Elezebeth Mathews ^1,2* Alejandro Cifuentes ³ Elena Ibañez ³ Miroslava Rossenova Atanassova ⁴

• ¹ Central University of Kerala, Kasaragod, India
• ² Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
• ³ Laboratory of Foodomics, Institute of Food Science Research, Madrid, Asturias, Spain
• ⁴ Møreforsking (Norway), Volda, Norway

Sustainable Development Goals envisages holistic development and well-being in the perspective of life course approach. Good nutrition sets the foundation of health, from the preconception to proper growth and development in childhood and adolescence, and good health and well-being in the adulthood. Proper nutrition during the first 1,000 days of life 3 is critical for physical growth and cognitive development. Childhood undernutrition causes nearly 45% of death among children under the age of 5 years 3 (WHO) resulting in long-term irreversible effects, including impaired physical growth, recurrent infections and cognitive underdevelopment 4 . In a randomized intervention study by Gsoellpointner et al., at Vienna, nutrient supplementation by early introduction of solid foods improved zinc, calcium, and phosphorus intake in Very Low Birth Weight (VLBW) infants at 1st year of life. Authors further recommended prolonged iron and vitamin D supplementation at least until 12 months in order to meet the recommended levels. Larson et al., in a meta-analysis of trials on egg consumption and growth in children found significant improvements in height and weight in children compared to control group, suggesting egg as an affordable nutritional option in low-middle income countries. Beyond diet supplementation, much importance needs to be given to address the social determinants of health to combat malnutrition. A study Sanin et al., explored the factors influencing childhood undernutrition in vulnerable regions of Bangladesh using Bangladesh Demographic and Health Survey data (2007-2018). A decadal reduction in stunted growth and underweight among under-fives were observed, and found that urban residence, age and gender of child, morbidity, maternal body mass index, maternal and paternal education, decision-making ability, use of contraceptives, the occurrence of domestic violence, antenatal care, mode of delivery, birth interval, as well as geographic region were associated with childhood malnutrition.Adolescence is a transitional phase of human life from childhood to adulthood, characterized by physical, mental and psychosocial changes. Survivors of childhood malnutrition often manifest with Chronic Energy Deficiency (CED) and more than one type of malnutrition. Yulia et al., in a study in Indonesia found that half of the adolescents in urban (54%) and rural (61.7%) areas at risk for Chronic Energy Deficiency and consumed inadequate macronutrients. Double Burden of Malnutrition (DBM) characterized by both over-and under-nutrition is predominant in low middle income countries as a result of complex interaction of poor nutrition, biological factors, environmental and social influences across the life course. A school-based study by Getacher et al., among 10-19 year olds in Ethiopia found DBM prevalence of 21.5% (14.8% thinness and 6.7% overweight/obesity) and was associated with age, sex, type of school, dietary diversity, frequency of meals, home gardening practice, illness history and knowledge on nutrition. Multisectorial interventions addressing the two contradictory nutrition paradigms are critical to alleviate growing burdens of malnutrition. Healthy eating among adolescents can be enhanced by creation of healthy eating and active environment space in the learning settings right from the early years. Pre-school and school educators need to be trained with necessary skills and expertise to enhance the holistic development of the child, including healthy behaviours on diet and physical activity. Educational institutions are platforms to mould healthy future generations. In a study by Lafave et al., CHEERS eHealth program improved nutrition and physical activity practices within Early Childhood Education and Care (ECEC) centres. He found educators' personal nutrition-related knowledge, attitude and behaviours to be positively associated with their self-assessments of the nutrition environment and practices in ECECs. The CHEERS survey Food Served subscale further showed a positive correlation with the objective measures of EPAO-Foods provided and Nutrition Policy subdomains.Maintenance of an optimum body mass index is critical at all stages of life. Globally 49% of adults are overweight or obese. Several studies continue to explore the diet-related factors that drive obesity, as well as effective nutritional therapies to prevent obesity. Cattaneo et al., in an RCT observed 4-week restricted Mediterranean diet to be effective in improving the anthropometric, and blood parameters among participants with severe obesity. Targeting taste as a new approach is recommended by authors to prevent the risk of therapeutic failure. Another randomized controlled trial by Hooshiar et al., among women with obesity and overweight in Iran, showed Alternate Day Modified Fasting (ADMF) diet to be effective in weight reduction [-5.23 (1.73) vs. -3.15 (0.88); P < 0.001] and body mass index [-2.05 (0.66) vs. -1.17 (0.34); P < 0.001] compared to Daily Calorie Restriction (CR) diet. There were significant improvements in sleep and daytime dysfunction. Future studies need to explore the long term effect of Alternate Day Modified Fasting (ADMF) diet on overweight/obesity. Conversely, low BMI was inversely related to mortality 5 . A study by Ishikawa et al., found improvements in the physical and mental health scores of health-related Quality of Life with 12 weeks Medium Chain Triglycerides (MCT) supplementation and moderate-intensity walking exercise among sedentary older adults aged 60-74 with low BMIs (< 24 kg/m2).Nutritional epidemiological studies have established irrefutable evidence on the relationship between diet and chronic diseases, and several observational studies, trials and meta-analysis have examined the complex relationship between diet and diseases. A prospective cohort study by Kityo et al., in Korea among 13,568 adults of the Health Examinees-Gem (HEXA-G) reported high intake of processed red meat to be a risk factor for all-cause mortality [men: hazard ratio (HR) 1.21, 95% CI 1.07-1.37; women: HR 1.32, 95% CI 1.12-1.56]. Increased risk of all-cause mortality (HR 1.21, 95% CI 1.05-1.39) and cancer mortality (HR 1.24, 95% CI 1.03-1.50) was observed in women with high intake of organ meat. Moderate intake of pork belly was associated with reduced risk of all-cause mortality in men (HR 0.76, 95% CI 0.62-0.93) and women (HR 0.83, 95% 0.69-0.98), but high intake was associated with increased risk of CVD mortality in women (HR 1.84, 95% CI 1.20-2.82). Xing et al., in a mendelian randomization analysis in European population showed genetically determined tea intake to have a causal impact on total body bone mineral density (TB-BMD), with an odds ratio (OR) of 1.204 (95% CI: 1.062-1.366, p = 0.004), especially in the age group of 45-60 years (OR = 1.360, 95% CI: 1.088-1.700, p = 0.007). Tea consumption increases bone density and reduces the risk of osteoporosis in the age group of 45-60 years within the European population. Findings of a large-scale prospective cohort study in the US by Qi et et al., of 101,190 participants with a median follow-up of 12,2 years suggested that dietary glycaemic index had a higher risk for renal cancer (HR Q3 vsQ1: 1.38; 95% CI: 1.09-1.74). Further studies are recommended in other populations to establish dietary GI as a modifiable risk factor for renal cancer prevention. Torabynasab et al., in a systematic review and meta-analysis of cross sectional studies found protective effect of dietary caffeine against development of depression, with no evidence linked to tea consumption. Authors recommend further longitudinal studies to establish the causal relationship between coffee, tea, and caffeine and the risk of depression. Maweri et al., in an updated meta-analysis found significant association between low serum levels of vitamin D and the risk of recurrent aphthous stomatitis (mean difference = -8.73, 95% CI: -12.02 to -5.44), recommends screening and supplementation of Vitamin D for prevention and treatment of aphthous stomatitis. Wang et al., observed the relationship between vitamin K and metabolic dysfunction-associated fatty liver disease among the United States population using the National Health and Nutrition Examination Survey 2017-2018. Metabolic dysfunction-associated fatty liver disease (MAFLD) population had a lower vitamin K intake than the non-MAFLD population, suggesting its protective effect. Further prospective studies or intervention trials are warranted to establish the causal relationship.Recent advances in molecular epidemiology has paved way to greater understanding of the molecular determinants of nutritional imbalances and disorders. The Oxidative Balance Score (OBS), which assesses the impact of diet and lifestyle on oxidative stress, has been linked to lower risks of metabolic syndrome. Liu et al., found oxidative balance score to be inversely related to NAFLD risk among 6341 adult participants using the US National Health and Nutrition Examination Survey 1999-2018. On a similar note, Park et al., found an inverse relationship between oxidative balance score and metabolic syndrome among 2735 adult over 19 years and 5,807 adults aged 40-69 years from Korean National Health and Nutritional Examination Survey (KNHANES) data and Korean Genome and Epidemiology Study (KoGES) respectively. These findings suggest the benefit of healthy lifestyle for prevention of metabolic syndrome. Wang et al., observed a 24% decrease in risk for non-cancer mortality (aHR = 0.76, 0.60-0.92) among 5009 cancer patients, who had Dietary total Antioxidant Capacity (DAC) but not of all-cause and cancer mortality. Higher dinner DAC rather than breakfast or lunch DAC was associated with a 21% lower risk of all-cause mortality (aHR = 0.79, 95% CI: 0.65-0.98) and 28% lower risk of non-cancer mortality (aHR = 0.72, 95% CI: 0.57-0.90). Authors emphasize advocacy on DAC consumption from dinner to reduce mortality risk in cancer survivors.Nutraceuticals-nutrient-based supplements and plant-derived products-are gaining recognition for their health benefits. Derbo et al., in a community based study in Ethiopia found 49.6% consumed Moringa Stenopetala leaves (locally known for reducing the risk of malnutrition, low birth weight, and anaemia) during pregnancy, and factors associated were younger age (below 24 years), rural residence, antenatal care attendance, history of contraceptive use, and having a good knowledge about the importance of Moringa Stenopetala. Studies have shown that omega-3 fatty acids improve nutritional status and reduce chronic inflammation in cancer patients, while flaxseed supplementation has shown no significant effect on sex hormone levels. Li et al., in a meta-analysis of RCT's found oral intake of fruit or fruit extracts showed significant improvements in skin hydration and decrease of trans-epidermal water loss (TEWL). Wang et al., in animal studies reported consuming fermented wax gourd, a traditional food of Eastern China enhanced the presence of beneficial probiotics and reduce pathogenic Helicobacter sp. in the mouse gut. Synbiotics, which combine probiotics and prebiotics, are another promising area of research. However, a study by Talebi et al., among women with polycystic ovary syndrome (PCOS) yielded mixed results, suggesting the need for more rigorous trials.Nutritional literacy is recognised to have a positive influence on behaviour change and adopting healthy eating practices. However, many populations, especially those living with HIV or in low-income regions, still face significant barriers to proper nutrition. Gemede et al., observed poor nutritional knowledge and poor nutritional practices among HIV positive adults was 74.9 and 69.1%, respectively in Ethiopia. Nutritional knowledge was associated with educational level, monthly income, adult occupation, and marital status of respondents. A study by Zhang et al., showed knowledge, attitude and practice of oil and salt intake were relatively poor, with region of the province, ethnicity, urban and rural residence, education, taste preference, and prevalence of chronic diseases influencing oil and salt-related KAP scores. Yang et al.. in a study among elderly populations in rural China found higher dietary indices to be associated with better quality of life scores, highlighting the important role of a healthy diet in improving overall wellbeing.The COVID-19 pandemic has had both short-and long-term effects on health, particularly affecting eating habits and lifestyle behaviours. Rafraf et al., in his study found university students experienced weight gain, reduced physical activity, and worsened sleep quality during the pandemic. In Indonesia, food insecurity worsened, affecting many families' ability to access nutritious foods. These findings suggest the need to address nutritional needs during and after the pandemic.At the population level, nutrition policies play a crucial role in promoting health. Kirk et al., examined the impact of the Affordable Care Act (ACA) on nutrient consumption in the United States, using data from the National Health and Nutrition Examination Survey (NHANES). The study found that the intake of micronutrients from nutrient-dense foods, such as fruits and vegetables, did not change significantly following the ACA. However, there was an increase in the use of nutritional supplements after the ACA (p = 0.05), particularly for magnesium (OR = 1.02), potassium (OR = 0.76), vitamin D (both D2 and D3, OR = 1.34), vitamin K (OR = 1.15), and zinc (OR = 0.83). This trend was observed in both the general population and in specific subgroups, including cancer survivors and Medicaid recipients. Given the connection between increased supplement use and expanded insurance coverage, the authors call for further research to better understand how broader access to nutritional supplements might influence the intake of both micro-and macronutrients to meet daily recommended nutritional requirements.Achieving SDG 3 requires a comprehensive approach to nutrition that goes beyond health to include sustainable food systems and equitable food distribution. Advances in food production and technology are essential for improving food quality and ensuring access to healthy food. Unsustainable agricultural practices, food waste, and inequitable food distribution exacerbate environmental degradation and hinder equitable access to nutritious foods. In order to combat this disparity, it is critical to focus on a new model of sustainable food manufacturing to have improved food production. Wang et al., in a review throws light on the "big food view" to improve food production, improve quality and diversity through scientific and technological innovation, and enable access to healthy food for better living.The path to achieving SDG 3 is inseparable from the global commitment to improving nutrition. Without addressing the roots of malnutrition and fostering sustainable food systems, the goal of ensuring good health and well-being for all will remain unmet. As we progress toward 2030, nutrition must not merely be an agenda item but the heart of efforts to realize health equity and environmental sustainability. A well-nourished population is the foundation of a prosperous and thriving world.