Context: A poor-quality diet with low diversity is central to the high prevalence of malnutrition among young Indian children. The Indian Integrated Child Development Services Scheme (ICDS) addresses this nutritional gap through its Supplementary Nutrition Program (SNP), which provides energy, protein, fat, and essential micronutrients to children via Take-Home Rations (THR, for children aged 6-36 months) and Hot Cooked Meals (HCM, for children aged 37-72 months). Aims: To examine the diet diversity of THR and HCM provided under ICDS-SNP across Indian states and identify strategies for improvement. Settings and Design: A pan-India study analysing 12 diverse food groups in the ICDS-SNP: cereals and millets, pulses and legumes, green leafy vegetables, other vegetables, roots and tubers, nuts and seeds, edible oils and fat, eggs, milk and milk-based products, other non-vegetarian foods, fruits, and sugar across states. Methods and Material: Diet diversity scores for THR and HCM were calculated based on the provision of these food groups. Regional variations and inclusion of locally available foods were examined. Statistical analysis used: Descriptive analysis was conducted to assess diet diversity scores across states. Regional patterns and variations in the SNP food composition were analysed. Results: The study revealed significant variability in diet diversity across states, with scores ranging from 3-11. Southern and Eastern states showed higher diversity, incorporating local fruits, vegetables, and animal-source foods like milk and eggs. Both THR and HCM were predominantly cereal based. Findings suggest that achieving diet diversity in ICDS-SNP is feasible but lagging states need tailored, geographically specific strategies.

BACKGROUND/OBJECTIVES:Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). METHODS:This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. RESULTS:Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product's health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. CONCLUSIONS:The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide.

Chronic exposure to hypoxia occurs in lowland populations, including soldiers, adventurers, tourists, and porters, during their ascent to high altitude. Hypobaric hypoxia induces oxidative stress and impairs the metabolism of micro minerals, including selenium, zinc, iron, and copper. The role of metalloproteins and their associated microminerals in preventing oxidative stress at different altitudes is incompletely understood. In this study, plasma samples were collected from lowlanders at sea level (SL), moderate altitude (A1-1585 m, A2-2290 m), and high altitude (A3-3500 m). Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to quantify selenium (Se), zinc (Zn), copper (Cu), and iron (Fe) levels. Antioxidant metalloproteins, including Copper-Zinc Superoxide dismutase (Cu-Zn SOD), Glutathione Peroxidase (GPx), Metallothionein (MT), Selenoprotein 1 (SEPP1), were quantified by enzyme-linked immunosorbent assay. Lipid peroxidation was assessed through malondialdehyde (MDA) and hydroperoxides through ferrous oxidation xylenol orange; FOX1 assay. We found that Se, Zn, Cu, and Fe levels were higher (p < 0.01) at A2 compared to SL and lower (p < 0.01) at A3 compared to A2. MT levels were higher (p < 0.01) at A1 and A3 compared to SL. SEPP1 levels were higher (p < 0.001) at A3 compared to SL, A1, and A2. Cu-Zn SOD levels were higher at A3 (p = 0.006). GPx levels remained consistent across all altitudes. MDA levels were significantly elevated (p = 0.013) at A3 compared to SL, while the FOX assay showed increased hydroperoxide levels (p < 0.001) at A2 and A3 as compared to SL. Our findings demonstrate that hypoxia leads to variations in micromineral levels at different altitudes, accompanied by elevated oxidative stress and dysregulated antioxidant metalloproteins potentially reflecting adaptive responses to oxidative stress at high altitude.

India's Supplementary Nutrition Programme (SNP), under the Integrated Child Development Services, provides a Morning Snack and a Hot Cooked Meal to children aged 36-72 months through Anganwadis (day-care centres). This study assessed these meals against SNP standards (2012) and age-specific ICMR recommendations, when standards were unavailable, and explored the use of linear programming (LP) to improve nutrient quality of SNP meals. A cross-sectional survey documented the SNP-meals, ingredients, serving portions and other details, using questionnaires administered to Anganwadi workers and programme officials from purposively selected Anganwadis across 27 States and Union Territories. Nutrient composition was estimated using standard food composition tables, and State-specific food lists and retail prices were incorporated into the LP framework to identify foods that could improve nutrient content of SNP meals. Energy standards were met in 56% of States, while 22% fell more than 20% below recommendations. Protein standards were achieved in 74% of States; however, declined to 52% after adjusting for digestibility. Only 22% of States met the ICMR-based fat requirement. Zinc, iron and folate were largely met, whereas calcium and vitamins A, B6 and B12 were below recommendations in more than half the States. Meals were predominantly cereal-based with limited inclusion of nutrient-dense foods. LP identified foods that reduced nutrient gaps, although many improvements exceeded the per-child cost allocation. Overall, meals showed wide variability, with persistent gaps in fat and key micronutrients. LP provides a structured approach to enhance nutrient provision within the programme setting, although meeting all nutrient targets may require adjustments to cost and procurement strategies.

Since the beginning of space missions, the food systems have undergone a sea change with prolonged manned missions and permanent space habitats. We have a better understanding of physiological changes which happen in humans in space and help in adaptation to the space environment. Yet, much remains underexplored and warrants further research. : Space missions today involve a considerable number of individuals operating in a microgravity environment for both short and long periods. The provision of food for such missions and managing the physio-pathological changes that affect nutritional requirements continue to be challenging. Food systems (food and beverages) used during every program to date have been shelf‐stable and were composed primarily of rehydratable or thermostabilized food items. Such foods usually have a lower hedonic value than fresh or frozen foods. Consequently, a reliable food system must provide a wide range of palatable and attractive foods as well as the tools to prepare them (through rehydration, heating, and cooling) to enhance the taste sensation of the crew. Adequate nutrition with easily accessible food is essential to this effort. To deliver nutritional recommendations to crew members for long-duration space missions, it is important to understand how nutritional status and general physiology are linked and affected by microgravity exposure. In view of this, it has been pointed out that nutritional countermeasures could rectify the physiological and behavioural anomalies during microgravity exposure. In this comprehensive narrative review, we have provided an overview of a few recent advances such as silkworm protein, good mood-vegan diet, 3-D food printing, and space garden’s produce for onboard support to food systems. It has also been found that exercise could be an addition to nutritional interventions. Areas of space exploration that require more in-depth research using ground-based bed rest models, as well as inflight microgravity conditions, are highlighted.

Purpose The purpose of this study is to collect and assess the evidence available on the effect of non nutritive sweeteners on appetite, weight and glycemic regulation. As a replacement for sugars, non-nutritive sweeteners (NNSs) are widely being used in different food products with the assumption that these would lower calorie intake and help to manage weight and blood sugar levels better. However, studies using animal models have reported that chronic exposure to NNSs leads to increased food consumption, weight gain and insulin resistance. Design/methodology/approach Evidence was acquired from systematic reviews or meta-analyses (2016–2021) of relevant clinical studies, especially randomized control trials using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Findings The review showed NNSs exposure did not conclusively induce increased food intake or change in subjective appetite ratings. Appetite biomarkers like ghrelin, gastric inhibitory peptide, C-peptide levels and Peptide YY remained mostly unaffected by NNSs. Meta-analyses of human randomized control studies showed a reduced energy intake and body weight. No significant change was seen in blood glucose levels, post-prandial glycemic or insulin response after consumption of NNSs. Adequate evidence is not available to conclusively say that NNSs influence gut health at doses relevant to human use. Research limitations/implications Most studies which are prospective cohort, observational and cross-sectional studies suggest that use of NNSs may promote obesity and metabolic syndrome in adults. Such studies are plagued by confounding variables and reverse causation. Mechanistic evidence is mostly based on in-vitro and in-vivo studies. The same causal pathways may not be operative or relevant in humans. Practical implications This review of available literature concludes that to achieve specific public health and clinical goals, the safe use of NNSs for the reduction of intakes of free sugars and energy should be explored. This would be possible by educating the consumer about energy compensation and understanding the nutritional content of artificially sweetened products in terms of calories coming from fat and complex carbohydrates used in the product. Originality/value This study was, thus, designed with the objective of examining the usefulness of NNSs in human population, especially with respect to insulin regulation, glycemic control and weight management. Well-designed randomized control trials which control for confounding variables are needed to generate high quality evidence.

Background In large supplementary feeding programs for children, it is challenging to create and sustain contextual, acceptable, nutritionally complete, and diverse supplemental foods. For example, the Indian Supplementary Nutrition Program (SNP) supplements the dietary intake of children, pregnant and lactating women, and severely acutely malnourished (SAM) children by offering dry take home rations (THRs) or hot cooked meals (HCMs) across India, but an optimization tool is necessary to create local contextual recipes for acceptable and nutritionally adequate products. Objectives This study aimed to create a linear programming (LP) model to optimize diverse food provisions for a SNP to meet its program guidelines, using locally available foods, within budgetary allocations. Methods A LP algorithm with appropriate constraints was used to generate an optimal THR based on raw foods, or an optimal weekly HCM menu comprised of a lunch meal with mid-morning snacks, based on user choices of foods and recipes. The database of foods used was created by a prospective survey conducted across all states of India for this purpose, such that the recipe and food optimization was diverse and specific to the guidelines for each beneficiary group. Results An interactive web-based app, which can optimize feeding programs at any population level, was developed for use by program implementers and is hosted at https://www.datatools.sjri.res.in/SNP/. In the Indian example analyzed here, the recommended optimized diets met the guidelines for diversified and nutritionally complete SNP provision but at a cost that was almost 25% higher than the present Indian budget allocation. Conclusions The optimization model developed demonstrates that contextual SNP diets can be created to meet macronutrient and most essential micronutrient needs of large-scale feeding programs, but appropriate diversification entails additional costs.

Background:India has seen a rise in consumption of foods high in fat, sugar, and salt that increases risk of diet-related noncommunicable diseases. Information on the drivers that determine food choices among adults will provide insights for policymakers to promote healthier food selection.Objective:This study assessed the determinants of food choices among adults in India.Methods:A cross-sectional study with a nonprobability purposive sampling technique in which adults were selected from residential colonies belonging to the 4 geographic zones of the city Delhi, India. Data was collected using a mixed methods approach on a total of 589 adults (20-40 y) belonging to upper-middle-income and high-income groups. Data was analyzed by the principal component analysis, chi-squared test, and logistic regression with a level of significance set at P value of < 0.05.Results:Most influential factors of food choices were brand (30%), nutritive value (22%), and taste (20%). The 3 factors that emerged from principal component analysis that determine food choices among adults were "individual," "social," and "food quality/wholesomeness." Focus group discussions also showed that the majority of participants were influenced by the "brand," "nutritive value," and "taste" of the food product while making food choices. Food choices were influenced by the company the person was eating food with, i.e., family members or friends. The cost of the food product was also an important driver of food choices among younger adults.Conclusion:Public health policy should utilize the determinants of food choices to bring about changes in the food environment by increasing the availability of healthier yet tasty food, bearing the cost in mind.

Nutritional inadequacies lead to various health problems among Indians. Improvements in diets can be addressed when different aspects of diet quality are known. The primary objective of the study was to assess diet quality of Indian adults belonging to the high-income group. The study also wanted to compare the suitability of two diet quality indices for use in the Indian scenario. A cross sectional study design with non-probability purposive sampling was used to collect data from 589 adults (20-40 years) in Delhi, India. Nutrient intake was assessed using the 24- hour dietary recall method. Two internationally recognized diet quality indices - Diet Quality Index- International Score (DQI-I) and the Global Diet Quality Score (GDQS) were selected to measure diet quality. 78% of the participants had poor diet quality using the DQI-I; the average score was 56.4 ± 5.6. The average DQI-I component scores for variety, adequacy, moderation and overall balance were 13.1±2.6, 27.5±2.2, 15.3±2.9, 0.43±0.9 respectively. Females were more likely (OR=2.07, 95% C.I.: 1.26 – 3.401) to have DQI-I scores in the lowest quartile (p=0.04). 88% had a moderate risk of nutritional inadequacy while 11% were at a high risk of nutritional inadequacy on the basis of their GDQS scores, the average of which was 16.9±2.1. There was a positive association between GDQS and DQI- I scores (ρ =0.316, p<0.001). The GDQS is better for assessing nutrient adequacy with healthy and unhealthy food consumption being compared. On the other hand, DQI-I gives a composite score combining the nutrient and food group intake and observes variety, adequacy, moderation and overall balance. Behaviour change communication strategies that encourage healthier food selection and promote dietary diversity may help improve nutritional quality of diets in Indian populations such as this one.

Adequate level of nutritional knowledge need not assure good dietary practices. Perceptions about the link between food and health as well as barriers in following healthy eating practices need to be examined to understand why people choose certain foods over others. The objective of the study was to assess the knowledge, perceptions and practices of adults regarding healthy eating. It is a cross-sectional, observational study where participants were selected purposively from a total of 23 housing colonies from four geographical zones (North, South, East, and West) of Delhi, India. A mixed methods approach was used to study the eating habits of 589 adults (20-40 years of age). A pretested questionnaire was used to gather information on knowledge, perceptions and practices regarding healthy eating. Twelve focus group discussions with 6-8 participants in each group were also conducted. The knowledge and practice scores had a weak positive relationship (p=0.181, p<0.01). Taste, emotional state of mind, social company and convenience influenced the food choices. Barriers such as lack of time to prepare meals, busy work schedules, not having skills to cook meals caused difficulty in following a healthy diet. Raising nutrition literacy levels cannot be the only focus of interventions to improve the quality of diet in a community. The barriers and enablers of a healthy diet need to be addressed in order to facilitate better food choices. A systematic ‘whole of society’ approach can be used to make a more conducive food environment.

Objectives: This study assessed food label reading habits and understanding of nutrition information on food labels by higher income adults in India. Design: It involved a cross-sectional study using non-probability purposive sampling. Setting: Data were collected by mixed methods approach between March 2019 and February 2020. Adults were selected from housing colonies in four geographical zones of Delhi, India. Method: A total of 589 adults (20–40 years) belonging to upper middle-income and high-income groups were selected. Associations between gender, family income, age, marital status, and label reading habits were assessed using Chi-square tests. Demographic predictors of food label reading habits were identified using binary logistic regression with a level of significance set at p < .05. Results: Participants read the food labels (79%) and noticed the nutrient claims (76%) on food labels. Female participants were more likely to understand nutrition information as compared with male participants (odds ratio [OR] = 1.52, p = .04). Female participants were also more likely to notice the nutrient claims on the packet of food products (OR = 1.99, p < .01) as compared with male participants. The majority of participants found the ‘traffic light scheme’ format easy to understand. Conclusion: Consumers look for nutrition information on food labels. They value healthier food alternatives but most are unable to decipher the nutrition labels. Food labels should communicate the healthfulness of products in a straightforward manner to enable better food choices.

School closure and home confinement during the COVID-19 pandemic have brought unprecedented lifestyle and dietary changes to the lives of families, particularly children. This paper aims to assess the impact of the COVID-19 pandemic on the eating and lifestyle habits of faimilies, with an emphasis on children. A cross-sectional online survey was conducted from October 2020 to March 2021 among 310 adults (≥18 years of age) living in North India. There were changes in cooking behaviour, food choices and eating behaviour among children and their families. This included a 51

Rise in prevalence of diet related non communicable diseases can be prevented by following balanced and healthy diets. The study aimed to assess adequacy of nutrient and food group intakes along with frequency of consumption of foods High in Fat, Sugar and Salt (HFSS). The study was a cross-sectional study with non-probability purposive sampling method. A total of 589 adults (20-40 years) were selected from housing colonies from four geographical zones of city. Dietary intake was assessed using 24-hour dietary recall method. Frequency and amount of foods consumed was recorded using a semi quantitative Food Frequency Questionnaire (FFQ). The differences in food groups and nutrient intakes across socio-demographic groups were assessed using Independent sample t-test and Mann-Whitney U test. Statistical significance was assumed at 5% level (p<0.05). Most participants had nutrient intakes lower than the EAR for calcium (97%), zinc (98%), riboflavin (100%), niacin (68%), vitamin B6 (96%) and vitamin A (60%). All participants had lower intakes of pulses, green leafy vegetables, other vegetables, fruits, milk and milk products, oilseed and nuts when compared to the recommended intakes. HFSS foods-sweet plain biscuits (46%), fried namkeen (37%), roasted namkeen (30%), non-carbonated drinks (29%) and deep-fried foods (25%) were eaten regularly by more than one fourth of participants. Participants occasionally consumed pizzas (60%), chat (54%), dosa (50%) and burgers (48%). Therefore, reducing the share of foods high in fat, sugar and salt and enabling healthier selection of food groups through behaviour change communication strategies will ensure adequate nutrient intakes.

Purpose Unsafe food can lead to various foodborne diseases and even death, especially among children. This paper aims to assess food safety knowledge and changes in practices and concerns among adults ≥ 18 years during the coronavirus disease 2019 (COVID-19) pandemic. Design/methodology/approach A cross-sectional, web-based survey was conducted among 325 adults living in Northern India. Demographic data and information regarding their knowledge, practices and concerns about various food safety issues were collected to see if there were any changes due to the COVID-19 pandemic. Findings The results showed that the participants had slightly higher than average knowledge and good food safety practices with mean scores of 9.75 ± 2.23 and 24.87 ± 2.28, respectively. Contracting COVID-19 from food and food packaging materials was of high concern for more than 70% of the participants. Majority (> 80%) of them reported an increase in the frequency of handwashing. About 16% of the participants used chemical disinfectants for washing fruits and vegetables. An increase (57.5%) in the frequency of food label reading was also noted during the pandemic. Freshness and the general quality of food items (49.5%), safety of food (30.8%) and cost (18.2%) were the top drivers that influenced the purchase decision. Originality/value This study highlighted the need to send out clear messages on safe food handling practices and keeping the tempo up for sustaining good hygienic practices. This will help in reducing the risk of foodborne diseases.

AbstractObjective:This study assessed diet diversity and consumption of ultra-processed foods and explored its impact on macronutrient intake and risk of micronutrient inadequacy.Design:Cross-sectional, non-probability snowball sampling.Setting:Nutrient intake was assessed using 24-h dietary recall method and diet diversity through FAO-diet diversity score (DDS). Mann–Whitney U test was used to assess differences in risk of inadequacy across gender. Spearman’s rank correlation assessed associations between energy contributed by ultra-processed food and risk of nutrient inadequacy.Participants:A total of 589 adults (20–40 years) belonging to upper-middle and high-income groups.Results:The average individual DDS was 4·4 ± 0·6. Most of the participants (>80 %) had intakes less than national recommendations of pulses/eggs/flesh foods, milk/milk products, fruits, vegetables and nuts. Ultra-processed foods contributed to 17 % of total energy intake, 12 % of protein, 17 % of carbohydrate, 29 % of added sugar, 20 % of total fat and 33 % of Na intake. The average risk of nutrient inadequacies for Zn (98 % v. 75 %), folate (67 % v. 22 %) and niacin (83 % v. 44 %) was higher among males than females (P < 0·001). The average risk of nutrient inadequacies for Fe (58 % v. 7 %), vitamin B6 (95 % v. 90 %) and vitamin A (68 % v. 44 %) was higher among females than males (P < 0·001). There was a positive correlation between energy contributed by ultra-processed food and risk of niacin (ρ = 0·136, P = 0·001) and folate (ρ = 0·089, P = 0·049) inadequacy.Conclusion:Reformulating ultra-processed food to reduce fat, sugar and salt and increase micronutrients and behaviour change communication strategies that promote dietary diversity will improve micronutrient adequacy and diet quality.

This study was aimed to assess the factors influencing food choices, food label reading habits, and understanding of nutrition information on food labels among adults. The study had a cross-sectional study design with a non-probability purposive sampling technique where adults who engaged in food purchase were selected from housing colonies from four geographical zones of the city. Key informants were contacted and thereafter snowball sampling was applied to collect data using a mixed-methods approach from 589 adults (20–40 years). Statistical analysis was performed with a level of significance P < 0.05. The most influential factors affecting food choices were brand (30%), nutritive value (22%), and taste (20%). Food selection depended on whether the adult had a meal with friends or family. Most participants read food labels (79%) and noticed nutrition and health claims (76%) on packaged food items. Most participants (80%) between 20–30 years read food labels and were most influenced by the health claim 'lowers cholesterol' (χ2 = 44.5, P < 0.001) compared to 30–40 year olds. Participants belonging to the upper-middle-income group were less likely to value nutrition over taste as compared to the high-income group while choosing food products adjusting for age, marital status, and gender (OR = 0.57, CI:0.381–0.86). Around 77% of participants believed that they understood nutritional information, though most (74%) could not identify whether foods were rich or low in specific nutrients. Females were more likely to understand nutrition information as compared to men (OR = 1.52, CI: 1.01–2.31). Among all the nutrient profiling models shown, the majority found the color-coded 'traffic light scheme' format easiest to understand. A combination of drivers influences food selection by an adult. The public health policy needs to adopt a food systems approach that brings about change in the food environment. The availability of healthy yet tasty alternatives needs to be encouraged and foods high in fat, salt, and sugar need to be discouraged. The packaging regulations need to ensure that food labels communicate about healthfulness in a simple manner to enable consumers to make better food choices. The first author (S.M.) received a Senior Research Fellowship from the University Grants Commission (India).

Abstract Objectives This review explored the relationship between knowledge among children and adolescents and their dietary behaviour. Content Potentially eligible original research articles were identified through a systematic search in PubMed, SCOPUS, Web of Science and WHO Virtual Health Library from 2000 to 2018. From the initial search, a total of 7,258 research articles were obtained. Duplicate studies were identified and removed. Observational studies on children and adolescents (5–19 years) of any gender, ethnicity and country were included in which the outcome measured was either a scoring of/ association between nutrition knowledge and practices. After screening using the inclusion criteria, 13 studies were selected for this paper. Summary and Outlook Four studies reported non-significant association between overall nutrition knowledge and practices. Only two studies found a significant association, out of which one showed a weak association highlighting that nutrition knowledge is not sufficient to result in healthy eating. Other factors which showed significant but weak associations with knowledge/practices included age, gender, nutritional status and lifestyle, peer influence, parents’/guardians’ knowledge, education and occupation level. The causal relationship couldn’t be examined in the present review due to the cross-sectional nature of the studies. Besides imparting knowledge through nutrition education interventions, there is a need for holistic behaviour change strategies including supporting food skills like menu planning, food shopping and cooking to encourage healthy eating habits among children. These interventions should target children from an early age, involving family/parents, teachers and peers to facilitate improvement in the food environment for sustainable change.