Chronic constipation is a prevalent disorder representing a significant public health problem. The management of chronic constipation remains challenging, with people reporting dissatisfaction with available treatment options (1). Current clinical guidelines offer limited dietary recommendations only, and there is a lack of comprehensive evidence-based guidelines for the dietary management of chronic constipation. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults via a systematic literature review and a Delphi consensus process among an expert steering committee.

The scope of the guidelines included dietary supplements, foods and drinks, and whole diets in adults with chronic constipation. Four systematic reviews and meta-analyses were performed to identify eligible randomised controlled trials (RCTs)(2-5). The findings generated from the meta-analysis of RCTs were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multi-disciplinary expert steering committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life. Statements were generated based on the findings only where ≥2 RCTs contributed to the meta-analysis (2-5). The “strength of recommendation” was assessed using the GRADE approach. Once statements were generated, they underwent consensus voting amongst the expert steering committee using a modified Delphi survey approach. Recommendation statements with ≥85% agreement were accepted.

The four systematic reviews included a total of 75 RCTs (2-5). Based upon these, 59 dietary recommendation statements were generated and accepted through the Delphi survey. In terms of dietary supplements, 15 recommendation statements related to fibre supplements (overall and specific types), 20 related to probiotics (overall and specific species or strains), 2 to synbiotics (overall), 5 to magnesium oxide, 2 to senna, and 3 to kiwifruit supplements. In terms of foods, 3 recommendation statements related to kiwifruits, 2 to prunes, and 2 to rye bread. In terms of drinks, 5 recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to lack of evidence. Ten statements had a very low level of evidence, 41 had low level of evidence, and 8 had moderate evidence. Twenty-seven statements were strong recommendations and 32 were qualified recommendations.

These are the first ever comprehensive evidence-based dietary guidelines for the management of constipation. Recommendations were made for several dietary supplements, foods and drinks that have never been previously included in clinical guidelines. These guidelines offer new evidence-based dietary recommendations that can be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

The impact of Human Milk (HM) bioactive compounds and microbiota on infant health is crucial yet complex. Current research highlights their role in immune system development and disease prevention (1-6). This review aims to synthesize existing literature on the role of HM’s bioactive compounds in the onset of diagnosed allergies, immunological diseases, and responses to infectious diseases in infants, along with related biomarkers.

The systematic review adhered to Synthesis without Meta-Analysis (SWiM), focusing on clinically defined allergies and immunological conditions, and responses to infectious diseases by infants and children up to 18 years. Studies analyzing HM microbiota and bioactive compounds of mothers in mother-infant pairs have been included. A comprehensive search strategy was employed across PubMed, Web of Science, SCOPUS, Scientific Electronic Library Online (SciELO), Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and LIVIVO. Quality assessment utilized Joanna Briggs Institute checklists for various study designs.

The systematic review encompassed 32 studies ranging from 1983 to 2023, representing a total of 7,888 mother-infant dyads focusing on HM bioactive compounds and microbiota’s impact on clinically defined immunological conditions in infants. More than 90% of the literature had been conducted in upper-middle- and high-income countries. In low- and middle-income countries, including Gambia, Bangladesh, and Nicaragua, only 3 studies were conducted. We identified that allergic and autoimmune conditions, investigated in 25 articles, particularly food allergy, sensitization, and atopic dermatitis, were inversely associated with HM linolenic and linoleic acid. Furthermore, infectious and immunological conditions, primarily diarrhea and Group B Streptococcus (GBS) infections, investigated in 7 studies, revealed significant inverse associations with human milk oligosaccharides (HMOs) (2'-fucosyllactose (2′-FL), lacto-N-difucohexaose I (LDFH-I)) and immunoglobulins (Anti-GBS secretory immunoglobulin A (SIgA), Anti-lipopolysaccharide immunoglobulin A (Anti-LPS IgA), Anti-cholera toxin immunoglobulin A (Anti-cholera toxin IgA)), respectively. Upper and lower respiratory tract infections, otitis media, and dental caries were inversely associated with galectins and galectin-3, lacto-N-tetraose (LNT), 2′-FL, and Haemophilus influenzae, suggesting potential protective effects of HM bioactive compounds.

Data shows that HM bioactive compounds such as polyunsaturated fatty acids (PUFAs), HMOs, and a number of specific immunoglobulin A (IgA) antibodies, might be protective for infants, possibly preventing the onset of symptoms and helping to avoid bacterial and parasitic infections, respectively. In this review, we address the increase in mechanistic knowledge about the protective effects of breastfeeding.

Globally, the burden of skin diseases is considerable, being the fourth largest cause of disability (1). Diet is a modifiable risk factor for many dermatological conditions and one of the mechanisms by which nutrition influences skin health is via the gut microbiome. Oral probiotics, prebiotics and synbiotics may have the potential to improve functional indicators of skin health and delay skin ageing (2).

This scoping review aimed to map the body of literature on the role of oral probiotics, prebiotics and synbiotics in maintaining and optimising skin health and function, and preventing and managing skin conditions, through the life course. The first stage of the scoping review, reported here, was the mapping of systematic reviews. The ongoing second stage involves the mapping of experimental and observational studies.

The scoping review was conducted in accordance with the JBI methodology for scoping reviews (3). Six electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus and Web of Science) were systematically searched without limits on language or date, along with sources of grey literature. All sources were considered for inclusion by two reviewers based on previously established criteria using the participants, concept and context framework.

The titles and abstracts of 8,972 studies were screened and subsequently 1,034 full texts were retrieved. Finally, 521 studies were included in the scoping review of which 72 were systematic reviews and are analysed here.

Most reviews analysed the efficacy of oral probiotics (93%), with 13% and 18% of reviews considering oral prebiotics and oral synbiotics respectively. These interventions were most reviewed in infants aged 0-12 months (78%), pregnant mothers (47%), and/or younger children (43%) inclusively. Only 28% and 19% of reviews considered adults up to, and above, 60 years respectively. Most systematic reviews included participants who were either diagnosed with (42%), or at risk of a skin disease (28%) with just 4% reviewing effects in primarily healthy populations (24% did not confirm the included populations).

Outcomes related to preventing and managing a skin condition were studied by 97% of reviews; just 2 reviews examined optimising skin health and function (namely skin hydration, and epidermal thickness) in healthy populations. Atopic dermatitis (AD) was the most studied skin disease; 33 of 36 meta-analyses indicated a positive effect on its prevention, compared to 19 of 26 meta-analyses on AD severity. The remaining reviews investigated psoriasis (n=2), urticaria (n=2), and acne (n=2).

This review has identified a plethora of evidence synthesis on oral probiotics, prebiotics and synbiotics in AD, particularly in infants and children, and a paucity of evidence synthesis in healthy populations. The second stage of the review considering the underlying experimental and observational evidence will determine the scope for further evidence synthesis or confirm gaps in the experimental data to inform future research.

Non-alcoholic fatty liver disease (NAFLD) is associated with long-time exposure to obesity, physical inactivity, smoking, and Western diets high in saturated fats, refined sugar, and low in fibres.(1) It is one of the most common chronic liver disease globally with a prevalence of 32% in 2022,(1) and is associated with greater risk of cardiovascular diseases as well as non-alcoholic steatohepatitis (NASH).(1) Currently, there is no medical treatment against NAFLD, but high consumption of plant-based protein sourced foods appear beneficial.

Legumes are considered an environmentally friendly and healthy protein source, low in saturated fat and energy density, and rich in dietary fibre(2). However, the scientific evidence on the association between legume intake and NAFLD in humans is sparse.(2) This study evaluated substituting red and processed meat, poultry, or fish with legumes on the risk of developing NAFLD.

We analyzed data from 124,194 UK Biobank participants who completed two or more dietary assessments using a 24-hour dietary assessment tool, the Oxford WebQ, developed and validated within the cohort,(3) and provided comprehensive information on covariates. Participants were invited to complete up to five Oxford WebQs from 2009 to 2012.(3)Incident NAFLD cases were identified through linkage to National Health Service registries.

Multivariable adjusted Cox proportional hazards regression models were used to conduct equal mass food substitution analyses, estimating hazard ratios (HR) and 95% confidence intervals (CI) for NAFLD when replacing one 80g serving/week of i) red and processed meat, ii) poultry, iii) or fish with legumes.

Age was the underlying time scale in the analyses. Person-years at risk were calculated from the date of the last completed Oxford WebQ to the date of death, loss to follow-up, diagnosis of NAFLD or NASH, or right censoring, whichever occurred first.

All participants gave written informed consent to participate in the study. The UK Biobank was approved by the National Information Governance Board for Health and Social Care and the National Health Service North West Multicentre Research Ethics Committee (ref 21/NW/0157).

Over a median follow-up period of 10.49 years (IQR: 10.4-10.9 years), 1,201 NAFLD cases were documented. Replacing 80 g/week of red and processed meat or poultry with legumes resulted in 4% and 3% lower rates of NAFLD, respectively (Meat HR: 0.96, 95% CI: 0.94–0.98; Poultry HR: 0.97, 95% CI: 0.95; 0.99). However, replacing fish with legumes was not significantly associated with NAFLD risk (HR: 0.98, 95% CI: 0.96–1.01). These findings remained consistent after adjusting for BMI.

Replacing red and processed meat or poultry with legumes could modestly reduce the risk of NAFLD. No significant association was observed for replacing fish with legumes.

The 2023 Nordic Nutrition Recommendations (NNR23) emphasize both planetary health and disease prevention through food-based guidelines(1). While previous planetary health diets may not guarantee sufficient micronutrient intake(2), these dietary patterns focusing on human and planetary health have shown positive associations between higher adherence and lower mortality(3). However, the health effects of adhering to the NNR2023 have not been investigated. This study aims to construct a diet score to investigate adherence to NNR2023, micronutrient adherence, and the association with mortality.

We constructed a diet score based on NNR2023 with 15 food components [1]. Points were given proportionally between 0 and 1 points, reflecting the level of compliance with each food component, with a maximum possible score of 15 points. We then followed men aged 45-79 from the Cohort of Swedish Men (n=48,850) (COSM) and women aged 48–83 years from the Swedish Mammography Cohort (n=39,984) (SMC), with extensive information collected on diet and lifestyle in 1997, 2009 and 2019(4). Cases were retrieved through the Swedish Patient Register using the Swedish Personal Identification Number and The Death Register(4). Participants were followed until death or administrative end of follow-up on 31stof December 2019. Micronutrient intake was derived from reported food intake and dichotomized at the recommended intake for vitamins and adequate mineral intake. Multi-variable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) using age as the underlying timescale.

Participants with the highest adherence to NNR2023 (>10 points, median (10 points), HR 0.77, 95% CI 0.74-0.80) exhibited a lower risk of all-cause mortality compared to those with the lowest adherence (<8 points, median (7.6 points)). Age- and sex-specific micronutrient recommendations for calcium, folate, and magnesium were more likely to be met for those with the highest adherence. However, vitamin D intake was lower in women, and calcium was lower in men under the age of 70. When analyzed as a restricted cubic spline, results indicate lower mortality risk with increasing adherence.

High adherence to NNR2023 is beneficial for achieving adequate micronutrient intake and reducing overall mortality.

Recipe boxes, or meal kits, offer pre-portioned ingredients for multiple meals, delivered to, and cooked at home. They are emerging on the food retail market and increasingly popular with an estimated grocery spend c.£1B GBP in 2023, tripled since 2018 [1]. They are marketed as healthy and may have the potential to improve dietary intake. but little or no research has been done on their nutritional profile. The aim is to assess the evolution of recipe box healthiness over time.

Data was collected in two cross-sectional online surveys in September 2018 and March 2023. At both time points, all recipe box companies operating were identified and, for those supplying sufficient nutritional information (for energy, total fat, saturated fat, carbohydrate, sugar, protein, salt, and fibre) per 100g or portion, details were extracted. Two internationally recognised standards were used to assess recipe box healthiness: the UK Food Standards Agency (FSA)Traffic Lights labelling guidance (2) and the World Health Organisation (WHO) guidelines for population nutrition (3) (4). The proportion of recipes that met FSA green colour coded nutrient levels indicating a healthier profile, (low in fat, saturates, sugars and salt, per 100g and per portion), or complied with WHO standards (for energy, fat, saturates, carbohydrate, sugar, protein, salt, and fibre content per portion), were calculated and compared between 2018 and 2023 using z-proportion tests in Python 3.10.

After excluding companies with insufficient nutritional information there was a decrease from 9 to 5 companies between 2018 and 2023. The number of recipes captured increased from 132 to 206. Approximately 50% of all recipes met the WHO standard for energy in both surveys (2023, 43-56%; 2018, 43-61%) (p=0.6207).

Statistically significant changes in realising nutrient guidelines occurred between surveys. By either metric only 20% (CI 15-26%) of recipes achieved salt targets in 2023: a 30-point reduction from 2018 (p<0.0001). There was a 20% increase in recipes fulfilling WHO carbohydrate guidelines with 63% (CI 56-69%) compared to 43% (CI 35-52%) (p=0.000457) in 2023 and 2018 respectively and relatedly for sugar, 50% (CI 42-59%), from 62% (CI 56-69%), (p-0.028).

Across the surveyed recipes, 43% (95% CI 39-46%) of all nutrients achieved FSA green light status in 2023, a smaller proportion than in 2018, 52%, (95% CI 47-56%) (p=0·0001). Similar proportions of nutrients complied with all WHO standards in 2023 and 2018, 40% (CI 37-42%) vs 41% (CI 37-43%) (p=0.744).

Most recipe boxes surveyed in 2023 had a poor nutritional profile, that had worsened since 2018. Recipe boxes need an improved nutritional profile, worthy of their 'health-halo', if they are to improve population nutrition. This is the first study to comprehensively analyse the nutritional profile of recipe boxes. A limitation is the lack of nutritional information for some companies.

Despite debilitating consequences, cancer-associated malnutrition often goes under-detected due to the lack of a standardised diagnostic tool (1). The Global Leadership Initiative on Malnutrition (GLIM) criteria was established in 2018 in order to standardise the diagnosis of malnutrition globally (2). The aim of this study was to determine the association between GLIM-diagnosed malnutrition and overall survival in a large cohort of patients with mixed-cancer types. This is the first study to stratify patients according to treatment intent and is one of the largest studies to identify reduced muscle mass using gold-standard CT analysis of body composition.

Patients receiving anti-cancer treatment for solid tumours were enrolled in a cross-sectional study to examine nutritional status between 2011-2016. The GLIM criteria was retrospectively applied. CT images at the third lumbar vertebrae (L3) were used to quantify skeletal muscle index and categorised according to previously published cut-points. Survival analysis was carried out using Kaplan-Meier curves and Cox-Regression.

Of 1405 patients enrolled, 52.5% were male. Mean age was 62 years (SD:12 years). The most common cancer diagnosis was gastrointestinal (44.5%) and 60.3% had metastatic disease. In total, 40.4% of participants were diagnosed with GLIM-malnutrition (14.8% had stage 1 moderate and 25.6% had stage 2 severe malnutrition). Median follow-up time was 102.4 months (95% CI 99.6–105.2 months). Median survival for those without malnutrition was 30.4 months (95% CI 23.5–37.2 months), versus 11.0 months (95% CI 6.6 – 15.4 months p<0.001) for those with stage 1 moderate and 10.0 months (95% CI 8.1–11.9 months p<0.001) for stage 2 severe malnutrition. Multivariate-analysis (controlling for gender, age, cancer site, GLIM-malnutrition and treatment intent) demonstrated a hazard ratio (HR) of death of 1.499 (95% CI 1.233–1.822, p<0.001) for stage 1 moderate and HR 1.548 (1.322–1.800, p<0.001) for stage 2 severe-malnutrition. The prevalence of stage 2 severe malnutrition was significantly higher in the palliative cohort (receiving supportive measures) (32.7%) when compared to patients being treated with curative intent (18.2%, p=0.004).

This study is one of the largest studies to date which uses CT analysis to accurately identify reduced muscle mass and confirms that the GLIM criteria can be used to predict overall survival in a large mixed-cancer cohort. These findings suggest that malnutrition, regardless of GLIM severity ranking has a significant impact on overall survival. Future research should focus on determining oncology specific cut-points for the GLIM criteria.

The out-of-home (OOH) food sector has a growing importance on the UK population diet, but the nutritional quality of the most influential OOH menu items has not yet been comprehensively characterised(1). It is also unclear how OOH food healthiness should be assessed. The primary study objectives were to assess the compliance of best-selling menu items in the UK with the ongoing calorie, salt, and sugar reduction programmes(2) and to compare the use of UK official healthiness assessment models and metrics,(3,4) using data collected in 2023/24. A secondary objective was to examine item-level changes in nutritional composition over time using 2021 data for a subset of menu items.

A cross-sectional survey of the 10 best-selling menu items of the 20 largest OOH companies in the UK was conducted online between September 2023 and March 2024, with manual imputation of missing nutrition data. Candidate healthiness assessment approaches included the UK Nutrient Profile Model (NPM)(3), Multiple Traffic Light Labelling (MTL),(4) and the targets, guidelines, and levy threshold included in the UK calorie, salt, and sugar reduction programmes.(2) Longitudinal item-level changes in nutrition composition were assessed retrospectively using archived August 2021 web-extracted data.

After excluding items where data imputation was not possible, 189 menu items were included in 2023/24, consisting mostly of main meals (25%), starter/side dish/small plates (18%), and sandwiches (18%). 59% of 184 products met their respective maximum calorie, salt, and/or sugar target/guideline; and 8 of the 20 applicable average target/guidelines were achieved. Depending on the healthiness assessment approach used, 46-78% of the menu items would not be deemed healthy. The NPM yielded the most lenient assessment due to not accounting for portion size; combining it with either category-specific or across-the-board maximum thresholds resulted in more stringent assessments. 117 food and 23 drink menu items could be tracked from 2021 to 2023/24; an increase in the median [interquartile range] salt content per serve was found in food (from 2.0g [1.3–3.7g] to 2.2g [1.4–3.8g], p=0.004). No other change in nutrition composition was observed over time at the menu item level.

This study comprehensively highlights the generally poor nutritional quality of best-selling OOH menu items in the UK, the lack of success of current voluntary programmes in driving impactful OOH product reformulation, and the limitations of the NPM for OOH application. Limitations include uncertainty around nutrition data accuracy (as either extracted from company websites or estimated using single purchases) and assessment of compliance with the calorie, salt, and sugar reduction programmes based solely on reformulation or portion size adjustments, not capturing mechanisms such as shifting sales. Our findings suggest that healthiness assessment in the OOH sector requires using either category-specific or across-the-board maximum thresholds for energy and ‘negative’ nutrients (e.g., salt, sugars) per serve.

Doctors’ and nurses’ (DNs) wellbeing in the National Health Service is important for ensuring safe healthcare delivery. However, demanding worker responsibilities, including irregular shift work, can significantly impact their health. These irregular working patterns are associated with higher sickness rates and stress among healthcare professionals due to the inherent challenges of the work (1,2). Shift work, in particular, disrupts sleep patterns and impairs cognitive function and performance, leading to poorer physiological and cardiovascular health (3). Furthermore, workforce shortages and difficulties adapting to a consistently demanding workload impact patient care delivery (4). Workplace nutrition can support health, offsetting some of these issues. However, there is a limited understanding of DNs’ dietary intake during shift work. Using the UK Biobank dataset, an open-access dataset of a prospective cohort study recruited from England, Scotland and Wales (5), this research aimed to understand DNs’ dietary intake against different shift work patterns.

To meet our research aim, Mann-Whitney U tests were used to explore the differences between doctors and nurses with different shift work patterns.

Of the 5,777 participants of doctors (n=1,962) and nurses (n=3,815) doing shift work, results indicated limited consumption of fruits, vegetables, fish and dietary fibre, as well as a high intake of meat, tea, coffee, and alcohol. Statistical significant differences in dietary intake were observed between DNs, with doctors consuming more unprocessed red meat per week (2.176 vs 2.053 portions, p<0.001), cups of coffee per day (1.57 vs 1.30 cups; p<0.001), and alcohol intake per week (63.146g vs 40.261g, p<0.001) than nurses. Meanwhile, nurses had a higher average consumption than doctors of fruit (2.840 vs 2.657 portions) and vegetables (2.415 vs 2.349 portions) (p<0.001), tea (3.14 vs 2.18 cups) and water (2.60 vs 1.40 cups) (p<0.001).

Various shift work factors influence dietary intake. Longer working hours and more frequent and consecutive night shifts were associated with poorer dietary behaviour, including reduced vegetable and meat intake and increased tea and coffee consumption. Doctors consumed less fruit when working over 30 hours per week (p=0.037) and on consecutive (p=0.020) and night shifts (p=0.048).

Our results suggest that DNs’ dietary intake is sub-optimal to recommended dietary guidelines. Shift work contributes to poorer workplace nutrition and health, especially during night shifts when access to nutritious food is limited. Doctors appeared to be more affected than nurses. Further research should explore practical strategies to consider the diverse working patterns to improve DN nutrition according to public health and dietary recommendations.

Periodontal disease has significant negative effects on the health and lives of people worldwide, including chronic pain, eating difficulties, social anxiety, economic costs of treatment, and lost productivity (1). Diet is an influential factor in managing periodontal disease (2). However, it is currently unclear whether following UK healthy eating recommendations outlined in the Eatwell Guide (EWG), which is a reference used in public health initiatives and clinical practice in the UK (3), is associated with risk of periodontal disease. To address this knowledge gap, this study examined cross-sectional and prospective associations between adherence to the EWG and the risk of periodontal disease.

This study was conducted using data from the UK Biobank prospective cohort study. EWG adherence scores were created using dietary data from 24-hour dietary questionnaires (Oxford WebQ). Participants were awarded points between 0–5 reflecting the extent to which they adhered to each of the 12 healthy eating recommendations outlined in the EWG (total score range: 0-60). Periodontal disease risk markers were assessed using self-reported oral health questionnaires. Logistic regression models were used to examine cross-sectional associations between levels of EWG adherence (low, medium and high) and odds of periodontal disease. Generalised estimating equations were used to analyse prospective associations. Analyses were adjusted for relevant covariates.

Cross-sectional analyses involving 158,899 participants showed significant associations between higher (odds ratio (OR) [95% Confidence Interval (CI)]: 0.876 [0.848–0.906]) and moderate (OR [95% CI]: 0.958 [0.927–0.989]) adherence to the EWG and lower odds of periodontal disease versus the low-adherence reference group. These results were consistent with prospective analyses (higher adherence: OR [95% CI]: 0.861 [0.834–0.888]; moderate adherence: 0.943 [0.914–0.973]). Results were robust to a range of sensitivity analyses.

Following UK-specific healthy eating recommendations, as outlined in the Eatwell Guide, could help lower the risk of periodontal disease. These findings warrant substantiation in future randomised controlled trials.

Products derived via fermentation, although heavily dominated by bacterial strains such as Lactobacillus, have now exponentially gained popularity with yeasts-based products in the last 7-8 years. This is well evidenced by the number of recent extensive reviews (1-4) and experimental studies (5, 6) that have emerged, exploring the yeast-product potential beyond the brewing and bakery industries. This raises research questions on its nutritional properties, considering that part of the nutrition field’s aim as a discipline is the global prevention of diet-related diseases. Thus, this study reflects a collaboration between microbiology and human nutrition, delving into the quantification of yeast’s response to modified fermentation environments.

Within these environments, our aims with their associated methods involved – quantifying growth, total protein, total nitrogen, and ascorbic acid content using the OD 600 nm spectrophotometer measurements, Bradford Assay, Kjeldahl process and the DCPIP assay respectively. Three yeasts were employed for these experiments - S. cerevisiae (SC), C. utilis(CU), and Y. lipolytica (YL). Six foodstuff media were initially used for growth measurements - onion, celery, strawberry, mushroom, beetroot, and commercial beetroot juice (CBJ). Alongside these quantifications, aims and further methods also included exploring ascorbic acid’s protection against peroxide through spot tests and testing cellular components such as cell-free extract against peroxide using both growth measurements at OD 600 nm and viability assay.

Results primarily revealed strawberry and CBJ as the best media with the greatest growth observed at OD600 - Strawberry (4.95 ± 0.2) and CBJ (5.73 ± 0.4) (values quotes for SC strain but also representative of others). Amidst the strains, SC stands out over CU and YL with consistently optimal values for each respective media based on their individual growth trends, and thus was chosen for all further experiments. Next, a fourfold rise in total protein and nitrogen was detected in our samples after 24 hours of fermentation in CBJ, accounting to 40% of dry weight as protein. Meanwhile, the CBJ’s cell-free extract addition led to a 3.6x lower death rate (7.9% versus 28.1% alive cells) after peroxide exposure, highlighting antioxidative inputs.

Primarily concerning S. cerevisiae yeast, our study managed to scrutinize the protein plus ascorbic acid content, and explore antioxidative action against peroxide, two of the main aims of our study. Additionally, our experiments led to a novel discovery of a certain CFE (cell-free extract) obtained post-fermentation in CBJ, demonstrating strong antioxidative properties against peroxide. The implications of this finding could be for a variety of demographics in the population in need of antioxidants and gut-associated benefits, subject to confirmation with further animal, and followingly human studies.

Excessive calorie, sugar and salt intake in children’s diets is a public health concern(1). The UK government introduced voluntary salt(2) and sugar(3) reduction programmes to improve the nutritional content of key food categories. Breakfast cereals are an important breakfast choice in children’s diet and are frequently marketed using child-appealing packages(4). This study aims to assess the impact of these initiatives on improving breakfast cereals with child-appealing packaging from 2020 to 2023.

We conducted repeated cross-sectional surveys yearly from 2020 to 2023, collecting data on energy, total sugars, fibre, and salt content per 100g from the nutrition information panel of breakfast cereals available in nine major UK retailers and meeting the child-appealing packaging (e.g. cartoons) criteria(5). Statistical analysis, including the Friedman test and χ2 tests, was performed to assess changes in nutritional content over time and compliance with the salt and sugar reduction programmes.

Total number of breakfast cereals surveyed each year were n=119, n=126, n=138, and n=133, respectively, with 80 products consistently surveyed (matched) across all four years. Matched breakfast cereals (n=80) showed statistically significant reductions in median total sugars and salt content in 2023 compared to 2020: median (Interquartile Range) total sugars reduced from 22g/100g (15.6-25.9) in 2020 to 19.9g/100g (15.5-22.6) in 2023 (P<0.001), and median (IQR) salt reduced from 0.50g/100g (0.28-0.70) in 2020 to 0.43g/100g (0.24-0.65) in 2023, (P=0.037). No significant changes were observed in energy or fibre contents, (p>0.05). Despite the modest reductions, 81% of breakfast cereals (n=133) collected in 2023 continued to exceed the recommended sugar reduction guideline (12.3g/100g), while only 6% exceeded the maximum salt target (0.90g/100g). Additionally, around 40% of breakfast cereals cereals in 2023 contained a third (per 30g) of a 4-6-year-old’s maximum daily recommendation of free sugars (19 g/d). There were significant variations in sugar, fibre and salt content between and across different retailers and manufacturers (P<0.05).

Our findings show modest yet ongoing reductions in sugar and salt content since 2020, demonstrating the potential feasibility of reformulating breakfast cereals. However, breakfast cereals with child-appealing packaging continue to be a major source of sugar in children’s diets. These findings demonstrate the urgent need for mandatory and comprehensive sugar reduction policies to effectively reduce children’s sugar consumption. Additionally, regulatory measures should be introduced to ensure companies use child-appealing tactics on their healthiest breakfast cereals to improve children’s food preferences, and diet. These steps are essential, building on the potential impact of the UK voluntary reduction programmes to improve children’s health and help reduce childhood obesity.

The benefits of consumption of a high quantity of plant-based foods on human health are widely reported in observational and intervention studies (1,2). A growing body of evidence indicates plant-based food diversity as a potential additional target for improvement of diet-related health outcomes (3). The aim of this study was to investigate associations between plant-based food diversity and cardiometabolic health outcomes in a nationally representative sample of UK adults.

Cross-sectional data collected as part of the National Diet and Nutrition Survey (NDNS) Rolling Programme Year 9 (2016/2017) were used (4). Plant-based food diversity from all plant food sub-groups (fruits, vegetables, grains, herbs, spices, nuts, seeds, fats, oils and beverages) was determined from analysis of 4-day estimated food diaries. Demographic data were collected by personal interviews and self-reported questionnaires. Health outcome data were collected at nurse visits; body mass index (BMI) and blood pressure were measured, and blood samples were collected for analysis of blood lipids and glycated haemoglobin (HbA1c). Associations between plant-based diversity and health outcomes were explored via multivariable linear regression, adjusted for age, sex, race, education and income (model 0), in addition to quantity of plant-based food, diet quality, daily energy intake, alcohol, smoking status, and prescribed medications (model 1), and BMI (model 2). Differences in health outcomes between diversity terciles (low, median 5.5 counts/d, IQR 1.8; moderate, median 8.1 counts/d, IQR 1.3; and high, median 11.0 counts/d, IQR 2.3) were assessed via analysis of covariance (ANCOVA), with covariates as described for models 0-2.

Overall, 638 adults were included (median age 47, IQR 30; 58.5% female; 90% white; 29% with a degree). Plant-based food diversity was positively associated with high density lipoprotein cholesterol (HDL-C) concentration (B = 0.024 mmol/L, 95% CI 0.005, 0.043, p = 0.014, adj. R2 = 0.212; model 0), and inversely associated with HbA1c concentration (B = -0.524 mmol/mol, 95% CI -0.977, -0.71, p = 0.023, adj. R2 = 0.559; model 1). Associations were no longer significant following additional adjustment for BMI (model 2). There was a significant difference in BMI across diversity terciles (p = 0.003; Quade non-parametric ANCOVA; model 0). Post-hoc pairwise comparisons revealed BMI was significantly higher in the moderate diversity tercile (median 27.5 kg/m2, IQR 7.0) in comparison to the high diversity tercile (median 26.0 kg/m2, IQR 6.0; p = 0.001).

This is the first study to determine the associations between intakes of diverse plant-based foods and cardiometabolic health outcomes in UK adults. Consumption of diverse plant-based foods is associated with cardiometabolic health benefits, namely higher concentrations of HDL-C, lower concentrations of HbA1c, and lower BMI. These results warrant further investigation in a robust randomised controlled trial, to elucidate the health effects and underlying mechanisms of consuming a high diversity of plant-based foods.

The rising prevalence of metabolic disorders underscores the need for dietary strategies to manage postprandial glucose levels and blood pressure. Protein has been widely recognized for its health benefits, to promote satiety and improve postprandial glucose control (1). Studies have shown that whey protein can significantly lower postprandial glucose and insulin levels in both healthy and diabetic individuals, with greater effectiveness when consumed as a starter before meals (2). However, a recent prospective cohort study indicated that while animal protein consumption may be linked to a higher risk of diabetes onset, incorporating plant-based proteins is advisable. This highlights the need to diversify protein sources in the diet to manage metabolic health and potentially reduce diabetes risk (3).

Therefore, the aim of the current study was to determine whether consuming pea protein isolate before a carbohydrate meal could effectively reduce postprandial glucose levels and blood pressure compared to the simultaneous consumption of protein and carbohydrates.

We examined pea protein isolate as a representative plant-based food source, known for its high protein content and accessibility. Ten healthy adults (2 male and 8 females; mean age: 25.6 ± 1 years; body mass index (BMI): 22.7 ± 1 kg/m2) participated in a crossover trial with three conditions, to consume 30g of pea protein isolate 30 min before (PrePP) or with (PP) a 50g carbohydrate meal, against a carbohydrate meal (control, CHO) provided with water. Continuous glucose monitoring and blood pressure were recorded over 180 minutes after the meal. The effect of the interventions on peak postprandial glucose responses and blood pressure were evaluated using a two-factor repeated measures ANOVA. Comparisons were made using Bonferroni’s test whenever a significant difference was observed. All statistical analyses were performed using GraphPad Prism with a statistical difference of p <0.05 considered as significant.

PrePP significantly delayed and reduced the postprandial glucose peak compared to PP and CHO (0.46 mmol/L at 60 min vs. 1.125 mmol/L for PP, p<0.05 and 1.89 mmol/L for CHO at 30 min, p<0.01). Diastolic blood pressure significantly decreased after both protein drinks compared to CHO, especially between 150 and 180 minutes (9.2 mmHg for PP and 4.2 mmHg for PrePP), while the control showed an increase of 1.6 mmHg from baseline (p < 0.05). Although systolic blood pressure also decreased in PP and PrePP, with reductions of 3.7 and 5.8 mmHg respectively, this change was not significant compared to the control, which decreased by 2 mmHg (p> 0.05).

This study indicates that pea protein preload can effectively reduce postprandial blood glucose levels and may also assist in managing blood pressure, offering a plant-based option for improving metabolic health. Further research is needed to better understand the mechanisms underlying these findings.

Graduates from life sciences, including nutrition, will be at the forefront of promoting environmental, social, and food systems sustainability. The requisite competencies for their future roles include systems thinking, interdisciplinary collaboration, and effective communication, which are essential to navigating the complex interrelationship between human health and the environment [1,2]. To address this need, a 'Living Laboratory’ (LL) within a higher education (HE) food service setting could enrich the traditional laboratory experience, allowing students to cultivate these skills through experiential learning. This project aimed to i) scope the published literature to characterise LL examples within a HE food environment and ii) explore the understanding and perceptions of a LL concept in a food service setting for final year student research projects among students and academics at King’s College London.

A systematic scoping review was conducted in accordance with PRISMA-ScR guidelines (Registration OSF:d7y96). Two databases were searched (PubMed/Medline, Web of Science) from January 2010 to July 2024 to identify articles reporting the design, implementation or evaluation of LL in HE food service settings. A narrative synthesis was performed, and the resulting themes were used to inform focus groups (KCL Ethics:LRM-23/24-42657) with academic staff (two groups, nine participants) and students (four groups, seven postgraduate and nine undergraduate participants). Focus group discussions were audio-recorded and transcribed verbatim. Data were analysed using an inductive thematic approach [3].

Twenty-one articles were included in the scoping review. Common terms used to describe the LL concept included ‘innovation’, ‘collaboration’, ‘diverse stakeholders’, ‘enabling students’ and ‘practical learning experiences’. Recommendations for implementing LLs were provided in six articles and included engagement and outreach with stakeholders; managing conflicts; assessing impact; and establishing ethical and governance frameworks. The focus group findings indicated that both students and academics view the LL concept as a dynamic, real-world setting, emphasizing engagement and collaboration with internal and external stakeholders. Academics perceived the educational benefits of LLs as fostering experiential learning and perceived the barriers to implementation as including a lack of resources, scheduling conflicts, insufficient stakeholder engagement and unclear governance frameworks. Students highlighted the importance of aligning projects with taught programme content. and identified challenges such as limited awareness, unequal engagement across disciplines, time constraints, and concerns about inclusivity and equity across campuses. Students agreed that the LL provided opportunities to develop skills and knowledge in sustainability, science communication and real-world evidence studies, opening new career options after graduation. Lastly, altruism to improve food environments for peers and future students was a significant driving factor in student engagement.

Implementing LLs in HE food service settings requires input from multiple stakeholders. This scoping project identified key considerations from both academic staff and students to inform the co-design of a LL in a HE food service setting.

Various nutrient profile models (NPM) are used for food package labelling, such as Traffic Lights, Health Star Rating, Nutri-Score (1). However, these existing NPMs do not suit the context of mobile applications (app), where food is logged exclusively as consumed, not as sold. The inadequacy of existing NPMs for app use highlights a gap in accurately assessing the nutritional quality of foods as per real time consumption. This limitation underscores the need for developing a new model that takes into account highly variable portion sizes to ensure app users receive accurate nutritional feedback.

To fill this gap, the World Health Organization’s (WHO) Nutrient Profiling guidelines (2) were applied to develop a Nutrition Score (NS) within a weight loss (WL) coaching app as a NPM. The aim of this work is to study quantitative characteristics of the NS and its reception by the app users.

The eight-step procedure outlined in the 2010 WHO recommendations for developing NPMs (2) was followed to define the NS. 1) Purpose: To develop a system for providing non-judgmental feedback on digital food logs, accounting for portions; 2) To use an existing or develop a new model: Develop a new model specifically for in-app food feedback; 3) Scope of and exemptions to the model: For foods as they’re consumed; 4) Food categories: foods and drinks; 5) Nutrients included: Energy, protein, fibre, total sugar, saturated and unsaturated fats, sodium, calcium, vitamin C, alcohol; 6) Reference amount: Absolute values per given portion, “per 1000 kcal” and “per 100 g”; 7) Thresholds and/or scores: both; 8) Numbers for thresholds: European Reference Intakes(3,4) and FDA daily values(5) for primary thresholds (secondary are decided pragmatically).

To evaluate the NS, food logs recorded by eligible app users (18–70 years, 45–250 kg, 150–250 cm, meals recorded for at least 15 days in August 2024) were selected. Each log was scored (Optimal, Good, Fair or Low) and given a list of nutrient claims using the NS algorithm. From this we assessed the distribution of scores. Users acceptability of the NS was measured by calculating an average of 1–5 star ratings received.

During August 2024, 213,525 app users logged 5,593,617 meals each accompanied by a NS. Among those, 52,541 users logged meals for at least 15 days during August 2024: 3,650,833 meals in total. Median share (IQR) of Optimal, Good, Fair and Low meal scores was 14.5 (7.8–22.8)%, 48.7 (39.3–57.4)%, 19.2 (10.8–28.6)% and 2.6 (0.0–6.0)%. From 116,822 star ratings, the average rating was 4.5/5, and 67.3% of ratings scored 5/5.

WHO Nutrient Profiling was effectively used to develop a NS for an app, reflecting nutritional quality and receiving positive user acceptability. Further research is required to assess its association with WL and improvement in dietary adequacy.

Mental health disorders including depression and anxiety are major contributors to global disease burden. Evidence indicates that nutrition may play a role in supporting mental health, with most investigations centred on one-carbon metabolism related B-vitamins (1). Recently it has been reported that polyphenol supplementation, particularly those high in anthocyanins (such as blueberries) may improve mood states, including depressive symptoms and anxiety (2). This pilot study aimed to investigate the influence of a combined multivitamin and blueberry extract multinutrient (Vitals+, Heights, UK) on B-vitamin biomarkers and mental wellbeing in healthy adults.

14 healthy adults (8 males, mean age ±SD 38 ±10 yrs) were recruited. Exclusion criteria were: coeliac disease, mental health condition, pregnancy or breastfeeding or taking nutritional supplements in the past 3 months. Participants received an 8-month supplementation of Vitals+ once a day. The supplement contained, among other nutrients, thiamine (B1), riboflavin (B2) and vitamin B6 at a dose of 30mg each, 500μg of 5-Methyltetrahydrofolate (B9) and 25μg methylcobalamin (B12) alongside 80mg blueberry extract. B-vitamin biomarker status and mental state were assessed pre-post intervention.

Functional biomarkers of vitamin B1, B2 and B6 were measured using the Erythrocyte Transketolase (ETKac), Erythrocyte Glutathione Reductase (EGRac) and Erythrocyte Glutamic Oxaloacetic Trans-aminase (EGOTac) activation coefficient assays, respectively. Folate was measured in red blood cells (RBCF) and holotranscobalamin in serum was utilised for B12 assessment. Mental wellbeing was assessed using three validated questionnaires: the Profile of Mood States (POMS), Perceived Stress Scale (PSS) and the General Health Questionnaire-12 (GHQ-12). Differences in outcome measure were assessed pre-post intervention using paired samples t-tests (p<0.05 was considered significant).

At baseline 71% of participants had suboptimal/deficient thiamine status (ETKac ≤ 1.25) whereas 50% were riboflavin deficient (EGRac ≥1.40). Mean values ±SD for EGOTac, RBCF and holotranscobalamin were above the threshold for deficiencies, (1.37±0.12), (654±203 nmol/L) and (70±35 pmol/L) respectively, with no cases of deficiency for these nutrients. There was a significant improvement in thiamine (p=0.024), riboflavin (p<0.001), folate (p<0.001) and B12 (p=0.021) status post intervention but no change in vitamin B6 (p=0.167) biomarker status. For mental wellbeing outcomes, a trend towards significant improvement by 4-points was reported in the GHQ-12 (p=0.062), with a 30% reduction in participants fulfilling the criteria suggestive of psychological distress. There was no significant change in PSS (p=0.179) or total POMS (p=0.167). However, when subdomains of POMS were investigated, significant decreases in fatigue (p=0.028), confusion (p=0.017), self-esteem (p=0.022) and tension (p=0.047) were observed.

At baseline B6, folate and B12 status was adequate however thiamine and riboflavin deficiencies were prevalent. Vitals+ normalised thiamine and riboflavin status and further improved biomarker status of other one-carbon metabolism related B-vitamins. The multinutrient may present an easily accessible intervention to improve B-vitamin status and mental health and wellbeing in adults.

The cortisol awakening response (CAR), the sharp rise in cortisol level upon awakening, represents a unique aspect of hypothalamic pituitary adrenal (HPA) axis activity, combining features of circadian regulation and reactivity to awakening. Studies highlight that the CAR is influenced by state-like factors (e.g., subjective stress and poor sleep) and relates to health and ageing(1). Fluid regulation and the CAR share a common pathway, whereby hydration directly influences the secretion of arginine-vasopressin (AVP), which in-turn modulates HPA-axis activity and cortisol release. Studies have observed higher circulating and saliva cortisol in healthy, low drinking adults presenting with suboptimal hydration (e.g., elevated urine osmolality, UOsm); however, cortisol was only assessed at a single timepoint(2, 3). The study aim was to assess the influence of a change in daily fluid intake on the dynamic CAR.

From a sample of 71 eligible healthy adults (25 females, 46 males), 16 low drinkers (1315 ± 401 ml/day) and 16 high drinkers (4372 ± 1220 ml/day) were identified by adopting daily fluid intake thresholds from a matched UK population (4). In pairs, comprising a low and high drinker, participants underwent a 7-day habitual phase followed by a 7-day intervention phase. During the intervention phase low drinkers increased (+1953 ± 430 ml/day) and high drinkers reduced daily fluid intake (-3168 ± 1379 ml/day), adjusting only water intake. Saliva samples were collected at 0, 15, 30, and 45 minutes after awakening on the last two mornings of each phase, with compliance to sample timing (± 5 minutes) monitored as recommended (1). Saliva cortisol was assessed by ELISA and the CAR was reported as the area under the curve with respect to increase (AUCI) (1). Urine samples were collected the day before and the day of CAR sample collection (16:00-20:00) to assess UOsm.

Linear mixed model revealed a group (low drinkers, high drinkers)*phase (habitual drinking, intervention drinking) interaction for hydration (P < 0.01), whereby UOsm changed significantly in both low drinkers (mean ± SD: 582 ± 213 to 363 ± 200 mOsm/kg) and high drinkers (265 ± 153 to 612 ± 189 mOsm/kg), indicating the success of the intervention. However, no group*phase interaction was observed for the CAR (P = 0.9). The CAR was similar before and after the intervention in both low (AUCI: 15 ± 15 vs. 16 ± 8) and high drinkers (AUCI: 11 ± 14 vs. 12 ± 11), indicating that changing fluid intake did not affect the CAR. These findings remained when observations were restricted to participants who accurately complied to the CAR sampling protocol (N = 19).

These results suggest that the cortisol awakening response, which combines elements of circadian regulation and reactivity to awakening, is not influenced by daily fluid intake.

There is growing interest in analysing potential sustainability trade-offs and co-benefits when it comes to national dietary guidelines (1,2). However, biodiversity is one area that is often left out of these analyses. This scoping review explores the range of studies measuring potential land use impacts of aligning diets or food supply with national dietary guidelines, with a secondary aim to identify how often biodiversity is included.

Scopus, Food Science and Web of Science were searched for peer-reviewed articles which focused on dietary guidelines, land use and future scenarios or modelling, following the Joanna Briggs Institute scoping review method (3).The 1,481 papers retrieved were uploaded to EPPI Reviewer, and 191 duplicates were removed. After screening, a final set of 40 papers were included. Data on the methods used, dietary and environmental impacts, and policy recommendations were extracted. Due to the variation in how impacts were measured, it was not possible to carry out any statistical analysis.

The majority (75%) of papers were published in the last 5 years. In most studies aligning diets with dietary guidelines involved reducing meat (-7% to -74%) and sugar (-3% to -100%), and increasing fruit and vegetables (+17% to +207%), compared to current diets. Only one Australian study found an increase in meat (21%). Results for dairy were mixed with two papers identifying a reduction, based on diets in England and Wales, and Germany. Two papers indicated no change in dairy, while all other papers which included dairy indicated an increase, one with an increase of 500%.

Greenhouse gas emissions were the most common additional environmental factor included (n=30), followed by water (n=19), fertiliser (n=9) energy (n=7) eutrophication (n=3). Biodiversity was featured in only three papers, two of which found both reductions and increases in threats to biodiversity. The third study found most dietary guidelines are incompatible with Aichi biodiversity target to limit rate of cropland change.

Twenty-four authors made the following policy recommendations; incorporate environmental sustainability into dietary guidelines (n=8), having holistic and coherent food systems approaches (n=5), implement policies to change food production and promote sustainability (n=5), combine supply and demand side approaches (n=4), consider socioeconomic factors of food-environment nexus and related policies (n=3), use regional approaches to develop food policy (n=2), and implement measures to encourage dietary change (n=2).

Dietary results were relatively consistent across studies and regions, with most suggesting increasing fruit and vegetables, and reducing meat and sugar. Mixed environmental impacts highlight the need to include multiple environmental factors in diet and land use modelling, for a broader picture of potential trade-offs or co-benefits. Considering the importance of biodiversity to the food system, it is essential that it is included in more studies modelling the land use impacts of dietary guidelines.

Sustainable food based dietary guidelines could be leveraged by national governments to lead transitions to more sustainable food systems. Many countries are in the process of updating their national dietary guidelines to incorporate sustainability (1). In 2021 during the preparations for the United Nations Food Systems Summit, the Irish government announced their aim to become a world leader in sustainable food systems(2).To achieve this, a coherent food system approach is needed, which involves updating the dietary guidelines in line with this goal. To help inform future updates of dietary guidelines in Ireland, this study aimed to identify the sustainability gaps in current Irish dietary guidelines, and barriers to making them more sustainable.

The sustainability gaps in the guidelines and barriers to addressing them were identified by combining a content analysis of the Irish dietary guidelines and supporting documents to evaluate their sustainability, with semi-structured stakeholder interviews to identify barriers to sustainable dietary guidelines. The guidelines were evaluated using an integrated framework by Ahmed and colleagues (3) covering four dimensions of sustainability; ‘health’, ‘economic’, ‘ecological’ and ‘socio-cultural and political’. Semi-structured interviews were held with eight key stakeholders in research, food industry and governance in the Irish food system. Transcripts from interviews were analysed using NVivo 12. A thematic analysis was carried out based on Clarke and Braun’s method(4).

Across the four dimensions of sustainability, the Irish dietary guidelines scored highest in the ‘human health’ (6/8). Food safety and the nutrition aspects of food security were the two aspects of the human health dimension which were not incorporated in the dietary guidelines. However, scores were universally low in the other dimensions, scoring 1/8 in both the ‘socio-cultural and political’ and ‘economic’ dimensions, and 0/8 in the ‘ecological’ dimension. Key barriers to closing these gaps, identified by interviewees included: a siloed approach toward food policy in Ireland; lack of evidence of long-term nutritional impacts of shifting towards sustainable diets; knowledge and behaviours of consumers; no agreed framework defining and monitoring progress towards sustainability; the social and economic importance of animal sourced foods in Ireland and the affordability of sustainable diets.

Future versions of the dietary guidelines need to address the gaps identified in this study to incorporate multiple dimensions of sustainability. While doing so, the government will also need to tackle the barriers to closing these gaps highlighted by stakeholders, if they are to fulfil the ambition to be a world leader in sustainable food systems.

It would also be worthwhile carrying out research on barriers and enablers to compliance with dietary guidelines to improve uptake. An integrated food systems approach including larger sample a range of stakeholders, including consumers, is recommended when updating future dietary guidelines.