A Scoping Review on Institutionalization of Packaged Food Consumption in Academic Settings and Its Role in Promoting Diabetes Risk

Abstract

Background: The global burden of type 2 diabetes mellitus (T2DM) is escalating at an unprecedented rate, with 536.6 million adults affected worldwide as of 2021, a figure projected to rise to 783 million by 2045. India alone harbours over 77 million adults with diabetes, the second-largest absolute burden globally. Ultra-processed foods (UPFs), classified under the NOVA food system, have emerged as a robust, dose-dependent dietary risk factor for T2DM. Despite this evidence, academic institutions including medical colleges and teaching hospitals remain an overlooked micro-environment where packaged UPF consumption is normalised through routine distribution at seminars, conferences, and grand rounds. This is particularly paradoxical in health-sector institutions whose mandate is chronic disease prevention.

Objective: To compile data associating the intake of ultra-processed foods to the risk of type 2 diabetes, investigate the impact of academic institutional food environments on dietary habits, and determine evidence-based approaches for institutional food environment reform in the Indian setting.

Methods: This scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines (Tricco et al., 2018; Ann Intern Med). A systematic search was performed across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published January 2000 to March 2025. The research question was framed using the Population–Concept–Context (PCC) framework. Two independent reviewers screened records and extracted data using a structured charting form. Thematic synthesis addressed five domains: UPF epidemiology, pathophysiological mechanisms, institutional food environments, India-specific evidence, and policy recommendations.

Results: A total of 1,412 records were identified; 68 studies met full eligibility. Evidence consistently demonstrates a hazard ratio of 1.24 (95% CI 1.14–1.34) for the highest versus lowest UPF consumption category, and a 13% increased T2DM risk per 10% increment in UPF dietary share (HR 1.13, 95% CI 1.08–1.18). Five mechanistic pathways were delineated: nutritional degradation, diabetogenic food additives, processing-derived toxic compounds, packaging-derived endocrine disruptors, and gut microbiome dysbiosis. In India, UPF retail sales grew at 13% compound annual growth rate from 2011–2021, with biscuits accounting for over 43% of market share, the category most widely distributed at Indian academic events. A critical evidence gap exists as no validated intervention studies examine institutional food environment reform in Indian academic settings.

Conclusions: Academic institutions, particularly health-sector colleges, may benefit from transitioning from convenience-driven food provision toward evidence-informed health-promoting food environments. Ongoing FSSAI front-of-pack labelling deliberations may influence future procurement practices. Institutional food policy reform, integration with the National Programme for Non-Communicable Diseases, and primary research in South Asian academic settings remain important priorities.