{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:54:15Z","timestamp":1767380055141,"version":"3.48.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-002992"],"award-info":[{"award-number":["INV-002992"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["RS-2024-00355637"],"award-info":[{"award-number":["RS-2024-00355637"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Adequate dietary intake in early childhood is essential for growth and development. However, evidence on geographic disparities and recent trends in food group consumption among young children in India remains limited. This study investigated district-level changes in the consumption of specific food groups among children aged 6\u201323 months in India. Data from two National Family Health Surveys conducted in 2016 and 2021 of India were used, and a harmonized 720-district geometry was applied to ensure comparability across survey rounds. Multilevel modeling accounting for children nested within communities, districts, and states was used to derive precision-weighted estimates for non-consumption of seven food groups. District-level changes in non-consumption prevalence showed substantial geographic heterogeneity across all food groups. Nationally, non-consumption prevalence declined for most food groups, including other solid, semi-solid, or soft food (\u22122.0 percentage points), fruits and vegetables (\u22122.3), dairy products (\u22121.9), meat\/non-vegetarian foods (\u22121.1). In contrast, non-consumption of grains, roots, and tubers increased (+2.5). Substantial geographic heterogeneity was observed. Between 2016 and 2021, 380 districts experienced declines in non-consumption of other solid, semi-solid, or soft food and 379 in fruits and vegetables, whereas non-consumption of grains, roots, and tubers increased in 335 districts. District-level inequalities remained wide across all food groups. Geographically targeted nutrition interventions are needed to reduce within-country inequalities in young children\u2019s diets.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005077","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:52:45Z","timestamp":1767379965000},"page":"e0005077","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic variation in lack of food group consumption among children in India: An analysis of change across 720 districts, 2016\u22122021"],"prefix":"10.1371","volume":"6","author":[{"given":"Dahyun","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rockli","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min-Jeong","family":"Shin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-0721","authenticated-orcid":true,"given":"Sujata","family":"Saunik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.V.","family":"Subramanian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"issue":"1","key":"pgph.0005077.ref001","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12937-020-00632-x","article-title":"Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review","volume":"19","author":"P Dalwood","year":"2020","journal-title":"Nutr J"},{"key":"pgph.0005077.ref002","unstructured":"United Nations Department for Economic and Social Affairs. 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study","volume":"17","author":"SS Kim","year":"2017","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0005077.ref018","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s41055-016-0001-1","article-title":"The Hungry Nation: Food Policy and Food Politics in India","volume":"1","author":"D Banik","year":"2016","journal-title":"Food ethics"},{"key":"pgph.0005077.ref019","first-page":"1","article-title":"The Problem of Undernutrition: Positioning India and Its States","author":"A Singh","year":"2023","journal-title":"Sustainable Development Goals Series. 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Technical Report \u2013 District, Parliamentary Constituency, Assembly Constituency, and Village. 2023."},{"key":"pgph.0005077.ref025","unstructured":"Spatial Data Repository \u2013 Boundaries. https:\/\/spatialdata.dhsprogram.com\/boundaries\/#view=table&countryId=IA 2024 December 13."},{"key":"pgph.0005077.ref026","unstructured":"Survey of India. https:\/\/www.surveyofindia.gov.in\/ 2024 December 13."},{"key":"pgph.0005077.ref027","doi-asserted-by":"crossref","first-page":"101890","DOI":"10.1016\/j.eclinm.2023.101890","article-title":"Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993-2021","volume":"58","author":"SV Subramanian","year":"2023","journal-title":"EClinicalMedicine"},{"key":"pgph.0005077.ref028","volume-title":"MCMC Estimation in MLwiN v3.03","author":"WJ Browne","year":"2019"},{"key":"pgph.0005077.ref029","unstructured":"Rasbash J, Steele F, Browne WJ, Goldstein H. A User\u2019s Guide to MLwiN. https:\/\/www.bristol.ac.uk\/cmm\/media\/software\/mlwin\/downloads\/manuals\/3-07\/manual-web.pdf 2023. 2024 December 13."},{"issue":"2","key":"pgph.0005077.ref030","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/00031305.1998.10480547","article-title":"Markov Chain Monte Carlo in Practice: A Roundtable Discussion","volume":"52","author":"RE Kass","year":"1998","journal-title":"The American Statistician"},{"issue":"11","key":"pgph.0005077.ref031","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v052.i11","article-title":"runmlwin: A Program to Run theMLwiNMultilevel Modeling Software from withinStata","volume":"52","author":"G Leckie","year":"2012","journal-title":"J Stat Soft"},{"issue":"1","key":"pgph.0005077.ref032","doi-asserted-by":"crossref","DOI":"10.1038\/s41545-024-00355-0","article-title":"Examining geographic variation in the prevalence of household drainage types across India in 2019-2021","volume":"7","author":"A Jain","year":"2024","journal-title":"npj Clean Water"},{"key":"pgph.0005077.ref033","unstructured":"UNICEF. Early Childhood Nutrition: Preventing Malnutrition in Infants and Young Children. https:\/\/www.unicef.org\/nutrition\/early-childhood-nutrition 2024 December 13."},{"key":"pgph.0005077.ref034","unstructured":"FAO. Hunger and Food Insecurity. https:\/\/www.fao.org\/hunger\/en\/. 2024. 2024 December 13."},{"issue":"1","key":"pgph.0005077.ref035","doi-asserted-by":"crossref","DOI":"10.1080\/2330443X.2024.2436196","article-title":"Investigating the Implications of Goods and Services Tax Revenue on Economic Growth: Empirical Insight from Indian Economy","volume":"12","author":"S Garg","year":"2025","journal-title":"Statistics and Public Policy"},{"issue":"2","key":"pgph.0005077.ref036","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40171-021-00297-3","article-title":"Goods and Services Tax (GST) implementation in India: A SAP\u2013LAP\u2013Twitter analytic perspective","volume":"23","author":"AK Deshmukh","year":"2022","journal-title":"Global Journal of Flexible Systems Management"},{"key":"pgph.0005077.ref037","unstructured":"Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY). https:\/\/dfpd.gov.in\/Home\/ContentManagement?ManuId=3 2024 December 13."},{"key":"pgph.0005077.ref038","unstructured":"National Food Security Portal. National Food Security Act. https:\/\/nfsa.gov.in\/portal\/NFSA-Act 2024. 2024 December 13."},{"key":"pgph.0005077.ref039","unstructured":"Trading Economics. India GDP growth rate. https:\/\/tradingeconomics.com\/india\/gdp-growth 2024 December 13."},{"issue":"1","key":"pgph.0005077.ref040","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3390\/nu15010159","article-title":"Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey","volume":"15","author":"J Saha","year":"2022","journal-title":"Nutrients"},{"key":"pgph.0005077.ref041","doi-asserted-by":"crossref","first-page":"1032481","DOI":"10.3389\/fnut.2022.1032481","article-title":"Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases","volume":"9","author":"DG Peroni","year":"2023","journal-title":"Front Nutr"},{"issue":"1","key":"pgph.0005077.ref042","article-title":"Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood","volume":"92","author":"V De Sanctis","year":"2021","journal-title":"Acta Biomed"},{"key":"pgph.0005077.ref043","doi-asserted-by":"crossref","first-page":"100498","DOI":"10.1016\/j.gfs.2021.100498","article-title":"Ground truthing the cost of achieving the EAT lancet recommended diets: Evidence from rural India","volume":"28","author":"S Gupta","year":"2021","journal-title":"Glob Food Sec"},{"key":"pgph.0005077.ref044","unstructured":"International Institute for Population Sciences IIPS. National Family Health Survey (NFHS-5) India Report. 2019. https:\/\/dhsprogram.com\/pubs\/pdf\/FR375\/FR375.pdf"},{"issue":"1","key":"pgph.0005077.ref045","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1017\/S0007114516001598","article-title":"Dietary patterns in India: a systematic review","volume":"116","author":"R Green","year":"2016","journal-title":"Br J Nutr"},{"key":"pgph.0005077.ref046","article-title":"In India, 81% limit meat in diet and 39% say they are vegetarian","author":"M Corichi","year":"2021"},{"key":"pgph.0005077.ref047","unstructured":"National Dairy Development Board. Per capita availability of milk by states\/UTs. 2025. https:\/\/www.nddb.coop\/information\/stats\/percapitavail"},{"key":"pgph.0005077.ref048","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1093\/oso\/9780198885979.003.0008","article-title":"Gender Inequality and Intra-Household Consumption Disparities","author":"A Seth","year":"2024","journal-title":"India Social Development Report 2023. Oxford University PressOxford"},{"key":"pgph.0005077.ref049","article-title":"The State of Food Security and Nutrition in the World 2024","year":"2024","journal-title":"FAO; IFAD; UNICEF; WFP; WHO;"},{"issue":"11","key":"pgph.0005077.ref050","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1016\/j.agwat.2008.04.006","article-title":"Groundwater governance through electricity supply management: Assessing an innovative intervention in Gujarat, western India","volume":"95","author":"T Shah","year":"2008","journal-title":"Agricultural Water Management"},{"issue":"1","key":"pgph.0005077.ref051","doi-asserted-by":"crossref","first-page":"841","DOI":"10.30574\/ijsra.2023.10.1.0828","article-title":"An overview of millets-the nutri-cereals: Its nutritional profile, potential health benefits and sustainable cultivation approach","volume":"10","author":"P Ashwin","year":"2023","journal-title":"Int J Sci Res Arch"},{"issue":"2","key":"pgph.0005077.ref052","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s13668-023-00470-3","article-title":"Measuring Food Insecurity in India: A Systematic Review of the Current Evidence","volume":"12","author":"FH McKay","year":"2023","journal-title":"Curr Nutr Rep"},{"key":"pgph.0005077.ref053","doi-asserted-by":"crossref","unstructured":"Swaminathan S, Vaz M, Kurpad AV. Protein intakes in India. Br J Nutr. 2012;108(Suppl 2):S50-8. https:\/\/doi.org\/10.1017\/S0007114512002413 23107548","DOI":"10.1017\/S0007114512002413"},{"key":"pgph.0005077.ref054","first-page":"71","article-title":"Mapping the Food Security Situation in Rural Bihar and Jharkhand: Insights from Two Food Security Atlases","author":"AN Sharma","year":"2023","journal-title":"India Studies in Business and Economics. Springer Nature Singapore"},{"key":"pgph.0005077.ref055","first-page":"18749","article-title":"Effects of trade liberalization on inequality in nutrition intake: Evidence from Indian districts","volume":"24","author":"Y Zhang","year":"2024","journal-title":"BMC Public Health"},{"issue":"1554","key":"pgph.0005077.ref056","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1098\/rstb.2010.0149","article-title":"Food consumption trends and drivers","volume":"365","author":"J Kearney","year":"2010","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"10","key":"pgph.0005077.ref057","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1038\/s41430-019-0406-0","article-title":"Socio-economic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4","volume":"73","author":"S Agrawal","year":"2019","journal-title":"Eur J Clin Nutr"},{"key":"pgph.0005077.ref058","unstructured":"Accountability Initiative. India\u2019s Public Distribution System in the Pandemic. https:\/\/accountabilityindia.in\/blog\/indias-public-distribution-system-in-the-pandemic. 2024. 2024 December 13."},{"issue":"45","key":"pgph.0005077.ref059","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.aba1715","article-title":"Agricultural diversification promotes multiple ecosystem services without compromising yield","volume":"6","author":"G Tamburini","year":"2020","journal-title":"Science Advances"},{"key":"pgph.0005077.ref060","unstructured":"United Nations Climate Change. Climate Resilient Food Systems Alliance. https:\/\/unfccc.int\/crfs-alliance 2024 December 13."},{"issue":"12","key":"pgph.0005077.ref061","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.3945\/jn.117.257303","article-title":"Integrating nutrition interventions into an existing maternal, neonatal, and child health program increased maternal dietary diversity, micronutrient intake, and exclusive breastfeeding practices in Bangladesh: A cluster-randomized program evaluation","volume":"147","author":"PH Nguyen","year":"2017","journal-title":"Journal of Nutrition"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T18:52:53Z","timestamp":1767379973000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005077"}},"subtitle":[],"editor":[{"given":"Nancy Angeline","family":"Gnanaselvam","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005077","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}