Macronutrient Intake and Carbohydrate Quality in Indian Adults With and Without Type 2 Diabetes: The Multicentre I-STARCH-1 Cross-Sectional Study

Background: Contemporary data on macronutrient intake and carbohydrate composition in Indian adults are limited. The Indian Study to Assess Real-World Carbohydrate Consumption (I-STARCH-1) characterised these patterns among adults with and without type 2 diabetes mellitus (T2DM). Methods: This multicentre cross-sectional study included 1104 adults (690 with T2DM and 414 without) recruited by convenience sampling from 29 diabetes-focused centres across 14 Indian states. Dietary intake was assessed using a structured three-day dietary recall. Between-group differences were estimated using linear mixed-effects models adjusted for age and sex, with the centre as a random intercept. Results: Carbohydrates contributed 62.1% of the energy, fat 25.1%, and protein 12.8%. Mono- and disaccharides accounted for 20.1% of the total carbohydrate intake, and fibre intake averaged 15.4 g/day. Participants with T2DM had lower carbohydrate %E and a lower simple-carbohydrate proportion of total carbohydrate, but higher protein and fat %E; these differences persisted after adjustment. Absolute fibre intake did not differ between the groups. The composition varied modestly across the four geographic zones. Descriptively, the carbohydrate contribution was lower and the fat contribution was higher than that in the Study To Assess the dietaRy CarboHydrate content of the Indian type 2 diabetes population (STARCH) 2014 cohort, but the cohorts were non-harmonised. Conclusions: Carbohydrates remained the predominant energy source, with low fibre intake. The overall macronutrient profile closely resembled the contemporary national population estimates. The findings support attention to carbohydrate composition and fibre adequacy alongside quantity but describe healthcare-seeking adults rather than the general Indian population.