Food insecurity and its determinants among adults in North and South India.

BACKGROUND: Food insecurity is a major public health problem worldwide. In India, there are limited food insecurity assessment studies using a conventionally accepted method like the Food Insecurity Experience Scale (FIES), developed by the Food and Agricultural Organization (FAO). This study aims to measure food insecurity using the FIES and explore its determinants and association with body mass index (BMI) among Indian adults.  METHODS: In a cross-sectional study, we used FIES to measure food security in a sample of 9005 adults residing in North and South India. Using questionnaires, socio-demographic factors, dietary intake and food security data were collected. The dietary diversity scores (FAO-IDDS) and food insecurity scores (FAO-FIES) were calculated. Body size was measured and BMI was calculated.  RESULTS: The mean age of the study participants was 52.4 years (± 11.7); half were women and half resided in rural areas. Around 10% of the participants reported having experienced (mild or moderate or severe) food insecurity between October 2018 and February 2019. Dietary diversity (measured by FAO's Individual Dietary Diversity Scores, IDDS) was low and half of the participants consumed ≤ 3 food groups/day. The mean BMI was 24.7 kg/m2. In the multivariate analysis, a lower IDDS and BMI were associated with a higher FIES. The place of residence, gender and wealth index were important determinants of FIES, with those residing in South India, women and those belonging to the poorest wealth index reporting higher food insecurity. CONCLUSION: Food security is understudied in India. Our study adds important evidence to the literature. Despite having marginal food insecurity, high prevalence of low diet quality, especially among women, is disconcerting. Similar studies at the national level are warranted to determine the food insecurity situation comprehensively in India and plan appropriate policy actions to address it effectively, to attain the key Sustainable Development Goals (SDG).