**Background:** Nepal is a landlocked, agriculture-dependent South Asian country where agriculture contributes about one-third of GDP and employs two-thirds of the population. Despite poverty reduction, the country continues to suffer from severe malnutrition and food insecurity. With rapid population growth, urbanization, and limited arable land, the balance between food supply and demand is critical. This study examines whether Nepal's agricultural production can sustainably meet the dietary needs of its population, using a land carrying capacity (LCC) framework at national, regional (three ecological belts), and county scales from 2000 to 2020.
**Methods:** The study uses agricultural production data from FAO and the Statistical Yearbook Nepal, food consumption data from FAO Food Balance Sheets, and a household questionnaire survey of 200 Nepalese households conducted in December 2021 (100% validity; reliability 0.769, validity 0.779). A food–calorie conversion model was applied, accounting for conversion factors, intake part coefficients, and waste coefficients for each food category. Two demand standards were used: basic cereal demand (400 kg/person/year) and comprehensive calorie demand (2400 kcal/person/day). The improved LCC model calculated the population that could be supported under each standard, and the Land Carrying Capacity Index (LCCI) classified districts into surplus, balance, or deficit categories. County-level population data for 2020 came from WorldPop, and land use data from GlobeLand30.
**Key Results:** At the national level, cereal carrying capacity improved from 17.79 million people in 2000 to a level that shifted from deficit to critical balance after 2018, but remained below the actual population (29.13 million in 2020). Calorie supply was more favorable: LCC rose from 22.60 million in 2000 to 29.78 million in 2020, exceeding the actual population after 2012. Nationally, calorie supply has been in a state of balance (critical to surplus) over the past 20 years. Regionally, the Terai belt had the highest carrying capacity (15.47 million for cereals; 17.40 million for calories) and was in balance surplus, while the Mountain belt had the lowest (1.42 million for cereals; 0.51 million for calories) and remained in deficit. The Hill region showed intermediate results with the smallest gap between carrying and actual population. At the county level, disparities were extreme: Kathmandu had an LCCI of 16.92 for cereals and 12.64 for calories, meaning its food supply could support only 0.15 million and 0.20 million people respectively against an actual population of ~2.5 million. Counties in the Terai (e.g., Jhapa, Morang, Kailali) had carrying populations exceeding 1 million. The household questionnaire revealed an average daily calorie intake of 2046 kcal per person, with grains (mainly rice) accounting for 62.91% of intake. Under an open trade system, food imports improved Nepal's cereal and calorie balance, especially after 2010.
**Clinical Implications:** While not a clinical study, the findings have direct implications for nutrition and public health policy. The persistently low dietary diversity (grains >60% of calories) and inadequate average calorie intake (2046 kcal/day from the household survey, below the 2400 kcal standard) indicate widespread nutritional risk. The severe regional disparities in food access—particularly the Mountain region's chronic deficit and Kathmandu's extreme dependency—point to geographic inequities in food security that likely contribute to malnutrition. Policy recommendations include improving cultivated land quality, optimizing food planting structure to increase non-cereal supply (meat, eggs, milk), investing in agricultural technology, and using targeted food trade policies to alleviate population pressure.