Madagascar faces persistent challenges in food security and nutrition due to its overwhelming reliance on rice-based agriculture and widespread poverty. The Malagasy diet is dominated by starchy staples, particularly rice, which supplies most daily energy and protein but lacks essential amino acids such as lysine. This dietary monotony, combined with limited intake of animal-source foods, fruits, and vegetables, results in widespread micronutrient deficiencies, particularly in calcium and vitamin A. National data reveal that both macronutrient and micronutrient supplies fall short of recommended intake levels, especially for vulnerable populations such as women and children. Chronic undernutrition, stunting, and hidden hunger are prevalent, exacerbated by poor infrastructure, rapid population growth, weak supply chains, and climate shocks. While rice remains culturally and economically important, overdependence on a single crop hinders dietary diversity and resilience. To improve nutritional outcomes, strategies must shift from a calorie-centric focus to a holistic approach that emphasizes nutrition-sensitive agriculture, dietary diversification using locally available foods such as legumes and green leafy vegetables, and targeted interventions in remote areas. Addressing these systemic issues is essential for building a more sustainable and resilient food system in Madagascar.