Identifying and informing stakeholders of sustainable dietary behaviors is thus essential. Here, using a non-linear optimization algorithm, we identify a sustainable diet for each of India's 35 states. These diets meet daily recommendations for 29 nutrients, exist within five environmental planetary boundaries, including greenhouse gas emissions, freshwater use, cropland use, nitrogen, and phosphorus application, and satisfy several cultural acceptability constraints. Results reveal that, while such a sustainable diet is possible, it will cost 50% more than current diets in most Indian states. Our results offer optimistic news that India's nutrition problem can be solved without jeopardizing the environment. The Indian food consumption trajectory will play a key role over the next decade in deciding the fate of the United Nations (2030) global Sustainable Development Goals (SDGs). India is home to over 1.3 billion people (almost 20% of the global population) and suffers from a triple burden of malnutrition as high rates of hunger (undernutrition or calorie deficiency), overnutrition (overweight, obesity due to excessive caloric intake), and hidden hunger (micronutrient deficiency, i.e., deficiency of essential vitamins and minerals) coexist.1Meenakshi J.V. Trends and patterns in the triple burden of malnutrition in India.Agric. Econ. 2016; 47: 115-134Crossref Scopus (57) Google Scholar Almost every third child under the age of 5 years in India is undernourished with 36% underweight, 38% stunted (short height for age), and 21% wasted (low weight for height).2NITI AayogNITI Aayog (National Institution for Transforming India). Government of India. Nourishing India—National Nutrition Strategy.https://niti.gov.in/writereaddata/files/document_publication/Nutrition_Strategy_Booklet.pdfDate: 2017Google Scholar The number of stunted children in India account for almost one-third of the world's cases of stunting.3UNICEF-World Health Organization—The World BankJoint Child Malnutrition Estimates—Levels and Trends. WHO, 2017Google Scholar This coincides with a high prevalence of overweight, obesity, and concomitant non-communicable diseases (NCDs)4Shankar B. Agrawal S. Beaudreault A.R. Avula L. Martorell R. Osendarp S. Prabhakaran D. Mclean M.S. Dietary and nutritional change in India: implications for strategies, policies, and interventions.Ann. N. Y. Acad. Sci. 2017; 1395: 49-59Crossref PubMed Scopus (24) Google Scholar with an estimated 61% of deaths5World Health Organization Noncommunicable Diseases Progress Monitor 2017. WHO, 2017Google Scholar in India attributable to NCDs in 2017 and almost 20% of men and women suffering from overweight/obesity.2NITI AayogNITI Aayog (National Institution for Transforming India). Government of India. Nourishing India—National Nutrition Strategy.https://niti.gov.in/writereaddata/files/document_publication/Nutrition_Strategy_Booklet.pdfDate: 2017Google Scholar In addition, almost two-thirds of the Indian population suffers from deficiency of one or more micronutrients.6Rao N.D. Min J. DeFries R. Ghosh-Jerath S. Valin H. Fanzo J. Healthy, affordable and climate-friendly diets in India.Glob. Environ. Chang. 2018; 49: 154-165Crossref Scopus (58) Google Scholar, 7Chaudhary A. Gustafson D. Mathys A. Multi-indicator sustainability assessment of global food systems.Nat. Commun. 2018; 9: 848Crossref PubMed Scopus (240) Google Scholar, 8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. 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Prevention of micronutrient deficiencies in young children: consensus statement from infant and young child feeding chapter of Indian Academy of Pediatrics.Indian Pediatr. 2019; 56: 577-586Crossref PubMed Scopus (10) Google Scholar The country also faces several environmental constraints in its ability to produce adequate quantities of nutritious food, such as freshwater scarcity, limited land resource, high cost of importing fertilizers from abroad, and its commitment to reduce greenhouse gas (GHG) emissions under the Paris climate deal.14Shrivastava K. India ratifies Paris Climate Treaty: here's all you need to know. Hindustan Times.http://www.hindustantimes.com/india-news/whatsigning-the-paris-climate-change-treaty-means-for-india/story-RsDH1IAohQNEqRxb426YbM.htmlDate: 2016Google Scholar India's land mass covers only 2.4% of global land although ∼60% of the country's land mass is used for agriculture often with multiple harvests per year.15Department of Agriculture CFW State of Indian Agriculture 2015–016. Ministry of Agriculture & Farmers Welfare, Government of India, New Delhi2016Google Scholar Crop irrigation using ground and river water (blue water) accounts for 90% of freshwater use, leaving groundwater reserves depleted and resulting in acute drinking water shortages every year in many of its regions.16Rodell M. Famiglietti J.S. Wiese D.N. Reager J.T. Beaudoing H.K. Landerer F.W. Lo M.H. Emerging trends in global freshwater availability.Nature. 2018; 557: 651-659Crossref PubMed Scopus (715) Google Scholar Further increase in local water scarcity can reduce the exports of key crops to global markets as well increase the need for crop imports. It is important that efforts to address malnutrition do not jeopardize environmental planetary boundaries leading to destabilization of ecosystems with cascading negative impacts on economy and human well-being.17Steffen W. Richardson K. Rockström J. Cornell S.E. Fetzer I. Bennett E.M. Biggs R. Carpenter S.R. De Vries W. De Wit C.A. Folke C. Planetary boundaries: guiding human development on a changing planet.Science. 2015; 347: 1259855Crossref PubMed Scopus (4933) Google Scholar,18Springmann M. Clark M. Mason-D’Croz D. Wiebe K. Bodirsky B.L. Lassaletta L. de Vries W. Vermeulen S.J. Herrero M. Carlson K.M. Jonell M. Options for keeping the food system within environmental limits.Nature. 2018; 562: 519-525Crossref PubMed Scopus (1091) Google Scholar Poverty is also widespread in India and at the household level, economic constraints prevent access to healthier foods, which is clear from the fact that, already, on average, Indians spend 40%–50% of their household expenditure on just food, and for the poorest this share can be >90%.19Anand R.K. Naresh K. Tulin V. Volodymyr T. Understanding India’s Food Inflation: The Role of Demand and Supply Factors. International Monetary Fund, 2016Google Scholar Although substantial progress has been made over the past decades20Tak M. Shankar B. Kadiyala S. Dietary transition in India: temporal and regional trends, 1993 to 2012.Food Nutr. Bull. 2019; 40: 254-270Crossref PubMed Scopus (21) Google Scholar in reducing hunger, increasing agriculture production, and improving per capita incomes, eradicating malnutrition for its huge population given tremendous environmental and economic constraints is a massive challenge for India in the 21st century. In addition to supplying side interventions, such as increasing food production by closing crop yield gaps, dietary changes provide novel opportunities for countries to achieve food sustainability.7Chaudhary A. Gustafson D. Mathys A. Multi-indicator sustainability assessment of global food systems.Nat. Commun. 2018; 9: 848Crossref PubMed Scopus (240) Google Scholar,8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar,21Chen C. Chaudhary A. Mathys A. Dietary change scenarios and implications for environmental, nutrition, human health and economic dimensions of food sustainability.Nutrients. 2019; 11: 856Crossref Scopus (71) Google Scholar Transitioning to sustainable diets can create win-win scenarios for nutrition and environmental outcomes at a local as well as global level.9Willett W. Rockström J. Loken B. Springmann M. Lang T. Vermeulen S. Garnett T. Tilman D. DeClerck F. Wood A. et al.Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems.Lancet. 2019; 393: 447-492Abstract Full Text Full Text PDF PubMed Scopus (3228) Google Scholar However, answering the question of what constitutes a sustainable diet that is low in environmental impact, adequate in nutrition, affordable to the majority of people, and is culturally acceptable in the region, remains a formidable challenge. Studies looking at dietary sustainability in India and the consequences on nutrition, environment, and expenditure simultaneously are rare. Most studies focus on limited aspects of nutrition (e.g., protein and calories only) or environment (e.g., water use or GHG).22Boyer D. Sarkar J. Ramaswami A. Diets, food miles, and environmental sustainability of urban food systems: analysis of nine Indian cities.Earth's Future. 2019; 7: 911-922Crossref Scopus (12) Google Scholar, 23Green R.F. Joy E.J. Harris F. Agrawal S. Aleksandrowicz L. Hillier J. Macdiarmid J.I. Milner J. Vetter S.H. Smith P. Haines A. Greenhouse gas emissions and water footprints of typical dietary patterns in India.Sci. Total Environ. 2018; 643: 1411-1418Crossref PubMed Scopus (41) Google Scholar, 24Vetter S.H. Sapkota T.B. Hillier J. Stirling C.M. Macdiarmid J.I. Aleksandrowicz L. Green R. Joy E.J. Dangour A.D. Smith P. Greenhouse gas emissions from agricultural food production to supply Indian diets: implications for climate change mitigation.Agric. Ecosyst. Environ. 2017; 237: 234-241Crossref PubMed Scopus (110) Google Scholar Others have found that shifting to healthy diets in India might lead to a high increase in environmental footprint25Aleksandrowicz L. Green R. Joy E.J. Harris F. Hillier J. Vetter S.H. Smith P. Kulkarni B. Dangour A.D. Haines A. Environmental impacts of dietary shifts in India: a modelling study using nationally-representative data.Environ. Int. 2019; 126: 207-215Crossref PubMed Scopus (32) Google Scholar or cost to consumers.26Hirvonen K. Bai Y. Headey D. Masters W.A. Affordability of the EAT—Lancet reference diet: a global analysis.Lancet Glob. Health. 2020; 8: e59-e66Abstract Full Text Full Text PDF PubMed Scopus (196) Google Scholar Such trade-offs make it extremely difficult to design sustainable dietary guidelines. Recent studies have shown that optimization algorithms are excellent tools in determining region-specific sustainable diets that fulfill multiple goals.6Rao N.D. Min J. DeFries R. Ghosh-Jerath S. Valin H. Fanzo J. Healthy, affordable and climate-friendly diets in India.Glob. Environ. Chang. 2018; 49: 154-165Crossref Scopus (58) Google Scholar,8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar However, these past optimization studies are either limited in geographical scope (i.e., country-average rather than sub-national resolution)8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar or do not take into account affordability (economic constraints) of proposed diets8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar or consider a limited number of environmental or nutritional aspects.6Rao N.D. Min J. DeFries R. Ghosh-Jerath S. Valin H. Fanzo J. Healthy, affordable and climate-friendly diets in India.Glob. Environ. Chang. 2018; 49: 154-165Crossref Scopus (58) Google Scholar To fill the above research gaps, here we identify region-specific sustainable diets for all 35 Indian states using a non-linear optimization algorithm.8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar,27Ye Y. Interior Algorithms for Linear, Quadratic, and Linearly Constrained Non-linear Programming. Department of EES, Stanford University, Stanford1988Google Scholar An optimization algorithm is a procedure that involves comparing various solutions iteratively until an optimum or satisfactory solution is found from a set of available alternatives. This usually involves maximizing or minimizing a real mathematical function by choosing input values from an allowed set and computing the value of the function. Our optimization approach chooses different diets (by changing intake amounts of 111 food items) iteratively until a predefined objective (the deviation from current diet is minimized) is achieved under several nutritional, cultural, economic, and environmental constraints. Such a diet meeting the objective and constraints is termed as sustainable diet (see the experimental procedures and Chaudhary and Krishna8Chaudhary A. Krishna V. Country-specific sustainable diets using optimization algorithm.Environ. Sci. Technol. 2019; 53: 7694-7703Crossref PubMed Scopus (32) Google Scholar for details). We link the state-specific current food consumption data28National Sample Survey OfficeNutritional Intake in India, 2011–12. NSS 68th Round. Government of India, 2014Google Scholar providing intakes of 111 food items (in g capita−1 day−1) with Indian food composition tables providing content of 29 nutrients in each of the 111 items,29Longvah T. Anantan I. Bhaskarachary K. Venkaiah K. Indian Food Composition Tables. National Institute of Nutrition, Indian Council of Medical Research, 2017Google Scholar,30United States Department of Agriculture (USDA) National Nutrient Database for Standard References. Release 28. USDA Agricultural Research Service.http://ndb.nal.usda.gov/ndb/search/listGoogle Scholar recommended dietary intakes for India,31National Institute of Nutrition, Hyderabad. National Institute of NutritionDietary Guidelines for Indians: A Manual. NIN, 2011Google Scholar,32Vitamin and Mineral Requirements in Human Nutrition. World Health Organization, Food and Agriculture Organization, Rome, 2004.Google Scholar and recently available India-specific emission factors providing impacts per gram of food items for five environmental domains: GHG, blue water, land, nitrogen, and phosphorus application.6Rao N.D. Min J. DeFries R. Ghosh-Jerath S. Valin H. Fanzo J. Healthy, affordable and climate-friendly diets in India.Glob. Environ. Chang. 2018; 49: 154-165Crossref Scopus (58) Google Scholar,18Springmann M. Clark M. Mason-D’Croz D. Wiebe K. Bodirsky B.L. Lassaletta L. de Vries W. Vermeulen S.J. Herrero M. Carlson K.M. Jonell M. Options for keeping the food system within environmental limits.Nature. 2018; 562: 519-525Crossref PubMed Scopus (1091) Google Scholar,25Aleksandrowicz L. Green R. Joy E.J. Harris F. Hillier J. Vetter S.H. Smith P. Kulkarni B. Dangour A.D. Haines A. Environmental impacts of dietary shifts in India: a modelling study using nationally-representative data.Environ. Int. 2019; 126: 207-215Crossref PubMed Scopus (32) Google Scholar The blue water footprint represents the amount (in liters) of surface and ground water delivered to crops through irrigation.25Aleksandrowicz L. Green R. Joy E.J. Harris F. Hillier J. Vetter S.H. Smith P. Kulkarni B. Dangour A.D. Haines A. Environmental impacts of dietary shifts in India: a modelling study using nationally-representative data.Environ. Int. 2019; 126: 207-215Crossref PubMed Scopus (32) Google Scholar The objective function of the algorithm along with five acceptability constraints aim to minimize the deviation from current dietary behavior. The several constraints of the algorithm (listed in Table 1) will ensure that the increase in the cost remains as low as possible while the optimized diet meets the daily nutritional recommendations (for 25 essential nutrients and four nutrients of health concern) and the environmental footprints of per capita daily diet remain below the respective planetary boundaries for GHG emissions, freshwater use, cropland use, nitrogen application, and phosphorus application.6Rao N.D. Min J. DeFries R. Ghosh-Jerath S. Valin H. Fanzo J. Healthy, affordable and climate-friendly diets in India.Glob. Environ. Chang. 2018; 49: 154-165Crossref Scopus (58) Google Scholar,18Springmann M. Clark M. Mason-D’Croz D. Wiebe K. Bodirsky B.L. Lassaletta L. de Vries W. Vermeulen S.J. Herrero M. Carlson K.M. Jonell M. Options for keeping the food system within environmental limits.Nature. 2018; 562: 519-525Crossref PubMed Scopus (1091) Google Scholar By considering the difference in optimized and current intake amounts of all food items, we quantify how much each state's current dietary behavior needs to change to achieve a sustainable diet.Table 1Nutritional, environmental and acceptability constraints used in this studyConstraint typeValueNutritional constraintsEnergy2,300–3,200 kcal/cap/daySugar≤125 g/cap/daySaturated fats≤23 g/cap/dayTotal fats≤65 g/cap/dayCholesterol≤300 mg/cap/dayProtein≥52 g/cap/dayFiber≥29 g/cap/dayPolyunsaturated fatty acids≥14 g/cap/dayPotassium≥3,247 mg/cap/dayCalcium≥630 mg/cap/dayIron≥19 mg/cap/dayMagnesium≥252 mg/cap/dayCopper≥0.8 mg/cap/dayPhosphorus≥757 mg/cap/dayManganese≥2 mg/cap/daySelenium≥55 μg/cap/dayZinc≥10.3 mg/cap/dayThiamin≥1.1 mg/cap/dayNiacin≥15 mg/cap/dayRiboflavin≥1.4 mg/cap/dayFolate≥176 μg/cap/dayPantothenic Acid≥4.7 mg/cap/dayCholine≥550 mg/cap/dayVitamin A≥581 RAE/cap/dayVitamin C≥40 mg/cap/dayVitamin E≥10 mg/cap/dayVitamin K≥80 μg/cap/dayVitamin B6≥1.8 mg/cap/dayVitamin B12≥0.9 μg/cap/dayEnvironmental constraintsCarbon emissions≤1,866 gCO2eq./cap/dayFreshwater use≤786 L/cap/dayLand use≤5.01 m2/cap/dayNitrogen use≤27.4 gN/cap/dayPhosphorus use≤6.35 gP/cap/dayAcceptability constraintsTotal weight≥0.8 times and ≤1.5 times the total weight of current dietIndividual foods>0.1 times and <95th percentile of current levelsItems from PDS (%)= current levelsAlcohol, spices, stimulants= current levelsBeef, pork≤ current levelsItems with zero intake≤10 g in the optimized dietEconomic constraintsDaily expenditure on diet≤1.5 times expenditure on current diet Open table in a new tab Note that, currently, almost 70% of the Indian population lives in rural areas and hence rural diets are more representative of Indian diets at present. However, the percentage of the national population living in urban areas has been steadily increasing in the last decades due to migration of labor for job opportunities from rural to urban areas and other demographic factors. As urbanization further increases in the coming decades, it is important to study the rural-urban dietary and nutritional disparities. We therefore present the results for both rural and urban diets per state here. We also plotted all three sustainability dimensions (nutrient density, cost, and environmental emissions) for each food item in one graph through which one can identify the most preferred food items to address the deficiency of each of the 25 essential nutrients (i.e., items that, compared with others, are high in nutrients but low in cost and environmental emissions). Here, we show that the widespread malnutrition in India can be overcome without jeopardizing the environment albeit it will entail an ∼50% increase in food expenditure at the household level and a ∼35% increase in agricultural land demand. While there is huge heterogeneity across the 35 states, in most states, a shift to sustainable diet will entail a vegetable intake increase by 2 times that of current levels, a fruit, pulse, and other grains (millet, sorghum, maize) intake increase by 4–5 times, and a nuts intake increase by over 10 times current levels. The intake of dairy, rice, and sugar needs to be reduced by half from current levels in most states. Our findings enable a holistic understanding of the state-specific dietary transformation pathways whose adoption can help progress toward simultaneous achievement of multiple SDGs in India. India has huge geographical heterogeneity in food consumption habits. The north has relatively higher intakes of wheat, sugar, oils, and dairy, but much lower intakes of fish, meat, and poultry than other regions. The south has higher intakes of fish, poultry, rice, fruits, spices, and stimulants, but much lower intakes of roots and wheat. Diets in western states are relatively rich in oils, fats, and other grains (sorghum, millet, barley, maize), while the eastern states have higher intakes of roots and vegetables. The diet of the north-east region is characterized by higher meat and rice products and lower dairy and wheat products.28National Sample Survey OfficeNutritional Intake in India, 2011–12. NSS 68th Round. Government of India, 2014Google Scholar For almost all states, the intakes of animal-based products (eggs, beef, pork, poultry) is very small (<10 g capita−1 day−1). Dairy intake is considerable (>100 g) across all states except the north-east and rural east where it is around 50 g. The fruit intake is also low (<50 g) in almost all states, except in the southern states where it exceeds 100 g. The vegetable intake amounts are almost the same throughout India at around 150 g capita−1 day−1. In contrast with the rest of India, the rural west eats much higher amounts of other grains (millet, sorghum, rye, maize), while the daily per capita pulse intake is around 30 g everywhere except in the north-east, where it is around 15 g. Intake of nuts is negligible in all states, while sugar intake is high everywhere except in the north-east.28National Sample Survey OfficeNutritional Intake in India, 2011–12. NSS 68th Round. Government of India, 2014Google Scholar We found that, in general, the rural areas consumed higher amounts of rice and other grains (sorghum, millet, barley, maize), while the urban areas consumed higher amounts of dairy, fruits, vegetables, and wheat products. The exceptions here are the northern states where rural areas consumed higher wheat and dairy products than their urban counterparts. The amounts consumed of rest of the foods was almost similar among rural and urban areas for any given state.28National Sample Survey OfficeNutritional Intake in India, 2011–12. NSS 68th Round. Government of India, 2014Google Scholar In terms of individual nutrients, for both rural and urban areas, we found that the current intake of 11 out of 24 essential micronutrients (fiber, iron, niacin, potassium, riboflavin, thiamin, vitamin A, vitamin E, zinc, polyunsaturated fatty acids, and pantothenic acid) to be below the recommended levels for almost all 35 Indian states (Tables 2 and S1).Table 2Current nutrient deficiency ratios and sustainable food sources to address themNutrientNorthNERuralSouthWestPreferred food source to address deficiencyEastFiber0.660.680.660.480.63lentils, grams, groundnut, pulses, spicesVitamin A0.520.520.670.630.69carrot, radish, dark-leafy vegetablesRiboflavin0.460.590.600.590.57pulses, spinach, turmeric, chiliesPotassium0.460.60.590.490.55beans, grams, peas, ginger, cumin cardamomNiacin0.350.220.260.190.34groundnut, coconut, lentils, barley, beansZinc0.320.330.360.120.3pulses, grams, beans, lentils, coconutPFA0.30.550.490.350.21groundnut, walnut, millets, gram flourVitamin E0.390.710.520.240.07tomato, carrot, gourds, groundnut, spicesThiamin0.160.290.280.310.27peas, groundnut, grams, pulses, peasIron0.190.240.310.160.21beans, peas, melons, spices, spinachPantothenic acid0.170.380.370.300.36eggs, groundnuts, millets, dates, garlicCholine0.240.360.300.160.15bajra, peas, dhania, turmericCalcium0.060.280.340.120.22fish, peas, grams, beans, spicesNutrient deficiency ratio is 1 minus the ratio of daily per capita intake of a nutrient divided by its recommended daily allowance (RDA) value. Higher deficiency ratio for a nutrient indicates that diet is highly deficient in it and that its intake must increase considerably from current levels. The deficiency ratio of rest of the 12 nutrients is close to 0 for almost all states and hence not shown here. In the optimized diet, the deficiency reached 0 for all nutrients in each state. See Table S1 for results per state per nutrient. Preferred food sources are the ones that have high nutrient density by weight yet low in cost and environmental impact. NE, northeast; PFA, polyunsaturated fatty acid. Open table in a new tab Nutrient deficiency ratio is 1 minus the ratio of daily per capita intake of a nutrient divided by its recommended daily allowance (RDA) value. Higher deficiency ratio for a nutrient indicates that diet is highly deficient in it and that its intake must increase considerably from current levels. The deficiency ratio of rest of the 12 nutrients is close to 0 for almost all states and hence not shown here. In the optimized diet, the deficiency reached 0 for all nutrients in each state. See Table S1 for results per state per nutrient. Preferred food sources are the ones that have high nutrient density by weight yet low in cost and environmental impact. NE, northeast; PFA, polyunsaturated fatty acid. Among these 11 nutrients, the deficiency of 4 nutrients (riboflavin, fiber, potassium, and vitamin A) is particularly severe in that their current intake is not even 50% of the recommended daily allowance (RDA) levels in almost all states. The intake of the other seven nutrients was around 70%–90% of their RDA. In addition, the RDA of calcium and choline was also not met in around 18 of the 35 states (Table S1). The average daily per capita intake (DPCI) of all 25 nutrients in rural areas was only slightly less than or equal to their urban counterparts. Regarding geographical heterogeneity in nutrient deficiency across India, we found that, unlike rest of India, the average diets of certain states and regions do not have deficiency of certain nutrients, for example, average diets of most northern and southern states are not deficient in calcium and choline, respectively (Table 2).