Global food security challenges, driven by the need to feed an estimated 10 billion people by 2050, require sustainable agricultural practices which strengthen nutritional adequacy while minimising environmental impacts. Yet, decision-making to foster food systems which consider both human and planetary health is growing in complexity. This paper, presented at an International Atomic Energy Agency-supported symposium at the 14th European Nutrition Conference of the Federation of European Nutrition Societies, highlights the potential of stable isotope techniques in generating valuable evidence to help support the development of sustainable food systems. It focuses on three methods: the dual tracer stable isotope technique for measuring protein digestibility, the Fe isotope dilution technique for assessing Fe absorption, loss and balance and the deuterium oxide dose-to-mother technique for estimating breast milk intake. The dual tracer isotope method provides a minimally invasive assessment of protein quality from a diverse variety of crops and novel sources, supporting the transition towards environmentally conscious, protein-rich diets. The Fe isotope dilution technique can be used to address Fe requirements across different population groups and calculate Fe absorption from whole diets or after consuming crops designed to be nutritionally sufficient, thus guiding dietary guidelines and agricultural strategies. Finally, the deuterium oxide dose-to-mother technique provides precise data on breast milk intake, underscoring the role of breastfeeding in sustaining optimal infant nutrition and the conservation of resources. These methods have the ability to generate critical evidence to support policy development and food system innovations that prioritise human health and environmental preservation.

Substantial changes resulting from the interaction of environmental and dietary factors contribute to an increased risk of obesity, while their specific associations with obesity remain unclear. We identified inflammation-related dietary patterns (DP) and explored their associations with obesity among urbanised Tibetan adults under significant environmental and dietary changes. Totally, 1826 subjects from the suburbs of Golmud City were enrolled in an open cohort study, of which 514 were followed up. Height, weight and waist circumference were used to define overweight and obesity. DP were derived using reduced rank regression with forty-one food groups as predictors and high-sensitivity C-reactive protein and prognostic nutritional index as inflammatory response variables. Altitude was classified as high or ultra-high. Two DP were extracted. DP-1 was characterised by having high consumptions of sugar-sweetened beverages, savoury snacks, and poultry and a low intake of tsamba. DP-2 had high intakes of poultry, pork, animal offal, and fruits and a low intake of butter tea. Participants in the highest tertiles (T3) of DP had increased risks of overweight and obesity (DP-1: OR = 1·37, 95 % CI 1·07, 1·77; DP-2: OR = 1·48, 95 % CI 1·18, 1·85) than those in the lowest tertiles (T1). Participants in T3 of DP-2 had an increased risk of central obesity (OR = 2·25, 95 % CI 1·49, 3·39) than those in T1. The positive association of DP-1 with overweight and obesity was only significant at high altitudes, while no similar effect was observed for DP-2. Inflammation-related DP were associated with increased risks of overweight and/or obesity.

Chrono-nutrition is an emerging field that examines how the frequency and timing of meals impact health. Previous research shows inconsistency in the relationship between chrono-nutritional components and cardiometabolic health. We investigated cross-sectional associations between these components and cardiometabolic health in 825 Iranian adults aged 20–59 years. Dietary data, including the number of eating occasions, meal timing and meal irregularity of energy intake, were collected using three 24-h dietary recalls. Anthropometric measurements, blood pressure and laboratory tests (fasting plasma glucose, lipid profile, insulin, uric acid and C-reactive protein) were conducted. Insulin resistance and sensitivity (homeostatic model assessment for insulin resistance, homeostatic model assessment for insulin sensitivity), the TAG-glucose, the lipid accommodation product and BMI were calculated. The demographic and morning-evening questionnaire was completed. General linear regression was used to assess associations between chrono-nutritional components and outcomes. Interactions with age and BMI were examined in all associations. Chrono-nutrition components were not significantly related to cardiometabolic risk factors in the total population. However, a lower number of eating occasions was associated with an increased LDL-cholesterol:HDL-cholesterol ratio (β (95 % CI): 0·26 (0·06, 0·48)) among overweight and obese participants. Additionally, less irregularity in breakfast energy intake was associated with a lower total cholesterol:HDL-cholesterol ratio (–0·37 (–0·95, –0·18)) and a lower LDL-cholesterol:HDL-cholesterol ratio (–0·32 (–0·79, –0·13)) among participants with a normal BMI (all P< 0·05). The study concluded that more frequent meals and regular energy intake might enhance cardiometabolic health cross-sectionally, highlighting the need for prospective studies to further investigate these associations and the mediating role of BMI.

n-3 PUFA delivered by fish oil supplements alter the number and functions of circulating extracellular vesicles (EV), but consumption of oily fish does not reproduce this effect. In order to assess the effects of fish oil supplements and oily fish, at a level achievable in the diet, on EV numbers, composition and procoagulant activity in healthy human volunteers, forty-two healthy subjects were assigned to one of three treatment groups: (i) fish oil supplements plus white fish meals, (ii) control supplements plus oily fish meals or (iii) control supplements plus white fish meals for 12 weeks in a randomised, double-blind, placebo-controlled, parallel trial; circulating EV were enumerated and their procoagulant activity assessed using thrombin generation and fibrinolysis assays. Our results showed that fish oil supplements decreased circulating EV numbers and reduced EV-stimulated thrombin generation, but the consumption of oily fish at half the dose of EPA had no effect on either EV number or thrombogenic capacity. Consumption of both oily fish and fish oil supplements increased the EPA and DHA contents of EV, and the proportion of EPA in circulating EV was strongly associated with EV-stimulated thrombin generation. This study revealed that the additional 1 g/d EPA delivered in the fish oil supplements is required to decrease the numbers and thrombogenic capacity of EV, since oily fish at a level achievable in the diet had no effect. Increasing EPA intake beyond current guidelines for oily fish consumption may therefore be required for cardiovascular benefits relating to EV.

In the last decades, it has been well known that low-grade inflammation plays a potential role in the pathogenesis of different cancers. The aim of this systematic review and meta-analysis of observational studies was to evaluate the association between inflammatory potential of diet measured through the Dietary Inflammatory Index (DII), Energy-adjusted DII (E-DII), Empirical Dietary Inflammatory Pattern (EDIP), the Inflammatory Score of Diet (ISD), and risk of colorectal cancer (CRC) and site-specific colon cancer. A systematic electronic search of PubMed/Medline, Scopus, the Web of Sciences and reference lists up to 21 November 2023 was performed. Data were pooled by the generic inverse variance method using random effect model. To assess the heterogeneity of included studies, the I2 index was used. A total of twenty-eight original studies, comprising 2 287 836 participants, were selected to include in this meta-analysis. Pooled results showed a significant association between higher adherence to pro-inflammatory diet and increased risk of CRC (effect size (ES): 1·39; 95 % CI 1·29, 1·51; I2 = 82·9 %), colon (ES: 1·40; 95 % CI 1·26, 1·55; I² = 73·3 %, P< 0·01), proximal colon (ES: 1·28; 95 % CI 1·17, 1·40; I² = 29·1 %), distal (ES: 1·50; 95 % CI 1·30, 1·74; I² = 63·5 %) and rectal (ES: 1·46; 95 % CI 1·23, 1·74; I² = 80 %). Stratified analysis by type of dietary indices noted that greater adherence to the DII, E-DII and EDIP were related to significant increase in the risk of overall CRC and site-specific colon cancers. Our results highlighted the proposed role of inflammatory potential of diet as important risk factor for CRC. Adherence to an anti-inflammatory dietary pattern should be recommended to reduce incidence of CRC, globally.

Indigenous peoples are often not routinely included in iodine programmes because of language barriers and remote access and may thus be at higher risk of iodine deficiency disorders, which could adversely impact their quality of life. We conducted this cross-sectional study in the remote Pwo Karen community of Thailand to determine the urinary iodine concentration of school-aged children and women of reproductive age and investigate the iodine content in household salt. We measured urinary iodine concentration in spot urine samples from healthy school-aged children and women of reproductive age, administered a questionnaire, estimated daily iodine intake and collected household salt samples to determine salt iodine concentration. The median urinary iodine concentration (range) of school-aged children (n 170) was 192 (136–263) µg/l, which was significantly higher than women of reproductive age (n 306) (147 (89–233) µg/l) (P < 0·001). The estimated daily iodine intake in school-aged children and women of reproductive age were 135 and 195 μg/d, respectively. The median (range) iodine concentration in rock and granulated salts consumed in the households were 2·32 (0·52–3·19) and 26·64 (20·86–31·01) ppm, respectively. Surprisingly, the use of iodised salt and the frequency of seafood consumption were NS predictors of urinary iodine concentration in these two groups. Our data suggest that school children and women of the Pwo Karen community have sufficient iodine intake, indicating the Thai salt iodisation programme is effectively reaching even this isolated Indigenous community. Sentinel surveys of remote vulnerable populations can be a useful tool in national iodine programmes to ensure that programme coverage is truly universal.

Fine particulate matter (PM2·5) is a known risk factor for heart failure (HF), while plant-based dietary patterns may help reduce HF risk. This study examined the combined impact of PM2·5 exposure and a plant-based diet on HF incidence. A total of 190 092 participants from the UK Biobank were included in this study. HF cases were identified through linkage to the UK National Health Services register, with follow-up lasting until October 2022 in England, August 2022 in Scotland and May 2022 in Wales. Annual mean PM2·5 concentration was obtained using a land use regression model, while the healthful plant-based diet index (hPDI) was calculated using the Oxford WebQ tool based on two or more 24-hour dietary assessments of seventeen major food groups. Cox proportional hazard models assessed the associations of PM2·5 and hPDI with HF risk, and interactions were evaluated on additive and multiplicative scales. During a median of 13·4-year follow-up, 4351 HF cases were recorded. Participants in the highest PM2·5 tertile had a 23 % increased HF risk (hazard ratio: 1·23, 95 % CI: 1·14, 1·32) compared with those in the lowest tertile. Moderate or high hPDI was associated with reduced HF risk relative to low hPDI. The lowest HF risk was observed in individuals with high hPDI and low PM2·5 exposure, underscoring the protective role of a plant-based diet, particularly in areas with lower PM2·5 levels. A healthy plant-based diet may mitigate HF risk, especially in populations exposed to lower PM2·5 levels.

Rheumatoid arthritis (RA) is a prevalent autoimmune disease, and there is growing evidence suggesting a potential correlation between dietary factors and the pathogenesis of this condition. In order to investigate the causal relationship between diet and RA, we conducted a two-sample Mendelian randomisation (MR) analysis to examine the causal associations between twenty-two dietary factors and RA. Summary data from genome-wide association studies (GWAS) of RA were obtained from large GWAS meta-analyses. GWAS summary data for twenty-two dietary factors were obtained from UK Biobank. Random-effects inverse variance weighted was used as the primary method for assessing causality, and analyses of heterogeneity and horizontal pleiotropy were performed to ensure the accuracy of the results. Research indicates a negative genetic causal relationship between cereal intake (OR = 0·64, 95 % CI: 0·41, 0·99, P = 0·048) and oily fish intake (OR = 0·70, 95 % CI: 0·52, 0·95, P = 0·020) with the risk of RA. Other dietary factors were not causally related to RA. Sensitivity analysis shows that our results are reliable. This study provides genetic evidence suggesting that cereal intake and oily fish intake are protective factors for RA, indicating that RA patients and individuals at high risk should make appropriate dietary adjustments.

Dietary intervention is a key strategy for preventing and managing chronic kidney disease (CKD). However, evidence on specific foods’ effects on CKD is limited. This study aims to clarify the impact of various foods on CKD risk. We used two-sample Mendelian randomisation to analyse the causal relationships between the intake of eighteen foods (e.g., cheese, processed meat, poultry, beef and non-oily fish) and CKD risk, as well as estimated glomerular filtration rate (eGFR)cr and eGFRcys levels. The inverse variance weighting method, weighted median method, MR-Egger regression, simple mode and weighted mode were employed. The sensitivity analysis included Cochran’s Q test and the Egger intercept test. According to the main method, the IVM results indicated that frequent alcohol intake was linked to higher CKD risk (P= 0·007, 0·048). Protective factors included cheese (OR = 0·71, (95 % CI: 0·53, 0·94), P= 0·017), tea (OR = 0·66, (95 % CI: 0·43, 1·00), P= 0·048) and dried fruit (OR = 0·78, (95 % CI: 0·63, 0·98), P= 0·033). Oily fish (β = 0·051, (95 % CI: 0·001, 0·102), P= 0·046) and dried fruit (β = 0·082, (95 % CI: 0·016, 0·149), P= 0·014) were associated with elevated eGFRcys. Salad/raw vegetables (β = 0·024, (95 % CI: 0·003, 0·045), P= 0·028) and dried fruit (β = 0·013, (95 % CI: 0·001, 0·031), P= 0·014) were linked to higher eGFRcr, while cereal intake (β = –0·021, (95 % CI: −0·033, −0·010), P < 0·001) was associated with lower eGFRcr. These findings provide insights for optimising dietary strategies for CKD patients.

This study aimed to investigate the association between family characteristics and adherence to the EAT-Lancet dietary recommendations in 7-year-old children. This is a prospective birth cohort study with 2125 children from Generation XXI (Porto, Portugal), who provided 3-day food diaries at age 7, used to assess habitual food consumption. At the age of 4, maternal diet was assessed using a Food Frequency Questionnaire, and a diet quality score was calculated (higher scores indicating a better maternal diet), and parental–child feeding practices were assessed with the Child Feeding Questionnaire. Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH) at the age of 7 years, previously adapted to paediatric age. Hierarchical linear regression models (consecutive addition of blocks of variables based on a theoretical framework) were employed to evaluate the associations between family characteristics and adherence to the WISH at age 7 (β regression coefficients and the respective 95 % confidence intervals (95 % CI)). Higher maternal age and education at child’s birth were associated with increased adherence to the WISH at age 7 (β = 0·018, 95 % CI 0·005, 0·031; β = 0·038, 95 % CI 0·024, 0·053, respectively). A better maternal diet quality and using more restrictive practices on child’s diet, at 4 years old, were both associated with higher scoring in the WISH at 7 years old (β = 0·033, 95 % CI 0·018, 0·049; β = 0·067, 95 % CI 0·009, 0·125, respectively). Early maternal sociodemographic and diet quality play a significant role in influencing the adherence to a healthy and environmentally sustainable dietary pattern at school-age.

The diet proposed by the EAT-Lancet Commission has faced criticism concerning its affordability. This study aimed to investigate the cost associated with a greater alignment to the EAT-Lancet reference diet in the province of Québec, Canada. The dietary habits of 1147 French-speaking adults were assessed using repeated web-based 24-h recall data collected between 2015 and 2017 in the cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study. Diet costs were calculated using a Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute’s multivariate Markov Chain Monte Carlo method. Adherence to the EAT-Lancet diet was assessed using the EAT-Lancet dietary index (EAT-I). Associations between diet costs and EAT-I scores were evaluated using linear regression models with restricted cubic splines. After adjustment for energy intake, a higher EAT-I score (75th v. 25th percentiles) was associated with a 1·0 $CAD increase in daily diet costs (95 % CI, 0·7, 1·3). This increase in diet costs was mostly driven by the following component scores of the EAT-I (75th v. 25th percentiles, higher scores reflecting greater adherence): vegetables (1·6 $CAD/d, 95 % CI: 1·2, 2·1), free sugars (1·6 $CAD/d, 95 % CI: 1·3, 1·9), fish and plant-based proteins (1·4 $CAD/d, 95 % CI: 1·0, 1·8), fruits (0·9 $CAD/d, 95 % CI: 0·4, 1·3) and whole grains (0·4 $CAD/d, 95 % CI: 0·0, 0·8). Inversely, a greater score for the poultry and eggs component was associated with reduced diet costs (–1·2 $CAD/d, 95 % CI: −1·7, −0·7). This study suggests that adhering to the EAT-Lancet diet may be associated with an increase in diet costs in the province of Québec.

The aim of this study was to analyse the validity and reliability of the Turkish version of the renal inpatient nutrition screening tool (Renal iNUT) for haemodialysis patients. The Renal iNUT and the malnutrition universal screening tool (MUST) were used in adult haemodialysis patients at two different centres to identify malnutrition. The subjective global assessment (SGA), regarded as the gold standard for nutritional status assessment, was utilised for comparison. Structural validity was assessed using biochemical values and anthropometric measurements, while reliability was assessed using repeated the Renal iNUT assessment. Of the 260 patients admitted, 42·3 % were malnourished (SGA score was B or C). According to the Renal iNUT, 59·6 % of the patients were at increased risk for malnutrition (score ≥ 1) and 3·8 % required referral to a dietitian (score ≥ 2). According to the MUST, 13·1 % of the patients were at increased risk for malnutrition and 8·5 % required referral to a dietitian. The Renal iNUT was found to be more sensitive in detecting increased risk of malnutrition in haemodialysis patients compared with the MUST (59·6 % v. 13·1 %). According to the SGA, the sensitivity of the Renal iNUT is higher compared to the MUST (89 % and 45 %, respectively). Kappa-assessed reliability of the Renal iNUT was 0·48 (95 % CI, 0·58, 0·9) and a moderate concordance was observed. The Renal iNUT is a valid and reliable nutritional screening tool for evaluating haemodialysis patients to determine their nutritional status. The use of the Renal iNUT by dietitians will contribute to the identification of malnutrition and its treatment.

Free sugar intakes are currently higher than recommended for health, yet effective strategies for reducing consumption are yet to be elucidated. This work investigated the effects of different dietary recommendations for reducing free sugar (FS) intakes, on relevant outcomes, in UK adults consuming > 5 % of total energy intake (TEI) from FS. Using a randomised controlled parallel-group design, 242 adults received nutrient-based (n 61), nutrient- and food-based (n 60), nutrient-, food- and food-substitution-based (n 63) or no (n 58) recommendations for reducing FS at a single timepoint, with effects assessed for the following 12 weeks. Primary outcomes were FS intakes as a percentage of TEI (%FS) and adherence to the recommendations at week 12. Secondary outcomes included TEI, diet composition, sugar-rich and low-calorie-sweetened food consumption and anthropometry. In intention-to-treat analyses adjusted for baseline measures, %FS reduced in intervention groups (%FSchange = –2·5 to −3·3 %) compared with control (%FSchange = –1·2 %) (smallest B = –0·573, P = 0·03), with effects from week 1 until week 12 and no differences between interventions (largest B = 0·352, P = 0·42). No effects of the interventions were found in dietary profiles, but change in %FS was associated with change in %TEI from non-sugar carbohydrate (B = 0·141, P < 0·01) and from protein (B = –0·171, P = 0·02). Body weight was also lower at week 12 in intervention groups compared with control (B = –0·377, P < 0·05), but associations with %FS were weak. Our findings demonstrate the benefit of dietary recommendations for reducing FS intakes in UK adults. Limited advantages were found for the different dietary recommendations, but variety may offer individual choice.

Colorectal cancer (CRC), the third most common cancer globally, causes over 900 000 deaths annually. Although vitamin D is observed to have potential anti-carcinogenic properties, research findings on its preventable effect against CRC remain inconclusive. Notably, different subsites within the colon and rectum may be associated with distinct risk factors. While some studies have explored this relationship with circulating 25-hydroxyvitamin D (25(OH)D), the results remain contradictory. Our study employed a nested case–control design, involving 775 CRC cases matched with 775 cancer-free controls based on age, region of living and the time of blood sampling. The study was conducted within the Norwegian Women and Cancer post-genome cohort, which comprises approximately 50 000 women. We measured pre-diagnostic circulating plasma 25(OH)D status 5–13 years before diagnosis. Adjustment variables were based on self-administered questionnaires and included BMI, physical activity level, smoking, intake of processed meat, calcium, alcohol and fibre. An increase of 5 nmol/l in 25(OH)D reduced the risk of proximal colon cancer by 6 % (OR = 0·94, 95 % CI 0·89, 0·99). Furthermore, a sensitivity analysis revealed a 62 % increased risk among the women with 25(OH)D levels below 50 nmol/l compared with sufficient levels, ≥ 50 to < 75 nmol/l (OR = 1·62, 95 % CI 1·01, 2·61). No association was found with CRC, colon or distal colon cancer. We observed a subsite-specific association between 25(OH)D and CRC, highlighting the need for further investigation to elucidate the potential underlying mechanisms and clinical implications.

Protein fermentation in the human gut is often associated with adverse health effects. Hence, understanding the fermentation characteristics of dietary undigested proteins is important for a comprehensive nutritional value of foods. This study investigated the protein fermentation kinetics of diet-derived proteins from thirty-one different foods using an in vitro model and human faecal inoculum. The undigested diet-derived protein substrate originated from porcine ileal digesta obtained from assessment of the digestible indispensable amino acid score (DIAAS) of the foods. Significant variations in fermentation kinetic parameters, particularly in maximum gas production rate (Rmax) and time to reach cumulative gas production (GP) from the substrate (TGPs), were observed. The Rmax ranged from 15·5 (se 0·7) ml/h for wheat bran-derived to 24·5 (se 0·9) ml/h for oatmeal-derived proteins. Egg-derived proteins had the shortest TGPs (14·7 (se 0·7) h), while mushroom-derived proteins had the longest (27·6 (se 7·1) h). When foods were categorised into five groups (‘animal protein’, ‘grains’, ‘legumes’, ‘fungi, algae and microorganisms’ and ‘others’), no significant differences were found in fermentation kinetics parameters. Samples were additionally incubated with porcine inoculum to assess potential donor-species effects. Human inoculum showed significantly lower Rmax, cumulative GP and microbiota turnover than porcine inoculum, indicating reduced fermentative activity. Linear regression analysis revealed correlations between human and porcine-derived inoculum only for Rmax (R2 = 0·78, P < 0·01) and TGPs (R² = 0·17, P < 0·05). These findings underscore the importance of using human inoculum in in vitro studies to better predict health implications of foods with DIAAS values.