Nutrition plays a pivotal role in health and disease prevention and management and through its interactions with social and personal factors, influences an individual's growth, development and life chances, as well as long-term health and longevity. These factors include amongst others, genetic inheritance, ethnicity, socio-cultural context, sex and gender. Although different interpretations exist, in general sex refers to the genetic, biological and physiological attributes that distinguish females, males and intersex whereas gender refers to socio-cultural and politically constructed roles and behaviours associated with a feminine, masculine or non-binary identity, which vary from society to society. Sex has implications for key biological processes involving food and nutrients as well as life-stage differences in nutritional requirements. Sex and gender may have implications in how individuals engage in different dietary behaviours and respond to nutrition interventions. The Irish Section Nutrition Society 2023 Conference sought to enhance understanding of the role of sex and gender in nutrition research; explore the influence of sex and gender on risk of non-communicable diseases and examine sex- and gender-specific considerations across the life course. This short editorial provides an overview and highlights of the conference.

The night-time economy contributed £93.7bn to the total UK economy in 2023(1) and relies on extensive employment of night workers. There is strong evidence to support the association between shift work, predominately involving night shifts, and adverse cardiometabolic health(2). However, there are limited evidence based dietary guidelines available for night workers or nutritional practitioners(3). Simulated shift work studies have significantly contributed to understanding how eating at night impacts physiology however, real world research is needed among shift workers. Engaging end users in research design is key to inform acceptable and feasible interventions.

The aim of the Eating on The Night Shift study (King’s College London Ethics:LRM-22/23-35745) is to understand how UK night workers view working at night in relation to nutritional health and wellbeing and the barriers and enablers to participating in nutritional research studies.

Semi-structured qualitative interviews were undertaken with a convenience sample (n=18) of UK night workers between June and September 2023. Interviews were held virtually and covered experiences of working night shifts, perceptions about night work and health, and perceptions of, and barriers and facilitators of engagement with, nutritional research. All interviews were audio recorded and transcribed verbatim. Transcripts were coded using an inductive thematic analysis approach to identify overarching themes and sub-themes(4).

Of the final sample 13 were female (72%), 39% worked a rotating shift pattern, 50% had worked night shifts for between one to three years and 39% were employed in the healthcare sector. Four overarching themes were identified 1) The consequences of night work on health and wellbeing: this theme included concerns about the impact on physical and psychological wellbeing and on cognitive function during night shifts, 2) Eating at night means a less healthy diet: this theme highlighted the concerns about less healthy diets at night and how night work impacts meal planning and eating patterns, 3) Working at night has wider knock-on effects: sub themes were related to the negative impact on physical activity, sleep and social networks and 4) Nutritional research is perceived as important but there are barriers – barriers discussed were related to workload and the ability to change eating patterns, identified enablers were clear study instructions and financial compensation.

The results suggest that night workers are aware of the negative long-term consequences working nights has on their health. Furthermore, efforts to maintain a healthy lifestyle are impeded by the nature of night work and its disruptions to the circadian rhythm. Although night workers support research to understand how diet during night work can impact long-term health, several barriers to taking part in research need to be considered in the design of research studies. This will ensure that studies are acceptable and feasible to the night shift population.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

The FAO states that the term food sovereignty focuses on food for the people by placing people’s need for food at the centre of policies and insists that food is more than just a commodity. Food Sovereignty also promotes knowledge and skills by building on traditional knowledge; using research to support and pass on this knowledge to future generations; and rejecting technologies that undermine local food systems. It is essentially a movement that “recognizes that control over the food system needs to remain in the hands of producers, and is clearly focused primarily on small-scale agriculture of a non-industrial nature, preferably organic”(1). In Māori terms, Kai Sovereignty is drawn first from the relationship of foods to our needs; it is expressed through whakapapa, and has an overarching contribution to food security. Traditional foods abound in Aotearoa. The relationships are longstanding, expressive and contribute to our wellbeing in various ways(2). But the true cultural value of traditional foods is diminishing as new foods, lifestyles and experiences succeed them. Kai sovereignty therefore is at risk of being relegated to historical discourse. The FAO acknowledgement of the intergenerational role of traditional knowledge to support food sovereignty aligns well to the Māori experience. This knowledge covers a myriad of food relationships including foraging, producing, harvesting, processing, cooking and manaakitanga. We are in a renaissance period that seeks to rediscover our relationship with the pātaka, the food store. So much knowledge has been lost, but much also remains. How we draw that together in a way that acknowledges the whakapapa or historical relationship alongside the present and future. The right to achieving kai sovereignty is yet to be properly understood within our communities. The first steps lie in the knowledge space; sharing and acknowledgement of our food traditions before they are lost or misinterpreted.

By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.

The fungal cell wall facilitates an immune response and may be involved in intestinal immune training (1,2). It is also fermentable by the gut microbiome, thus, consumption of fungi changes gut microbial ecology (3). Yet, the specific effects of consuming fungal foods on the gut mycobiota (i.e., gut fungi) have not been well studied. An interesting case study is mycoprotein, a fungal based protein produced from Fusarium Venenatum (4). We have previously reported that mycoprotein consumption attenuates faecal water genotoxicity, a surrogate marker of colorectal cancer risk, as well as modulates faecal metabolite excretion and gut bacterial composition (5). Here, we aimed to evaluate the impact of consuming a diet high in mycoprotein on gut mycobial ecology, and to explore relationships between mycobial composition and faecal genotoxicity.

Here we leverage stool samples from Mycomeat: a randomised crossover-controlled trial, recruiting 20 healthy male adults to adhere to 2-week diets comprising 240 g/day of mycoprotein based foods or red and processed meat, separated by a 4-week washout. Internal transcriber spacer (ITS) sequencing was performed to characterise the mycobiota. Alpha diversity before and after study phases was compared using Wilcoxon tests. Beta diversity was compared by permutational multivariate analysis of variance (PERMANOVA) based on Bay-Curtis dissimilarities. Differences in mycobial taxa within and between study phases were compared using Wilcoxon tests. Changes in mycobiota composition was then regressed against faecal excretion of metabolites using mixed- effects models to understand the impact of myco-ecology on the wider colonic environment. Finally, given the abundance of mycobial genotoxins in nature, we regressed mycobial taxa against faecal water genotoxicity.

There were significant shifts in the abundance of several taxa following both diets. Notably, mycoprotein consumption was associated with an increase in the abundance of Malasseziales sp. (P = 0.02) and a reduction in Candida Albicans (P = 0.01). Meat consumption was associated with an increase in Phaeoacremonium Tuscanum (P = 0.01) and Rhodotorula Mucilaginosa (P = 0.008), and reduction in Penicillium Commune (P = 0.02). In addition, Aspergillus Caesiellus was associated with lower faecal genotoxicity (P = 0.04), whereas Penicillium Commune (P = 0.04) and Penicillium Olsonii (P = 0.03) were both associated with higher genotoxicity. Regressing mycobial taxa against faecal metabolites revealed a number of significant associations, including between Penicillium Commune and austdiol, a putative mycotoxin (P < 0.001) as well as 1-methyladenine, a methylated DNA base with cytotoxic properties (P = 0.001).

The gut mycobiota is malleable through a fungi rich diet alongside changes within the wider microbiome. Members of the gut mycobiota predicted faecal genotoxicity and faecal excretion of toxins in this model, and there may be value in further exploring the gut mycobiota and the contribution of mycotoxins in gut health and colorectal cancer risk.

Pacific Island communities are disproportionally impacted by the effects of climate change, and as teina (younger sibling) to our Pacific tuakana (older sibling), it is our responsibility to ensure these communities have resilience through co-developed solutions to these real-world problems. We focus on marine and freshwater ecosystems, understand their intrinsic links to Pacific communities, while, in partnership with science, empower and enable local knowledge to steer the waka. With more than 20 years’ experience of supporting Pacific communities, we deliver our positive impact through knowledge exchange, capability and capacity development, and problem solving. We strive to learn and grow our own capability, while brokering knowledge between Aotearoa, the Pacific, and our world leading research partners. Our aim is that Pacific Island communities gain a deeper scientific understanding of their aquatic systems, have the tools to rejuvenate and conserve these ecosystems, are empowered to transform their food systems towards more healthy, sustainable, and resilient pathways, and can adapt to the impacts of climate change. We take a systems approach that incorporates adaptive solutions, which are community-led, thereby ensuring a long-lasting positive impact into the future. Our Kete is filled with world-leading expertise from different organizations, which ensures a greater collective impact where it is needed most. This presentation will cover the seven themes within our Pacific Impact area, with a particular focus on food safety and security in relation to ciguatera poisoning (the number one cause of non-bacterial seafood illness affecting Pacific Island communities) (1,2), analytical laboratory development, and transforming food systems.

Increasing the sampling resolution when examining plasma hormone and metabolite profiles will more accurately describe diurnal/circadian rhythms and expose previously undiscovered ultradian rhythms that underpin metabolic physiology(1). In human research studies this must be tempered by the practical, ethical and safety concerns of repeated cannulation/blood draws. Here we examine the correlation between hormone and metabolite profiles present in interstitial fluid microdialysate(2), and plasma to help solve this dilemma.

Hormonal markers of circadian phase (melatonin, cortisol) and metabolites will show similar profiles in plasma and interstitial fluid.

Compare time-series hormone and metabolite profiles collected in interstitial fluid using a novel ambulatory microdialysis collection device (U-RHYTHM) with simultaneously drawn plasma samples.

All study protocols were reviewed by Health Sciences Faculty Research Ethics Committee, University of Bristol. Fasted healthy male volunteers aged 18-35 (n=3) were fed a standardised breakfast (08:00), lunch (13:00), dinner (19:00) and snack (22:00) (2225kCal [83g protein, 273g carbohydrate, 83g fat, 27g fibre]). Participants remained on the study bed, lights off/sleep occurred between 23:00-07:00 (<4 lux).

A 20kDa cutoff 30 mm linear microdialysis membrane was placed in periumbilical subcutaneous tissue, perpendicular to the midline. The membrane was perfused at 1µl/min and the microdialysate collected every 20 minutes for 25 hours into discrete samples using a portable fraction collector (URHYTHM) worn around the waist. Time-matched blood samples were obtained from an antecubital fossa canula.

All samples were stored at -80°C prior to analysis. Hormones and metabolites were measured via targeted UPLC-MS/MS metabolomics, for the metabolites the AbsoluteIDQ® p180 kit (Biocrates Life Sciences AG)) was used with 10µL of plasma(3) and 15µL of microdialysate.

Simultaneous time-courses of n = 24 metabolites were detected in plasma and interstitial microdialysate: alanine, arginine, asparagine, citrulline, glutamine, glutamate, glycine, histidine, isoleucine, leucine, lysine, methionine, ornithine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine, valine, trans-4-Hydroxyproline, taurine, carnitine and acetylcarnitine.

Spearman rank cross correlation identified the time shift that was required to reach highest correlation between the plasma and microdialysate profiles. Excluding taurine, microdialysate profiles were delayed by 32.3 minutes (range 0-130) and 12.9 minutes (range 0-50) for participant 1 and 2, respectively (p <0.05), only 3/20 metabolite profiles were correlated for participant 3. Trans4-hydroxyproline had the strongest correlation (rs 0.890, 0.814 and 0.808), with only participant 3 displaying a time shift (50 minutes). Taurine had the weakest correlation in all 3 participants. (rs 0.096, 0.182, 0.325).

These data demonstrate that our novel approach can be used to comprehensively detect hormone and metabolite profiles in interstitial fluid. Thus, the U-RHYTHM would serve as a useful tool, not only to increase sampling resolution in controlled laboratory studies but would prove particularly useful for examining circadian/ultradian profiles for chronobiology and nutrition studies in free-living individuals.

This review presents evidence related to the postprandial responses after consumption of dairy products focusing on the effect of the dairy matrix and lipid response, which was also presented as part of a speech at the Nutrition Society Winter Conference, January 2023. The key findings are that the dairy product(s) that differentiate from others in the postprandial TAG response are products with a semi-solid structure. There were no differences in lipid responses between cheese and butter. The main factors viscosity, fat globule size and milk fat globule membrane do not seem to explain the effect of the dairy matrix in the acute postprandial response. In summary, it is very difficult to investigate the effects of the dairy matrix per see and with the few studies conducted to date, no clear cause and effect can be established. Future research should focus on the semi-solid dairy matrix, and studies investigating specifically the yoghurt matrix are warranted.

Atopic diseases, including asthma and eczema, represent a substantial public health problem in children and adolescents globally; asthma is the commonest chronic disorder of childhood(1). Research suggests that the origins of childhood asthma lie in utero, and several components of the maternal diet during pregnancy have been investigated in relation to atopic outcomes in children. Epidemiological evidence suggests that a higher intake of sugar during pregnancy is associated with a higher risk of childhood asthma and atopy(2,3). However, randomised trial evidence supporting such a link is lacking.

Aims

1. 1. To examine whether a low glycaemic index (GI) dietary intervention during pregnancy decreases the risk of asthma and eczema in childhood.

2. 2. To assess observationally whether maternal intake of sugar during pregnancy is positively associated with asthma and eczema in childhood.

This is a secondary analysis of children from the ROLO trial. Healthy women were randomised to receive an intervention of low GI dietary advice or routine antenatal care from early pregnancy. All women completed a 3-day food diary in each trimester of pregnancy. Estimates of maternal intake of sugar in each trimester were averaged to provide mean intakes during pregnancy. Mothers reported current doctor-diagnosed eczema in their children at 2-years of age (n=271), and current doctor-diagnosed asthma and eczema in their children at 5 (n=357) and 9-11 years (n=391) of age. Multivariable logistic regression models were used a) to test the effect of the intervention on child outcomes overall, and stratified by maternal education level (with, versus without, a complete tertiary level education), and b), in observational analyses, to analyse the relation between sugar and carbohydrate intake in pregnancy and child outcomes.

There was weak evidence overall for a reduction in asthma at 5-years of age in children whose mothers received the low GI dietary intervention during pregnancy compared to usual care [adjusted odds ratio (OR) 0.43 (95% CI 0.18, 1.03); P=0.06]. However, in stratified analyses the intervention was associated with a marked reduction in risk of asthma at 5-years of age in children born to mothers with lower educational attainment [adjusted OR 0.16 (0.03, 0.85); P=0.032]. Intake of sugar during pregnancy was positively associated with the development of asthma at any time point in childhood [adjusted OR per quartile of mean sugar intake 1.40 (0.99, 1.97), P-trend=0.048] and at 5-years of age [adjusted OR per quartile 1.55 (1.00, 2.40), P-trend=0.046]. No associations with eczema outcomes were found.

This novel study provides stronger evidence that higher sugar intake during pregnancy is associated with an increased risk of asthma among offspring. An intervention to reduce sugar intake in pregnancy may have potential as a primary prevention strategy, particularly amongst children born to mothers with lower educational attainment.

For some 20 years, science funding bodies have been asking for the integration of sex- and gender-related factors into the content of research and innovation. The rationale for those requirements has been the accumulated evidence that sex and gender are important determinants of health and disease. The European Commission (EC) has been the first, since 2002, to seriously ask for the integration of sex and gender into research and innovation in the context of their multi-annual framework programmes. When introduced, this condition was not immediately applauded by the research community, who perhaps lacked training in methods for the integration of sex- and gender-related factors. The EC Expert Group on Gendered Innovations sought to fill this gap. This review describes the work of this international collaborative project which has resulted in the development of general and field-specific methods for sex and gender analysis and 38 case studies for various research domains (science, health and medicine, environment, engineering) to illustrate how, by applying methods of sex and gender analysis, new knowledge could be created. Since 2010, science funding bodies in Canada, the USA and several EU member states have followed the example of the EC issuing similar conditions. Although the effects of nutritional patterns on a range of (physiological and health) outcomes may differ for men and women, sex and gender analyses are rarely conducted in nutrition research. In this review, we provide examples of how gender is connected to dietary intake, and how advancing gender analysis may inform gender-sensitive policies and dietary recommendations.

Reducing meat consumption is essential to curb further climate change and limit the catastrophic environmental degradation resulting from the current global food system. However, consumers in industrialised countries are hesitant to reduce their meat intake, often because they find plant-based foods less appealing. Despite the climate emergency, eating meat is still perceived as the norm, and recommended in most national dietary guidelines. To support the transition to more sustainable diets by providing insights for increasing the appeal of plant-based foods to mainstream consumers, this review presents recent research findings on how people think and communicate about meat-based and plant-based foods. The key findings we review include: (1) while vegans think about plant-based foods in terms of enjoyable eating experiences, omnivores think about plant-based foods in terms of health, vegan identity and other abstract information that does not motivate consumption in the moment. (2) Packages of ready-meals and social media posts on Instagram present plant-based foods with fewer references to enjoyable eating experiences than meat-based foods. (3) Presenting plant-based foods with language that references enjoyable eating experiences increases their appeal, especially for habitual meat eaters. This language includes words about sensory features of the food (e.g., crunchy, creamy), eating context (e.g. pub; with family) and immediate positive consequences of eating (e.g. comforting, delicious). In contrast, the term ‘vegan’ is strongly associated with negative stereotypes. Hence, rather than referring to being vegan, meat-free or healthy, the language used for plant-based foods should refer to sensory appeal, attractive eating situations and enjoyment.

Fructose-containing sugars can exaggerate postprandial lipaemia and stimulate hepatic de novo lipogenesis (DNL) when compared to glucose-based carbohydrates(1). Galactose has recently been shown to increase postprandial lipaemia compared to glucose(2), but mechanisms remain uncharacterised. The aim of this study was to assess the effect and mechanisms of lactose-induced lipaemia.

Twenty-four non-obese adults (12 male and 12 female) completed three trials in a randomised, crossover design (28 ± 7-day washout). During trials, participants consumed test drinks containing 50 g fat with 100 g of carbohydrate. The control carbohydrate was a glucose polymer (maltodextrin), the experimental carbohydrate was galactose-containing carbohydrate (lactose) and the active comparator was fructose-containing carbohydrate (sucrose). Hepatic DNL was assessed by the 2H2O method and [U-13C]-palmitate was added to the test drink to trace the fate of the ingested fat. Blood and breath samples were taken to determine plasma metabolite and hormone concentrations, in addition to plasma and breath 2H and 13C enrichments. Data were converted into incremental under the curve (iAUC) and were checked for normality by visual inspection of residuals. Differences between trials were assessed by one-way ANOVA. Where a main effect of trial was detected, post- hoc t-tests were performed to determine which trials differed from lactose according to the principle of closed-loop testing.

The plasma triacylglycerol iAUC (mean ± SD) in response to maltodextrin was 51 ± 68 mmol/L*360 min. Following lactose ingestion, plasma triacylglycerol iAUC increased to 98 ± 88 mmol/L*360 min (p<0.001 vs maltodextrin), which was comparable to sucrose [90 ± 95 mmol/L*360 min (p=0.41 vs lactose)]. Hepatic DNL in response to maltodextrin was 6.6 ± 3.0%. Following ingestion of lactose, hepatic DNL increased to 12.4 ± 6.9% (p=0.02 vs maltodextrin), which was comparable to sucrose [12.2 ± 6.9% (p=0.96 vs lactose)]. Exhaled 13CO2 in response to maltodextrin was 10.4 ± 4.1 mmol/kgFFM*360 min. Following ingestion of lactose, exhaled 13CO2 was 8.8 ± 4.9 mmol/kgFFM*360 min (p=0.09 vs maltodextrin), which was lower than sucrose [11.1 ± 3.9 mmol/kgFFM*360 min (p=0.01 vs lactose)].

These data are consistent with the hypothesis that hepatic de novo lipogenesis contributes to both lactose and sucrose-induced lipaemia and provide a rationale to investigate the longer-term effects of lactose and sucrose on metabolism.

This abstract was awarded the Student Competition prize.

Time-limited eating is a dietary intervention whereby calorie intake is limited to a specific window of time during the day(1). The usual eating windows (EW) of adults, and how this can be manipulated for dietary interventions, is well documented(2). However, there is a paucity of data on the usual EW of children and adolescents, which may be a useful intervention for reducing obesity.

The primary objective was to systematically review existing literature on the usual EW of children and adolescents. Secondary objectives were to identify average clock times of first and last food/drink intakes and also variations in EW and clock times by age, nationality or weight status subgroups, if available data allowed.

Two databases (Medline and Embase) were searched for eligible papers published between February 2013 and February 2023. Included papers were forward searched using the citation network on Web of Science. 6347 papers were identified, and after deduplication 4569 papers were screened by two independent reviewers. Methodological quality was assessed using a Joanna Briggs Institute checklist(3).

Ten studies were included, with both observational and experimental designs. These studies had a total population of 4,589 participants, with individual study sample sizes ranging from 22 to 2195. Ages of participants ranged from 6 – 20 years, with six studies involving adolescents alone (≥10 years), and four involving children and adolescents. There were four studies from the USA, two from Germany and one each from Brazil, India, The Netherlands and pan-European.

Narrative synthesis showed large variations in average eating windows from 9.7 to 16.4 hours. Only four studies included clock times of intake, with large variations in both first and last intake times. Five studies were included in a random-effects meta-analysis, in which heterogeneity was considerable (I2 = 95.8%), and pooled duration of usual daily eating was 11.3 hours (95% confidence interval (CI) 10.95, 11.73). Sources of heterogeneity included differences in study design and populations, variation in dietary assessments methods and definition of eating windows. Narrative synthesis of an adolescent sub-group showed eating windows increased as children got older. Four studies were included in a random-effects sub-group meta-analysis, with a pooled EW of 11.2 hours (95% CI 10.27, 12.05; I2 = 96.6%) in adolescents. Insufficient data prevented further subgroup analysis.

In conclusion large variations in eating windows exist across different study populations, with limited data available on first and last intake times; however, the pooled data suggest it may be possible to design time-limited eating interventions in paediatric populations aimed at reducing eating windows. Further high-quality research, of eating windows and associations with health outcomes, is needed.

The purpose of the present article is to describe the current state of sex and gender data collection in nutrition science research, discuss the effects of flawed data collection practices, highlight considerations for transgender and gender non-conforming populations and propose a sex- and gender-informed approach to human subjects research. Sex and gender are separate constructs that are often conflated in nutrition research and practice. Current nutrition surveillance programmes in the United States, United Kingdom and Ireland do not accurately capture sex and gender data, which undermines the accuracy of the analyses and excludes gender minorities. Transgender and gender non-conforming populations have distinct clinical and psychosocial nutrition considerations that require further research to inform nutrition policy and practice, such as anthropometric and biochemical changes with hormone therapy, eating disorders, food insecurity and nutrition as a source of empowerment or expression of gender identity. Researchers can apply a sex- and gender-informed approach to human subjects research by treating sex and gender as separate, relevant demographic data, appreciating gender as a fluid construct, and approaching data collection on gender minorities with sensitivity to privacy and confidentiality.

Food insecurity – when individuals or households have difficulty accessing sufficient, safe, culturally appropriate and nutritious food due to lack of money or other resources – is a global public health concern. Levels of food insecurity have increased across the UK in recent years, due in part to a decade of austerity, widespread loss of income during the COVID-19 pandemic and the more recent cost-of-living crisis, leading to rising use of food banks. The stress of living with uncertain access to food and going periods without food is damaging to physical and mental health. Food insecurity is linked to both obesity and malnutrition, as often the most readily available foods are processed, high in fats, sugars and salt, but low in essential nutrients for health. While recognising that many of the drivers of food insecurity, and health inequalities more broadly (i.e. the social determinants of health) lie outside the health service, it is increasingly acknowledged that the National Health Service – and primary care in particular – has a key role to play in mitigating health inequalities. This review considers the potential role of healthcare in mitigating food insecurity, with a focus on primary care settings. Recent initiatives in Scotland, such as community links workers and general practitioner practice-attached financial advice workers, have shown promise as part of a more community-oriented approach to primary care, which can mitigate the effects of food insecurity. However, a more ‘upstream’ response is required, including ‘cash first’ interventions as part of broader national strategies to end the need for food banks.

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the ‘dimensions’). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally.

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.

The circadian timing system regulates many aspects of metabolic physiology, including the postprandial response to meals(1). Experimental inversion of circadian and behavioural rhythms by 12 hours adversely effects markers of metabolic health(2). We investigated effects of a more modest 5hour delay in behavioural cycles.

Fourteen participants completed an 8-day in-patient laboratory protocol, with controlled sleepwake opportunities, light-dark cycles, and diet. The 5-hour delay in behavioural cycles was induced by delaying sleep opportunity. We measured: melatonin to confirm central circadian phase; fasting markers and postprandial metabolism; energy expenditure; subjective sleepiness; and appetite, throughout the waking period.

After the phase delay, there was slower gastric emptying at breakfast, lower fasting plasma glucose, higher postprandial plasma glucose and triglycerides, and lower thermic effect of feeding. Any changes were abolished or attenuated within 48-72 hours. Further, we show no difference in 16 h waking energy expenditure.

These data extend our previous findings, which showed no time-of-day effect on energy expenditure in healthy adults.

The trace element selenium is known to protect against oxidative damage which is known to contribute to cognitive impairment with ageing (1,2). The aim of this study was to explore the association between selenium status (serum selenium and selenoprotein P (SELENOP)) and global cognitive performance at baseline and after 5 years in 85-year-olds living in the Northeast of England.

Serum selenium and SELENOP concentrations were measured at baseline by total reflection X-ray fluorescence (TXRF) and enzyme-linked immunosorbent assay (ELISA), respectively, in 757 participants from the Newcastle 85+ study. Global cognitive performance was assessed using the Standardized Mini-Mental State Examination (SMMSE) where scores ≤25 out of 30 indicated cognitive impairment. Logistic regressions explored the associations between selenium status and global cognition at baseline. Linear mixed models explored associations between selenium status and global cognition prospectively after 5 years. Covariates included sex, body mass index, physical activity, high sensitivity C-reactive protein, alcohol intake, self-rated health, medications and smoking status.

At baseline, in fully adjusted models, there was no increase in odds of cognitive impairment with serum selenium (OR 1.004, 95% CI 0.993-1.015, p = 0.512) or between SELENOP (OR 1.006, 95% CI 0.881-1.149, p = 0.930). Likewise, over 5 years, in fully adjusted models there was no association between serum selenium and cognitive impairment (β 7.20E-4 ± 5.57E-4, p = 0.197), or between SELENOP and cognitive impairment (β 3.50E-3 ± 6.85E-3, p = 0.610).

In this UK cohort of very old adults, serum selenium or SELENOP was not associated with cognitive impairment at baseline and 5 years. This was an unexpected finding despite SELENOP’s key role in the brain and the observed associations in other studies. Further research is needed to explore the effect of selenium on global cognition in very old adults.