Chrononutrition studies the effect of timing, regularity and frequency of eating on body metabolism and health. Diurnal eating patterns may be obtained based on time-of-day and regularity and its association with health outcomes investigated in national representative samples(1,2).

In this study we focus on the Italian population over 50 and we aim to study how their sociodemographic characteristics, such as sex, civil and professional status, geographical area of residence, affect their energy intake at different times of the day.

We used INRAN-SCAI national representative survey conducted in 2005/2006(3), including sociodemographic information from questionnaires and 3-day-diet-diaries on 1317 over-50 subjects. The energy intake has been aggregated according to Italian dietary habits into 6 time-slots (6-9am/9am-12/12-3pm/3-7pm/7-10pm/10pm-6am). For each time-slot, we applied multilevel analysis including 3 levels (repeated measures within individuals, between individuals and due to specific sociodemographic strata), to estimate the respective components of intake variability. The third-level stratification resulted in 40 clusters based on sex, professional status, geographic region of residence and civil status. The study further applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)(4) to analyze how sociodemographic factors influence daily calorie intake, comparing two mixed effect models, one “null” model including also fixed effects of other potential confounders (age, smoking, alcohol, total intake) as well as the day of data collection, and one “main” model, which, additionally, included the main effects for the variables determining the strata.

In terms of fixed effects, results showed significant energy intake variations in energy at different time-slots, depending on the area of residence (on average 47 kcal less at breakfast and 164 kcal more at lunch in the South compared to North-West, p<0.001) and data collection day (122kcal more at lunch on the third day falling in the weekend, compared to first day in the week, p<0.001). Furthermore, people who worked (on average 29 kcal more at dinner) and those who didn’t live alone (26 kcal more at lunch) tended to consume more calories during some main meal times while those living alone were more likely to have out-of-meal eating patterns (13 kcal more at afternoon and night snacking times).

MAIHDA demonstrated that only dinner and night times had an intersectional effect, i.e. 56% and 86% percent of their variability respectively was not explained by main effects and was therefore attributable to the interaction among sex, region, professional and civil status.

Our study offered a detailed description of how selected social and demographic factors were related to dietary behaviors held during the 24-hours. The findings are critical for crafting tailored nutritional advice to help mitigate the health threats faced by an aging population. The analysis will be extended to more recent survey samples of the Italian population, when available.

Sub-optimal status of one or more of the interrelated B-vitamins (folate, B12, B6 and riboflavin) is common among older adults1, and considerable observational evidence links low B-vitamin status (and/or elevated concentrations of the related metabolite, homocysteine) with a higher risk of agerelated diseases2,3. These nutrients are interlinked though their roles in one-carbon metabolism, but very few studies have investigated the major contributors to status of all four B-vitamins or the trends in B-vitamin biomarkers with advancing age. The aim of this study, therefore, was to investigate the contribution of fortified foods and supplements to dietary intakes and biomarkers of B-vitamins in older adults.

From a total sample of community-dwelling older adults (n = 5,186; ≥ 60 years) initially recruited to the Trinity-Ulster-Department of Agriculture (TUDA) study from 2008–2012, an eligible subset (n = 953) was re-investigated between 2016 and 2019. Dietary intake was assessed using a 4-day food diary (over four consecutive days) in combination with a food-frequency questionnaire. Mean daily energy and B-vitamin intakes were calculated using a customised version of the nutritional software package Nutritics (V.4). Non-fasting blood samples were collected at initial sampling and at follow-up to measure corresponding B-vitamin biomarkers. Statistical differences between categories of fortified food consumption and supplement use were assessed using ANCOVA (with adjustment for relevant covariates), while relationships between dietary and corresponding biomarker variables were examined using Pearson correlation coefficients.

As dietary intakes of fortified foods increased (from 0 to > 7 portions per week), biomarkers of each B-vitamin improved in a stepwise manner (P<0.001), and there was a corresponding decrease in plasma homocysteine concentrations (P<0.001), and the highest B-vitamin biomarkers were observed in those taking B-vitamin supplements. Although mean values for B-vitamin biomarkers generally compared favourably with normal ranges, deficient status of individual B-vitamins at initial sampling (2008 – 2012) was identified in: serum folate (8%), vitamin B12 (8%), vitamin B6 (8%), riboflavin (23%). Non-consumers of fortified food or supplements were at greatest risk of deficiency for each B-vitamin. Dietary intakes from foods were significantly correlated with corresponding biomarkers for serum folate (r = 0.458, P<0.001), plasma pyridoxal-5-phosphate (PLP; r = 0.192, P 0.002) and erythrocyte glutathione reductase activation coefficient (EGRac; r =−0.197, P 0.001), whereas no significant correlation was observed for vitamin B12 intake with status.

In conclusion, regular consumption of fortified foods is an effective means to improve intakes and status of folate and related B-vitamins, reduce homocysteine concentrations and lower the prevalence of B-vitamin deficiency. These results emphasise the importance of fortified foods and supplements in contributing to status and highlight potential opportunities for the food industry to develop a wider range of foods fortified with sufficient levels of B-vitamins to optimise status and support healthy ageing.

There is strong evidence that low muscle strength and muscle mass are associated with an increased the risk of mortality and morbidity.⟨1⟩ Muscle mass and strength progressively decline from around the fourth decade⟨2⟩, a process known as sarcopenia, for which there is no effective pharmacological treatment.⟨3⟩ Current literature indicates that resistance exercise and/or supplementation with n-3 fatty acids can be beneficial for muscle strength and mass in older adults.⟨4⟩ However, the sample sizes in these studies are relatively small and are restricted to only resistance exercise. The relationship between dietary n-3 fatty acid intake, rather than supplements, and general physical activity, rather than resistance exercise, and muscle strength and mass remain unknown. The aim of the current study, therefore, was to investigate the associations of n-3 fatty acid intake with handgrip strength and muscle mass indices in older adults. A secondary aim was to investigate whether these associations differed by physical activity status.

Analyses included 53,994 participants from the UK biobank study (25,773 men and 28,221 women). Participants were aged 60 years or older with complete data for outcome, predictor and covariate variables. Multivariable linear regression analyses were performed to explore the associations between n-3 fatty acid intake and grip strength index (kg/m²) and muscle mass index (kg/m²) in three separate models. All analysis were performed stratified by sex and physical activity status (active/inactive). Model 1 was adjusted for age, ethnicity, deprivation index and month of assessment. Model 2 was also adjusted for total energy intake and model 3 was also adjusted for multimorbidity count.

In model 3 there were positive associations between n-3 fatty acid intake and grip strength index in women with a 0.03 kg/m² (95% CI 0.00 to 0.06 kg/m²) higher grip strength index seen in those who were active and a 0.04 kg/m² (95% CI 0.00 to 0.08 kg/m²) higher grip strength index in those who were inactive for each additional gram of n-3 fatty consumed per day, with no associations in active (p = 0.355) or inactive (p = 0.186) men. In model 3, no association between n-3 fatty acid and muscle mass index were seen in men who were active (p = 0.981) or inactive (p = 0.331) and in women who were active (p = 0.843) or inactive (p = 0.058).

Although n-3 fatty acid intake was significantly associated with grip strength index in older women, regardless of their activity status, the magnitude of this association was very small and unlikely to be clinically relevant. Additionally, n-3 fatty acid was not associated with muscle mass index. Therefore, manipulation of n-3 fatty acid intake within the normal dietary range is unlikely to be an effective strategy to prevent and/or treat sarcopenia and n-3 fatty acid supplements are likely required.

Mental health disorders are the leading cause of ill-health and disability, with depression and anxiety being among the most prevalent(1). There is a growing body of evidence to indicate that optimal nutrition can help to promote better mental health, while suboptimal dietary patterns or status of specific nutrients have been associated with a greater risk of depression and anxiety, but the evidence is conflicting(2,3,4,5). Therefore, the aim was to conduct a systematic review with metaanalyses to investigate the effect of interventions with specific nutrients or dietary patterns on mental health outcomes in adults.

Searches were conducted using the electronic bibliographic databases: MEDLINE, EMBASE and PsycINFO. The inclusion criteria were randomised controlled trials or controlled dietary interventions; study duration ≥ 12 weeks; participants aged ≥ 18 years old; outcome measures of depression or anxiety. The meta-analysis was conducted using Cochrane Review Manager Software (RevMan), version 5.4. The Risk of Bias and Quality of Evidence were assessed utilising the Cochrane Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, respectively.

A total of 68 studies met the inclusion criteria: 5 investigated dietary patterns, while 63 were nutrient interventions, involving omega-3 (n = 22), vitamin D (n = 18), B-vitamins (n = 10), zinc (n = 7), iron (n = 1), vitamin D combined with calcium (n = 4), and omega-3 combined with vitamin D (n = 1). Insufficient studies were available to conduct a meta-analysis for any nutrient in relation to anxiety; all results relate to depression. Meta-analysis results showed that zinc intervention significantly reduced depression (standardised mean difference (SMD) in depression scores was −0.67; 95% Confidence Interval (95% CI) −0.96, −0.37); 4 studies, GRADE: moderate certainty). No significant effects on depression were reported in response to intervention with omega-3 fatty acids [SMD 0.26 (95% CI −0.64, 0.12); 10 studies, GRADE: moderate certainty] or vitamin D [SMD 0.07 (95% CI 0.34, 0.47); 10 studies, GRADE: moderate certainty], while there were insufficient studies to perform a meta-analysis for B-vitamins and depression. There was also no significant effect of the Mediterranean Diet on depression [SMD −0.95 (95% CI -1.90, 0.01); 3 studies, GRADE: high certainty], and insufficient studies for analysis of the Dietary Approaches to Stop Hypertension (DASH) diet.

The results indicate that zinc supplementation has beneficial effects on depression, but there were no significant effects of intervention with the Mediterranean Diet, omega-3 fatty acids or vitamin D. These meta-analyses are however based on a limited number of intervention studies and therefore no firm conclusions can be reached. Further intervention trials are required to fully investigate the effects of specific nutritional factors on mental health.

There is evidence for associations between polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and psychosis risk(1–3). However, the existing literature has focused on PUFA measurements at single timepoints(4,5), which may overlook dynamic patterns of variability over time. The aims of this study were: 1) To describe longitudinal trajectories of plasma omega6:omega-3 ratio and DHA in a large general population sample; and 2) To evaluate associations between trajectories and psychosis-spectrum outcomes in early adulthood.

We performed a cohort study within the Avon Longitudinal Study of Parents and Children. 3635 participants completed psychiatric assessments at age 24 years (2247 [61.8%] female). Participants provided plasma samples at four timepoints when aged 7, 15, 17 and 24. Plasma omega-6:omega-3 ratio and DHA levels (% total fatty acids) were measured using nuclear magnetic spectroscopy, then standardised by sex.

Psychosis-spectrum outcomes were assessed at age 24. Psychotic experiences (PEs) and psychotic disorder were assessed using the Psychosis-Like Symptoms interview (PLIKSi), as was the total number of PEs (range 0 to 11). Negative symptoms score (range 0 to 10) was measured using the Community Assessment of Psychic Experiences.

Curvilinear growth mixture modelling was used to derive longitudinal trajectories of plasma omega-6:omega-3 ratio and DHA levels over time. Trajectories were adjusted contemporaneously for body mass index at each timepoint. Associations between trajectory membership and outcomes were adjusted for sex, ethnicity, parental socioeconomic class, smoking and alcohol use.

A three-trajectory solution was optimal for omega-6:omega-3 ratio (stable average, n = 3282 [90.3%]; slightly above average, n = 61 [1.7%]; and persistently high, n = 292 [8.0%]) and DHA (stable average, n = 2739 [75.4%]; persistently high, n = 245 [6.7%]; and persistently low, n = 651 [17.9%]).

Relative to stable average, trajectories characterised by persistently high omega-6:omega-3 ratio and persistently low DHA were associated with increased odds of PEs and psychotic disorder in unadjusted analyses, but these associations attenuated on adjustment for covariates. Conversely, the persistently high omega-6:omega-3 ratio trajectory was associated with increased number of PEs (adjusted β 0.41, 95% confidence interval [CI] 0.05−0.78, p = 0.026) and negative symptoms (adjusted β 0.43, 95%CI 0.14−0.72, p = 0.004). Similarly, the persistently low DHA trajectory was also significantly associated with increased number of PEs (adjusted β 0.45, 95%CI 0.14−0.76, p = 0.004) and negative symptoms (adjusted β 0.35, 95%CI 0.12−0.58, p = 0.003).

Persistently high plasma omega-6:omega-3 ratio and persistently low plasma DHA were associated with increased PEs and negative symptoms of psychosis at age 24. Optimisation of PUFA status during development warrants further investigation in relation to psychosis-spectrum outcomes in early adulthood. Limitations include that causality cannot be inferred and residual confounding is possible. Attrition occurred along a socioeconomic gradient, although we used multiple imputation to avoid complete-case biases. Strengths include the use of a wellcharacterised cohort, and the use of biomarker measurement of plasma PUFAs.

Increasing evidence indicates that (poly)phenol consumption can have beneficial effects in human brain function(1). The overall aim of this project is to investigate whether consumption of a (poly)phenol rich cranberry drink improve mental health and cognitive function in university students via the gut-brain axis.

A parallel randomised controlled trial was conducted in 72 young healthy final year university students assigned to consume 236 mL cranberry drink (442 mg polyphenols) or nutrient matched placebo, daily for 12 weeks. The primary outcome was mood, measured as Total Mood Disturbance (TMD), using the Profile of Mood States (POMS) questionnaire. Secondary outcomes included stress, anxiety and depression levels, measured using the Perceived Stress Scale (PSS), and the Hospital Anxiety Depression Scale (HADS) questionnaire, salivary cortisol levels and cognitive function measured using the Online General Cognitive Assessment Battery (CogniFit). All of these questionnaires were measured every 4 weeks. Blood and urine samples were collected to measure inflammatory markers, gut-brain-axis metabolites, short chain fatty acids (SCFA), and cranberry polyphenols metabolites. Faecal samples were also collected for measuring gut microbiome diversity and composition and faecal metabolomics. Diet was assessed using food frequency questionnaires (FFQ), 7-day food diaries (EPIC) and 24 h online dietary recalls (intake 24) during the study. Linear mixed-effect model (LMM) and ANCOVA were used to investigate the relationship between the 2 trial arms.

No significant differences were found between treatments for mood, stress levels, anxiety, depression, circulating short chain fatty acids or inflammatory markers, however a significantly lower diurnal area under the curve of salivary cortisol (p = 0.010) and significantly higher short-term memory (Z-score: p = 0.024; Raw-score: p = 0.034) was found at 12 weeks in the cranberry group compared with the placebo. Besides, significant differences between interventions were found in plasma gut-brain axis metabolites, including the kynurenine and bile acids pathway which were kynurenine (p = 0.023), kynurenic (p = 0.032), quinolinic (p = 0.018), and glycolithocholic acid (p = 0.04) as well as several plasma and urinary cranberry (poly)phenol metabolites were modulated by cranberry consumption.

In conclusion, daily cranberry (poly)phenol supplementation for 12 week did not improve mood, stress, anxiety, and depression symptoms in healthy university students, however it may modulate cortisol levels and some aspects of cognitive function via the gut-brain axis.

Emerging evidence suggests protective properties of a Mediterranean diet (MD) in relation to prevention and management of mood disorders(1). However, there is paucity of dietary interventions investigating adherence to MD and effects on mood and wellbeing in individuals without a clinical diagnosis. The present study aimed to investigate the effects of adherence to a short-term MD on mood and wellbeing in healthy adults.

A controlled crossover design randomly assigned 18 adults (Age(yrs) 53.74 ( ± 7.10), BMI(kg.m2)26.62 ( ± 5.45)) to follow a MD or their habitual diet (control) for 7-days, before switching to the alternate condition (following a 7-day washout). At baseline, an Educational Group Session familiarised participants with MD principles through informal presentation and interactive explanation of participant resource booklets to use at home throughout the MD condition only. Anthropometric characteristics, self-reported mood (Profile of Mood States (POMS), Lader Visual Analogue Scale(VAS)) and wellbeing (Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) were assessed at baseline and upon completion of each diet condition. The MD Adherence Screener (MEDAS) assessed adherence to the interventions.

A significant difference was found in MD adherence scores between MD (M=11.3, SD=1.8) and Control Diet (CD) (M=2.5, SD=1.5); t(17)=16.1, p<0.001). Main effects analysis using a general linear model controlling changes in body mass index showed significant effects of MD intervention versus the CD on the change in total mood disturbance (M(MD)=−15, SD=12), M(CD)=−3, SD=9), F(1,31)=4.9, p=0.034); feelings of calm (VAS) (M(MD)=9, SD=14), M (CD)=−2, SD=6), F(1,31)=8.5, p=0.006); wellbeing (M(MD)=6, SD=5), M(CD)=−2, SD=6), (F(1,31)=6.6, p= 0.015).

These findings suggest that a short-term dietary change towards a MD can improve mood, feelings of calm and overall wellbeing in middle aged adults.

Chronic low-grade inflammation has been associated with poor mood states and reduced mental well-being, increasing the chances of comorbidities such as diabetes and mental illness (1). Inflammation and stress share a bi-directional relationship (2), impacting an individual’s mood and mental well-being. Whole food interventions such as the Mediterranean diet (MD) possess antiinflammatory properties and might offer protection for perceived stress and mood disorders (3). This systematic review investigated the effects of whole food interventions on stress, mood, and mental well-being.

The following databases were searched for studies published until the end of March 2024:

MEDLINE, CINAHL, Prospero, Web of Science, Cochrane Library (n = 6). Inclusion criteria were: (1) RCT; (2) mean participant age between 18 and 65 years; (3) measured one (or more) relevant outcomes e.g. stress, mood, or mental wellbeing; (4) whole food intervention. The Cochrane Risk of Bias v2 will be used to assess randomised controlled trials (RCT) (4).

The review identified 3,854 results in accordance with the PRISMA guidelines with fifteen meeting inclusion criteria. Backward citation searching yielded 8 studies. A total of twenty-three studies were included in this review. Seventeen applied whole food dietary intervention (WFDI) while six investigated supplementing the habitual i.e. adding nuts to diet (STH). Seventeen studies used WFDI: MD (n = 7), Nordic diet (n = 1), Ketogenic diet (n = 1), time-restricted eating (n = 1), a priori diets (n = 7). The remaining six STH studies supplemented with: nuts (n = 3), basil (n = 1), cacao (n = 1) and corn leaf (n = 1). Five studies reported positive changes in mood states i.e. vigor (p <.05). Two of these investigated the effects of a 10-day MD intervention compared to habitual diet, finding significant improvement in mood states (n = 4). Three studies measured mental well-being as an outcome with WFDI, MD (n = 1) and a priori diets (n = 2) reporting significance (p <.05) but demonstrating heterogenicity in measurement methods. Two studies were conducted with the outcome of stress with a WFDI, Mediterranean diet (n = 1) and a priori (n = 1). The findings reported to have a positive effect on reducing stress, when compared to baseline (p < .035). Four studies examined the effects of STH on mood states reporting positive significant change respectively: nut (n = 2), basil (n = 1), cacao (n = 1).

This systematic review is the first to examine the interaction of whole food intervention with stress, mood, and/or mental well-being. Our findings offer an insight to the interplay of different whole food interventions, whether entire diet or supplementation on the outlined outcomes in this review. The findings demonstrate heterogenicity of measurements which could be a factor in not establishing significance in some studies (n = 9). Other considerations of this review are the confounding variables that can influence stress, mood, and mental well-being such as physical activity, hydration, sleep quality.

Tea produced from the tea plant (Camellia sinensis) is potentially beneficial for health: it contains theanine and caffeine which may improve short-term physiological outcomes such as accuracy of attention,(1,2) and polyphenols, specifically flavan-3-ols, which may improve long-term health outcomes such as cardiovascular diseases.(3,4) The aim of this systematic review and meta-analysis was to update the overall understanding of the effects of tea, or theanine (alone or in combination with caffeine), on cognition, mood, and/or sleep outcomes in healthy participants.

The Cochrane Library, Embase, and Medline were systematically searched, up to and including August 2023, for randomised controlled trials investigating the short-term effects of tea, theanine alone, or theanine plus caffeine interventions, on cognition, mood, and sleep outcomes in healthy participants. Where possible, meta-analysis was performed using standardised mean differences (SMD), or mean differences, with 95% confidence intervals (CI), in random effects models. SMDs and CIs were re-expressed (ReSMD) in the units of the most common measurement tool used by the studies in each meta-analysis.

Fifty RCTs were included in the review; data from fifteen RCTs were eligible for at least one meta-analysis. In the first hour (h1) and second hour (h2) after intake, differences were found between the effects of theanine plus caffeine, and placebo, that favoured the former, on cognitive outcomes including choice reaction time (h1; ReSMD: -24.71 ms; 95 % CI: -51.90 to 2.48), digit vigilance task accuracy (h2; ReSMD: 1.59 %; 95 % CI: 0.17 to 3.01), and attention switching task accuracy (h2; ReSMD: 1.10 %; 95 % CI: 0.43 to 1.77), and mood outcomes including overall mood (h2; ReSMD: 3.46 units on the caffeine research visual analogue scale; 95 % CI: -1.36 to 8.28) and alertness(h2; ReSMD: 2.94 units on the Bond-Lader visual analogue scale; 95 % CI: −0.87 to 6.75). Improvements favouring theanine, compared to placebo, were found for cognitive outcomes including rapid visual information processing accuracy (h2; ReSMD: 1.20 %; 95 % CI: 0.75 to 1.65) and reaction time (h2; ReSMD: -9.77 ms; 95 % CI: -16.98 to -2.55), and choice reaction time (h1; ReSMD: -18.01 ms; 95% CI: -31.27 to -4.83). No consistent evidence was found to indicate whether tea or theanine were beneficial for sleep.

This meta-analysis provides evidence that theanine plus caffeine, and theanine alone, possibly improve attention and mood, however, tea-inequivalent doses, small numbers of studies eligible for meta-analysis, and confidence intervals showing uncertainty surrounding the direction and magnitude of overall effect sizes, were common. More research of tea or tea-equivalent bioactive doses, in free-living participants, would be beneficial. PROSPERO registration no. CRD42022351601

University students often face high levels of stress and sleep disturbances due to their academic demands and lifestyle factors(1). Ashwagandha (Withania somnifera), an adaptogenic herb, has shown the potential to mitigate stress and improve cognitive function(2). However, limited research has examined its effects on these variables in university students. This study aimed to determine the effects of ashwagandha supplementation on sleep quality, mood, and cognitive function in university students.

A randomized, double-blind, placebo-controlled crossover study was used. Nine university students (5 males, 4 females; Age: 21±1 years; BMI: 25±2.5 kg/m2) were randomly assigned to receive 500 mg of standardized ashwagandha root extract capsules for 7 days or a placebo (encapsulated cornstarch) with a 7-day washout between treatments. Sleep was measured during the 7-day supplementation period using the Loughborough Daily Sleep Diary. Postsupplementation mood and cognitive function were measured by the Profile of Mood States (POMS) scale(3) and computerised Stroop, and Deary-Liewald simple and choice reaction tasks(4). Paired sample t-tests were used to determine differences between the ashwagandha and placebo conditions with calculated effect sizes (Cohen’s d).

Participants reported lower confusion indicator on the POMS following ashwagandha compared to the placebo (mean±SD: 4.8±2.0 vs 7.6±3.1 arbitrary units; P=0.03; d = −0.92). No other differences were found for any other mood indicators, sleep, or cognitive function parameters (P > 0.05).

These data suggest that ashwagandha may improve feelings of confusion in university students but further studies with larger sample sizes are needed to verify these findings and elucidate the underlying mechanisms.

Many adverse outcomes for both mother and baby can result from suboptimal maternal nutrition during pregnancy(1). Pregnancy is seen as an opportunity to encourage beneficial lifestyle changes(2). The Health Service Executive published nutritional guidelines for pregnancy in Ireland(3), however there is no standardised approach for assessment in antenatal care. The FIGO Nutrition Checklist is a tool which asks “yes/no” questions about dietary intakes in pregnant women with the goal of identifying deficits compared to recommendations. A “no” answer to one or more questions indicates a possible nutrition risk in the diet. Implementation of the Nutrition Checklist during pregnancy would benefit both mother and baby. The aim of this study is to assess the nutritional intakes of pregnant women attending the public outpatient clinic in the National Maternity Hospital, Dublin using the FIGO Nutrition Checklist, and assess the acceptability of the tool for use as part of routine antenatal care.

This observational cross-sectional study used two self-administered questionnaires to (i) assess women’s nutritional intakes to identify those at nutritional risk, and (ii) assess the acceptability of the Nutrition Checklist as part of routine antenatal care. Recruitment took place from December 2023 to February 2024. All English-speaking women of any gestation or parity attending the public outpatient department of NMH were eligible to take part. Baseline characteristics were obtained through their hospital records on the electronic chart system. Statistical analysis was completed using IBM SPSS.

A total of 102 pregnant women were recruited during routine antenatal clinics in the public outpatients department in the NMH, Dublin, Ireland. Most (88.7%) declined following a special diet. The majority (85.7%) answered “No” to at least one diet quality question, highlighting potential nutritional risk. Only 43.9% reported eating at least one portion of fish per week and 20.4% reported consuming <1 serving of wholegrains per day. Current folic acid intakes were high among the cohort, however 16.3% answered “No” to currently taking folic acid. The acceptability of the checklist was excellent. Most (70.6%) women strongly agreed that the checklist was easy to complete, with 80% recommending using it in practice and most (81.4%) of the women who took part in the survey agreed that the checklist contained useful information, with only 1% disagreeing.

The FIGO Nutrition Checklist identified numerous nutritional concerns and the acceptability of the checklist was excellent. This suggests that using the tool as part of routine antenatal care should be considered.

UK antenatal guidelines state that midwives should discuss nutrition, diet, and vitamin supplementation at booking-in appointments(1). Our earlier research suggests that this rarely happens(2). Participant and Public Involvement (PPI), enhances research by making it more meaningful and reliable. This study incorporated PPI to elicit the experiences of postnatal women regarding the nutrition and weight management advice they received during antenatal care and their opinions regarding the design of a future resource for midwives.

Eight postnatal women were recruited from a Children’s Centre in Liverpool. They were asked questions by one researcher, about: a) any nutrition advice given by midwives during their antenatal care and b) their opinions regarding the development of a nutrition resource for midwives in future. Notes of the conversations were made by a second researcher; these were then transcribed and analysed thematically. Participants were given a shopping voucher to thank them for their input.

Regarding the development of a resource, three themes were identified: 1) Factual information, 2) The Midwives approach, 3) Include us. They identified that they wanted more in-depth facts from midwives, particularly regarding key nutrients and food that should be included in a healthy diet “Good nutrition grows babies”. However, they felt that midwives needed to improve their approach to discussing diet and weight, to include more empathy and sensitivity, as women often felt judged or anxious by comments that were made “It’s not what they say – it’s the way they say it”. Finally, they agreed that their voices should be included in the development of a resource, with midwives and service users coming together to share their views “Get them [midwives] involved in something like this”.

All women agreed that a nutrition resource for midwives was needed as they were dissatisfied with the advice they received. They wanted less focus on food safety/food to avoid and increased emphasis on food and essential nutrients to include. Involving the expertise of dietitians/nutritionists in the resource would help to address knowledge gaps and inconsistencies. Midwives would benefit from training regarding sensitive weight management advice too, as weight was rarely discussed or was approached in a distressing way. This has been documented elsewhere with the recommendation that training regarding sensitive weight management advice should be included in the midwifery curriculum and mandatory training(3). Support and expertise from a health psychologist would help to develop this aspect of the resource. Including the experiences and opinions of service users alongside midwives will be vital to the success of developing a suitable resource for midwives, so ongoing PPI activities need to be considered.

Obesity prevalence is rising globally. Living with obesity can lead to increased reproductive challenges and compromise preconception health, defined as the overall health of non-pregnant individuals of childbearing age (15-49 years)(1). Folic acid supplement use, considered a key preconception health behaviour, is pivotal for the prevention of neural tube defects in offspring(2). Guidelines suggest women with obesity take a higher dose (5mg/day) to reduce the risk of fetal complications(3). This research explored trends in Body Mass Index (BMI) in the preconception and early pregnancy period in Northern Ireland (NI) and the prevalence of folic acid supplement use across BMI categories, exploring differences based on deprivation.

Anonymised national data collected in the Northern Ireland MATernity System (NIMATS) were accessed via the UK Secure eResearch Platform Data, provided by the HSC Honest Broker Service. The NI Multiple Deprivation Measure (NIMDM) (2017) aggregates the rankings of seven specific domains into a single ranking, used to categorise deprivation into quintiles for comparison (Q1 highest deprivation vs Q5 least deprivation). Healthy weight, overweight, and obesity were classified as BMI 18.5–24.99kg/m2, 25.00–29.99kg/m2 and ≥30kg/m2, respectively. Folic acid supplement use was self-reported. Multiple linear regressions explored trends in BMI between 2011 and 2021 and χ2 tests explored associations between BMI categories and folic acid supplement use from 2014-2021. The ‘Healthy Reproductive Years’ Patient and Public Involvement and Engagement (PPIE) advisory panel (aged 18-45 years), were involved throughout the study.

The analyses included a total of 255,117 pregnancies, with missing data addressed per variable.

The percentage of women entering pregnancy with a healthy BMI decreased between 2011 and 2021 (48.65%, n = 12,144, and 39.55%, n = 4,316, respectively), while the percentage of women with obesity increased over the same period (18.11%, n = 4,520, and 27.36%, n = 2,986, respectively). Regression models suggested an average increase of ∼1 unit of BMI per calendar year in women entering pregnancy (p<0.001). There were higher proportions of pregnancies conceived by women with overweight or obesity in the highest deprivation quintile (Q1, 53.57%) compared to the least deprivation (Q5, 46.37%). Folic acid supplement use was mostly initiated after conception (59.03%) rather than before (37.54%), as recommended. Among women living with obesity, preconception supplement use of 5mg of folic acid was low (8.74%, n = 2,990). Lower proportions were observed for preconception supplement use of 400mcg among women in the quintile of greatest deprivation (Q1, 21.41%) versus least deprivation (Q5, 44.06%).

Analyses demonstrated an increased number of women entering pregnancy with an elevated BMI and suboptimal preconception folic acid supplement use, particularly for women with obesity. It highlights significant health inequalities according to NIMDM regarding obesity and folic acid supplement use. There is a need to address modifiable preconception health risks, particularly for those from lower socioeconomic groups.

Healthy diet during preconception and pregnancy is evidenced to benefit maternal health and reduce risk of non-communicable diseases in offspring (such as obesity, diabetes, hypertension, cardiovascular and mental health problems)(1). In the UK, population-based initiatives (e.g., Healthy Start Schemes, drop-in sessions at Family Hubs), and antenatal appointments (7-10) with midwives have the potential to influence dietary behaviours during pregnancy. However, despite policy, guidance and initiatives, nutritional recommendations in the prenatal period are not being met and healthcare professionals can struggle to support the delivery of nutritional advice(1–3). This study aimed to understand: the facilitators and barriers to healthy food and diet practices during preconception and pregnancy; how these barrier(s) could be addressed, and the changes required to facilitate good food practices.

The research used a qualitative exploratory approach. Women (aged > 18 years) living across the UK, who were trying to conceive, pregnant or had babies under 6-months old, were recruited to attend a virtual focus group. Focus groups were led using a topic guide including ‘prompt’ questions; they were audio recorded and transcribed verbatim by a professional agency, and thematically analysed according to the stages offered by Braun and Clarke(4). Ethical approval was granted by the University of Hertfordshire Health, Science, Engineering & Technology Ethics Committee with Delegated Authority [protocol number: HSK/SF/UH/04840].

Five focus groups were conducted with 19 participants (aged 18-44 years). Participants were trying to conceive (n = 3, 15.7%), pregnant (n = 3, 15.7%) or had babies under 6 months old (n = 15, 78.9%). Participants resided in England (n = 6, 31.6%), Wales (n = 4, 21.1%), Scotland (n = 4, 21.1%) and Northern Ireland (n = 5, 26.3%). The findings revealed three main themes (Challenges of trying to eat healthily; Facilitators to eating healthily; Changes required) and eight subthemes (Mothers’ load; Body sabotage; Food environment; Information not individualised; Planning skills; Family support; Co-creation and investment for the future; Access to professional advice). Participants spoke of internal factors (such as tiredness and nausea) and external influences (for example, their financial situation and local food environment) that impacted their ability to eat healthily. There was a view that the one dimensional ‘do not eat…’ (P16) instruction was ‘disempowering’ (P1) and in prepregnancy and pregnancy women needed to be empowered to eat healthily. Participants identified online apps, group sessions (as part of antenatal courses) and/or one-to-one advice in GP practices from nutritionists or dietitians, as potential mechanisms for facilitating healthy diets.

There is a need for clear, consistent, engaging and culturally appropriate dietary information that is co-created with pregnant women and those trying to conceive, as well as access to professionals (such as nutritionists and dietitians) who can give both generic and tailored advice.

Dietary intake before and during pregnancy has significant health outcomes for both mother and baby(1). Before developing effective interventions to improve dietary intake during pregnancy, it is important to understand what dietary changes pregnant women make without intervention. This study aims to provide an update from the Hillier and Olander, 2017(2) systematic review, examining women’s dietary changes before and during pregnancy and to identify characteristics of the women making these changes.

A systematic search strategy was employed using EBSCO database, from May 2016 to October 2023 to capture those published after the 2017 systematic review(2). Search terms included those relating to preconception, pregnancy, diet and food intake. All papers were quality assessed using the Scottish Intercollegiate Guidelines Network methodology checklist for cohort studies. The search revealed 726 articles, narrowed to full-text review of 36 studies. In total, 11 research articles were included in the review. The findings were narratively summarised in line with the aims of the review.

The included studies continued to showed marked heterogeneity, which impacts on the findings. Two studies that reported energy and macronutrient intake data, both describe a significant increase in energy intake (100-600 kJ) during pregnancy potentially explained through an increase in carbohydrate intake (%TEI). Of the studies who reported changes in food group analysis (n = 10), a majority report an increase in fruit and vegetable intake with a reduction in fish, processed meat, fried food and caffeine consumption during pregnancy. Adherence to healthy eating index and diet diversity scores were reported in 6 studies and indicated minimal improvement between preconception and pregnancy scores. The characteristics of the women participating in these studies continues to suggest that increased age and education status remain associated with healthier dietary changes; with physical activity and screentime also to be considered however these factors were not assessed in all studies included.

The included articles show varied results in dietary intake during pregnancy as compared to before, this outcome was similar to the 11 studies included in the 2017 review(2). The updated review demonstrates a development in data analysis strategy, including healthy eating index rather than limiting to specific changes in individual energy and macronutrients. Future research is needed on related changes women and their partners make to their eating behaviour before, during and after pregnancy, not solely what they eat at different time points(3). These changes include frequency and quantity, time and place of eating, eating circumstance, eating preparation(3). Above and beyond this, most determinants identified were on individual level(3), and more focus on environmental and policy factors are important.

Good nutrition during the postpartum period, which is also the inter-pregnancy period for many women, has short and long-term health benefits for the mother and her offspring(1). Gaining a better understanding of mothers’ dietary patterns at the postpartum stage will help shape appropriate strategies to encourage the adoption of a healthy and more varied diet. This exploration is a preliminary analysis that aims to assess intake of total fat and dietary fibre in a UK cohort of postpartum women with overweight and obesity and examine its relationship with income and ethnicity.

A sample of 892 postpartum women (up to two years after having a baby) with overweight or obesity were recruited from five UK locations (Belfast, Bradford, London, Stirling, Cardiff) to participate in the Supporting MumS (SMS) randomised controlled trial to examine the effectiveness of an automated text-based delivered weight management intervention. At baseline, researchers measured participants’ height and weight and calculated their body mass index (BMI). Baseline diet was self-reported and assessed using the Fat and Fibre Barometer (FFB), a validated scale measuring the consumption frequency of 20 dietary sources of fibre or fat(2). Items were scored from 1-5 and an average FFB score was calculated; greater values indicate a diet higher in fibre-rich foods and lower in fat-rich foods. Information on income and ethnicity was also collected. Multivariable linear regression analysis tested for associations between FFB scores and ethnicity and household income, accounting for BMI, age and study site.

Participants were from a range of ethnicities (Asian: 17%, N = 151; Black: 11%, N = 100; White: 66%, N = 589; Mixed/Other: 6%, N = 52). Household income distribution was: ≤£40K = 41.5%, N = 370; and >£40K = 49.8%, N = 445. Average age was 35 years ranging from 21-57 years. Thirty-nine per cent of women lived with overweight and 61% with obesity. The FFB score was calculated for the 856 of 892 participants who provided complete dietary information (Mean ± SD=3.03 ± 0.42, range: 1.9-4.6). There was no statistically significant association between FFB score and ethnicity.

There was a significant relationship between the FFB score and household income (0.015, P = 0.025, CI = 0.002−0.028), with women from higher incomes having higher FFB scores.

Our results from a large, socioeconomically diverse sample of women with overweight or obesity in the postpartum period showed that mothers from higher income households consumed more fibre and less fat. This is consistent with results of national surveys highlighting the income gradient in food habits and in meeting dietary guidelines among women in the UK(3). Addressing these dietary inequalities will require concerted action from a wide range of stakeholders.

The SMS study is funded by the National Institute for Health Research (Research award: NIHR131509).

Recurrent miscarriage (RM) is defined as 3 or more consecutive pregnancy losses, prior to 24 weeks gestation(1). In the UK, RM currently affects 1 in 100 (1%) of couples who are trying to conceive(2). At present there is limited information regarding the role of nutrition in the occurrence of RM and on the dietary intake of women who have experienced RM. Thus, investigating links between dietary intake, gene expression, and pregnancy outcomes is crucial. Public and Patient Involvement (PPI) is considered important in health research since it enhances the quality, relevance, impact, and integrity of research activities(3). RM is a sensitive issue, so incorporating the views of service-users in the research design is important. The main aims of this study were to understand the views of women with RM on the proposed research and to strengthen the design by integrating their suggestions.

The main study will aim to use mixed methods to explore the dietary intake of women with RM to determine if there is a relationship between achieving Dietary Reference Values or not, placental health, and pregnancy outcomes (if pregnancy is achieved). For PPI, women were recruited from a specialised recurrent miscarriage clinic in a hospital located in North-West England. Four women participated in a virtual PPI session and were asked for their views on the proposed research design. The session was recorded and transcribed using Microsoft Teams transcription. The researcher initiated the session by presenting a breakdown of the study design, followed by an explanation of its aims and rationale. Participants were queried about their perspectives on the study design through a series of questions. Participants were sent a £20 e-voucher, aligning with INVOLVE guidelines(3).

Participants stressed the significance of the research given the absence of nutrition guidance for women with RM. They approved the sensitive recruitment approach and expressed interest in joining the study. However, concerns emerged regarding women who have experienced RM following IVF treatment, and whether they would be ‘eligible for inclusion or not’. Participants suggested extending the food diary duration from 3 to 5 days for better accuracy in reflecting their eating habits. This was not viewed as overly burdensome, and they suggested that such activities could serve as ‘a distraction’ during ‘early pregnancy anxiety’.

A limitation of this study was the small number of participants. However, this PPI approach further strengthened the research design, as the study design was revised to integrate the suggestions made by the women, including aligning the eligibility criteria to include women who had undergone IVF and experienced RM. Additionally, the food diary duration was extended from 3 to 5 days, which will result in the collection of better-quality dietary data, without risking compliance fatigue.

Maternal death rate in the UK has risen sharply and reached levels above those observed in the previous 20 years. Between 2020 and 2022 there were 13.41 deaths for every 100,000 maternity cases compared to 8.79 deaths per 100,000 cases in 2017–19(1). In conjunction with this, maternal mortality rates show significant disparities: women from black ethnic backgrounds have a three times higher risk of dying as mothers than white women(2). The maternal death rate for women in the most deprived areas is twice that of those residing in the least deprived areas(3) emphasising the need for ongoing efforts to close these gaps.

Located in Islington, Manor Gardens is a unique charity committed to improving maternal health by offering essential support services to expectant women. Their programmes include providing pre and postnatal care, mental health assistance, nutrition guidance, and access to health care professionals.

The aim of this study was to combine quantitative analysis of the charity’s maternity information system with qualitative interviews to evaluate the maternity services provided by the charity. Specifically, the study sought to assess service utilisation, explore user experiences and perceptions of their maternity care experiences.

Ethical approval was obtained from the London Metropolitan University to analyse the data from the charity’s maternity information system. We included women who used their services from 2019 to 2023. In addition to this, eight opportunistic face -to- face interviews were undertaken and thematically analysed to understand the impact of cultural and socioeconomic factors on their maternity care experience.

We identified 256 women had accessed the charity’s services of whom 70 were included in our report due to incomplete data. Forty-nine percent (n = 34) of women were identified as having minority ethnicities, 35% as other and 16% as white. Forty-six percent (n =32) did not speak English or had basic English. Social isolation, domestic abuse, seeking asylum, unsuitable housing and not having a bank account were among the barriers which prevented access to healthcare. Only 19% confirmed they had registered with a GP.

The thematic analysis identified the following themes: Migration and Settlement Experience,

Cultural Barriers, Healthcare Experience, Maternity Care and Postpartum Challenges and Support Systems. The interviews revealed the experiences of mothers, marked by social isolation, language and cultural barriers impacting understanding of healthcare procedures, struggles following childbirth magnified by impoverished living standards. These highlight the importance of effective support systems and culturally sensitive health care.

Our findings suggest that by supporting maternal health, Manor Gardens Charity has the potential to identify barriers which can adversely impact the lives of many women and their families within a deprived community.

Alternative proteins provide a better way to feed the world(1) and have great potential to support the United Nations’ sustainable development goals in ending hunger, promoting sustainable energy use, protecting the climate, and promoting good health(2). However, consumers’ acceptance of alternative proteins is much lower than that of conventional meat(3). With the alternative protein market consistently growing since 2021(4), it is essential to summarise and update factors affecting consumer acceptance of alternative proteins to inform relevant organisations such as the government and support industry development. Using a systematic review, this study aimed to understand and compare consumers’ acceptance of five popular alternative proteins (algae, pulses, plant-based alternative proteins, insects, and cultured meat) and identify research trends and essential factors influencing consumption of alternative protein foods. Specifically, the study compared familiarity and external factors in consumer acceptance.

Building upon an existing systematic which included studies published by 2020, five electronic databases were searched. This review followed PRISMA guidelines, covering Western and Eastern countries, and articles published between June 2020 and March 2023. A total of 112 articles from 40 countries were included. Following the innovation-decision process framework, factors between alternative protein types, products, and psychological and external variables are compared, and changes over time are identified.

Italy (n = 15), China (n = 13) and the United Kingdom (n = 12) were the top 3 in publication numbers. Surveys (n = 95) were the most used method in the studies. Insects (n = 41) and cultured meat (n = 21) were the most popular. The findings reveal that consumers show moderate acceptance of alternative proteins, but a relatively higher acceptance of food products made with these proteins. Tastiness emerged as the top concern in alternative protein consumption, highlighting the importance of sensory appeal. Environmental benefits plus health beliefs also played a significant role in consumer acceptance. Interventions to illustrate food safety and quality variables correlated to a higher willingness to consume alternative proteins. Food neophobia and diet showed distinguished value in consumer acceptance level. Participants who had experienced eating insects showed significant differences in food neophobia scores, subjective norms, attitudes, and intentions. Meal composition and trust in the chef increased consumers’ willingness to consume. Many studies focused on developing alternative protein food products and determining their appropriateness for consumption in different contexts. Consuming alternative proteins with family or friends with positive emotions was more acceptable to consumers.

Consumers’ different acceptance levels and critical factors of alternative protein consumption illustrated the essentials of focusing more on consumer categorisation. The fast expansion of the global alternative protein market and accelerated study output call for building a more complete standardised management and information supply system.

2023 was reported as the warmest year on record, and the global mean temperature reached 1.45°C above the 1850 to 1900 pre-industrial average(1). Emissions from food production are estimated to push global warming over the 1.5°C target set by the Intergovernmental Panel on Climate Change (IPCC)(2). The food industry contributes to one-third of greenhouse gas emissions (GHGe), and accounts for 70% of the world’s fresh water use, through unsustainable practices within food production, packaging and transportation(3). The LIFE Climate Smart Chef (CSC) project was developed to support EU Climate Policy in line with the objectives of the Farm to Fork Strategy(4). This study aims to analyse the nutritional and environmental impact of recipe reformulation by chefs on the CSC project between January to May 2023.

Under the CSC project, 164 chefs were required to enter their recipes into Nutritics, complete a higher level training course on sustainable menu design, and then reformulate their recipes in an in-person workshop where the Nutritics “Foodprint” sustainability module was turned on. Foodprint profiles a recipe’s carbon impact into a simple A to E grading system based on boundaries defined by the CSC project. 178 recipes from 27 chefs were entered into Nutritics software, and analysed for environmental impact (SuEatable LIFE database) and nutrition (energy, saturated fat, salt, sugar, and front of pack labels).

Environmental analysis showed a reduction in carbon (μ −40%; −20% to −75%) and water (μ -38%; 25% to -64%) following reformulation. While the number of A grade recipes remained the same, recipes with “Low” and “Medium” carbon grades B and C (B grades +7%, C grades +4%) and “High” carbon grade D recipes increased (+1%), “Very high” carbon E grade recipes (>1.2kg C02eq) decreased by 15%. For the nutrition analysis, there was a reduction in saturated fat content (μ -11%; 0 to +18g) and salt (μ -5%; 0 to +3.3g), whereas sugar increased after reformulation (μ + 16.3%; 0 to +32g). The Nutrition front of pack labels were impacted by reformulation; “red” labels decreased for salt and saturated fat, but increased for sugar (salt -17%; saturated fat -46%; sugar +50%), recipes labelled “amber” decreased for salt, but increased for saturated fat (salt -5%; saturated fat +6%; sugar 0%) and recipes labelled “green” increased for salt and saturated fat, but decreased for sugar (salt +7%; saturated fat +7%; sugar -1%).

Reformulation should consider multiple factors to ensure a net positive impact on environment and health. This analysis quantifies and provides insight into reformulation as a strategy in sustainable menu design. Quantifying impact may provide an evidence-based for food service reformulation strategies and targets. Future research should analyse additional factors such as cost and demographics, and in-depth statistical analysis.