Food Based Dietary Guidelines (FBDG) are a set of recommendations that describe the quantity and types of foods to consume to promote healthy eating and prevent diseases such as obesity. However, when assessing compliance with FBDG, calculating contributions from composite dishes is challenging, since the specific recipe ingredients are often unknown. This project aims to establish proportional contribution of composite dishes to food groups defined by the Irish and UK FBDG. This will facilitate automated assessment of compliance with FBDG for users of novel technology such as Nutritics, a suite of integrated nutrition analysis software tools for healthcare professionals, educators and industries. Territory specific food composition data (n = 3291) for Ireland and the UK were downloaded from the 2015 McCance & Widdowson Composition of Foods Integrated Dataset (CoFIDs). Recipes were identified and classified into groups broadly aligned with the food groups defined in the Healthy Food for Life Ireland and the Eatwell Guide UK. Supplementary recipe details were accessed from McCance & Widdowson 7th Edition book and online resources. Recipes were categorised by recipe type and ingredients were categorised into food groups. Percentage contribution of each food group to the total recipe was calculated. Of the 3,291 foods, 1,108 were classified as recipes, details were available for 138 of these. Of the 138 recipes, there were fruit & vegetable dishes (n = 20), breads, potatoes, pasta and rice dishes (n = 12), meat, fish and alternative protein sources dishes (n = 40), dairy dishes (n = 23), high fat/oil, sugar, salt dishes (n = 43). For fruit & vegetable dishes, the median percentage contribution to the fruit & vegetable food group was 67% (15% min/ 100% max). For breads, potatoes, pasta and rice dishes the median percentage contribution to the breads, potatoes, pasta and rice food group was 53% (17% min/ 89% max). For meat, fish and alternative protein sources dishes, the median percentage contribution to meat, fish and alternative protein sources food group was 55% (16% min/ 85% max), for dairy dishes, the median percentage contribution to the dairy food group was 90% (53% min/ 96% max). For high fat/oil, sugar, salt dishes the median percentage contribution to the high fat/oil, sugar, salt food group was 22% (3% min/ 97% max). The calculation of recipes into percentage contribution to food groups can support assessment of adherence to FBDG when using reference recipes. This is a useful tool to support healthcare professionals when assessing dietary intake where specific recipe components are unknown.

Reduced inflammatory signaling (IL-1RI-/-) alters metabolic responses to dietary challenges (1). Inflammasome deficiency (e.g. IL-18-/-, Asc-/-) can modify gut microbiota concomitant with hepatosteatosis; an effect that was transferable to wild-type (WT) mice by co-housing (2). Taken together, this evidence suggests that links between diet, microbiota and IL-1RI-signaling can influence metabolic health. Our aim was to determine whether IL-1RI-mediated signaling interacted with the gut microbiome to impact metabolic tissue functionality in a diet-specific fashion. Male WT (C57BL/J6) and IL-1RI-/- mice were fed either high-fat diet (HFD; 45% kcal) or low-fat diet (LFD; 10% kcal) for 24 weeks and were housed i) separately by genotype or ii) with genotypes co-housed together (i.e. isolated vs shared microbial environment; n = 8–10 mice per group). Glucose tolerance and insulin secretion response (1.5 g/kg i.p.), gut microbiota composition and caecal short-chain fatty acids (SCFA) were assessed. Liver and adipose tissue were harvested and examined for triacylglycerol (TAG) formation, cholesterol and metabolic markers (Fasn, Cpt1α, Pparg, Scd1, Dgat1/2), using histology, gas-chromatography and RT-PCR, respectively. Statistical analysis included 1-way or 2-way ANOVA, where appropriate, with Bonferroni post-hoc correction. Co-housing significantly affected gut microbiota composition, illustrated by clustering in PCoA (unweighted UniFrac distance) of co-housed mice but not their single-housed counterparts, on both HFD and LFD. The taxa driving these differences were primarily from Lachnospiraceae and Ruminococcaceae families. Single-housed WT had lower hepatic weight, TAG, cholesterol levels and Fasn despite HFD, an effect lost in their co-housed counterparts, who aligned more to IL-1RI-/- hepatic lipid status. Hepatic Cpt1α was lowest in co-housed WT. Adipose from IL-1RI-/- groups on HFD displayed increased adipocyte size and reduced adipocyte number compared to WT groups, but greater lipogenic potential (Pparg, Scd1, Dgat2) alongside a blunted IL-6 response to pro-inflammatory stimuli (~32%, P = 0.025). Whilst caecal SCFA concentrations were not different between groups, single-housed IL-1RI-/- adipocytes showed greatest sensitivity to SCFA-induced lipogenesis. Interestingly, differences in tissue functionality and gut microbiome occurred despite unaltered glucose tolerance; although there was a trend for phenotypic transfer of body weight via co-housing. For all endpoints examined, similar genotype/co-housing effects were observed for both HFD and LFD with the greatest impacts seen in HFD-fed mice. In conclusion, while the gut microbiome may be an important consideration in dietary interventions, these results question the magnitude of its impact in relation to the IL-1RI-dependent immunometabolism-glucose homeostasis axis.

Leukocyte DNA methylation patterns associated with habitual diet may reveal molecular mechanisms involved in the pathogenesis of diet-related chronic diseases and highlight targets for prevention and treatment. We aimed to examine peripheral blood derived leukocyte DNA methylation signatures associated with diet quality. We meta-analyzed epigenome-wide associations between diet quality and DNA methylation levels at over 400,000 cytosine-guanine dinucleotides (CpGs). We conducted analysis primarily in 6,662 European ancestry (EA) participants and secondarily in a group additionally including 3,062 participants of non-European ancestry from five population-based cohort studies. DNA methylation profiles were measured in whole blood, CD4 + T-cells, or CD14 + monocytes. We used food frequency questionnaires to assess habitual intake and constructed two diet quality scores: the Mediterranean-style diet score (MDS) and Alternative Healthy Eating Index (AHEI). Our primary analysis identified 32 diet-associated CpGs, 12 CpGs for MDS and 24 CpGs for AHEI (at FDR < 0.05, corresponding p-values = 1.2×10-6 and 3.1×10-6, respectively) in EA participants. Four of these CpGs were associated with both MDS and AHEI. In addition, Mendelian randomization analysis indicated that seven diet-associated CpGs were causally linked to at least one of the CVD risk factors. For example, hypermethylation of cg11250194 (FADS2), which was associated with higher diet quality scores, was also associated with lower fasting triglycerides concentrations (p-value = 1.5×10-14) and higher high-density lipoprotein cholesterol concentrations (p-value = 1.7×10-8). Transethnic meta-analysis identified nine additional CpGs associated with diet quality (either MDS or AHEI) at FDR < 0.05. Overall quality of habitual diet was associated with differential peripheral leukocyte DNA methylation levels of 32 CpGs in EA participants. The diet-associated CpGs may serve as biomarkers and targets for preventive measures in CVD health. Future studies are warranted to examine diet-associated DNA methylation patterns in larger, ethnically diverse study samples.

High consumption of ω-3 long chain polyunsaturated fatty acids (PUFAs) has long-term health benefits. The principal dietary source of these ω-3 PUFAs (eicosapentaenoic acid, EPA and docosapentaenoic acid, DHA) is seafood, particularly oily fish. However current fish stocks are decreasing, indicating a need for alternative sources of bioactive PUFAs. Plant-derived ω-3 PUFAs (alpha-linolenic acid, ALA and stearidonic acid, SDA) may be able to provide land-based sustainable sources, but their functionality has been underexplored.

Anti-inflammatory effects of ALA and SDA were compared to EPA and DHA in cultured EA.hy926 endothelial cells. Cells were treated with PUFAs (10, 25 and 50 μM) for 48 hours prior to stimulation with tumour necrosis factor for 24 hours. PUFAs incorporation was measured by gas chromatography and inflammatory responses were measured by ELISA, RT-PCR, western blot and flow cytometry. Adhesion of THP-1 monocytes to EA.hy926 cells was determined using a static adhesion assay.

All PUFAs were incorporated into EA.hy926 cells in a dose-dependant manner (10 and 50 μM). Pre-treatment with ALA, SDA, EPA and DHA (50 μM) had differential effects on inflammatory responses in EA.hy926 cells depending on PUFA and response examined.

EA.hy926 cells pre-treated with SDA had lower concentrations of soluble ICAM-1 (p < 0.05); however EPA and DHA resulted in greater reduction (p < 0.0001). EPA and DHA pre-treated EA.hy926 cells had significantly lower concentrations of IL-6 (p < 0.0001), IL-8 (p < 0.0001) and MCP-1 (p < 0.05, p < 0.01). ALA pre-treatment did not significantly affect any of the cytokines examined. Lower cell surface expression of ICAM-1 (p < 0.05), was seen for EA.hy926 cells pre-treated with SDA again to a lesser extent than EPA and DHA (p < 0.001, p < 0.0001), with no effect seen after ALA treatment.

EA.hy926 cells pre-treated with ALA had significantly higher relative gene expression of NFKB (p < 0.05), as well as a tendency for more phosphorylated NFKBp65 protein (p < 0.06). In contrast, EA.hy926 cells pre-treated with DHA had significantly less phosphorylated NFKB (p < 0.0001). EA.hy926 cells with DHA treatment had significantly higher relative gene expression of PPARa (p < 0.05). SDA and EPA had no effect on expression of either of the genes or proteins examined.

Finally pre-treatment with ALA, SDA and DHA all resulted in reduced adhesion of THP-1 monocytes to EA.hy926, however this effect not observed with EPA.

Marine derived PUFA, particularly DHA, resulted in potent anti-inflammatory effects within this endothelial cell model. Of the two plant derived PUFAs, SDA treatment lead to some anti-inflammatory effects, which were not seen after treatment with ALA.

Pregnant women who are overweight/obese are particularly vulnerable to vitamin D insufficiency owing to higher physiological requirements and lower status (25(OH)D concentrations) associated with obesity. Achieving adequate maternal vitamin D status with current recommendations (10μg/d) remains controversial.

This study examined supplementation effects (10μg-vs-20μg vitamin D3/d) throughout pregnancy (12 weeks gestation until delivery) on vitamin D status of normal weight, overweight and obese pregnant women and on cord blood, using a double-blind randomised vitamin D intervention study (MO-VITD). 240 pregnant women were recruited throughout the year at antenatal clinics in Northern Ireland (equal numbers of normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (> 30kg/m2)). Non-fasting maternal blood samples were collected at 12, 28 and 34–36 weeks gestation and from the umbilical cord after delivery and analysed for total serum 25(OH)D using LCMS.

A high prevalence of vitamin D insufficiency (25–50nmol/L) was found in the 1st trimester in both treatment groups (41.5% and 48.8%; 10μg vs. 20μg respectively). Maternal 25(OH)D concentrations increased from the 1st to 3rd trimester in both the 10μg/d and 20μg/d groups, with a higher increase in the 20μg group (17.1 ± 24.7 and 28.8 ± 33.3nmol/L, P = 0.002). There was no difference in cord blood 25(OH)D concentrations between treatment groups.

Women who started pregnancy with insufficient 25(OH)D concentrations remained insufficient throughout pregnancy in the 10μg/d group (49.9 ± 28.2nmol/L at trimester 3). In the 20μg/d group, women starting pregnancy as insufficient achieved levels of sufficiency in the 2nd (58.9 ± 30.6nmol/L) and 3rd (64.0 ± 35.9nmol/L) trimesters. Women who started pregnancy with sufficient vitamin D status (25(OH)D > 50nmol/L), maintained levels of sufficiency throughout pregnancy irrespective of treatment group (83.1 ± 24.4 and 96.7 ± 30.7 at trimester 3 in 10μg/d and 20 μg/d groups respectively); findings were similar across all BMI categories.

Obese women who started pregnancy with an insufficient status were found to have deficient cord blood (25(OH)D < 25 nmol/L) in both the 10μg/d and 20μg/d groups (19.4 ± 20.2 vs. 19.5 ± 9.4nmol/L respectively), whilst obese women who started pregnancy with sufficient status (> 50nmol/L) had cord blood concentrations considered insufficient (40.2 ± 18.4 vs. 44.2 ± 15.6nmol/L; 10μg vs. 20μg groups respectively).

Based on our findings of the high prevalence of vitamin D insufficiency in early pregnancy, maternal vitamin D supplementation of 20μg/d is advisable to maintain maternal vitamin D status in pregnant women in Northern Ireland.

Breakfast is considered to be the most important meal of the day, which significantly contributes to overall dietary quality. Global trends suggest a decline in breakfast consumption frequency in all age groups over the years. Breakfast skipping is associated with increased risk of weight gain, insulin resistance and type 2 diabetes, which are crucial risk factors of cardiovascular diseases (CVD). Regular breakfast consumption as a modifiable risk factor might be of great interest for cardiovascular prevention. Several prospective cohort studies showed contradictory findings on breakfast skipping and CVD risk. To the best knowledge of authors, this topic was not covered by any previous meta-analysis. Therefore, this review aimed to summarise the evidence on the association between breakfast skipping and CVD risk in prospective studies with particular emphasis on dose-response relationship and quality of existing evidence. A comprehensive search of the literature was performed using PubMed and Embase databases until February 2019, with no restriction to language and date. Inclusion criteria were as following: (1) participants aged ≥ 18 years, (2) prospective design, (3) information about breakfast consumption/skipping frequency and (4) outcome is the risk of CVD including coronary heart disease, stroke or heart failure. For high versus low comparison, random effects model was applied using the inverse variance method. Greenland-Longenecker method was used to conduct linear dose-response meta-analysis. Potential nonlinear association were examined using restricted cubic splines model. Heterogeneity was evaluated using the Cochrane Q test and I2 statistic with value > 50% indicating substantial heterogeneity. Quality of evidence was assessed using NutriGrade tool. Out of 877 records identified in the literature search, four prospective cohort studies with 7258 CVD cases were included. Comparing breakfast skipping to regular breakfast consumption, there was a positive association with CVD risk (RR = 1.17 95%CI: 1.02–1.34, I2 = 39%, pheterogenity = 0.14). In linear dose-response meta-analysis, each additional day of breakfast skipping was related to 2% higher risk of CVD (RR = 1.02 95%CI: 1.00–1.04, I2 = 15%, pheterogenity = 0.31, n = 3). No non-linear association was observed (pnon-linearity = 0.53, n = 3). The quality of evidence for these associations was rated as low. This review indicated that breakfast skipping is associated with increased risk of CVD. Potential implementation of these findings in cardiovascular prevention has to consider low trust in existing evidence. Further prospective studies on this topic have to focus on the type of foods and meals consumed during breakfast, as well as BMI mediation.

Recent evidence suggests that synchronizing eating-fasting schedules with body's circadian rhythms or day-night cycles is important for metabolic health. Besides food quantity and quality, food timing may contribute to weight regulation. However, it is unclear if this factor during pregnancy can influence maternal weight retention after childbirth. Using data from a prospective cohort, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study, we examined the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months. We assessed 687 pregnant women for their circadian eating pattern (night-eating, night-fasting and eating episodes) and diet quality (Healthy Eating Index) based on information derived from 24-h dietary recall at 26–28 weeks’ gestation. Night-eating was defined as > 50% of total energy intake during 1900–0659 h; night-fasting duration was determined based on the longest fasting interval between consumption of a calorie-containing food or beverage during 1900–0659 h; eating episodes were defined as events that provided ≥ 210 kJ with time intervals between eating episodes of ≥ 15 min; diet quality was ascertained using the Healthy Eating Index which measures adherence to the Singapore dietary guidelines for pregnant women. PPWR was calculated by subtracting the weight at the first antenatal clinic visit from weight at 18-month postpartum. Substantial PPWR was defined as weight retention of 5 kg or more. Adjusting for maternal age, ethnicity, education, parity, night shift, mood, body mass index and total energy intake, multivariable binary logistic regression analysis was performed to estimate odds ratio (OR) of substantial PPWR in relation to circadian eating pattern and diet quality. Of 687 women, 110 (16%) had substantial PPWR. After confounders adjustment, night-eating (OR 1.95; 95% confidence interval 1.05, 3.62) and lower diet quality (1.91; 1.17, 3.10) were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night-fasting duration and number of eating episodes. During pregnancy, women with higher caloric consumption at night and lower diet quality had a greater likelihood of substantial PPWR. These findings suggest that aligning eating time with day-night cycles and adherence to dietary guidelines during pregnancy may help to alleviate overweight and obesity risk in postpartum life. There is a possibility that these eating patterns persist beyond pregnancy and pose implications for long-term obesity development. Further investigation on this area is required.

The importance of dietary protein for the maintenance of muscle mass and strength is heavily discussed. However, adequate energy intake is an underlying assumption but often not considered. In this study, we investigated the impact of daily intake and meal distribution of both protein and energy on muscle mass and strength. In a cross-sectional study, a total of 184 older individuals (gender: 86F/98M, age: 70.2 ± 3.9 yrs, BMI: 25.4 ± 3.7 kg/m2; means ± SD) were recruited. Participants underwent a 3-day weighed dietary record, Dual-energy X-ray Absorptiometry (DXA) scan, hand-grip strength, and Maximal Voluntary Isometric knee-extension Contraction (MVIC). Participants were divided into two categories: lower (LOW; < 0.83 g/adjusted(a)BW/day) or higher (HIGH; ≥ 1.1 g/aBW/day) protein intake levels analysed by gender to characterize a daily protein and energy intake pattern. Main meal protein and energy intake distributions were calculated, and correlations were made. Further, energy intake at breakfast and lunch divided by total energy intake (energy ratio) was correlated with appendicular skeletal muscle index (ASMI), hand-grip strength, and MVIC were determined using the LOW/HIGH-protein-intake categorization. Further, gender-specific ASMI, hand-grip strength and knee extension were compared based on the following four distinct daily protein intake ranges: < 0.66; ≥ 0.66- < 0.83; ≥ 0.83- < 1.1; ≥ 1.1 g/aBW/day. A positive correlation appeared between protein and energy intake in all main meals (r ≥ 0.57, p < 0.0001). In the LOW category, positive correlations were found between energy ratio and ASMI (r = 0.16, p = 0.048), hand-grip strength (r = 0.40, p = 0.0009), and MVIC (r = 0.36, p = 0.0019), whereas no associations were found in the HIGH category. ASMI, hand grip, and MVIC were similar regardless of the protein intake ranges, though with women being lower than men (p < 0.05) in all outcomes. These results show that total daily protein intake did not affect muscle mass and strength in our cohort. However, our data demonstrate that greater energy intake in breakfast and lunch relative to total energy intake is associated with higher muscle mass and strength, particularly when protein intake is lower than 0.83 g/aBW/day, indicating the potential importance of meal energy content at lower intakes of protein.

Sarcopenia, characterised by loss of skeletal muscle mass and strength with age, is a significant risk factor for loss of mobility and independence. The combination of low muscle mass and high fat mass in sarcopenic obesity is associated with particularly poor outcomes. Micronutrient deficiencies can occur alongside obesity despite total energy surplus, and older individuals may be at greater risk of deficiency. Research suggests vitamin C is important for musculoskeletal health, but the relationship with obesity is underexplored.

This study aimed to investigate associations of plasma vitamin C with obesity status and explore the relationship with the sarcopenic risk factor, low skeletal muscle mass.

EPIC-Norfolk cohort study data were analysed. Bioelectrical impedance analysis-estimated fat free mass (FFM; a proxy for skeletal muscle mass) was adjusted for BMI to give a scaled variable, FFMBMI. A ‘low muscle mass’ category was defined as individuals with the lowest 10% FFMBMI, representing those at high risk of sarcopenia. Plasma vitamin C (ascorbic acid) concentrations were categorised as inadequate (< 50micromol/L) or adequate (≥ 50micromol/L), and obesity status as non-obese (< 30kg/m2) or obese (≥ 30kg/m2).

Individuals were grouped according to vitamin C and obesity status: 1, non-obese and adequate vitamin C; 2, non-obese and inadequate vitamin C; 3, obese and adequate vitamin C; and 4, obese and inadequate vitamin C. Using logistic regression, the odds ratio (OR) of each vitamin/obesity status group was calculated in relation to membership of the ‘low muscle mass’ category. Analyses were sex-stratified and adjusted for age, smoking status, physical activity, social class, menopausal and HRT status in women, statin use, and corticosteroid use.

Data were analysed for 5903 men (mean 62.9 years, SD 9.0) and 7416 women (mean 61.5 years, SD 9.0). Prevalence of vitamin C inadequacy was higher in obese vs non-obese individuals (men 45.8% vs 33.0%; and women 26.0% vs 15.3%). The odds of ‘low muscle mass’ were higher in all vitamin/obesity status groups vs group 1, but the greatest odds were seen for group 4 (combined obesity and inadequate vitamin C) in men (OR 16.5, 95% CI: 12.6–21.6; p < 0.001) and women (OR 30.2, 95% CI: 23.0–39.8; p < 0.001).

In this cohort of older individuals higher prevalence of vitamin C inadequacy is associated with obese individuals. Of importance to musculoskeletal health and our understanding of sarcopenia is the observation that while vitamin C inadequacy and obesity are each independently important, their coexistence is a particularly strong predictor of sarcopenic risk.

Nudge interventions aim at changing people's behaviour by altering the choice architecture of environments. Workplaces provide an appropriate setting for these interventions, since the majority of adults make a remarkable proportion of daily dietary choices there. Using the baseline data of a choice architectural “StopDia at Work” study, we here aim to identify differences in diet quality between various employee groups.

Altogether 1205 employees of 16 Finnish employers answered an anonymous questionnaire comprising items on: 1) work quality (how the employee mainly works: seated, standing or moving a little, moving), 2) habitual eating location (staff restaurant, other restaurant, recreation room/own workstation/etc. place at the workplace, elsewhere), and 3) consumption of vegetables/fruit/berries, unseasoned nuts/almonds/seeds, foods high in salt and fat, foods high in sugar and fat, and water during working hours. A diet quality score was computed based on foods consumed at work. Kruskall-Wallis test was used to assess differences in dietary patterns.

Forty-eight percent of respondents worked mainly seated, 27% by standing or moving a little, and 24% by moving. Twenty-four percent typically ate their main meal in a staff restaurant, 5% in a restaurant outside the workplace, and 67% in a recreation room/own workstation/etc. place at the workplace. Vegetable intake differed depending on work quality (χ2(2) = 25.450, p < 0.001) and eating location (χ2(3) = 27.511, p < 0.001), being the highest among employees working seated, and employees eating in a staff restaurant. Consumption of foods high in salt and fat differed according to work quality (χ2(2) = 22.715, p < 0.001), employees with physical work reporting higher intakes compared to employees working seated (p < 0.001). Consumption of nuts/almonds/seeds, foods high in sugar and fat, and water did not differ between employee groups. Diet quality scores differed depending on work quality (χ2(2) = 22.153, p < 0.001), employees working seated, standing or moving a little scoring higher than employees with physical work (p < 0.01).

Employees with physical work had poorer diet quality than employees with sedentary work. As nudge interventions are assumed to influence behaviour independent of individual's background, they thus provide a potential approach to target also employees with physical work. Consumption of vegetables was lower among employees not eating in a staff restaurant. Therefore, nudge interventions aimed at increasing vegetable intake should be designed also to other workplace settings than staff restaurants, the predominant study setting thus far.

Protein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.