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BACKGROUND: Women of reproductive age are at an increased risk of anemia and micronutrient deficiencies. Evidence supports the role of periconceptional nutrition in the development of neural tube defects (NTDs) and other pregnancy complications. Vitamin B(12) deficiency is a risk factor for NTDs and may modify folate biomarkers that predict NTD risk at the population level. There is an interest in mandatory fortification with vitamin B(12) and folic acid for anemia and birth defect prevention. However, there are limited population-representative data needed to inform policy and guidelines. OBJECTIVES: This randomized trial will be conducted to evaluate the efficacy of quadruple-fortified salt (QFS; iron, iodine, folic acid, vitamin B(12)) in 1,000 households in Southern India. METHODS: Women 18 to 49 y who are not pregnant or lactating and reside within the catchment area of our community-based research site in Southern India will be screened and invited to participate in the trial. After informed consent, women and their households will be randomized to receive one of the following 4 interventions: 1) double-fortified salt (DFS; iron, iodine), 2) DFS + folic acid (iron, iodine, folic acid), 3) DFS + vitamin B(12) (iron, iodine, vitamin B(12)), or 4) DFS + folic acid and vitamin B(12) (QFS; iron, iodine, folic acid, vitamin B(12)) for 12 mo. Structured interviews will be conducted by trained nurse enumerators to collect sociodemographic, anthropometric, dietary, health, and reproductive history data. Biological samples will be collected at baseline, midpoint, and endpoint. Whole blood will be analyzed for hemoglobin using Coulter Counter. Total vitamin B(12) will be measured by chemiluminescence; red blood cell folate and serum folate will be evaluated using the World Health Organization-recommended microbiologic assay. CONCLUSIONS: The results of this randomized trial will help to evaluate the efficacy of QFS to prevent anemia and micronutrient deficiencies. Clinical trial registration numbers: NCT03853304 and Clinical Trial Registry of India REF/2019/03/024479. REGISTRATION NUMBER: NCT03853304 and REF/2019/03/024479.

COVID-19 and its associated regulatory measures including lockdowns, curfews, and physical distancing norms have significantly affected individual's dietary and culinary behaviours. Although there is ample empirical evidence available on dietary changes within the Indian context, very limited evidence exists about the factors influencing these dietary modifications and changes in culinary behaviours during COVID-19 lockdown. Therefore, the aim of this qualitative study was to explore the views of Indian household food gatekeepers towards meal planning, food purchasing, and meal preparation during the pandemic and its associated lockdowns. A convenience sample of 34 female gatekeepers from the Mumbai metropolis participated in online interviews. Interviews were conducted in English and Hindi (then translated in English), audio-recorded and transcribed verbatim. Underpinned by Template Analysis technique, transcribed data were analysed manually and using the NVivo software program. The interview structure guided the development of themes. The emerging themes included were: Increased household cooking; Involvement of children and male members in food-related activities; Experimentation in the kitchen; Adoption of meal planning skills; Increase in online food shopping; Bulk buying; Shortage of food items; Reduced consumption of outside home food; Increased variety of home-cooked meals; Increase in snacking and overall food intake; Determinants of food choices; and Family meals-a new norm. In the light of these findings, developing family-focussed, web-based nutrition programs to enhance gatekeepers' and their families' food literacy including declarative and procedural nutritional knowledge would be beneficial. The importance of organisational culinary behaviours such as planning meals in advance, shopping with a food list should be promoted to prevent hoarding and subsequently reduce strain on the food supply system. With a surge in domestic cooking, low cost nutritious recipes with the use of local and seasonal produce should be emphasized promoting healthy eating among the gatekeepers and their family members. The inclusion of food studies in the school curriculum will facilitate the development of culinary skills among children and youth. Also, there is a need for further research and surveillance to strengthen understanding of sustainability of healthy culinary behaviours practiced during the pandemic.

Iron deficiency is the leading cause of anemia in India. In spite of implementation of a National iron supplementation programme of anemia control, the rate of decline in anemia prevalence has not been satisfactory. To address this issue, a National consultation meeting is being organized by the Ministry of Health and Family Welfare, Government of India, 23-24th April 2018, AIIMS, New Delhi. The purpose of the background document is to facilitate the deliberations of the above meeting. In this document, we discuss the latest progress in studies of iron metabolism, bioavailability, requirement and RDA for Indians. Hepcidin is a circulating peptide hormone secreted by the liver that plays a central role in coordinating the use and storage of iron with iron acquisition. Therefore, we considered it important to review and include trials on modulation of hepcidin during iron supplementation. Further, we made an attempt to review iron supplementation trials in Indian pregnant women and children to sequentially assess the basis for fixing iron dosage. Finally, we made an attempt to apply theoretical basis of computation of iron dose for the age/gender and physiological group for treatment of anemia due to iron deficiency. In the light of the role of hepcidin in iron nutrition, we consider it important to characterize the contextual determinants and establish the iron dosage. We believe that the systemic regulation may not allow the body to store adequate amounts of iron from oral doses in short duration of 100 days. Based on the biology of iron it appears that iron homeostasis leading to assimilation of storage of iron is a very slow process and may require practice of contextual food synergy systems to improve iron content (fortified foods) and bioavailability (vitamin C rich fruits) throughout life cycle.