Geographic variation in lack of food group consumption among children in India: An analysis of change across 720 districts, 2016-2021.

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 6-23 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 (-2.0 percentage points), fruits and vegetables (-2.3), dairy products (-1.9), meat/non-vegetarian foods (-1.1). 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's diets.