The aim of this review is to provide an overview of the history in support of the role of dietary saturated fatty acids (SFA) in the development of cardiovascular disease (CVD), and the controversy and consensus for the evidence in support of guidelines to remove and replace SFA with unsaturated fatty acids. The review will also examine the existence, origins, and implications for CVD risk of variability in serum LDL-cholesterol in response to these guidelines. While the quality of supporting evidence for the efficacy of restricting SFA on CVD risk has attracted controversy, this has helped to increase understanding of the inter-relationships between SFA, LDL-cholesterol and CVD, and reinforce confidence in this dietary recommendation. Nevertheless, there is significant inter-individual variation in serum LDL-C in response to this dietary change. The origins of this variation are multi-factorial and involve both dietary and metabolic traits. If serum biomarkers of more complex metabolic traits underlying LDL-responsiveness can be identified, this would have major implications for the targeting of these dietary guidelines to LDL-responders, to maximise the benefit to their cardiovascular health.

The colonisation of Australia around 250 years ago resulted in significant disruptive changes to the lifestyle and diet of Aboriginal and Torres Strait Islander peoples. Traditional foods high in micronutrients, including vitamin D, have been largely replaced with energy-dense foods(1). Sun exposure—a primary source of vitamin D—may be reduced due to changes in clothing and housing structure(2). Consequently, there is a high prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D concentration < 50 nmol/L) and low vitamin D intake among Aboriginal and Torres Strait Islander peoples(2,3). There is a need for a public health strategy to improve vitamin D status. Since few foods naturally contain vitamin D (e.g., fish, eggs, and meat), food fortification could be a suitable public health strategy to increase vitamin D intake without changing consumption behaviour. In Australia, besides food mandated for fortification (e.g., edible oil spreads), few foods permitted for voluntary fortification are routinely fortified. We aimed to model vitamin D food fortification scenarios among Aboriginal and Torres Strait Islander peoples. We used nationally representative food consumption data from the 2012–2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (n = 4,109) and analytical vitamin D food composition data(4) to model four food fortification scenarios. Scenario 1 modelled the addition of the maximum permitted amount of vitamin D to all foods permitted for fortification in Australia: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages (e.g., water with added sugar, vitamins and minerals), and iv) selected ready-to-eat breakfast cereal. Scenarios 2a–c included vitamin D concentrations higher than permitted in fluid milks/alternatives (1 μg/day) and butter/margarine/oil spreads (20 μg/day). Scenario 2a: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages. Scenario 2b: as per Scenario 2a plus selected ready-to-eat breakfast cereals. Scenario 2c: as per Scenario 2b plus bread (not permitted for vitamin D fortification in Australia). Vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples by ~3–6 μg/day. Scenario 2c showed the highest potential median vitamin D intake increase from baseline of 2 μg/day to ~8 μg/day. Across all scenarios, the vitamin D intake of all participants remained below the Australian Tolerable Upper Intake Level of 80 μg/day. Our findings demonstrated that vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples in Australia. However, the most impactful vitamin D fortification strategy (Scenario 2c) would require a revision of the Australia New Zealand Food Standards Code to permit the addition of higher amounts of vitamin D than currently permitted and the inclusion of bread as a food vehicle for fortification.

Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.

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.

Optimal early childhood nutrition is central to healthy growth, wellbeing and development. The World Health Organisation (WHO) Regional Office for Europe Nutrient and Promotion Profile Model (NPPM)(1) recommends that commercial infant and toddler foods do not carry compositional, nutrition, health or marketing claims. The Food Regulation Standing Committee of Australia and New Zealand (NZ) has identified labelling of these foods as a current area of concern(2). This study aims to identify on-pack labelling and marketing claims on commercial packaged foods aimed at infants and toddlers in NZ. Relevant infant and toddler products available in NZ supermarkets were identified through Nutritrack(3), a packaged food database managed by the University of Auckland. Information was collected from four major NZ supermarket chains in Auckland. Photographs of packaged foods and beverages were taken and names, brands, labelling, ingredients and NIP information identified. Data were collected between April and July 2023. In January 2024, online supermarket websites were checked for additional products. Infant products were those intended for ages up to 11 months as indicated on the package, and toddler products for ages 12 months to 36 months. Claims on each side of the package were coded using a pre-existing coding structure according to the three main categories identified in the WHO NPPM, composition and nutrition claims, health claims, and marketing claims, The absence or presence of the type of claim was noted. Descriptive statistics were conducted using Microsoft Excel to analyse frequency of types of claims. Two hundred and ten products were identified, 167 infant and 43 toddler products. All products had some type of claim on the package. On average, there were 7 unique types of claims per product (range 3-14) for both infant and toddler foods. The most common type of claims were composition and nutrition claims, with a mean of 4.0 types per product, followed by 3.3 types of marketing claims and 0.16 health claims. The most prevalent composition and nutrition claims were ‘free from’ claims relating to the absence of ingredients generally perceived to be harmful, most commonly flavours (on 72% of packages), colours (71%), added sugar (53%), preservatives (43%) and salt (33%). Two-thirds of packages (68%) carried statements on the natural or healthy nature of the ingredients mentioning words like organic/fresh/real or natural on-pack. All infant and toddler products carried some type of claim with the most common being about the composition or nutrition of the product, particularly the absence of additives, sugar and salt. Regulation is needed to ensure that parents and caregivers receive accurate information, preventing them from being misled when making purchasing decisions for their children.

Poor diet is a risk factor for chronic noncommunicable diseases and related mortalities(1). The community food environment is one of the determinant factors for dietary quality(2). In high-income countries, the dietary impact of the community food environment is more pronounced in low socioeconomic areas(3). This study aimed to assess the healthiness of food outlets and its association with Socioeconomic Index for Areas (SEIFA) and Local Government Areas (LGA) in the Illawarra Shoalhaven region, Australia. A desk-based cross-sectional study was conducted using a list of registered food outlets obtained from councils of local government areas. Food Environment Score was used to assess the healthiness of food outlets that classify food outlets as healthy, less healthy, and unhealthy(4). The Index of Relative Advantage and Disadvantage (IRSAD) at statistical area level two was used to define SEIFA and was extracted from the Australian Bureau of Statistics (ABS) 2021 census data. Logistic regression was conducted to identify the association between the healthiness of food outlets with LGA and SEIFA. Of the 1924 food outlets, 52.4% (n = 1008) were in Wollongong, 14.1% (n = 272) in Shellharbour, 8.3% (n = 160) in Kiama, and 25.2% (n = 484) in Shoalhaven LGA. Out of 1924 food outlets, 281 (14.6%) were categorised as healthy, 790 (41.1%) as less healthy, and 853 (44.3%) as unhealthy. Wollongong had 2 times more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 2.0 (95% CI: 1.5, 2.5)), Shellharbour had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.3, 2.3)), and Kiama had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.1, 2.5)). IRSAD 5 had 40% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.6 (0.4, 0.8)) and IRSAD 4 had 50% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.5 (0.3, 0.8)). Large proportion of food outlets were categorised as unhealthy and less healthy. There were disparities in the healthiness of food outlets across LGAs and SEIFA. Intervention strategies need to be designed to increase the availability of healthy food outlets and limit unhealthy food outlets, particularly in low socioeconomic areas.

Plant-based substitutes (PBS) are seen as a convenient way to transition to a more plant-based diet, but their potential health benefits and nutritional concerns remain debated. Based on a review of the literature, it is concluded here that the primary risk of insufficient nutrient intake with PBS concerns iron and calcium, which are critical to the nutritional value of PBS. Other risks were identified but these would depend on the characteristics of the overall diet, as is the case for iodine in a diet containing no seafood or dairy, and vitamin B12 in a vegetarian/vegan diet. Conversely, the use of PBS is also expected to confer some benefits for long-term health because it would result in higher fibre intakes (in the case of meat PBS) and lower SFA intakes (but higher PUFA/MUFA intakes), but attention should be paid to a potential increase in sodium intake with PBS of meat products. In fact, a recurring finding in this review was that PBS is a very heterogeneous food category involving considerable variations in ingredient and nutrient composition, and whose design could be improved in order to foster nutritional and health benefits. The latter also depend on the animal food that is being replaced and are only deemed likely when PBS replace red meat. The fortification of PBS with key nutrients such as iron and calcium may constitute an actionable public health solution to further shift the balance in favour of PBS in the context of the current dietary transition in western countries.

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.

Claims relating to foods’ nutrition content and potential health benefits have been shown to influence consumer preferences and purchases regardless of the nutritional quality of the product(1). In Australia, permitted claims include nutrition content claims, which refer to the presence or absence of a nutrient, and health claims, which refer to health benefits of foods or nutrients in a product. Health claims include general level health claims, which refer to normal processes and functions, and high level health claims, which refer to a disease or biomarker of a disease. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC), however this is not required for products to make a nutrition content claim. The aim of this study was to examine the use of nutrition content and health claims made on Australian ready meal products and assess the proportion of products displaying claims that meet the NPSC. Analysis of the ready meal category in the 2023 FoodSwitch database, a repository of Australian food packaging images and label data for over 28,000 foods developed by The George Institute for Global Health, was conducted(2,3). Foods in the ready meal category were identified and data from the nutrition information panel was collated to calculate whether they met the NPSC. Nutrition content and health claims were extracted from product images and categorised according to claim type (nutrition or health claim) and claimed nutrient or attribute. The proportion of products meeting the NPSC was then calculated overall and by claim type (nutrition content vs health claims). Data were available for 777 ready meal products. Of these, 682 (87.8%) met the NPSC. In total, 2051 nutrition content or health claims were identified across the ready meal products, with 1909 (93.1%) of these categorised as nutrition content claims. The remaining 142 claims identified were general level health claims, with no high level health claims identified. Almost all (n = 1857, 97.3%) nutrition content claims and all general level health claims were made on products which met the NPSC. The most common claims related to protein, energy and fibre content. The use of claims was prevalent across the ready meal food category in Australia, with claims relating to nutrient content being most common. While most claims were made on products that met the NPSC, there is a need for further research to ensure the NPSC appropriately distinguishes between healthy and less healthy food products. This will ensure consumers are equipped to make informed decisions when purchasing food products.

The estimated global preterm birth rate in 2020(1) was more than 10% of livebirths or 13.4 million infants. Despite the importance of neonatal nutrition in optimising growth, neurodevelopment, and later metabolic disease risk, there is inconsistency in nutrition recommendations for preterm infants(2). Incomplete or inconsistent reporting of outcomes in nutrition intervention studies is part of the reason for the lack of consensus on optimal nutrition. To reduce uncertainty in measuring or reporting nutritional intake and growth outcomes in preterm studies, a consensus process is needed to identify relevant measures for patients, parents/caregivers, researchers, and health professionals. We aimed to develop a minimum reporting set (MRS) for measures of nutritional intake and growth in preterm nutrition studies. We collaborated with a group of international researchers from 13 countries and registered this study at the COMET initiative (registration number 3185). The target population was individuals born preterm at any gestational age and study location whose nutritional intake was assessed before first hospital discharge and whose growth was assessed at any age. Measures reported in preterm nutrition studies were systematically reviewed and used to develop the real-time Delphi survey(3) using Surveylet (Calibrum) software, including 13 questions about nutritional intake and 14 about growth outcomes. We used a snowball process to recruit participants from the consumer, healthcare provider, and researcher stakeholder groups with expertise in preterm infants, nutrition, and growth to rate the importance of each measure on a 9-point Likert scale. Participants initially rated the survey items without seeing other participants’ responses, saved and refreshed the page to see the anonymous responses of other participants, and had the option to change their rating and provide reasons for their answers. Participants’ final scores for each item will be used to identify the consensus criteria for that item(3). To date, we have recruited 246 participants from 31 countries across 5 continents, including 58 (24%) consumers, 156 (63%) healthcare professionals, and 26 (11%) researchers. Preliminary findings indicate that 12 measures of nutritional intake and 4 of growth have met the criteria for inclusion in the MRS. However, participant recruitment and survey responses are ongoing. A final consensus meeting is planned for November 2024 to confirm the MRS.

The nutrition workforce plays a vital role in disease prevention and health promotion, with expanding job opportunities shaped by factors like aging populations, climate change, global food systems, and advancing technologies(1,2). Preparing students for careers that require adaptability involves understanding the valuable skills they possess and identifying any gaps. This research aimed to identify the skills and knowledge valued by students who had recently completed work-based placements, and explore recent graduates’ experiences, challenges, and preparedness for employment. At the end of their work-based placements students give presentations sharing their experiences and learning. Permission was sought from ten students to analyse the recordings of these presentations. The presentations were selected to include a range of nutrition fields, including sports nutrition, public health, community nutrition, dietary counselling, food and industry, and nutrition communication. Additionally, a list of graduates (within four years of graduation) from various fields (as above) was compiled and they were invited to participate. Semi-structured interviews (n=10) were conducted online via Zoom and recorded. The interview guide included open-ended questions on employment experiences, challenges, preparedness, and required skills. The interviews, transcription and analyses were completed by two student researchers between November 2023 and February 2024. Thematic analysis using NVivo software was used to identify themes. The themes developed included the importance of skills relating to; i) communicating complex nutrition concepts to the public, ii) collaborating within diverse teams, iii) identifying and filling personal knowledge gaps. In addition Graduates felt practical experience from their University study boosted their preparedness for the workforce, though many struggled to apply their skills in non-traditional roles and expand their career scope. In summary, ongoing focus on team-based projects, communication with non-science audiences, and strategies for continuous learning using evidence-based sources are crucial for both undergraduate and postgraduate education.

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.

Women are the primary food providers within Cambodian families, however little is known about what influences their food choices. Despite recent economic improvements, Cambodia remains the second poorest country in south-east Asia(1). Twenty-two percent of Cambodian children have stunting and 16% are underweight(2). Cambodian women of reproductive age exhibit the double burden of malnutrition, with 44% having anaemia and 33% with overweight or obesity(2). Nearly half of Cambodian women do not achieve minimum dietary diversity, with diets consistently low in vitamin A, thiamine, calcium, zinc and iron(3). Strategies to improve Cambodian families’ dietary intake are therefore needed. Factors influencing food choice are complex and multidimensional(4), and no previous studies have explored how Cambodian women make food decisions. This study aimed to understand Cambodian women’s food-related decision-making for themselves and their families. This qualitative study applied a descriptive methodology consistent with the experiential paradigm. Four 90-minute focus groups were conducted in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged 18+ years with at least one child aged under five who have primary responsibility for food provision within their family. Focus groups were facilitated by an Australian researcher (JW), using an interpreter to translate between Khmer and English languages. Groups discussed perceptions about food related to health, prompted by ‘conversation cards’ depicting food sources and nutritional benefits of five key nutrients. Reflexive thematic analysis was used to analyse the focus group data(5). Three themes were identified: 1) food access impacts choice; 2) responsible nurturing food provision role; and 3) dichotomous perceptions of food. Access to food strongly influenced food choices made by Cambodian women. High cost and low availability prompted women to forage for easily accessible ingredients such as water plants, fish, crabs and fruit, or choose cheaper, lower-quality foods from the market. Cambodian women strived to fulfil their responsibility to provide healthy, nourishing meals for their family within their capabilities, prioritising their husband and children over themselves. Nutritional awareness included understanding that fruit and vegetables contained vitamins, and meat was a good source of iron. They perceived certain traditional Khmer soups as ideal healthy meals, providing adequate energy and strength for hard-working husbands and growing children, and preventing sickness. Cambodian women considered healthy food using a range of dichotomous factors beyond their nutritional value, including ‘wet or dry’ food, ‘helpful or harmful’ in relation to immediate body symptom responses to food, cultural food taboos and use of chemicals on fresh vegetables. These findings indicate the need for future nutrition interventions targeting Cambodian communities to address women’s perceptions about the health-related qualities of foods, and access to nutritious foods so that behaviour change strategies are practical, culturally appropriate and acceptable.

Malnutrition from poor diet is a persistent issue in Sri Lanka, especially among women and children. High rates of undernutrition and micronutrient deficiencies are documented among rural poor communities(1). Household food production may enhance maternal and child nutrition directly by increasing access to diverse foods and indirectly by providing income to diversify diets(2). This study explores the cross-sectional relationship between household food production and individual dietary diversity among women aged 18-45 years and children aged 2-5 years in Batticaloa district, Sri Lanka. We randomly selected 450 low-income mother-child pairs receiving a Samurdhi subsidiary, having a home garden. Through face-to-face interview, we gathered information on the types of crops grown and livestock reared in the preceding 12 months. Production quantity and utilization were also detailed. Additionally, socio-demographic information and market access were obtained. To measure women’s dietary diversity (DD), we used a scale based on 10-food groups and a 7-food group scale for children. Women who consumed five or more food groups were defined as meeting the Minimum Dietary Diversity of Women (MDD-W), whereas children who consumed of four or more food groups met the minimum standards. Multiple linear regression and binary logistic regression were used to identify the factors predicting individual DD. Complete data for 411 pairs were analysed. The results showed, only 15.3% of the women met MDD-W, with a mean DDS of 3.3 (SD = 1.2). Children had a mean DDS of 3.3 (SD = 1.2), and 41.1% of them met the minimum diversity. Regression analysis indicated that growing leafy vegetables was positively associated with increased dietary diversity of women (β = 0.337; 95% CI: 0.13, 0.54; p = 0.001) and children (β = 0.234; 95% CI: 0.05, 0.42; p = 0.013) but not with meeting the minimum diversity. Moreover, monthly income above 35,000 LKR, higher education level, a secondary income source andfood security were also positively associated with women’s DD. Conversely, living further away from the main road reduced the women’s DD. Interestingly, livestock ownership was only associated with women meeting the MDD-W, but not for children. For children, monthly income was a strong predictor of DD and meeting minimum diversity. Surprisingly, living far from the market was associated with increased DD in children (β = 0.018; 95% CI: 0.01, 0.03; p = 0.013), while distance to main road had a similar effect as in women. Notably, selling their produce at the market contributed to meeting the minimum dietary diversity in children (β = 0.573; 95% CI: 0.14, 1.02; p = 0.013). These findings suggest that enhancing household food production could play a crucial role in improving dietary diversity and addressing malnutrition, particularly in rural Sri Lankan communities, and potentially in other similar settings.

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.

Traditional Cambodian recipes have been prepared the same way over time, with their nutritional quality largely unknown. Poor nutritional status is common among Cambodian children with 22% experiencing stunting and 16% underweight(1), while Cambodian women exhibit the double burden of malnutrition with 44% having anaemia and 33% above the healthy weight range(1). Most Cambodian women have inadequate intakes of key nutrients including vitamin A, thiamine, zinc and iron(2). Recent Cambodian studies have focused on increasing nutrient intakes, with improved nutritional quality of mixed dish recipes a novel, potential approach(3). However, the absence of a Cambodian-specific food composition database means nutrient information for common mixed dishes is unavailable. This study aimed to quantify the nutrient profile of traditional mixed dishes commonly consumed by Cambodian women and children. A secondary aim was to qualitatively explore Cambodian women’s receptiveness to nutrient-enhanced traditional mixed dishes. A sequential mixed methods approach was used to collect traditional recipes and nutritionally analyse Khmer mixed dishes, then conduct qualitative focus groups to assess recipe acceptability. Over 900 recipes were collected by Cambodian women who had a child < 5 years via a custom-built smartphone app, as part of a dietary assessment study in Cambodia in 2019 and 2020. After grouping and counting recipes to determine consumption frequency, ingredients and quantities, these were consolidated into 27 commonly consumed recipes. The nutrient composition of consolidated recipes was determined using an INFOODS template(4). Dietitians then created six nutritionally-enhanced versions of Khmer mixed dishes by switching or adding common high-nutritive ingredients. In Siem Reap province four 90-minute focus groups were conducted with Cambodian mothers (two rural, two urban). Three dishes per group were prepared and served with rice, and women’s responses to each nutritionally-enhanced Khmer mixed dish were discussed. Nutrient analysis indicated that a median serve of traditional Khmer fish soup contributed 25% protein, < 10% iron and folate, and < 20% zinc and thiamine required daily for non-lactating women. Initially Cambodian women were sceptical about modifying traditional Khmer recipes, expressing resistance to change: ‘They would wonder, where did you learn that?’. Inspecting each dish, they discussed how strange the ingredients seemed, disbelieving their acceptability: ‘It is weird […], never put other green leaves’. After tasting, women expressed surprise they liked the flavour, describing these modified dishes as ‘unique’ or ‘creative’, recognising they would ‘gain more nutrition’ with this enhanced recipe. Most women declared they would try this modified dish at home ‘I would like to share it to my sister and my friends and family’. Results highlight future interventions promoting nutritionally-enhanced recipes of commonly consumed meals need to support women to overcome initial resistance through trialling them to evaluate acceptability, prompting them to share with their household.

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.

Global efforts to combat micronutrient deficiencies have often focused on assessing nutrient intakes and supplies(1,2), yet no studies have explored the role of crop selection and land suitability to tackle these deficiencies. This study aims to bridge this gap using existing estimates of global prevalence of iron(3) and zinc(4) deficiencies to identify crops with the highest potential to mitigate these deficiencies. Using the USDA food composition database, we established nutrient profiles for 37 widely cultivated crops, focusing on their iron and zinc content per 100 grams. To evaluate these crops’ effectiveness to meet nutrient requirements, we compared compositions to Harmonized Average Requirements (H-ARs) for women of reproductive age (WRA), a group particularly vulnerable to micronutrient deficiencies. The H-ARs account for variations in nutrient absorption and bioavailability(5). For each crop, we calculated the percentage of the H-AR met by 100 grams of iron and zinc content. This percentage was adjusted for the global prevalence of iron and zinc deficiencies by introducing deficiency weighting—multiplying each crop’s nutrient contributions by the global prevalence of iron and zinc deficiencies. The result was a deficiency-weighted nutrient score for each crop. Soybeans scored highest at 61.67, followed by cowpeas (50.30), pearl millet (33.69), and Phaseolus beans (31.33), indicating their strong potential to address global iron and zinc deficiencies. Next, we integrated these nutrient scores with global land suitability and yield potential data from the Global Agro-Ecological Zones (GAEZ) database to map regions most suited for growing these nutrient-dense crops. On average, our findings show that Tonga is the most suitable country for soybean cultivation, with a potential yield of 3.77 tons per hectare (tons/ha), Uruguay for cowpeas (2.82 tons/ha), Lithuania for Phaseolus beans (3.93 tons/ha), and Guinea-Bissau for pearl millet (3.87 tons/ha). Through multivariate clustering, we linked global deficiency patterns with yield potential across various regions. Countries such as those in the Caribbean, Eastern, Western, and Middle Africa, and Southern and Southeastern Asia emerged as priority regions where the production of these crops would be most beneficial to combat iron and zinc deficiencies. The results provide valuable insights to align agricultural land use practice with nutritional requirements, particularly in regions with high iron and zinc deficiency prevalence.