This abstract was presented as the Nutrition in the Treatment, Management and Prevention of Disease Theme Highlight.

Chronic constipation is a prevalent gastrointestinal condition affecting approximately 10% of the global population(1) and is associated with substantial healthcare costs and quality of life impairments in the UK(2). While the aetiology of chronic constipation is not fully understood, lower dietary fibre intake is associated with greater risk of constipation(3) and consumption of fruits, vegetables, and wholegrains is recommended within clinical guidelines. Although not diagnostic for constipation, low stool weight is a common feature and is associated with greater risk of colorectal cancer(4); yet few studies have ever measured stool weight in constipation. This study investigated associations between frequency of plant food intake and stool weight in people with constipation.

Baseline data from a dietary intervention trial were analysed, which included participants meeting Rome IV criteria for constipation. Self-reported data on habitual consumption of nine plant food categories were collected using a validated tool. Participants performed 7-day total stool collection, which was weighed on the same weighing scales at the research centre. Associations between intake frequency for each plant food category and daily stool weight (total stool weight divided by 7 days) were analysed using independent-samples t-tests (SPSS, version 28, p<0.05 considered significant).

Ninety-nine people with Rome IV constipation (89% female; mean [ ±SD] age 32.4 [ ± 12.4] y; BMI 23.0 [ ±3.2] kg/m2) provided 7-day total stool collections. Mean ( ± SD) stool weight was 72.5±47.2 g/day (minimum 2.1 g/day; maximum 280.6 g/day). Stool weight was significantly higher among those consuming fruit once or more per day (86.2±48.2 g/day), compared with those consuming fruit less than once per day (62.4±44.1 g/day; p = 0.012). Stool weight was also higher among those consuming vegetables once or more per day (98.6±59.1 g/day) compared with those eating vegetables less than once per day (62.2±37.2 g/day; p<0.001). Differences for green salad (79.6±52.1 g/day; 63.3±38.5 g/day; p = 0.088) and high-fibre breads (84.1±46.6 g/day; 65.1±46.6 g/day; p = 0.05) were borderline significant, when comparing those consuming these more than once per week, compared with once or less per week (respectively). No significant differences were found for frequency of consuming fruit juices, potatoes, vegetable soups/stews, high-fibre cereals, or beans and lentils.

This is the most comprehensive analysis to date of measured stool weight in constipation, and its association with plant food intake. Despite presence of constipation, participants with higher intakes of fruit and vegetables had a greater daily stool weight; an important feature associated with lower colorectal cancer risk(4). However, intakes were not sufficient to manage their constipation symptoms. Intervention studies investigating potential benefits from increasing fruit and vegetable intakes in people with constipation are required and are currently underway.

This abstract was presented as the Food Systems Theme Highlight.

The rate of climate change has significantly increased over the last decade, with 2023 reported as the warmest year on record(1). Human activities contribute significantly to greenhouse gas emissions (GHGe) and environmental degradation(1) with food production and consumption contributing up to 37% of global emissions(2). Recognising the power of food service, and food choices, is crucial in addressing these environmental challenges(3). Data on the impact that reformulation has on reducing environmental impact is required to ensure evidence based strategy development and data based decision making. The LIFE Programme Climate Smart Chef (CSC) project aims to engage chefs to promote low-emission, nutritious diets aligned with EU Climate Policy and the Farm to Fork (F2F) Strategy. It targets improved public health, reduced environmental impact, and food waste(4). Under this project, a digital environmental impact tool ‘Foodprint’ was developed by Nutritics. This study aims to analyse the nutritional content and environmental impact of original and reformulated recipes entered by chefs who completed training between July and October 2023.

Chefs were required to enter their recipes, undertake training on sustainable menu design and subsequently reformulate their recipes using Foodprint as a post training exercise. 200 recipes were created by the chefs (100 original; 100 reformulated). Nutritics software was used for the analysis, with the LIFE Su-Eatable LIFE database on carbon and water selected for use in the Foodprint tool. The impact of reformulation on nutrition, carbon and water was analysed using SPSS V29.

For the environmental analysis, reformulating the recipes had significant reductions in carbon emissions (P =0.002), (Average −51.18%; Range −6.66 −0.96 kg C02eq), water footprint (P =0.278), (Average -46.63%; Range −17839L to 4035L). For the nutrition analysis, reductions were also observed for sugar (P=0.001), (Average −9.42%; Range −16.40g to +24g), salt (P = 0.233), (Average −12.57%; Range −5.42g to +1.80g), and saturated fat (P =0.043) (Average −39.77%; Range -34.90g to +12.20g).

Reformulation resulted in decreased environmental impact, and improved nutrition. This study gives a quantitative indication of how reformulating menus can reduce carbon, while improving the nutrient profile of food offerings. This research contributes valuable insights into the use of software to reformulate menus, the complex impact of recipe reformulation, and its potential to positively impact both health and environmental sustainability. This research indicates the potential of menu reformulation in advancing sustainability goals and promoting healthier food choices. Future analysis should analyse cost, additional environmental impacts, serving size, and demographic analysis to provide more in-depth analysis.

This abstract was presented as the Nutrition and Optimum Life Course Theme Highlight.

The n-3 polyunsaturated fatty acids (n-3 PUFA), eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3), are known for their beneficial roles in regulating inflammation(1). The omega 3 index (O3I) refers to the percentage of EPA+DHA within the erythrocyte membrane with respect to total fatty acids and is a recognised biomarker for cardiovascular disease(2). An O3I >8% is proposed to confer the greatest level of cardioprotection(2). Fish is the richest dietary source of n-3 PUFAs and has been noted as one of the main predictors of a higher O3I(3). Current UK dietary guidelines recommend the consumption of two portions of fish per week; albeit the efficacy of these recommendations in raising the O3I is unknown(4). The aim of this study was to investigate the influence of consuming two portions of fish per week on the O3I amongst low fish consuming women of childbearing age.

Data were analysed from the iFish study(5), an 8-week randomised controlled trial where low fish consuming women, were randomly assigned to consume either no fish (n = 18) or 2 portions of tuna (n = 8) or sardines (n = 9) per week. Total n-3 PUFA concentrations of the fish provided in the intervention were 6.47g/100g for sardines and 4.57g/100g for tuna. Fasting blood samples were collected at baseline and post-intervention. The O3I was determined in red blood cells in the control and two portions of fish groups by OmegaQuant Europe. Analysis of covariance, adjusting for age, BMI, and baseline O3I, examined the effect of the fish intervention on the O3I. Chi-square test was used to compare the O3I between groups when categorised as at risk (<4%), intermediate risk (48%) and low risk (>8%).

Participants had a mean ± SD age of 25.5 ± 6.4 years. Baseline median (IQR) O3I of the cohort was 5.7 (5.2, 6.7) %. There was no significant difference in the O3I between treatment groups at baseline. Consumption of two portions of fish significantly increased the O3I when compared to the consumption of no fish [6.73 (5.41, 7.38) % vs 5.58 (5.12, 6.49) %, respectively, p = 0.034]. Those consuming two portions of sardines, an oily fish high in n-3 PUFAs, had a significantly greater O3I when compared to those consuming two portions of tuna [7.38 (6.83, 8.37) % vs 5.61 (5.29, 6.79) %, respectively, p<0.001]. Post-intervention, the proportion of participants in the low risk O3I category (>8%) was greater in the two portions of fish group when compared to the control group; albeit this did not reach statistical significance (p = 0.104).

In support of the current dietary guidelines, increasing fish consumption of low consumers to two portions of any fish per week will increase the O3I. Future research should determine the potential cardioprotective properties of a higher O3I as a result of consuming fish.

This abstract was presented as the Novel Nutrition Research Methodologies and Technologies

Theme Highlight. Queuosine (Q) is a vital micronutrient crucial for protein translation and cellular function in humans. Deficiencies of Q have been linked to chronic illnesses, such as inflammatory bowel disease, neurodegenerative diseases, and various cancers. Human requirements for this micronutrient have not yet been established. Thus far, there has been no systematic investigation of the human diet to understand typical intakes. It is necessary to measure the levels of Q metabolites in commonly consumed foods to identify the richest dietary sources and determine Q intake. Only then can its role in human health and disease be established.

This study aimed to comprehensively analyse Q distribution in the UK diet by quantifying it in foods, identifying rich sources, and ultimately, enabling the design of dietary intervention studies assessing Q absorption/bioavailability.

Data from the UK National Diet and Nutrition Survey (NDNS 5Y) were processed to identify the most frequently consumed foods in 31 main categories, reflecting the dietary habits of >99.5% of UK consumers. Extraction techniques were developed, including a methanol-based method for extracting free Q metabolites and a specialized approach for isolating tRNA-bound Q metabolites from various food matrices. Quantitative LC-MS/MS (SCIEX 5500+) was utilized to accurately measure queuine (q), Q, Q monophosphates (QMPs), and Q precursor (PreQ1) in food samples. These values were summed to determine Total Q levels. Additionally, four-day food diary data from 93 participants in the Northern Ireland Dietary Assessment Study (NIDAS) were analysed to determine the average daily consumption of Q metabolites in adults. Dairy sources were considered promising, so five commercial probiotic yoghurt brands were compared side-by-side.

Q metabolite levels varied significantly across various food types. Total Q metabolite levels in foods ranged from 0.05ng/g to 80ng/g, with a mean level of 20ng/g. The calculated Q consumption of participants in NIDAS ranged from nil/day in some individuals to 170µg/day in others, with a typical mean intake of 18µg/day. The mean amounts (ng/g) of Total Q metabolites (tRNA-bound + free) measured in food categories were dairy 57.2 ± 9.7, meat 20.1 ± 9.9, poultry 4.9 ± 4, and plant-based milk 15.3 ± 10, fruits 2 ± 1.3, vegetables 5.3 ± 2.8, starchy foods 2.2 ± 0.7. Dairy products emerged as significant sources of Q metabolites based on these findings. Concentrations observed in shortlisted probiotic yoghurts ranged from 32 to 352 ng/g.

This study determined typical Q intakes and is the first to identify Q-rich food sources in the UK diet. The highly Q-enriched probiotic yoghurt products could be used in controlled dietary intervention studies to assess Q absorption/bioavailability and this micronutrient’s role in human health and disease.

Folic acid supplement use is involved in the prevention of neural tube defects, the most common major malformations of the central nervous system(1). Women with childbearing potential are advised to take supplements containing 400mcg/day of folic acid in the period preceding pregnancy until the 12th week of pregnancy, while some women (e.g., women with obesity) require a higher dose of 5mg/day(2). Despite these public health recommendations, there is limited translation to folic acid supplement use behaviours(3). In Northern Ireland, data on women’s selfreported periconception folic acid supplement use can be accessed via the Northern Ireland MATernity System. Using this dataset, the current study reports trends of periconception folic acid supplement use (2015-2020), exploring differences based on women’s age, deprivation, pregnancy planning, gravida, and body mass index (BMI) at their antenatal booking appointment.

R, accessed via the UK Secure eResearch Platform, was used to calculate yearly proportions of selfreported periconception folic acid supplement use. To comply with disclosure controls, only complete cases were retained for analyses. When necessary, years were combined (e.g., instead of yearly prevalences, data on BMI was analysed in 2015-2016, 2017-2018, and 2019-2020) and numerical restrictions were applied (e.g., BMI was restricted to values between 14-70kg/m2). Patient and Public Involvement and Engagement strategies were adopted throughout the study.

Analyses included 132,205 pregnancies. Under a third of pregnancies were primigravida (30.90%), and less than half of pregnancies were conceived by women with a BMI within the healthy range (44.75%). In most cases (58.96%), folic acid supplement use was initiated after, rather than before, conception. Preconception supplement use of 400mcg of folic acid declined between 2015 and 2020 (34.40%-30.03%) and was especially low in young women (i.e., <25 years old), women living in the most deprived areas, and women who did not report planning their pregnancy. Although postconception supplement use of 400mcg also declined, trends exhibited a slight increase in the last year (2019: 51.38%; 2020: 53.94%). Preconception and postconception use of supplements containing 5mg of folic acid increased throughout the study period (3.57%-4.98% and 4.02%-7.67%, respectively). The most notable increase was observed among women with obesity, especially those with BMI≥40kg/m2 (preconception: 8.31%-15.70%; postconception: 23.05%-37.97%).

Overall, these analyses of routinely collected maternity data indicate that folic acid supplement use before pregnancy remains suboptimal in Northern Ireland. The use of higher-dose supplements (5mg/day) is increasing for specific population groups, but it remains at a concerning low level particularly in the preconception period. Although based on women’s self-reported folic acid supplement use, these findings can provide valuable insights for policymakers and healthcare professionals, informing the development of future interventions and campaigns. These may include long-term awareness-raising initiatives and preconception support for all women, especially at-risk groups.

Good maternal nutrition is vital for positive pregnancy outcomes. However, midwives report a lack of confidence and skills regarding advising pregnant women about diet and weight during antenatal care(1). Research has shown that the delivery of nutrition education sessions for midwives can improve their knowledge and skills(2), but there is no evidence that this leads to a change in practice. The aim of this study was to evaluate a series of nutrition education sessions for student midwives, delivered by a dietitian, to determine if it is likely to lead to a change in practice.

Final year student midwives (n = 33) were recruited during a final taught nutrition session at their university. They were asked to provide free-text feedback on anonymous post-it notes regarding their thoughts and feelings as to whether the taught nutrition sessions were likely to result in a change in their midwifery practice. The comments were collated and analysed thematically.

Three main themes were identified: 1) Nutrition as a priority 2) Personalised Nutrition 3) Sources of information and signposting.

Most students commented that they now viewed maternal nutrition as ‘important’ and intended to prioritise discussions about nutrition in their future practice. They realised that messages needed to be personalised “It has made me aware to tailor advice to different women.” They also appreciated that signposting women to reliable sources of information or other health professionals helped to support ‘evidence-based practice,” and was an important part of their role: “The additional resources and signposts were really helpful.”

The results from this convenience sample of student midwives indicates promising findings that the taught nutrition sessions are likely to result in a positive change in practice. UK antenatal guidelines state that midwives should discuss nutrition, diet, and vitamin supplementation at booking-in appointments(3), but earlier research suggests that this rarely happens(1). Nutrition education which is delivered by a dietitian and focuses on case studies and care pathways, appears to have empowered student midwives to consider incorporating some of this applied knowledge and advice into their practice.

Optimal gestational weight gain (GWG) during pregnancy is required for healthy foetal growth, however excessive GWG has been linked with adverse effects including increased risk of caesarean delivery and postpartum weight retention(1). Currently no UK GWG guidelines exist, and women are not routinely weighed throughout pregnancy; consequently, women’s understanding of GWG remains poor(2). The aim of this study was to explore factors influencing weight change during and post-pregnancy, plus identify potential opportunities that could help women manage weight during this period.

Women aged 18-45 years-old who had a full-term, singleton, uncomplicated pregnancy within the last 3 years were recruited from mother and toddler groups, advertising on social media platforms and a university-wide email sent to staff and students. 108 eligible women completed the online questionnaire, between April and June 2023, on their experience regarding changes in body weight during and post-pregnancy. Follow on focus groups were then conducted within the same population. 4 focus groups with 2-5 participants per group and a 1-2-1 interview (n = 13 participants) were conducted online between September and October 2023, using a semi-structured topic guide. Discussions ranged between 32 to 90 minutes (average 59 minutes), were audio recorded, transcribed verbatim and thematically analysed(3) using NVivo12 software, with each theme being assigned to one level of the ecological model(4). Ethical approval was granted by Ulster University’s Research Ethics Committee.

Respondents reported in the online questionnaire, they did not receive enough information around weight management during (81.5%) and post-pregnancy (86.1%). Barriers to managing weight during and post-pregnancy were identified at each level of the ecological model. At the intrapersonal level (n = 4 themes), namely: changes in diet (convenience foods/ snacks), priorities (priority on the baby), lack of knowledge (not aware of adverse effects) barriers to physical activity (tired). At the interpersonal level (n = 3 themes), namely: lack of time (parity, working mum), conflicting advice (friends and family), lack of support (lack of support at appointments). At the environment and society level (n = 3 themes), namely: COVID-19 pandemic (amenities closed), location (rural communities), societal expectations. At the institutional and policy level (n = 1 theme), namely: system failing (lack of follow-up care). Potential strategies to help manage weight were also identified, at the intrapersonal level (n = 1 theme), namely: need for further information (components of GWG), interpersonal level (n = 1 theme), namely: support groups. At the environment and society level (n = 1 theme), namely: messaging (realistic expectations), institutional and policy level (n = 2 themes), namely: regular weighing, and further follow-up care.

In conclusion, mothers report receiving insufficient information around weight management, with barriers identified at each level of the ecological model highlighting that support is needed on multiple levels during and post-pregnancy, with potential strategies identified to assist mothers which informs future studies.

Limited sunshine and dietary vitamin D make vitamin D deficiency very common in Ireland. Breastfeeding is the universal recommendation and supplies the best combination of nutrients and bioactive factors for all infants(1). However, maternal diet and nutrition status impacts concentrations of certain nutrients in breastmilk and therefore vitamin D concentrations can be lower than recommended for infants(2,3). This study aimed to determine the vitamin D intakes and food sources of breastfeeding mothers in Ireland.

Data was collected as part of the WellFed study, a 4-week randomised control trial investigating the effectiveness of a food supplement containing a protein hydrolysate and beta glucan (Wellmune®) during lactation on immune and gut health (LS-23-07-OSullivan). Participant vitamin D intakes were assessed using FoodBook24 self-completed 24-hour recalls. Foods were grouped into food groups to determine their contribution to intake as well as the contribution from natural and added vitamin D foods. Data was analysed using IBM SPSS Statistics (version 27).

Dietary analysis of 45 participants indicated that maternal vitamin D intakes were low (6.4 ± 4.6μg/day). Most participants (96%) did not meet the 15μg/day recommendation, despite 56% of participants reporting they consumed some form of vitamin D supplement. Natural vitamin D foods like eggs and egg dishes, fish and fish products, meat and meat products and foods with added vitamin D including breakfast cereals, beverages, and milk and yoghurt were the key food groups contributing to intake, with the majority coming from natural food sources.

Low dietary vitamin D intake is common among breastfeeding women and diet alone is insufficient to achieve the daily vitamin D requirements even when supplements are consumed. As natural food sources of vitamin D are limited and infrequently consumed, recommendations to consume more vitamin D foods may not be successful as a standalone strategy to improve vitamin D status. A combination of approaches including the promotion of vitamin D rich food consumption, supplementation strategies, and the introduction of food fortification policies may be a feasible method for improving vitamin D across the population.

Children’s cooking programs have been linked to increased cooking frequency and positive dietary outcomes (1,2). A systematic review on children’s cooking interventions with a control group, in a variety of settings, on all age groups has not yet been conducted. Thus, we aimed to examine the effects of children’s participation in published cooking interventions on their cooking skills, food acceptance, and dietary behaviors; and the quality of the scientific evidence.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent electronic searches across six databases were conducted to identify cooking-focused interventions with comparison groups among participants aged up to 18 years old, published in English, between 2017 and 2022. Studies were assessed on quality using the Academy of Nutrition and Dietetics Evidence Analysis Library quality criteria checklist.

Among 1104 articles identified, 23 met inclusion criteria and described main results for distinct interventions. Interventions varied in participant age, settings, cooking sessions and program length. Knowledge of cooking skills, self-efficacy and involvement were the most frequent positive outcomes; improvements in dietary intake were rarely achieved. Seven studies were highly rated for research quality.

Lack of assessment standardization, variability in program characteristics, and insufficient intervention description made it difficult to discern best practices for children’s cooking programs.

Improvements in intervention development and measurement instruments are needed.

Interventions that include hands-on cooking lessons seem promising in improving knowledge and self-efficacy, however, further exploration is needed on the factors that make cooking programs successful long-term, while considering age and gender.

The school food and drink environment offers opportunities to improve pupils’ food and drink choices, with school food accounting for up to 30% of pupils’ dietary intake(1). School canteens are often overcrowded and chaotic, which may lead to pupils choosing less healthy but quicker options. Interventions aiming to improve adolescents’ dietary behaviours have been conducted but usually lack adolescent involvement and can have limited impact on pupils’ dietary choices(2). Pupil involvement in design and development may lead to more acceptable interventions(3). The aim was to explore potential interventions with secondary school-aged pupils focused on key areas of the school food and drink environment.

A total of three North East England secondary schools were recruited based on pupil eligibility for free school meals and index of multiple deprivation. Approximately eight pupils (aged 12 – 13) were recruited per school to participate in three focus groups. Consent was collected from parents and pupils. In focus group one, pupils prioritised areas within the school food and drink environment for potential interventions. In focus group two, pupils explored what these interventions might comprise. Finally, pupils reviewed the acceptability, sustainability, and feasibility of their interventions. Thematic analysis using a coding framework was used to analyse data.

Ethical approval was granted by Newcastle University Ethics Committee, reference number: 2402/24272/2021.

Across the three schools, twenty-two (m=9; f=13) pupils participated in the focus groups. Preliminary analysis revealed the inability for pupils to eat their school lunch outside was a key area for improvement. Pupils felt that with dedicated areas to eat outside, they would have more time to eat and not rely on convenient options. Incorrect menus in the canteen also meant pupils did not know what they could select and instead chose the same, often less healthy options. Pupils wanted posters in the canteen to promote the available healthier options previously used in nudge-based interventions. School food and drink were usually considered poor value for money due to high prices and perceived poor quality of school food compared to what is available outside of school. Pupils felt that introducing meal deals or food-based rewards for healthier options would encourage higher consumption due to them being perceived as better value for money.

Prioritised areas and interventions within the school food and drink environment were schoolspecific. Before interventions are conducted in schools, further understanding of the school context and whether interventions are appropriate are needed. Further work exploring continued project development, including further pupil and school staff input to explore intervention feasibility is required.

Food literacy is a valuable life skill, and developing these skills early in life is shown to have a positive association with cooking attitude and behaviours, health and diet quality in later life(1,2). There is a plethora of food messaging available for children and adolescents but little evidence on which strategies are effective and why(1,2). As part of a larger research programme funded by safefood, the current study explored the experiences, perceptions and attitudes of children (411yr) and adolescents (12-18yr) on existing models and approaches on food and nutrition education, and food messaging on the island of Ireland.

This research was based on qualitative methodology with friendship pairs with children and focus groups with adolescents to obtain their experiences, perceptions, and attitudes on existing models and approaches on food messaging. Data were collected to reflect different groups in terms of social class, age, region and rural/urban. Recruitment and data collection were completed in schools on the island of Ireland. Data were analysed using thematic analysis(3). Ethical approval was obtained.

Using data from 12 friendship pairs (n = 10 males, n = 14 females; mean age 8 (SD2.0)yr) and 6 focus groups (n = 16 males, n = 30 females, mean age 15 (SD1.6)yr), three overarching themes were identified, namely (1) “Food messages that made the most impact”, (2) “Food messaging through surveillance and monitoring”, and (3) “Ideas to improve food messaging”. Overall, children and adolescents reported mixed experiences, perceptions and attitudes to food and nutrition education, and food messaging. They recalled food messages from social media, schools, sports coaches and family, with the most impact included an element of fun and practical components, such as cooking, tasting and gardening, being most memorable. They had an awareness and a basic knowledge of nutrition and food messaging, such as “you need to drink more water if you are exercising”,“eat vegetables with this meal as you’ve had enough pizza this week”, “that’s too much sugar”, and “we only have treats in our lunch boxes on Fridays”. There was an indication that social media such as YouTube, Instagram and TikTok, presents both potential harms and potential benefits on the attitudes to and knowledge of nutrition, and subsequent dietary behaviours among children and adolescents.

This study found that children and adolescents had mixed experiences, perceptions and attitudes to food and nutrition education, and food messaging. Although children and adolescents may be aware of the heathy eating guidelines, there appears to be a misconnect in translating into practical everyday use. Food and nutrition education, and food messaging for children and adolescents needs to be communicated with simple clear messages, consistently with repetition using practical and fun methods in partnership with schools, and families, taking account of the harm/benefit potential of social media.

Obtaining data on pupils’ school food intakes often relies upon self-reported dietary assessment methods, which can be subject to reporting errors(1). Online tools offer an engaging, streamlined method, however reporting errors still exist. Furthermore, gaining access into schools to conduct research is challenging(2). School food purchase data may offer an alternative approach. Objective data on individual-level school food purchases can be obtained for the whole school day owing to cashless canteens. The use of school food purchase data as a method to assess dietary intakes in secondary school pupils warrants exploration. The aims of the study were to assess the information available in school food purchase data and explore its potential in assessing food group and nutrient intakes.

Individual pupil-level purchase data was obtained from five secondary schools over a four-week period. Following data cleaning and manipulation in excel and Stata v18, the proportion of food and drink items that were assigned an Intake24 food group and linked to a UK Nutrient databank code(s) was calculated.

Ethical approval was obtained from the Faculty of Medical Sciences Ethics Committee, Newcastle University (ref: 2482/26614). Data protection impact assessment was created to ensure efficient transfer of data.

The data captured school food purchases in 3466 pupils; this equated to approximately 80% of total pupils purchasing at least one item at school across the four-week period. A total of 119125 purchases were made by pupils. There were 367 different food and drink item descriptions. Ninetytwo percent (n = 338) of these were able to be assigned to a food group, for example ‘veg/salad’ and ‘hot meat baguette’. This accounted for 82% (n = 97821) of total purchases. Of these, 258 food and drink items (60% of total purchases) contained enough information for a nutrient code to be assigned, for example ‘flapjack’ and ‘Radnor Fizz drink’.

Eight percent (n = 29) did not have enough information to assign either a food group or nutrient code. These included items such as ‘Main Dish’ and ‘Packed Lunch Deal’. These accounted for 18% (n = 20954) of total purchases across the four-week menu cycle.

Pupil-level purchase data is a novel and feasible approach to obtaining objective food intake data on a large scale, maximising generalisability of findings. Obtaining intake data on >3000 pupils in a short time frame would be unachievable using traditional dietary assessment methods. There are some limitations in the use of pupil purchase data to assess pupils’ nutrient intakes, for example, missing portion size information. However, the use of average portions warrants investigation. Future work to compare purchases with self-reported data to assess agreement with validated dietary assessment methods is required.

A healthy diet is a key determinant of healthy ageing(1). Research indicates that individuals from Black African communities (both born in the UK and migrants communities) often have bicultural dietary patterns including both Westernised and African dietary practices(2). While this is known for the general Black African adult population, there remains a dearth of research on older African adults who may experience a complex nutrition landscape owing to an interplay of perceptions of healthy/unhealthy diets, social and cultural factors which can have negative outcomes for nutrition and health in later life. The aim of this study was to explore perceptions of eating well and healthy diets as determinants of inequalities in nutrition and healthy ageing in older African adults.

A mixed methods cross-sectional study was conducted in older Africans, ≥ 55 years in the UK. Qualitative data was collected using Photovoice(3), an innovative visual, community-based participatory research (CBPR) method whereby participants take photographs to document, reflect upon health and social issues from their own perspective. As a research method, photovoice provides an alternative to the traditional barriers and enablers approach to understanding complex health challenges and is suited for use for populations who have been disenfranchised by traditional research methods(4). A purposive sample of 12 participants were provided with cameras and encouraged to take photos describing what they considered as healthy and unhealthy food and thoughts on eating well and older adult’s health. Semi-structured interviews were conducted to gain insights into the photos. Thematic analyses using both deductive and inductive approaches of photos and transcripts were conducted to develop and refine emerging themes using a framework.

Participants were 62 ± 5.4 years and, 75% female. The majority were married (58.3%), living with family (41.7%), educated to postgraduate degree level (50.0%) and fulltime employed (66.7%). Emerging themes around healthy eating included variety and dietary diversity, organic foods, traditional foods, plant-based foods and healthy cooking methods. Themes around unhealthy food included ultra-processed foods, take-out foods, appearance, preservatives and consuming fats and oils. Hydration, social eating, accessing health and dietary advice, eating food that meets ageing needs, nostalgic eating and physical activity were the key themes that emerged around eating well and older adults’ health.

This research provides new insights on perceptions of healthy eating among older African adults using photovoice, a novel participatory research method. The findings contribute to a better understanding of perceptions of healthy diets as a determinant influencing nutrition and healthy ageing in older African adults. There is a need for further research to understand i) how these perceptions influence dietary intake and ii) the complex interactions in nutritional knowledge, tradition, cultural and social factors to inform the design of effective community-based nutrition intervention tailored to ethnic identity of older African adults.

The UK population is ageing and becoming more ethnically diverse(1). Nutrition is a key modifiable determinant of healthy ageing but there is little published data of dietary patterns in ethnic minority groups. The reasons for poor dietary habits of older adults from ethnic minority groups could be attributed to cost of living, language barriers, age, availability of traditional foods(2). As part of a larger research study to improve nutritional health in older adults (TANGERINE: nuTritional heAlth aNd aGeing in oldER ethnIc miNoritiEs), the aim of this study was to investigate vegetable intake in different older ethnic groups compared with a white (British) reference population.

We used food frequency questionnaire (FFQ) data drawn from Wave 2 (2010-2012) and Wave 13 (2021-2022) of Understanding Society, a UK household panel survey(3). We calculated the proportions of vegetable intake by ethnic group for each wave, weighted for population representativeness, and used (weighted) logistic regression for intake (everyday vs less than every day) to adjust for potential confounders. Data from the WHO food insecurity questionnaire in wave 13 was used to evaluate the ethnic group differences in food insecurity.

The percentage vegetable intake at least every day was reduced between Waves 2 and 13 in all ethnic groups. At both Waves all ethnic groups, except Indian ethnicity have lower vegetable intakes than white (British) reference group. The age and sex adjusted odds ratios (OR) (95% confidence intervals) at Wave 2 were 0.60 (0.51, 0.71) for Caribbean, 0.67 (0.56, 0.79) for African, 0.36 (0.28, 0.44) for Pakistani, 0.78 (0.62, 0.98) for Bangladeshi and 1.10 (0.94, 1.28) for Indian. The differences could be largely explained by lower income and greater area deprivation for Bangladeshi, less so for Caribbean, African and Pakistani groups. Results were similar for Wave 13. All ethnic groups, except Indian had higher odds of greater food insecurity than the white (British) reference group, largely attributed to income and area deprivation, for example, the OR for Pakistani group compared with white (British) reference group decreased from 1.74 (1.18, 2.56) to 1.05 (0.70, 1.58). However, for the African group, the OR remained greater than white reference population at 2.55 (1.73, 3.76) even after accounting for socioeconomic position.

The findings suggest differences in vegetable intake between different ethnic groups which have been maintained between 2010-2012 and 2021-2022 and may be explained to some extent by socioeconomic disadvantage. Whilst we used cross-sectional analyses of self-reported data, there remains a need for further large-scale studies using longitudinal and experimental designs in older ethnic groups considering socioeconomic position, recognising the importance of heterogeneity and the need to analyse ethnic groups individually, rather than as a group for measurements of dietary intake.

Approximately two out of three adults and three in ten children living in Scotland are overweight or obese, which increases their susceptibility to non-communicable diseases such as type II diabetes, specific cancers, heart disease, and stroke(1). The burden of poor diet and its associated health consequences disproportionately affect those living in the most deprived communities(1). Cost of living pressures have exacerbated this issue, making a healthy diet unaffordable for many lowincome households(2,3). Thus, promoting affordable and practical ways to help low-income families improve dietary behaviours and achieve a healthy weight represents a priority for Scottish public health policy(3). For such interventions to be appropriately tailored and targeted, it is important to better understand the intended recipients. The present study aimed to assess the dietary practices and psychosocial characteristics of users of Aberdeen City community-based interventions (e.g., food banks, social cafés, community kitchens) designed to support low-income communities in accessing food and engaging in healthier food practices.

From January to June 2023, a cross-sectional survey was conducted employing convenience sampling among users of community-based interventions (N = 105; 73 females) situated in an urban location. The questionnaire assessed diet quality (measured through a short-form FFQ and a 10point self-rated diet quality item), household food insecurity (HFIAS), mental health (PHQ-4), wellbeing (Cantril Ladder), intention and self-efficacy toward healthy eating, and sociodemographic variables. Data were analysed using descriptive statistics, group comparisons, Pearson correlations, and regression analyses.

Results indicated that community-based food provision users are highly vulnerable to food insecurity and related negative health experiences. Among participants, 53.3% reported severe food insecurity, 18.1% reported moderate levels, and higher food insecurity was significantly associated with higher levels of mental distress (r = .41, p<.001) and lower well-being (r = -.460, p<.001). Results also indicated that service users have a diet high in discretionary foods and drinks (26% consume daily >1 portion of fizzy juice, 18.2% sweets, 16.7% crisps vs. 11.5% fruits and 10.6% vegetables). The mean dietary quality score (DQS) based on fruit, vegetable, oily fish, non-milk extrinsic sugar, and fat intake was 9.48 (SD =1.90) from a possible 15. In addition, 73.8% of participants rated their diet as unsatisfactory. Both low objective and subjective diet quality scores were also significantly associated with greater mental distress (r = -.287, p = .005; r = -.332, p = .001) and poorer well-being (r = .19, p = .049; r = .462, p<.001). Notably, service users who perceived their current diet as healthier reported stronger intentions to eat healthily in the future (r = .249, p = .013).

This study is part of a larger project aiming to optimise community-based dietary interventions for low-income populations. The results provide a clearer picture of the intended beneficiaries of such interventions and highlight user needs that can be prioritised in optimisation efforts.

This abstract was awarded the prize for best poster presentation.

Undernutrition is common among older adults and, if untreated, can lead to weight loss, adverse cognitive and functional health outcomes and poorer quality of life. The Mediterranean diet (MedDiet) has been associated with reduced nutrient deficiency1 and better cognitive health in older adults2, while adequate protein intake combined with exercise is crucial for maintaining muscle health during ageing3. Early intervention with MedDiet to meet energy and increased protein (1.2g/kg/day)4 and micronutrient needs of older adults in combination with exercise could help to prevent undernutrition during ageing but has not yet been tested.

The PROMED-EX trial is a 6-month randomised controlled trial evaluating a PROtein-enriched MED Diet, with and without Exercise on nutritional status and cognitive performance, in older adults at increased risk of undernutrition and cognitive decline.5 The current objective is to evaluate the 3month change in nutritional status and diet quality measured using repeated Mini Nutritional Assessment (MNA), 4-day food diaries and PROMED diet score (0-14). Food diaries were analysed for energy and nutrients using Nutritics at each time-point. Data was analysed on the intention-totreat principle using multiple linear regression to compare outcomes at 3 months after adjusting for baseline values. Dunnett’s procedure was used to control for multiple comparisons when comparing the two intervention groups with the control group.

One hundred and five eligible participants (69% female; mean age 67.7years [60-87 years]; BMI: 23.8 ± 3.4 kg/m2) were recruited and randomised into one of three groups: PROMED-EX (diet + exercise; n = 34), PROMED (diet only; n = 35) and Standard Care (control; n = 36).

After 3-months, the MNA score improved in both PROMED-EX and PROMED intervention groups compared with the control group by on average 2.6 points (95% CI 1.1, 4.1; P<0.01) and 2.2 points (95% CI 0.8, 3.7; P<0.01) respectively; after adjusting for baseline MNA. Similarly, the mean 3-month increase in diet quality score was +4.0 (95% CI 3.1, 5.0); +4.6 (95% CI 3.7, 5.4) points in PROMEDEX and PROMED respectively; P<0.001, versus Control.

No between group changes in energy intake were detected, however protein and selected micronutrient intakes improved in the intervention groups. Compared to the control group, the between-group difference in mean protein intake was +21.4g/day (95% CI 9.8, 32.9) in PROMED (P<0.001) and +9.0g/day (95% CI -3.1, 21.0) in PROMED-EX (P>0.05). There was significantly greater improvement in dietary fibre, selenium, iron and vitamin D intakes in both interventions relative to Control (all P<0.001).

This 3-month analysis demonstrates the positive effects of the PROMED-EX and PROMED interventions on nutritional status and diet quality, as well as improvement in selected nutrients in older adults vulnerable to both undernutrition and cognitive decline.

Up to 40% of dementia cases could potentially be prevented through targeting modifiable risk factors(1). South Asian communities are at increased risk for dementia, having an earlier onset and greater cumulative life-course exposure to dementia related risk factors(2). Research on dietary patterns, such as the Mediterranean Diet(3), has shown promise as a non-pharmacological strategy to reduce cognitive decline. Acculturation and the assimilation of dietary habits to that of the host country can mean that minority ethnic groups require tailored dietary advice to suit their needs(4). Therefore, cultural adaptation of dietary interventions is required to ensure that advice for brain health is culturally relevant. Research concerning which culturally adapted, or country-specific dietary interventions are brain healthy, is currently lacking. The aim of this research was to understand the perceived barriers and facilitators towards dietary change for dementia risk reduction among British South Asians.

Five focus groups were conducted with individuals of South Asian ethnicity (n =38) living in the North East of England. Patient and Public Involvement contributors from preliminary engagement activities supported recruitment from community and voluntary organisations. Data were transcribed and analysed using template analysis(4). This involved deductively analysing the data using relevant a-priori themes; pre-identified themes generated based on previous experience of the research team, and from a broad literature review.

Participants were aged between 26-82 years with the majority being female (n = 26, 68.4%), unemployed (n = 22, 57.9%), Pakistani ethnicity (n = 28, 73.7%), with an education level of college attendance or higher (n = 22, 57.9%). Themes identified included a lack of awareness of dementia, and the link between diet and dementia. Shame and stigma surrounding dementia was highlighted as a major issue that could influence willingness to engage in preventative strategies. Participants reported the main barriers to dietary change as: the influence of religious beliefs; issues with interpretation, accessibility, and lack of culturally appropriate resources; engrained dietary habits; time, cost, and convenience. Generational influences relating to differences in eating habits and awareness of healthy eating were highlighted as both a barrier and facilitator to behaviour change. Peer support strategies and the provision of practical, culturally sensitive dietary advice were viewed as facilitators.

This qualitative study highlights the need to increase awareness surrounding dementia prevention, specifically the role of diet, and to address this in a culturally sensitive way, that supports ethnic minority communities to improve their understanding and willingness to openly talk dementia. These findings will inform the development of a prototype for a dietary intervention, guided by the Medical Research Council guidance for complex interventions, and co-developed with the South Asian community, to explore how dietary advice for dementia prevention can be implemented in a culturally acceptable and feasible way in a community setting.

While adherence to a healthy diet is known to reduce dementia risk, the impact varies by diet type. This study examines the association between six dietary scores and dementia incidence.

In this prospective analysis, 210,269 participants aged 60 and above (mean age 64.1 years, 52.7% women) from the UK Biobank were included. Dietary adherence was assessed using six scores: Mediterranean Diet Adherence Index (MEDAS-14), Recommended Food Score (RFS), Healthy Diet Indicator (HDI), Mediterranean Diet Score (MDS), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), and a meat consumption index (MCI). Dementia incidence (allcause, Alzheimer’s, vascular, and non-vascular) was the primary outcome, analyzed using Cox proportional hazards models. The lowest quintile (low adherence) was used as reference group. Analyses were conducted using a 2-years landmark and adjusted for sociodemographic (age, sex, ethnicity and deprivation), lifestyle (physical activity, alcohol and smoking) and health-related factors (multimorbidity and BMI).

Among the participants, 4,151 developed dementia during the 8.9 years follow up. Those with the highest adherence to dietary patterns (Quintile 5) showed a reduced risk of all-cause dementia: 49% with MDS (HR: 0.51, CI: 0.42−0.62), 38% with MIND (HR: 0.77, CI: 0.60−0.99), and 19% with MEDAS-14 (HR: 0.81, CI: 0.64-1.00). No significant associations were found with HDI. Individuals reporting low meat consumption (<5 times a week) exhibited a 15% lower dementia risk compared to high meat eaters (≥5 times a week, HR: 0.85, CI: 0.77−0.94). No associations were observed with pescatarian or vegetarian diets. These patterns were consistent across both vascular dementia and Alzheimer’s disease.

Our findings suggest that higher adherence to certain healthy dietary patterns, particularly the Mediterranean and MIND diets, is associated with substantially lower risk of dementia. These findings emphasise the potential for achieving better brain health among older people by improving overall dietary pattern.

The POWER study (NCT05688956) is a 12-week randomised controlled trial (ongoing) investigating the effectiveness of a novel protein-based oral nutritional supplement combined with an online resistance training programme for community-dwelling adults aged 70+ who require home care and are at risk of sarcopenia. Older adults reliant on home care are an understudied cohort acknowledged as vulnerable to sarcopenia(1) and malnutrition(2). This study aims to report the preintervention (baseline) functional status and dietary intake of older adults recruited to the POWER study.

Community-dwelling adults (≥70 y) living in Ireland receiving supportive home care and at risk of sarcopenia. Sarcopenia was screened for using the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire with a cut-off score of ≥1(3) (out of 10). Participants were recruited into the POWER study between July 2023 and January 2024. Data on participant demographic, nutritional status (anthropometric measures and 24-hour multiple-pass dietary recall) and muscle strength (handgrip strength (Jamar® dynamometer) and five times sit-tostand) were obtained during pre-intervention home visits. Dietary intake was analysed using NutriticsTM software (version 5.96). Intakes of protein and kilocalories were calculated as grams per kilogram body weight (g/kgBW) and as kilocalorie per kilogram body weight (kcal/kgBW) respectively. Statistical analysis was performed using RStudio (2023.06.2).

Seventeen adults aged 70+ were recruited over a 7-month period (12F, 5M; age range 71-87 years). Ten participants were receiving informal home care (i.e., from a relative) with seven receiving professional home care. All participants had a SARC-F score over 4, with a mean score of 5±1.3. Median BMI was 28.7 (range 17.1-36.2) kg/m2. One participant was underweight (BMI 17.1 kg/m2), five were overweight (BMI ≥24.9 kg/m2) and six were living with obesity (BMI ≥30 kg/m2). Using the Mini-Nutritional Assessment-Full Form (MNA-FF), nine participants were at risk of malnutrition (MNA-FF 17–23.5), and one was malnourished (MNA-FF =16.5). Mean intake of protein was 0.84±0.23 g/kgBW/day, with only two participants consuming ≥1.0 g/kgBW/day. Mean daily energy intake was 1,488 kcal or 17.0 kcal/kgBW. Time taken for five times sit-to-stand was 21±8 seconds (>15 seconds for five rises(4)) and handgrip strength was 15±6 kg (<16 kg for females(4)) and 21±12 kg (<27 for males(4)) for females and males, respectively.

Analysis of the pre-intervention data from the POWER study indicates that older adults at risk of sarcopenia are not meeting recommended daily protein intakes of 1-1.2 g/kgBW(5). Participants also demonstrated poor muscle strength. This highlights the need for a multi-component approach to support dietary intake and muscle strength in older adults reliant on home care.

Alzheimer’s disease (AD) is the most common progressive central nervous system neurodegenerative disease globally(1). At present, the treatment of AD involves only symptomatic medications which have continually demonstrated little efficacy(2). Hericium erinaceus (HE), commonly known as lion’s mane mushroom, has not yet been fully utilised among western pharmacology for its medicinal purposes, demonstrating a possible omittance of a highly beneficial neuro-altering substance. To date, studies that have investigated the potential medicinal properties of HE have found that various neuroprotective effects are exerted when following consumption(3). The aim of this review is to systematically investigate the neuroprotective pathways impacted by dietary supplementation of HE, determine specific bio-compounds responsible, and highlight the importance of continued research to determine the true potential relevance of this therapeutic treatment for AD.

Electronic databases were systematically searched for studies investigating the relationship between HE and AD. For inclusion in this review, human studies must have been of a clinical design involving adults >30 years that are healthy, have mild cognitive impairment, probably AD or memory deficits. Animal studies were required to involve interventions that directly impact AD-related mechanisms. The exclusion criteria involved any observational studies that involved participants with other neurological implications, or any studies that noted existing interventions (i.e., medications, post-surgery, dietary intervention). A study quality assessment was conducted for all qualified studies using Cochrane RoB2 tools. Data extraction was undertaken according to PRISMA guidelines.

A total of 16 studies (including 3 human clinical trials and 13 animal model studies) met the criteria for inclusion. All studies included either behavioural, biochemical, ophthalmic, and neuroimaging assessments which demonstrated to be directly influenced by HE intake and highlighted key mechanisms previously associated with neurohealth promotion or neuropathological decline. Behavioural and biochemical clinical trial results revealed statistical differences (p < 0.05) between result comparison between HE and control groups and various week intervals. Animal model behavioural and biochemical assessments demonstrated positive findings. Histological assessments of AD-induced rodents following HE administration revealed statistically significant results (p < 0.05) in cholinergic transmitter and NGF concentrations, β-amyloid peptide plaque accumulation, and microglia and astrocyte activation compared to control groups.

Evidence suggests that an intake of HE, specifically the compound erinacine-A may be an appropriate and relevant candidate for the future therapeutic treatment for the prevention and delayed progression of AD. Application of HE demonstrated numerous improvements in AD-related behaviour, biomarker parameters, histological features, and physiological mechanisms while neuroprotective and neurotrophic properties were also clearly established. Nevertheless, the review highlights the necessity for continued research specifically human clinical trials to contribute continued evidence surrounding the use of HE for AD, to provide direction for future research and provide constructive methods for the possible future targeting of AD populations.