Dear Editor, The phenomenon of micronutrient “hidden hunger” presents a significant yet under-recognized risk for individuals in India who adopt restrictive vegan diets that exclude dairy and fortified foods.1,2 Inadequately planned plant-based diets may lack essential nutrients such as vitamin B12, iron, calcium, and vitamin D, thereby increasing the risk of megaloblastic anemia, neuropathy, and impaired bone mineralization, particularly among children, adolescents, and pregnant or lactating women.1,3 Concurrently, India is experiencing a rise in the consumption of ultra-processed foods (UPFs), which are energy-dense but deficient in micronutrients, exacerbating nutritional deficiencies while contributing to obesity, metabolic syndrome, and other non-communicable diseases.4,5 The 2024 ICMR-NIN Dietary Guidelines offer a practical “My Plate for the Day” model that harmonizes ethical food choices with nutritional adequacy.4 For an adult with a caloric requirement of approximately 2000 kcal, the guidelines advocate for a diverse selection of minimally processed foods from at least eight food groups, with vegetables and fruits comprising half of the plate, and the remainder consisting of cereals/millets, pulses, nuts and seeds, milk/curd, and limited visible fats.4 This food-based strategy addresses protein-energy malnutrition, micronutrient deficiencies, and diet-related non-communicable diseases, generally obviating the need for routine use of anti-obesity medications except in refractory cases.4,5 A growing concern is that many urban vegans meet protein requirements but rely heavily on UPF “vegan” substitutes, including refined snacks and sugary beverages, which increase glycemic load and displace nutrient-dense traditional foods.2,5 Recent evidence indicates that UPFs in plant-based diets may contain lower concentrations of micronutrients per 100 g compared to less processed foods, creating a paradox of high energy but low nutrient density.2 This issue is particularly pertinent for Indian women of reproductive age, where vitamin B12 deficiency and suboptimal bone health have intergenerational consequences.1,3 Strict vegans, especially children and pregnant or lactating women, should incorporate nutrient-dense plant foods with routine vitamin B12 supplementation and consider calcium/vitamin D supplements if fortified products or sun exposure are insufficient.2,3 Clinicians should actively inquire about dietary patterns, levels of processing, and supplement use and systematically screen high-risk vegan patients for anemia and bone health.1,3,5 Nutrition counseling must transcend the “veg versus non-veg” debate, emphasizing food diversity, processing, and mandatory vitamin B12 supplementation for strict vegans.1,2 In conclusion, a thoughtfully adapted ICMR-NIN plate—emphasizing whole foods and mandatory B12 supplementation—can render vegan diets safe across the life course while mitigating India’s escalating UPF-driven non-communicable disease epidemic.1-5 Figure 1 represents an illustrative “My Plate for the Day” for a 2000 kcal Indian adult, adapted for plant‑predominant diets with specific vegan food sources. Table 1 represents recommended plant‑based nutrient sources.Figure 1: “My Plate for the Day” for 2000 kcal Indian adultTable 1: Recommended plant‑based nutrient sourcesFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Kapoor et al. (Thu,) studied this question.