Ind. J. Phys. Anthrop & Hum. Genet. Vol. 43, No.

1, (2024) : 59-66

INADEQUACIES IN NUTRITIONAL INTAKE

AMONG VEGETARIANS

NEHA YADAV, VINEET CHAUDHARY,

KALLUR NAVA SARASWATHY AND NAOREM KIRANMALA DEVI

ABSTRACT
Vegetarian populations are usually at a high risk of developing multiple (macro
and micro) nutrient deficiencies. The present study aimed to capture the
nutritional status of adults of a vegetarian population by administering the
food frequency questionnaire (FFQ). A community-based cross-sectional study
was conducted among 500 individuals aged 30 to 70 years of either sex belonging
to the Jat community of Palwal District, Haryana. Demographic and dietary
intake data were collected using a pretested and modified interview schedule
and FFQ respectively. The status of macronutrient intake was found to be
relatively better than micronutrient intake among the participants. Nearly
75% of the participants were found to be consuming at least 50% of RDA
levels of each of the macronutrients. However, 50% to 100% of them were not
consuming even 50% of RDA levels of most of the micronutrients.
In conclusion, it is suggested that vegetarian food groups rich in
micronutrients should be promoted in this population.
Keywords: Macronutrients; micronutrients; recommended dietary allowances
(RDAs); nutrient adequacy; Nutrient deficiency

INTRODUCTION
Worldwide, nutritional deficiencies continue to be a major public health issue
that affects millions of people from all socioeconomic backgrounds and age groups
(Venkatesh et al., 2021). People with vegetarian, lacto-vegetarian and vegan
pattern of diet may experience aggravated nutritional inadequacies due to
restricted availability of some nutrients, a lack of dietary variety, and impaired
absorption of vital vitamins and minerals (Chouraqui et al., 2023). For instance,
essential minerals including vitamin B12, iron, zinc, calcium, and omega-3 fatty
acids may be insufficient in plant-based diets (Craig et al., 2021). If these
Neha Yadav, Department of Anthropology, University of Delhi, Delhi-110007; Vineet Chaudhary,
Department of Anthropology, University of Delhi, Delhi-110007; Kallur Nava Saraswathy,
Professor, Department of Anthropology, University of Delhi, Delhi-110007; Naorem Kiranmala
Devi (Corresponding Author), Associate Professor, Department of Anthropology, University of
Delhi, Delhi-110007, Email: kmaladevi01gmail.com (*These authors contributed equally to this paper
and share the first authorship)
60 Ind. J. Phys. Anthrop & Hum. Genet. Vol. 43, No. 1, (2024)

inadequacies are not corrected, they may impair bone health, cognitive growth,
immunological function, and general physiological well-being, potentially making
people more susceptible to comorbidities.
Investigating the relationship between dietary deficits and comorbidities
among vegetarian populations has special relevance in a nation like India where
varied cultural and religious practises have long emphasised vegetarianism.
Further, majority of studies, exploring nutritional status at community level,
have limited themselves with a few nutrients only; however, often more than
one nutrient deficiency exists in populations (Tulchinsky et al., 2023). Only a
limited number of studies so far have assessed the prevalence of multiple nutrient
deficiencies and their associated risk factors. Therefore, this community-based
study was carried out to capture the adequacy and inadequacy in the intake of
various nutrients as per the recommended dietary allowance (RDA) guidelines
by ICMR (2010) among the vegetarian adult population of Palwal district of
Haryana, India by administering the food frequency questionnaire (FFQ).

MATERIALS AND METHODS

Study design, recruitment of participants and data collection:

A community-based cross-sectional study was conducted among a total of 500
healthy vegetarian adult individuals of either sex (204 males and 296 females)
aged 30-70 years (52.5 ± 10.05 years) belonging to the Jat community of Palwal
District, Haryana, North India.
All the participants were free from major chronic disorders like CVDs, cancers,
psychiatric disorders, etc. Data on demographic variables (viz., age, sex, and
marital status) were collected using a pretested and modified interview schedule.
Data on dietary intake was collected using the Food Frequency Questionnaire
(FFQ). FFQ is a rapid, cost-effective, and validated tool for dietary assessment.
It evaluates the frequency of the food items consumed on a daily, weekly, monthly
and occasional basis. The data captured by FFQ analysed using Dietcal software
to assess the individual profile of nutrient intake (Kaur et al., 2014; Yadav et
al., 2022; Yadav et al., 2023; Yadav et al., 2023; Yadav et al., 2024). The
adequacy of dietary intake of various nutrients being studied was determined
by comparing the intake levels of various nutrients with RDA levels (ICMR,
2021). The present study contains an analysis of three macronutrients (protein,
fat, and carbohydrate), dietary fibre, and 18 micronutrients. Some micronutrients
(like vitamin B12, iodine, sodium, manganese etc.) were not a part of the analyses,
and inadequacy in their intake could not be reported. Nutritional data was
analysed statistically using IBM’s SPSS version 22.

Ethical approval and consent of participants:

The study was approved by the Departmental Ethics Committee, Department
of Anthropology, University of Delhi (reference number: Anth/2010/455/5.).
Inadequacies in Nutritional Intake among Vegetarians 61

Informed written consent, typed in the local language, was obtained from each
participant prior to recruitment in the study.

RESULTS

General characteristics of studied sample:

Out of 500 participants, 204 (40.8%) were males and 298 (59.2%) were females;
156 (31.8%) were 60 years of age or above; 459 (91.8%) were married, 36 (7.2
%) were widowed and 5 (1%) were unmarried and 225 (45%) were literate.
Median dietary intake of total fat and carbohydrates was found to be
significantly more than RDA levels among both males and females. However,
median intakes of protein and dietary fibre were found to be at par with RDA
levels among females and significantly lower than RDA levels among males
(Table-1). As far as micronutrients are concerned, median dietary intake of
most of the micronutrients (except phosphorous and selenium among both males
and females and total folate, vitamin C, and magnesium among females) was
found to be significantly lower than RDA levels among the participants (Table-
1).
Further, analysis was done to estimate the proportion of individuals
consuming various nutrients at par with RDA levels (e 100%), between 99 to
50% and less than 50% of RDA levels. This analysis revealed that extreme
inadequacy in dietary intake (<50% of RDA) of protein, total fat, and
carbohydrate was less prevalent among the participants (restricted up to 10.4%
only) (Table-2). However, inadequacy in dietary intake of micronutrients was
rampant, where 50% to 100% of participants were found to be consuming <50%
of RDA levels of vitamin A, vitamin B1, vitamin B3, vitamin B5, vitamin B6,
vitamin B7, vitamin C, vitamin D, total folate, iron, zinc and potassium (Table-
2). As a matter of concern, nearly 90-100% of participants were consuming
inadequate amounts of vitamins A and D.

DISCUSSION
The present study attempted to estimate the nutritional deficiencies both in
terms of macronutrients and micronutrients. Results of the present study suggest
intake of macronutrients (fat and carbohydrates) in the studied population is
almost reaching the adequacy levels. In fact, extreme inadequacy (who are not
even consuming 50% of RDA) with respect to protein intake is restricted to only
10% of the participants. Similar findings w.r.t. macronutrients have also been
reported (Shridhar et al., 2014; Bao et al., 2021). The possible reason behind
this observation could be the cereal (wheat) based consumption pattern of the
studied population. As per the available literature the vegetarian populations
of India heavily depend on wheat or rice-based diet which are usually rich in
nutrients such as fat, carbohydrates, selenium, and manganese and hence
fulfilling the required levels of macronutrients (McEvoy et al., 2012). However,
62 Ind. J. Phys. Anthrop & Hum. Genet. Vol. 43, No. 1, (2024)

such diets are invariably devoid of essential micronutrients (Venkatesh et al.,

2021).
The present study reveals the worrisome trend viz-a-viz micronutrient intake.
The status of intake of micronutrients in the studied population is found to be
extremely poor as 25%- 100% participants were not consuming even 50% of the
RDA for the selected micronutrients such as Vitamin A, B complex, C, D, calcium,
iron, magnesium, potassium and copper. Several studies have reported the similar
trend with respect to micronutrient intake which suggests that most of the
vegetarian populations are not able to meet adequate quantity of micronutrients
from their diet and are at a greater risk for developing micronutrient deficiencies
(Gonmei et al., 2018).
Several Nutritional programmes have been initiated and implemented in
India by the government to combat hunger since independence. The present
study also reflects sufficient intake of energy rich macronutrients; however,
status of micronutrients intake appears to be abysmal. A vast majority of Indians
rely on a cereal based diets which are not rich in micronutrient content
(Tulchinsky et al., 2010). Micronutrient deficiencies are likely to lead to many
morbid conditions like osteoporosis osteomalacia, thyroid deficiency, colorectal
cancer and cardiovascular diseases (Bhandari et al., 2015). However, the
observed inadequacies in micronutrient intake in the present population may
have a say on their disease profile, a discussion on which is beyond the scope of
the present research paper.
Some of the possible solutions for this problem could be promoting locally
available and affordable micronutrient rich food items, modifications in current
food programs to include micronutrient rich food items, and overall dietary
diversification (Pritwani et al., 2015). Modification in dietary habits may help to
reduce the risk of developing major chronic diseases like CVDs, anaemia,
osteoporosis, joint aches, anorexia, cognitive decline, weight loss, and
malnutrition. Hence, there is a need for modifications in the existing nutritional
programs, creating awareness, and promoting the daily intake of diet rich in
micronutrients for the maintenance of a healthy system. Also, regular
community-level counselling needs to be taken up to promote dietary
diversification (Chaudhary et al., 2022).

CONCLUSIONS
In conclusion, the present study documented the inadequacies in the RDAs of
selected nutrients among the adult population of Palwal District, Haryana. The
status of macronutrient in the study population is adequate as per the RDA.
But in case of micronutrients, percentage of deficient individuals varies from
10% - 90%. Therefore, large scale population-based studies need to be conducted
focussing on nutrient and disease profiles. Further modifications in the existing
government food programs and policies are needed where the focus should shift
from just hunger decline to nutrient adequacy.
Inadequacies in Nutritional Intake among Vegetarians 63

STATEMENTS AND DECLARATIONS

Funding: The work was supported by the Delhi University-Research and
Development Grant (DU-R&D), the Department of Science and Technology,
Government of India (DST) under grant number DST/CSRI/2018/162, and the
Department of Biotechnology, Government of India (DBT) under grant number
BT/PRI14378/MED/30/535/2010.
Declaration of Competing Interest: All authors declare to have no conflict
of interest.
Author Contributions: NY participated in data collection, data analysis,
data interpretation, and drafting of the manuscript. VC participated in data
collection, data analysis, data interpretation, and drafting of the manuscript.
NY and VC participated in data analysis, data interpretation, and editing. KNS
participated in the study design, data interpretation, and editing. NKD
participated in the conceptualization of the study, study design, data
interpretation, and editing. All the authors have given final approval of the
version to be published and have also agreed to be accountable for all aspects of
the work in ensuring that questions related to the accuracy or integrity of any
part of the work are appropriately investigated and resolved. The data that
support the findings of this study are available on request from the corresponding
author (NKD).

References
Bao, J. and L. N. Malunga, 2022. Compositional diversity in cereals in relation to their
nutritional quality and health benefits. Frontiers in Nutrition, 8, 819923. doi: https://
doi.org/10.1186/1475-2891-13-55
Bhandari, S. and M. R. Banjara, 2015. Micronutrients deficiency, a hidden hunger in Nepal:
prevalence, causes, consequences, and solutions. International scholarly research notices,
2015. doi: 10.1155/2015/276469
Chaudhary, V., Saraswathy, K.N. and R. Sarwal, 2022. Dietary diversity as a sustainable
approach towards micronutrient deficiencies in India. Indian Journal of Medical Research,
156(1):31-45. doi: 10.4103/ijmr.ijmr_3314_21.
Chouraqui, J. P., 2023. Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan
Children: Not So Obvious. Nutrients, 15(9): 2129. doi: 10.3390/nu15092129.
Craig, W. J., Mangels, A. R., Fresán, U., Marsh, K., Miles, F. L., Saunders, A. V., et al., 2021.
The safe and effective use of plant-based diets with guidelines for health professionals.
Nutrients, 13(11): 4144. doi: 10.3390/nu13114144
Gonmei, Z. and G. S. Toteja, 2018. Micronutrient status of Indian population. Indian Journal
of Medical Research, 148(5): 511-521. doi: 10.4103/ijmr.IJMR_1768_18
Kaur, G., 2014. Diet Cal-A tool for dietary assessment and planning. Department of Dietetics,
AIIMS. doi: https://doi.org/10.1177/03795721211025
McEvoy, C. T., Temple, N. and J. V. Woodside, 2012. Vegetarian diets, low-meat diets and
health: a review. Public health nutrition, 15(12):2287-2294. doi:10.1017/
S1368980012000936.
Pritwani, R. and P. Mathur, 2015. Strategies to Combat Micronutrient Deficiencies: A Review.
64 Ind. J. Phys. Anthrop & Hum. Genet. Vol. 43, No. 1, (2024)

International Journal of Health Sciences and Research. doi: 10.9790/0853-1506154750.

Shridhar, K., Dhillon, P. K., Bowen, L., Kinra, S., Bharathi, A. V., Prabhakaran, D. and S.
Ebrahim, 2014. Nutritional profile of Indian vegetarian diets–the Indian Migration
Study (IMS). Nutrition Journal, 13: 1-9. doi: https://doi.org/10.1186/1475-2891-13-55
Tulchinsky, T. H., 2010. Micronutrient deficiency conditions: global health issues. Public
Health Reviews, 32: 243-255. doi: https://doi.org/10.1007/BF03391600.
Venkatesh, U., Sharma, A., Ananthan, V. A., Subbiah, P. and R. Durga, 2021. Micronutrient’s
deficiency in India: a systematic review and meta-analysis. Journal of Nutritional Science,
10: e110. doi: 10.1017/jns.2021.102.
Yadav, N. and N. K. Devi, 2023. Protective role of vitamin B9 against high blood pressure: A
population-based study from Haryana, North India. Journal of Hypertension, 41(Suppl
3): e126.
Yadav, N., Chaudhary, V., Saraswathy, K. N. and N. K. Devi, 2022. Vitamin intake in obesity
and hypertension: A population-based study from Haryana, North India. Clinical
Epidemio lo gy and Glo bal Health, 18: 101178. doi: https://do i.org/10.10 16/
j.cegh.2022.101178.
Yadav, N., Chaudhary, V., Saraswathy, K.N. and N. Kiranmala, 2023. High dietary copper in
cognitive impairment among North Indian females: findings from a population-based
study. Egyptian Journal of Psychiatry, 44(3), 153-159. doi: 10.21608/EJPSY.2024.346071.
Yadav, N., Chaudhary, V., Thakur, M. K., Saraswathy, K. N. and N. K. Devi, 2023. Macronutrient
intake in dyslipidemia: a population-based study from Haryana, North India.
International Journal of Research in Medical Sciences, 11(9): 3336. doi: https://dx.doi.org/
10.18203/2320-6012.ijrms2023278.
 Table-1: Median intake of nutrients by the studied participants estimated by FFQ compared with RDA at P<0.05
Nutrient Males (n=204) Females (n=296)
RDA Median (IQR) % diff p-value RDA Median (IQR) % diff p-value
Protein 54 43.49 (31.32-57.85) -19.46 <0.001* 46 45.08 (31.73-57.62) -2.00 0.889
Total fat 30 48.38 (30.61-77.89) +61.26 <0.001* 25 47.51 (27.60-75.32) +90.04 <0.001*
Carbohydrate 130 189.67 (121.31-248.81) +45.9 <0.001* 130 191.07 (120.62-273.42) +46.97 <0.001*
Dietary Fibre 40 28.53 (17.07-38.24) -28.67 <0.001* 30 29.21 (17.09-39.83) -2.63 0.368
Vitamin A 1000 248.10 (189.55-335.65) -75.19 <0.001* 840 239.69 (187.47-330.02) -71.46 <0.001*
Vitamin B1 1.8 0.84 (0.58-1.19) -53.33 <0.001* 1.7 0.96 (0.69-1.27) -43.52 <0.001*
Vitamin B2 2.5 1.00 (0.78-1.5) -60.00 <0.001* 2.4 1.12 (0.78-1.52) -53.33 <0.001*
Vitamin B3 18 4.17 (2.59-6.37) -76.83 <0.001* 14 4.34 (2.92-6.37) -69.00 <0.001*
Vitamin B5 5 3.60 (2.58-4.89) -28.00 <0.001* 5 3.93 (2.90-5.06) -21.4 <0.001*
Vitamin B6 2.4 0.72 (0.53-1.15) -70 <0.001* 1.9 0.77 (0.52-1.27) -59.47 <0.001*
Vitamin B7 40 16.25 (11.22-25.03) -59.37 <0.001* 40 15.71 (10.41-22.82) -61.57 <0.001*
Total folate 300 138.11 (98.60-295.58) -53.96 <0.001* 220 141.90 (99.64-296.73) -35.50 0.116
Inadequacies in Nutritional Intake among Vegetarians

Vitamin C 80 35.54 (23.80-67.01) -55.57 <0.001* 65 44.56 (29.06-110.42) -31.44 0.562

Vitamin D 600 0.66 (0.52-1.06) -99.89 <0.001* 600 0.66 (0.52-1.04) -99.89 <0.001*
Calcium 1000 743.05(562.60-1035.50) -25.69 <0.001* 1000 784.54 (562.60-1040.77) -21.54 <0.001*
Iron 19 7.82 (5.21-16.11) -58.84 <0.001* 29 9.10 (5.60-18.07) -68.62 <0.001*
Zinc 17 5.72 (3.93-8.60) -66.35 <0.001* 13.2 5.99 (4.24-8.85) -54.62 <0.001*
Magnesium 440 281.01 (182.14-457.89) -36.13 <0.001* 370 333.34 (192.12-499.89) -9.90 0.294
Potassium 3500 1645.45 (1105.34-2972.32) -52.98 <0.001* 3500 1861.50 (1194.61-2990.49) -46.81 <0.001*
Phosphorus 1000 1039.84(757.92-1328.97) +3.98 0.106 1000 1058.29(774.54-1579.89) +5.82 <0.001*
Selenium 40 66.88 (45.67-90.27) +67.2 <0.001* 40 65.74 (46.39-103.08) +64.35 <0.001*
Copper 1.7 1.06 (0.69-1.83) -37.64 <0.001* 1.7 1.17 (0.70-1.85) -31.17 <0.001*
*Significant at p-value < 0.05
65
66 Ind. J. Phys. Anthrop & Hum. Genet. Vol. 43, No. 1, (2024)
Table-2: Distribution of participants according to nutrient adequacy (n = 500)
Nutrient e 100% RDA 50-99% RDA <50%RDA
Protein 40.2 49.4 10.4
Total fat 77.8 21.8 0.4
Carbohydrate 71.2 27.4 1.4
Total dietary Fibre 36.2 39.4 24.4
Vitamin A 0.2 9.2 90.6
Vitamin B1 7.6 67.2 25.2
Vitamin B2 5.2 35.8 59
Vitamin B3 2.2 15.8 82
Vitamin B5 24.6 55.8 19.6
Vitamin B6 5.4 22 72.6
Vitamin B7 1.4 36.6 62
Total folate 30.2 27.6 42.2
Vitamin C 32 27.8 40.2
Vitamin D 0 0 100
Calcium 32 58.8 9.2
Iron 9.4 29.2 61.4
Zinc 7.6 26.4 66
Magnesium 38 34.4 27.6
Potassium 16.8 33.6 49.6
Phosphorus 55.8 40.4 3.8
Selenium 85.2 13.8 1
Copper 31.4 32.2 36.4
RDA: Recommended dietary allowance
This document was created with the Win2PDF “print to PDF” printer available at
http://www.win2pdf.com
This version of Win2PDF 10 is for evaluation and non-commercial use only.
This page will not be added after purchasing Win2PDF.
http://www.win2pdf.com/purchase/