Getting to the heart of it:

Modern agriculture's impact on cardiovascular disease risk in India

Nishant Panicker, B.S.
November 2025

In this series thus far, I have explored the connections between food systems, colonialism and chronic cardiovascular disease (CVD) in South Asian communities. In the previous article, the cultural transition of foodways from traditional grains to rice, and the large impact of famines experienced by communities under colonial rule, were highlighted as mediators of increased cardiovascular risk. These were tied in to the thrifty phenotype hypothesis, that poor nutrition during fetal development could increase the likelihood of CVD in adulthood. In this article, I will describe the impact that post-colonial agricultural economic policies have had on nutritional and cultural shifts, and how these could have influenced the incidence of CVD in India. In particular, I will focus on a program known as the Green Revolution, drawing from seminal work by Sekhri and Shastry (2024) published in the American Economic Journal: Applied Economics.

The Green Revolution and increased incidence of metabolic syndrome

Though India had gained independence from the British empire in 1947, there was a challenge that had plagued the country long prior that needed solving in a post-colonial era – the lack of access to substantial nutrition. In the year 1966, the government introduced a set of agricultural programs that came to be known as the Green Revolution. This involved the widespread use of high-yielding varieties of certain crops, particularly wheat and rice, along with chemical fertilizers, pesticides, and expanded irrigation. The outcomes of the Green Revolution included a reduction in food prices, increased calorie availability and improved food security in light of the many famines that plagued the region. The program was remarkably successful in its primary goal, tripling the production of staple crops with only a 30% increase in cultivated land, averting widespread hunger and making the country self-sufficient in food grains.

However, the program had unintended long-term nutritional consequences (Figure 1). High yielding varieties of wheat and rice dominated the Indian agriculture sector, most predominantly in fertile, groundwater-rich regions of the country. In their work on two independent surveys, Sekhri and Shastry found that men born after 1966 had a higher incidence of diabetes, particularly in areas with abundant groundwater crucial for the cultivation of rice and wheat. An interesting conclusion from their work is the influence of the food grain on the risk of chronic disease – compared to wheat, rice is more carbohydrate-rich, has a higher glycemic index (increased spike in blood sugar post-consumption) and also has a lower protein content owing to the absence of gluten, which is found in wheat. They observed that the increase in diabetes risk was more significant in rice-eating households, compared to wheat-eating households.

Overall, their work found a strongly significant link between the onset of the Green Revolution in India and an increase in the incidence of diabetes. The authors discussed that the lack of evidence of an increase in heart disease and high blood pressure may have been due to the lack of statistical power, or to put it simply, insufficient data. However, as mentioned in a previous article of this series, there is an inextricable link between chronic metabolic diseases like diabetes, high blood pressure and CVD. The lack of statistical significance does not mean the link does not exist, but instead suggests that more data would be needed to determine the strength of this link.

Figure 1. A theory of the relationship between the Green Revolution and the risk of developing chronic diseases. Reproduced from Sekhri and Shastry (2024).

The dietary shift to calorie-dense, carbohydrate-rich diets was further motivated by government food security programs like the Public Distribution System (PDS) in India. As one of the world's largest food transfer programs, the PDS plays a crucial role in mitigating hunger by providing subsidized staple foods to hundreds of millions of people. However, the system has historically focused on distributing high-calorie staples like rice, wheat, sugar and oil. The merits of the PDS include the alleviation of malnutrition, and in some cases improved overall dietary diversity owing to the increased availability of household income. Predominant criticism of the program revolves around the sidelining of more nutritious alternatives like millets and pulses, reinforcing a national diet centred on refined carbohydrates. This combination of agricultural and social policies, while successful in combating acute famine, inadvertently contributed to a nutritional transition toward a less diverse, calorie-dense diet, a known risk factor for the development of metabolic syndrome and CVD.

Why does consumption of high-yielding varieties of rice and wheat increase the risk of chronic disease?

A recent study by Debnath et al (2023) in Nature Scientific Reports explored the change in grain mineral density of rice and wheat varieties grown over the last 50 years in India. This study found a trend in the average mineral density of these varieties – their calcium, zinc, iron, copper and other essential mineral content is steadily declining, while exhibiting an increase in concentrations of toxic elements like arsenic, barium and strontium. The researchers also found a depletion in the average daily intake of essential nutrients, both due to declining mineral density, but also reduced per capita consumption of these grains over the last 50 years. With metal toxicants like arsenic and barium being implicated in chronic respiratory disease, CVD and kidney toxicity, it is possible that their increased concentrations in newer rice cultivars could continue to predispose these communities to the aforementioned diseases.

Another study by Yilmaz et al (2024) in the journal Food Science & Nutrition focused on hidden hunger, nutritional insufficiency that is a result of the depletion of micronutrients, even if caloric needs are met. In addition to corroborating overwhelming evidence of lacking essential micronutrients, the authors described the role modern agricultural practices have played in exacerbating this problem, suggesting that the overuse of synthetic fertilizers and pesticides has reduced overall soil organic matter and fertility, and thereby impacted the nutritional content of crops (Figure 2).

Figure 2. A schematic detailing the link between the Green Revolution and the phenomenon of hidden hunger, the lack of essential micronutrients despite adequate caloric intake. Reproduced from Yilmaz et al (2024).

An important observation to highlight when taking into consideration the impact of modern agriculture and monocropping on chronic disease risk is the interplay between socioeconomic factors, modern agricultural practices and dietary patterns. Reduced crop diversity and the predominant farming of high-yielding crop varieties sets up a positive feedback loop that could potentially lead to an increase in chronic disease risk. Poverty and malnutrition drive the development of high-yielding crop varieties to satisfy caloric needs, but not nutritional needs. The affordability of these grains and their increased market demand prompts farmers to increase monocropping, losing out on agricultural biodiversity, reducing soil fertility and increasing the susceptibility of farmlands to pests. This in turn prompts the utility of more potent chemical pesticides and synthetic fertilizers, contributing to the problem of hidden hunger by way of reduced micronutrient composition. This pattern has been observed in other countries like Mexico too.

Over the course of this series, it must have become clear that the heightened CVD risk observed in South Asians likely represents a complex story consisting of genetic susceptibility, contemporary dietary and lifestyle factors, the economics of agriculture, adverse developmental programming linked to maternal nutrition and birth weight, and potentially, a deeper biological imprint left by historical periods of severe hardship under colonial rule. Recognizing the complex interplay between these various disciplines, spanning genetics, lifestyle, food science, development, and history, is crucial for developing effective public health strategies aimed at preventing and managing cardiovascular disease in South Asian communities. In the final article of this series, I will delve into fascinating ongoing and published research on interventions that could add fresh perspectives to our ever increasing understanding of CVD in these populations.

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