Search

Non-PR, IFPRI1; DCA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Diet-related risks cause 20% of global deaths (~11 million) per year (Afshin et al., 2019). Increased urbanization in low- and middle-income countries accompanied by a nutrition transition, involving increased consumption of unhealthy, processed foods and reductions in physical activity, has exacerbated diet-related risks, leading to increases in rates of overweight and obesity (Popkin et al., 2020). Diets in urban settings are also affected by the reduced time for food preparation, convenience and affordability of unhealthy foods. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to tackle these problems. FRANI was previously validated against observed weighed records, the gold standard for diet assessment, and shown to be as accurate as a trained dietician undertaking a standard, multi-pass 24-hr recall (Folson et al., 2023). FRANI was developed to also provide gamified nudges and personalized feedback designed to promote healthy food choices. The objectives of this study were to measure the acceptability, adherence, and likeability of FRANI, as well as its effects on the food choices of female youth in Accra, Ghana.

PR, IFPRI3; DCA; 2 Promoting Healthy Diets and Nutrition for all; ISI, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16–22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only—although more feasible for behavior change—was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.

PR, IFPRI3; ISI; DCA; CRP4; Alive and Thrive; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Bangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services. Objectives: We assessed the impact of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron-folic acid (IFA) and calcium consumption, and child feeding practices. Methods: We used a quasi-experimental design with a non-random assignment of 20 health facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n=2,455 observations and surveys with 1,678 pregnant [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering. Results: Exposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC check-ups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counselling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25pp) and calcium supplementation (19pp), adequate weight gain (44pp), and appropriate child feeding (27pp). Improvements were greater in the intensive than standard arm for number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23pp); no impact was observed for IFA and calcium consumption during pregnancy. Impacts were observed for early initiation (20pp), exclusive breastfeeding (45pp), introduction of solid or semi-solid foods (28pp), and egg and/or flesh food consumption (33pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms. Conclusions: Intensifying nutrition in government-aligned health services delivered by experi

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy

PR, IFPRI3; ISI; CRP4; Capacity Strengthening; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors an

Non-PR, IFPRI1; POSHAN; 2 Promoting Healthy Diets and Nutrition for all; CRP4, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Early life nutrition sets the stage for the health, nutrition, and development of young children. Optimal infant and young child feeding (IYCF) practices begin with timely initiation of breastfeeding, followed by exclusive breastfeeding and complementary feeding. This Data Note provides an overview of trends and patterns in IYCF practices in India at the national-, state-, and district levels based on the 2015-16 and 2019-21 National Family Health Surveys (NFHS) data. IYCF indicators were created following World Health Organization and UNICEF’s 2021 guidelines.

Non-PR, 2 Promoting Healthy Diets and Nutrition for all; IFPRI1; POSHAN, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, South Asia is home to more adolescents than any global region, and one in five adolescents globally live in India. Among the many issues that adolescents face, poor nutrition, non-communicable diseases (NCDs), marriage, and childbearing are of key importance as they have far-ranging and intergenerational consequences. This Data Note examines the national-level trends and spatial variability at state and district levels for a set of key nutrition outcomes, NCDs, marriage, and childbearing status among Indian adolescents (15-19 years; girls and boys). The findings are based on data from the three rounds of India’s National Family Health Surveys (NFHS) – NFHS 2006, 2016, and 2021. The Data Note concludes with key takeaways for adolescents’ wellbeing and identifies areas for improvement. This Data Note can be used for further inquiry by stakeholders including researchers, policymakers, and program staff at multiple levels.

PR, IFPRI3; ISI; DCA; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescence is a sensitive transition time that affects rights, roles, and responsibilities in food choice, yet limited evidence exists on dietary intakes during this critical period. This study assessed the food consumption pattern and the adequacy of energy, macronutrient, and micronutrient intakes among female youth belonging to three occupational groups in Vietnam. Dietary intakes were measured for 1001 participants aged 16–22 years using INDDEX24's 24-h recall method. Multivariate regression analyses were conducted to examine differences in diet outcomes among the three occupational groups. Dietary diversity was similar across groups but workers, compared to high school and college students, consumed less baked/grain-based sweets and fast foods, and more soft drinks, other sweets, and processed meat. Two-thirds of the sample showed energy intake lower than the estimated energy requirement, while a substantial percentage had insufficient or excessive intake of carbohydrate and fat. The mean probability of adequacy of nutrient intakes was low (0.33) and not different across all three occupational groups except for folate, which favored workers. Our study provides novel evidence supporting the development and implementation of interventions to achieve national targets, with emphasis on female youths who undergo special transitions in education, occupation, and lifestyle.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescent and young women face grave nutrition challenges, but limited evidence exists on solutions to improve their diets. Action-research was done over 3 years (2020–2022) in secondary cities of Colombia (Medellin) and Vietnam (Thai Nguyen) to identify nutrient deficits in adolescent and young women diets; elaborate food-based recommendations to improve their nutritional status using Optifood linear programming; and engage respondents in incorporating suggested recommendations to their diet using a Social Innovation Challenge approach. A total of 1001 respondents were interviewed in Vietnam, 793 in Colombia. The probability of nutrient inadequacy in both locations was highest for iron and calcium, followed by the risk of deficiency for several other vitamins and minerals. Social Innovation Challenge teams (11 in Vietnam, 9 in Colombia) were created and supported in developing solutions to improve diets and tackle those deficiencies. Awards and resources were transferred to the most promising solutions to enable their implementation. Pre/post measurements of the interventions’ impact using the Global Diet Quality Score as outcome metric showed significant improvement in the diets of Challenge participants. After introducing a series of companion articles that offer detailed results on those various steps, this paper draws strategic lessons from an action-research perspective.

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; Alive and Thrive, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background: Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. Objective: This qualitative study aimed to: (1) examine pregnant women’s experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption. Methods: We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework. Results: For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described rec

PR, IFPRI3; DataDENT; 2 Promoting Healthy Diets and Nutrition for all; 5 Strengthening Institutions and Governance, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Antenatal care (ANC) is an opportunity to receive interventions that can prevent low birth weight (LBW). We sought to 1) estimate LBW prevalence and burden in South Asia, 2) describe the number of ANC visits (quantity) and interventions received (quality), and 3) explore associations between ANC quantity, quality and LBW. We used Demographic and Health Survey (DHS) data from Afghanistan (2015), Bangladesh (2018), India (2016), Nepal (2016), Pakistan (2018) and Sri Lanka (2016) (n = 146,284 children <5y). Women were categorized as follows: 1) low quantity (<4 ANC visits) and low quality (<5 of 10 interventions received during ANC), 2) low quantity and high quality (≥5 of 10 interventions), 3) high quantity (≥4 visits) and low quality, 4) high quantity and high quality. We used fixed effect logistic regressions to examine associations between ANC quality/quantity and LBW (<2500 grams). LBW prevalence was highest in Pakistan (23%) and India (18%), with India accounting for two-thirds of the regional burden. Only 8% of women in Afghanistan received high quantity and high quality ANC, compared to 42–46% in Bangladesh, India, and Pakistan, 65% in Nepal and 92% in Sri Lanka. Compared to the low quantity/quality reference group, children of women with high quantity/quality ANC had lower odds of LBW in India (Adjusted Odds Ratio 0.84, 95% CI 0.78–0.89), Nepal (0.57, 0.35–0.94), Pakistan (0.45, 0.23–0.86), and Sri Lanka (0.73, 0.57–0.92). Low quantity but high quality ANC was protective in India (0.90, 0.84–0.96), Afghanistan (0.53, 0.27–1.05) and Pakistan (0.49, 0.23–1.05). High quantity but low quality ANC was protective in Sri Lanka (0.76, 0.61–0.93). Neither frequent ANC without appropriate interventions nor infrequent ANC with appropriate interventions are sufficient to prevent LBW in most South Asian countries, though quality may be more important than quantity. Consistent measurement of interventions during ANC is needed.

PR, IFPRI3; Cross-cutting gender theme; 5 Strengthening Institutions and Governance, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, The COVID-19 pandemic has disproportionately affected vulnerable populations. With its intensity expected to be cyclical over the foreseeable future, and much of the impact estimates still modeled, it is imperative that we accurately assess the impact to date, to help with the process of targeted rebuilding of services. We collected data from administrative health information systems in six South Asian countries (Afghanistan, Bangladesh, Nepal, India, Pakistan and Sri Lanka), to determine essential health services coverage disruptions between January–December 2020, and January–June 2021, compared to the same calendar months in 2019, and estimated the impact of this disruption on maternal and child mortality using the Lives Saved Tool. We also modelled impact of prolonged school closures on continued enrollment, as well as potential sequelae for the cohort of girls who have likely dropped out. Coverage of key maternal and child health interventions, including antenatal care and immunizations, decreased by up to 60%, with the largest disruptions observed between April and June 2020. This was followed by a period of recovery from July 2020 to March 2021, but a reversal of most of these gains in April/May 2021, likely due to the delta variant-fueled surge in South Asia at the same time. We estimated that disruption of essential health services between January 2020 and June 2021 potentially resulted in an additional 19,000 maternal and 317,000 child deaths, an increase of 19% and 13% respectively, compared to 2019. Extended school closures likely resulted in 9 million adolescents dropping out permanently, with 40% likely being from poorest households, resulting in decreased lifetime earnings. A projected increase in early marriages for girls who dropped out could result in an additional 500,000 adolescent pregnancies, 153,000 low birthweight births, and 27,000 additional children becoming stunted by age two years. To date, the increase in maternal and child mortality due

Non-PR, IFPRI1; POSHAN; CRP4; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), This Data Note provides an update on the prevalence of anemia and its determinants in India at state and districts levels, as well as coverage of a nutrition specific and nutrition sensitive interventions. Data were from the National Family Health Surveys in 2005 06, 2015 2016 and 2019 21. We first report national trends for 8 population groups (Figure 1 below). For each population group, we show anemia prevalence by severity category and at state and district levels using the two latest rounds of data. Lastly, we show recent trends in determinants of anemia and, nutrition and health interventions.

Non-PR, IFPRI1; POSHAN; CRP4; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), A set of global nutrition targets for maternal and child nutrition together with diet related non communicable diseases ( to be achieved by 2025 was endorsed by the World Health Assembly in 2013 These targets provide goals against which progress towards ending malnutrition in all its forms can be measured and contribute to the Sustainable Development Goals This data note describes trends in multiple forms of malnutrition and NCD outcomes at the national, state, and district levels for India using survey data from NFHS 3 2005 06 NFHS 4 2015 2016 and NFHS 5 2019 2021 Insights on other malnutrition targets such as anemia and breastfeeding will be forthcoming

Non-PR, IFPRI1; POSHAN; CRP4; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), Nutrition-specific interventions are aimed at improving the food, health, and care environment for women and children during the first 1000 days. These interventions span pregnancy, postnatal, and early childhood periods and include food and micronutrient supplementation, nutrition education and/or counselling, growth monitoring and promotion, as well as routine immunization, deworming, and care during illness. At 90% coverage, these interventions can contribute to 20% reduction in stunting and 61% reduction in severe wasting. India’s policy framework for health and nutrition is robust and includes most evidence-based nutrition and health interventions. Two large-scale national program platforms – the Integrated Child Development Services and the National Health Mission – together deliver these interventions across the country. India’s efforts at scaling up nutrition interventions are now also bolstered by the National Nutrition Mission. This Data Note describes the coverage of key nutrition and health interventions for which data are available in the National Family Health Surveys for 2015-2016 and 2019-2021. To examine coverage of interventions, indicators were created based on global definitions and making adaptations to Indian policy context where necessary. Data on women of reproductive age (15-49 years) with a child below five years of age from the most recent birth was used to compute these indicators. Indicator definitions are provided in Annex 1 of this Note.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background: The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear. Objective: We examined associations between maternal preconception Hb concentrations and anemia with: a) birth outcomes (weight, length, preterm, gestational age, small-for-gestational-age); b) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; c) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6-7y (Wechsler Intelligence Scale for Children). Methods: We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited and offspring were prospectively followed from birth (n=1599) through 6-7y (n=1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 11g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child and household levels. Results: At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01,0.12), 6 mo (0.08; 95% CI: 0.03,0.13), 12 mo (0.10; 95% CI: 0.04-0.15) and 24 mo (0.07; 95% CI: 0.02,0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6mo (0.89; 95% CI: 0.81-0.98), 12 mo (0.81; 95% CI: 0.74-0.89) and 24 mo (0.87; 95% CI: 0.79-0.95). Maternal preconception anemia was negatively associated with cognition (-1.64; 95% CI: -3.09, -0.19) and language development (-1.61; 95% CI: -3.20, -0.03) at 24mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6-7y. Conclusion: Maternal preconception Hb was associated with child Hb across the first 1000 days of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive outcomes at 6-7y in

PR, 2 Promoting Healthy Diets and Nutrition for all; IFPRI3; ISI, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy, Background: Inequity in child development is found at early age, but limited evidence exists on whether these gaps change over time and what are the mediators. Objective: We aim to (1) quantify wealth related gaps in cognitive and socio-emotional development in early and middle childhood; (2) examine how these gaps were mitigated by maternal, child factors and home environment. Methods: We assessed the offspring of women who participated in a randomized controlled trial of preconception micronutrient supplementation in Vietnam (n = 1599). Child development was measured by the Bayley Scales of Infant Development-III (at 1-2y) and the Wechsler Intelligence Scale for Children®—IV (at 6-7y). We used multivariable regression to estimate the changes in wealth gaps for child development over time, adjusting for potential factors that potentially influence cognitive development. Results: We found significant wealth gaps in cognitive development during early childhood (gaps between top and bottom quintiles: 0.5 SD); these gaps increased substantially in middle childhood (0.9 SD). Wealth disparity in social emotion did not change over time (0.26–0.28 SD). Maternal factors, quality of home environment, and child nutritional status mitigated the wealth gap in cognitive development (7-42%) in early childhood. The contribution of these mitigating factors was smaller in middle childhood (2- 15%). Wealth gap in social emotion reduced by 13% and 43% among children with better nutritional status at 2y and higher quality of home environment at 6-7y, respectively. Conclusion: Interventions focusing on improving quality of home environment, maternal education, wellbeing, and child nutrition status may help reduce developmental deficits associated with poverty.

PR, IFPRI3; Alive and Thrive; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Introduction: Alive and Thrive (A&T) implemented infant and young child feeding (IYCF) interventions in Bangladesh. We examine the sustained impacts on health workers' IYCF knowledge, service delivery, job satisfaction, and job readiness three years after the program's conclusion. Methods: We use data from a cluster-randomized controlled trial design, including repeated cross-sectional surveys with health workers in 2010 (baseline, n = 290), 2014 (endline, n = 511) and 2017 (post-endline, n = 600). Health workers in 10 sub-districts were trained and incentivized to deliver intensified IYCF counseling, and participated in social mobilization activities, while health workers in 10 comparison sub-districts delivered standard counseling activities. Accompanying mass media and policy change activities occurred at the national level. The primary outcome is quality of IYCF service delivery (number of IYCF messages reportedly communicated during counseling); intermediate outcomes are IYCF knowledge, job satisfaction, and job readiness. We also assess the role of hypothesized modifiers of program sustainment, i.e. activities of the program: comprehensiveness of refresher trainings and receipt of financial incentives. Multivariable difference-in-difference linear regression models, including worker characteristic covariates and adjusted for clustering at the survey sampling level, are used to compare differences between groups (intervention vs. comparison areas) and over time (baseline, endline, post-endline). Results: At endline, health workers in intervention areas discussed significantly more IYCF topics than those in comparison areas (4.9 vs. 4.0 topics, p < 0.001), but levels decreased and the post-endline gap was no longer significant (4.0 vs. 3.3 topics, p = 0.067). Comprehensive refresher trainings were protective against deterioration in service delivery. Between baseline and endline, the intervention increased health workers' knowledge (3.5-point increase in knowled

Non-PR, IFPRI1; POSHAN; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, BACKGROUND| Healthy diets are necessary for optimal growth and to carry out daily mental and physical tasks. Unhealthy diets drive all forms of malnutritionand dietary risks are the number one risk factor globally for deaths and disability (Global Burden of Disease collaborators, 2019). Given the importance of diet as a key driver of health and wellbeing, this Data Note examines available data from three rounds of India’s National Family Health Surveys (NFHS) on food consumption patterns of adult men and women. MEASUREMENT| NFHS asks women (15-49 years) and men (15-54 years) how frequently (daily, weekly, occasionally or never) they consume nine food groups including two unhealthy food groups (Figure 1). The 2020 Nutrient Requirements for Indiansoutlines the quantity per day of vegetarian foods to be consumed as part of a balanced diet (ICMR-NIN, 2020). The guidelines indicate that pulses can be replaced with animal-source foods for non-vegetarians. Thus, for this Data Note we constructed an additional indicator –daily consumption of pulses or egg or fish or chicken or meat –to estimate any protein consumption (Figure 1). Estimates are first presented at the national levelto provide an overall view of how diets have changed from 2005-06 to 2019-21. On subsequent pages, we show trends between 2015-16 and 2019-21 by stateand district. USE| This data note provides a broad view of diet patterns among adults and should be used for further inquiry by stakeholders including researchers, policymakers, and program staff at multiple levels. We recognize that NFHS is not a detailed dietary survey and does not ask about individual food items or the quantity of food consumed. Thus, this data note should be used as a starting point for discussion and to identify major areas of improvement in consumption and measurement.