Digital health technologies delivering dietary and lifestyle advice1,2 may offer a contemporary approach to menopause symptom mitigation in a large population base3. This study aimed to evaluate alterations in both diet quality and menopause symptom burden following the implementation of an app-based, personalised dietary intervention in peri- and postmenopausal participants.

Baseline and follow-up data (mean follow-up time, 207 ± 72 days) on diet, menopause symptom number (from 20 vasomotor, sexual, psychological and somatic symptoms), symptom severity (0-not at all, 1-a little, 3-quite a bit and 5-extremely) and other characteristics of 4,287 UK based participants of the ZOE PREDICT 3 study (1,000 perimenopausal and 3,287 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICT-FFQ)2 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)4. A novel Menopause Symptom Tracker Score (MSTS 0-100, Copyright © 2024 Zoe Limited) was used to capture symptom number and severity.

There was a modest increase in diet quality after the intervention in both peri- and postmenopausal participants; mean HEI from 76.4 ± 8.4 to 79.7 ± 6.8 (P<0.001) and from 78.7 ± 7.8 to 81.1 ± 6.4 (P<0.001), respectively. Baseline MSTS was higher in peri- versus postmenopausal participants 28.9 ± 15.1 vs. 18.1 ± 15.0 (P<0.001). However, both groups showed a significant decrease in mean MSTS after the intervention compared to baseline; mean change (95%CI) in perimenopausal was -8.7 (-9.5, -7.9; 30.1% reduction) and in postmenopausal was -6.6 (-6.9, -6.2; 36.5% reduction) (P for both <0.001).

The reduction in the overall MSTS was greater in perimenopausal compared to postmenopausal (P<0.001). Reductions in domain-specific MSTS for peri- and postmenopausal groups respectively, were as follows: vasomotor −0.56 (−0.71, −0.40; 24.9% reduction) and −0.47 (−0.54, −0.41; 31.8% reduction), sexual −0.72 (−0.87, −0.57; 18.6%) and -1.08 (-1.16, −0.99; 28.7%), psychological -2.3 (-2.5, 2.0; 35.0%) and -1.2 (-1.3, -1.1; 44.2%), somatic -5.1 (-5.6, -4.7; 31.5%) and -3.8 (-4.0, -3.6; 37.5%) (P for all <0.001). The reduction in the psychological and somatic domain-specific MSTS was greater in peri-compared to postmenopausal group (P for both <0.001).

This study supports the potential of personalised app-based dietary interventions in the mitigation of menopausal symptoms during menopause transition and its potential to affect the health and quality of life of millions. Further studies should investigate their efficacy in a randomised, controlled dietary intervention setting.

The nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between early life nutrition and academic achievement in adolescence. The Pacific Islands families (PIF) birth cohort(1) were born in the year 2000. When their child was 6 weeks old mothers were asked questions concerning food security over the last year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). Records of academic achievement for 649 youth were obtained from the National Certificate of Educational Achievement database in 2019. Highest qualifications and a composite ranking score allowed achievement to be assessed at levels 1, 2 and 3 of NCEA and for University Entrance (UE, lowest to highest). More females (27%) than males (18%) achieved UE as their highest qualification and more males (40%) than females (31%) achieved level 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food secure households and 17% from food insecure households. Logistic regression demonstrated that being female increased the odds of achieving UE 1.8 fold and food security a further 1.6 fold. The prevalence of food insecurity was not different by sex but high at 29% and 42% using the PIF and MOH measure of food insecurity respectively. This work emphasises the importance of maternal and early life food security for subsequent academic achievement and the well-being of future generations.

The role of diet in the prevention and management of menopausal symptoms is poorly understood1,2. Digital health platforms have the potential to optimise collection of population-level menopause symptom data particularly in a rapidly changing environment2,3. This study explored the prevalence of menopause symptoms utilising data collection capabilities of a mobile app in a large population of peri- and postmenopausal women and to investigate novel associations between diet quality and symptoms.

Baseline data on diet, 20 menopause symptoms (i.e. 3 vasomotor, 3 sexual, 4 psychological and 10 somatic) and other characteristics of 70,412 participants of the ZOE PREDICT 3 app-based study in UK (n = 27,932 peri- and n = 42,480 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICTFFQ)4 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)5.

The burden of menopausal symptomatology was high; with 99.8% and 92.7% of peri- and postmenopausal participants reporting 1 or more symptoms respectively and 66.0% and 41.2% of peri- and postmenopausal participants experiencing >12 symptoms, respectively (P<0.001). Mean ( ±SD) symptom number was greater in the peri- versus postmenopausal group; 13.5±3.8, vs. 10.5±5.5 (P<0.001). HEI (mean±SD) was slightly lower in the peri- versus postmenopausal group; 73.9±9.7 vs. 76.6±8.9 respectively (P<0.001). Logistic regression analyses showed that a 20 unit increase in HEI was associated with reduction of 6%-37% and 12%-43% in likelihood of symptom presence (dependent on the symptom) in peri- and postmenopausal participants, respectively (P<0.05). ORs remained significant in adjusted models (for age, BMI, use of hormone replacement therapy, total energy intake and home environment (urban, rural) showing reductions of 7%-19% and 6-21%, respectively (P<0.05). Logistic regression analyses revealed that a similar increase in HEI (20 units) was associated with 17% and 19% reductions in the number of symptoms reported by peri- and postmenopausal women after multiple adjustments (P<0.05).

This large observational study confirms the high prevalence of menopausal symptoms among peri- and postmenopausal women and provides new evidence between adherence to healthy eating and reduced likelihood of menopausal symptoms, increasing the potential for symptom reduction by specific dietary approaches. Further studies should examine this relationship in longitudinal and dietary intervention settings.

Emerging evidence has indicated that perinatal exposure to low-calorie sweeteners (LCSs) might be associated with adverse pregnancy outcomes and offspring health(1). The aim of the study was to examine the patterns and predictors of LCS consumption among pregnant women in Australia. A web-based survey was conducted among 422 pregnant women aged 18-50 years between September and October 2022. Participants were recruited by a reputable consumer panel provider, Qualtrics. Sociodemographic, lifestyle, dietary intake (including LCS consumption), pregnancy-related characteristics, and participants’ awareness regarding the potential health effects of LCS were assessed. We assessed LCS consumption from twelve food groups that are common sources of LCS(2). To identify LCS consumption patterns and predictors of the patterns, a latent class analysis and hierarchical multinomial logistic regression was employed, respectively. The women’s mean (SD) age was 30 (4.6) years. Overall, 95% of the women reported consuming any LCS in the current pregnancy. Three different LCS consumption patterns were identified. Infrequent or non-consumers, representing 50% of the women, included those who rarely or never consumed LCS-containing foods and beverages (with a probability of less than 10%). The second pattern, moderate consumption, which encompassed 40% of the women, indicated low to moderate consumption of LCSs (for instance, the likelihood of consuming LCS-containing drinks ranged from 18% to 50%). The third pattern highlighted habitual consumption. These individuals (10%) had a high likelihood (ranging from 75% to 95%) of consuming foods from all food groups that contained LCS. The majority of women (71%) were unaware of the potential adverse effects of LCS, and only 25% expressed concerns about the potential impacts of LCS on their health and the health of their offspring. Moreover, women who frequently consumed sugar-sweetened beverages (SSBs) (≥2 times/week) or had gestational diabetes were over three times more likely to adopt a habitual LCS consumption pattern compared to those who consumed SSBs less often [adjusted relative risk ratio (aRRR) = 3.17, 95% CI: 1.39-7.21] and those without gestational diabetes [aRRR = 3.53, 95% CI: 1.03-12.10]. Additionally, having a medical condition was linked to a 55% lower chance of moderate LCS consumption compared to infrequent or non-consumption. These findings indicate LCS consumption is widespread, but awareness of its potential adverse health effect is low among pregnant women in Australia. Public health interventions to increase the awareness of potential adverse effect of LCS consumption, particularly among pregnant women with moderate and habitual consumption are warranted.

Evidence suggests that low carbohydrate eating patterns are effective for rapid weight loss 1, however, little is known about their long-term effects on the risk of chronic diseases. We assessed the association of a low carbohydrate diet score (LCD) with the incidence of type 2 diabetes using Melbourne Collaborative Cohort Study (MCCS) data. Between 1990 and 1994, the MCCS recruited 41,513 people aged 40 to 69 years. The first and second follow-ups were conducted in 1994-1998 and 2003-2007, respectively2. We analysed data from 39,185 participants. LCD at baseline was calculated as the percentage of energy from carbohydrate, fat, and protein. The higher the score the less carbohydrate contributed to energy intake. The association of LCD quintiles with the incidence of diabetes was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic and other confounders. LCD was positively associated with diabetes risk. Higher LCD score (p for trend = 0.001) was associated with increased risk of type 2 diabetes. Quintile 5 (38% energy from carbohydrates) versus quintile 1 (55% energy from carbohydrates) showed a 20% increased diabetes risk (incidence risk ratio (IRR) = 1.20 (95% CI: 1.05-1.37)). A further adjustment for BMI and WHR eliminated the association. Mediation analysis demonstrated that BMI attributed 76% of the LCD & diabetes association. Consuming a low carbohydrate diet, reflected as a high LCD score, may increase the risk of type 2 diabetes which is largely explained by obesity. Results imply the need for further studies, including clinical trials investigating the effects of a low carbohydrate diet in type 2 diabetes.

Plant-based dairy alternatives (PBDAs) consumption has assumed a more significant role in populations shifting to more sustainable eating habits. However, PBDAs do not necessarily replace the nutrient value of cow’s milk and dairy products, particularly that of essential micronutrients such as iodine(1). Cow’s milk and dairy products are the primary source of iodine in the UK diet(2), and substituting with PBDAs may negatively affect iodine intake. Here, we aimed to (i) investigate the implications for iodine intake and adequacy of partial replacement of milk, cheese, and yoghurt with commercially available PBDAs per UK Net Zero recommendations(3) and (ii) evaluate the potential of introducing bread products made using iodised salt as prophylaxis against iodine deficiency in population intakes due to the proposed changes.

The present study used the dietary modelling software DaDiet(4) to examine iodine intake in the diets of children aged 1.5-13 years and females aged 14-49 years. We used data from the National Diet and Nutrition Survey (2016-2019) and brand-level iodine concentration data(5). Firstly, several scenarios that accounted for the population impact of replacing 20% or 35% of milk and dairy product consumption with PBDAs were modelled. Secondly, we modelled the changes by substituting salt in bread with iodised salt at a 30 µg/kg concentration. Relative to the usual diet, we calculated the change in iodine intake and the proportion with intake below the UK Lower Reference Nutrient Intake (LRNI) or above the Upper Limit (UL).

Replacing 20% of dairy products with PBDAs would result in a meaningful decrease in usual iodine intake in all population groups, except females aged 14-18 years, without impacting the population proportion below the LRNI. A 35% replacement would result in a meaningful decrease in iodine intake (9-20%) compared to the usual diet for all population groups. A 35% replacement would also increase the proportion of females aged 19-49 years with iodine intakes below the LRNI to 21%. Adding iodised salt to bread products would increase the usual iodine intake across all population groups and decrease the proportion of intakes below the LRNI (2-14% change). Particularly for females aged 14-18 years, where 40% increases in iodine intake were observed (97 to 136 µg/day) and would not have a meaningful impact on the proportion above the UL in any population group.

Introducing iodised salt in bread products would counteract the negative effect of PBDAs on iodine intake in all population groups. Replacing milk and dairy products with PBDAs per current UK Net Zero goals would reduce population iodine intake unless measures are implemented to minimise the impact on usual iodine intake. Introducing iodised salt to bread products is one countermeasure that would minimise the impact on iodine intake without increasing the population above the UL.

Iodine is an essential trace mineral and a key component of thyroid hormones, which are essential during pregnancy and infancy for brain and neurological development(1). The main dietary sources of iodine in the UK are seafood and dairy products, particularly milk(2). Recently, plant-based alternatives to seafood and dairy products have increased in popularity, particularly among young adults(3). Unless adequately fortified, these alternatives have a lower iodine content than their animal-based counterparts(4). This is a concern because consumers of plant-based alternatives are exposed to highly variable products and might be at risk of iodine deficiency. The number of alternative products on the market is rapidly expanding. Therefore, we aimed to investigate changes in the iodine fortification of plant-based alternatives to milk, yoghurt, cheese, and fish between 2020 and 2023.

This study was a cross-sectional market survey of the eight leading UK supermarkets conducted in four annual waves (2020-2023) to evaluate the availability and composition of plant-based alternatives in the UK. The market was surveyed in December each year using online store data to search for plant-based products (milk, yoghurt, cheese, fish). Data was extracted from the product nutrition information and ingredient list.

We found a 49% increase in plant-based products over the four years. During the 2023 wave, we identified 446 products, including plant-based milk (n 241), yoghurt (n 79), cheese (n 97) and fish alternatives (n 29). The number of products has grown in all categories since 2020, with the largest increase of 141% in plant-based fish alternatives. After excluding organic products, which cannot be fortified, only 35% (n 70) of milk alternatives, 6% (n 4) of yoghurt alternatives and 3% (n 3) of cheese alternatives were fortified with iodine in 2023, compared with 85% (n 169), 52% (n 46), and 55% (n 52), respectively, with calcium. Compared with 2020, there was no significant change in the proportion of milk, cheese or yoghurt alternatives fortified with iodine in 2023 (p>0.05). No fish alternatives were fortified with iodine. The range of iodine fortification of milk alternatives remained stable from 2020 to 2023 (11.3–45 μg/100mL), and the mean fortification all four years (25.4-27.4 μg/100mL) was lower than the average iodine concentration of conventional cow’s milk (30 μg/100mL)(5). Yoghurt and cheese alternatives were fortified at 22.5–45 μg/100g, similar to cow’s milk cheese and yoghurts.

Our study highlights that most plant-based alternatives are not iodine-fortified and that using unfortified alternatives puts consumers at risk of iodine deficiency. Due to their increasing popularity, manufacturers of such alternative products should consider fortifying their products with an appropriate amount of iodine. Consistent and adequate fortification, accurate labelling and nutrition education are needed to help consumers make healthy and informed choices.

Stroke ranks as the world’s second leading cause of death and third in causing disabilities, a preventable disease affecting people of all demographics. Primary prevention is crucial to mitigate its impact by addressing modifiable risk factors such as poor diet, low physical activity (PA), obesity, smoking, high blood pressure (BP), elevated cholesterol, and blood glucose levels. This study evaluated quality of diet and other stroke modifiable risk factors among New Zealand (NZ) participants recruited at the baseline phase of the PERKS-International trial. PERKS is a Phase III, multicentre, prospective, pragmatic, open-label, single-blinded endpoint, two-arm randomised controlled trial conducted across Australia and NZ(1). Participants aged >35 and ≤75 years with ≥2 modifiable risk factors for stroke were assessed using the Life’s Simple 7 (LS7) score. LS7 includes seven components (BMI, BP, total cholesterol, blood glucose, dietary pattern, smoking, and PA) categorising into ideal, intermediate, and poor level. Height, weight, and BP were measured. Total cholesterol and blood glucose were measured via CardioChek PA Analyser. An online FFQ and Physical Activity Questionnaire were administered. Descriptive analyses and correlation coefficients were used to examine the characteristics of participants at the baseline. In NZ, out of 395 targeted participants, 375 (Female = 230, mean age = 57yrs) from diverse ethnic groups (NZ European = 204, Māori = 35, Pacific = 17) were recruited and assessed. Among LS7 metrics, smoking had the highest proportion of those in the ideal category (88%), followed by blood glucose (62%), total cholesterol (49%), dietary pattern (34%), BP (22%) and BMI (13%). Nearly 64% consumed <5 portions of fruits and vegetables per day. Almost half of the participants consumed beans and pulses less than once a week. About 43% and 31% consumed fibre-rich breakfast cereal and wholemeal bread less than once a week. Almost 10% drank fizzy drinks ≥4 times/week. Nearly 40% consumed sweets such as biscuits, cakes, and chocolate at least twice a week. Over half of the participants consumed red meat and chicken 2-3 times/week. In terms of other risk factors, over half of the participants were obese (BMI≥ 30 kg/m2). Only 12% were current smokers. About 10% drank alcohol 5-7 days/week. Physical activity expenditure (MET minutes/week) showed no significant sex difference. The LS7 factors correlated significantly were BMI and blood glucose (r = 0.157, p<0.01), total cholesterol and smoking (r=-0.129, p<0.01), BP and BMI (with a moderate correlation of r = 0.308, <0.001). The NZ participants in the PERKS-International trial, had poor diets, along with suboptimal lifestyle and biomedical stroke risk factors, reflecting the inclusion criteria for the study. Urgent action is required for the primary stroke prevention at population-level. The results of the trial, expected in 2024, will show the benefit of a mobile phone app on reducing these stroke risk factors.

Consumers are increasingly switching to plant-based dairy alternatives (PBDA) for environmental sustainability(1). Dairy products are important sources of protein, calcium, iodine, and vitamin B12 for the Irish population(2), whereas PBDA have variable nutritional composition. The aims of this study were to compare nutritional composition of PBDA marketed in Ireland with dairy counterparts; identify the most nutritionally equivalent plant-based beverage to dairy milk and compare the environmental impact of both.

A survey (online and in-store) of grocery outlets (92% of Irish market share) was conducted in summer 2023. Data collected included labelling information (brand, nutritional content, and organic status) of PBDA products; and micronutrients added to fortified low-fat dairy milks. The PBDA products were compared with the nutritional composition of counterpart dairy products, obtained using CoFID(3) and data collected. Greenhouse gas emissions (GHGe; kgCO2eq/100g) and water use (L/100g) in the production of dairy milk and the most nutritionally equivalent plant-based beverages were compared using Foodprint(4). SPSS (version 25) was used for statistical analysis.

Out of 214 PBDA identified, 72% (n153) were alternatives to milk, 14% (n30) to cheese and 14% (n31) to yoghurts. A total of 32% (n68) PBDA were unfortified (no added micronutrients) of which just over half (54%, n37) were labelled organic. Of the 153 PBDA to milk, 67% (n102) were fortified with at least one micronutrient. The most common fortification was calcium (65%, n100), followed by vitamin D (59%, n90). Iodine was added to 22% (n34) of products. Fortified plant-based beverages, compared with milk, provided lower amounts of calcium and iodine (115.7mg/100ml vs. 142.5mg/100ml; and 7.7µg/100ml vs 30µg/100ml for calcium and iodine respectively). PBDA to cheese (n30) were lower in energy, total fat and saturated fat compared with dairy cheese but contained low amounts of protein (0.8g/100g vs. 24.1/100g for PBDA and dairy counterparts respectively). Among PBDA to cheese, 60% (n18) were fortified; 37% (n11) with vitamin B12 and 30% (n9) with calcium. Unfortified products contained negligible amounts of micronutrients. Of the 31 PBDA to yoghurts, only soya-based (71%, n22) products were comparable to dairy yoghurts in terms of protein (4.0g/100g vs. 4.5g/100g, respectively). Coconut-based products (26%, n8) compared to dairy yoghurts provided over nine-fold higher saturated fat (6.7g/100g vs. 0.7g/100g, respectively). The majority (84%, n26) PBDA to yoghurts were fortified with calcium and one product was fortified with iodine. GHGe were lower for soya-based beverages compared to milk (0.09kgCO2eq/100g vs. 0.15kgCO2eq/100g, respectively), however water use was higher (29.7L/100g vs. 0.64L/100g).

Due to protein content, fortified soya-based products represent the best PBDA choices nutritionally in Ireland, where such beverages are environmentally comparable with dairy milk. Micronutrient fortification, in terms of nutrients and amounts added, was identified as a key factor in ensuring the adequacy of PBDA.

Including nuts in the diet has been associated with improvements in cardiovascular disease (CVD) risk factors including high blood pressure (BP) and hyperlipidaemia (1–2). However, few studies have investigated if the same benefits exist for medicated and unmedicated populations. This systematic review and meta-analysis investigated the effects of nut intake on BP and lipids, with a sub-analysis evaluating response differences according to BP and lipid-lowering medication usage. MEDLINE, EMBASE, Scopus and Web of Sciences databases were searched for randomised controlled trials (RCTs) of longer than 3 weeks duration that assessed the effects of whole tree nuts or peanuts on BP and lipid responses. The American Diabetes Association Quality Criteria checklist was used to assess the risk of bias, and studies with a negative rating were removed from the meta-analysis. A random-effects meta-analysis was conducted, with subgroup analyses performed based on medication use (medicated, unmedicated, unreported, and mixed-use). Inter-study heterogeneity was estimated using the I2 test statistic. Data from 107 articles describing 98 studies (61 parallel, and 37 cross-over designs) were included in the meta-analysis. Overall, significant benefits of nut consumption were observed for triglycerides (TG) (mean difference [MD]: −0.11 mmol/L, 95% confidence intervals [CI]: −0.16, −0.06, p < 0.01, I2: 32.95%), total cholesterol (TC) (MD: −0.15 mmol/L, 95% CI: −0.22, −0.08, p < 0.01, I2: 61.84%), and low-density lipoprotein cholesterol (LDL-C) (MD: −0.12 mmol/L, 95% CI: −0.19, −0.06, p < 0.01, I2: 52.7%), but not high-density lipoprotein cholesterol, systolic BP, or diastolic BP. Among unmedicated populations, nut intake resulted in a significant decrease in TG (MD: −0.16 mmol/L, 95% CI: −0.30, −0.03, I2: 75.93%), and TC (MD: −0.21 mmol/L, 95% CI: −0.39, −0.03, I2: 86.59%), while in those with unreported medication use, there were significant decreases in TG (MD: −0.08 mmol/L, 95% CI: −0.15, −0.01, I2: 0%), TC (MD: −0.15 mmol/L, 95% CI: −0.22, −0.07, I2: 0%) and LDL-C (MD: −0.12 mmol/L, 95% CI: −0.19, −0.06, I2: 0.44%). No significant effects were observed for BP and lipids in the mixed medication group. While there were significant improvements in lipid profiles overall with tree nuts and peanuts consumption, we observed no benefits for BP. Furthermore, significant beneficial effects on lipids were only observed in those with unreported and no medication use. Few studies investigated effects in medicated participants only (n = 1 study for lipids), and the precise proportion of medication use within the mixed medicated group remains unclear. Consequently, it remains uncertain whether the lipid-lowering properties of consuming nuts remain when hyperlipidaemia is managed with medications. Further studies are needed to explore the influence of medication in combination with dietary approaches on responses to additional CVD risk factors.

Animal foods, especially dairy products, eggs and fish, are the main source of iodine in the UK. However, the use of plant-based alternative products (PBAP) is increasing owing to issues of environmental sustainability. We previously measured the iodine content of milk-alternatives(1) but data are lacking on the iodine content of other plant-based products and there is now a greater number of iodine-fortified products. We aimed to compare: (i) the iodine concentration of fortified and unfortified PBAP and (ii) the iodine concentration of PBAP with their animal-product equivalents, including those not previously measured such as egg and fish alternatives.

The iodine concentration of 50 PBAP was analysed in March 2022 at LGC using ICP-MS. The products were selected from a market survey of six UK supermarkets in December 2021. Samples of matrix-matched (e.g. soya/oat) fortified and unfortified alternatives to milk (n = 13 and n = 11), yoghurt (n = 2 and n = 7) and cream (n = 1 and n = 5) were selected for analysis, as well as egg- (n = 1) and fish-alternatives (n = 10). We compared the iodine concentration between PBAPs and data on their animal-product equivalents(2).

The iodine concentration of fortified PBAPs was significantly higher than that of unfortified products; the median iodine concentration of fortified vs. unfortified milk alternatives was 321 vs. 0.84 µg/kg (p<0.001) and of fortified and unfortified yoghurt alternatives was 212 µg/kg vs 3.03 µg/kg (p = 0.04). The fortified cream alternative had a higher iodine concentration than the unfortified alternatives (259 vs. 26.5 µg/kg). The measured iodine concentration of the fortified products differed from that of the product label (both lower and higher); overall, the measured iodine concentration was significantly higher than that stated on the label (mean difference 49.1 µg/kg; p = 0.018).

Compared to the animal-product equivalents, the iodine concentration of unfortified PBAPs was significantly lower for milk (p<0.001) and yoghurt (p<0.001), while there was no difference with fortified versions of milk (p = 0.28) and yoghurt (p = 0.09). The egg alternative had an iodine concentration that was just 0.6% of that of chicken eggs (3.38 vs. 560 µg/kg). Three (30%) of the fish alternatives had kelp/seaweed as ingredients and the median iodine concentration of these products was (non-significantly) higher than those without (126 vs 75 μg/kg; p = 0.83). However, the iodine content of all fish-alternative products was ten-times lower than that of fish (median 99 vs. 995 µg/kg; p<0.001).

The majority of PBAP are not fortified with iodine but those that are fortified have a significantly higher iodine concentration than unfortified products and are closer to the value of their animal equivalents. From an iodine perspective, unfortified plant-based alternatives are not suitable replacements and consumers should ensure adequate iodine from other dietary sources. Manufacturers should consider iodine fortification of a greater number of plant-based alternatives.

People of Chinese ethnicity develop type 2 diabetes mellitus (T2DM) at a younger age and lower body mass index (BMI) than their Caucasian counterparts. Furthermore, Chinese migrants to Westernised countries have an increased risk of metabolic diseases compared to those in their country of origin(1,2). We propose that this increased risk is due to a greater manifestation of metabolic abnormalities in response to altered diet and lifestyle behaviours. Although fasting lipaemia and glycaemia are commonly used to predict risk of CVD and T2DM, assessment of impaired postprandial metabolism has been found to be a more sensitive indicator of risk(3). We hypothesised that Chinese migrants, at risk of T2DM, exhibit impaired postprandial lipid and lipoprotein metabolism compared to Australian-born Caucasian counterparts. Chinese and Caucasian adults at risk of T2DM were recruited to the study in which postprandial lipaemia and glycaemia were monitored following consumption of a high fat and high carbohydrate breakfast meal followed by a mixed, lunch meal. In a nonrandomised acute crossover trial, 15 adults (n = 8 Chinese and n = 7 Caucasian) aged ≥ 18 and ≤ 65 years at risk of T2DM (AUSDRISK score > 12 (median = 14.0, IQR = 3.0)), attended two postprandial test days separated by ≥ 7-day washout period. Test breakfast meals were isocaloric (3.6 MJ), high fat (46% energy from fat, 46% energy from carbohydrates) or high carbohydrate (74% E carbohydrates, 17.5% E fat). Blood samples were collected at baseline (fasting), 180 min and 360 min after consumption of the breakfast meal. The lunch meal (3.7 MJ, 18% E fat, 76% E carbohydrates) was consumed 240 min after baseline. Samples were analysed for lipaemia and glycaemia. Additionally, chylomicron-rich, and VLDL-rich lipoprotein fractions were isolated by sequential ultracentrifugation and chylomicron particle number (apolipoprotein (apo) B48), triacylglycerol (TAG), and total cholesterol were assessed in these fractions. Data were analysed using a mixed between-within-subject analysis of variance. There were no differences in age, and baseline anthropometric measures between groups, apart from the Chinese group exhibiting significantly lower waist circumference and BMI compared to the Caucasian group. There were no differences between groups in blood measures, apart from a higher total- and LDL-cholesterol concentration in the Caucasian compared to the Chinese group (P<0.05). Despite identical fasting TAG concentrations, the Chinese group, compared with the Caucasian group exhibited significantly elevated serum TAG and chylomicron-apo-B48 concentrations at 360 min following both test meals (P<0.01). All other postprandial measures were not different between groups. These findings show that despite having identical or improved fasting glycaemia and lipid profile, the Chinese group exhibited impaired postprandial lipid metabolism which may contributes to their increased risk of metabolic diseases.

Methods to reduce obesity and type 2 diabetes in Aotearoa New Zealand are desperately needed, with obesity one of the greatest predisposing factors for type 2 diabetes as well as heart disease, and certain cancers.1 A recent New Zealand report2 identified several interventions that might benefit people with established diabetes, the most promising being a period of rapid weight loss, followed by supported weight-loss maintenance. Such weight loss has shown to achieve what was previously thought impossible, diabetes remission,3 as well as appreciably reduce the risk of cardiovascular disease and prevent diabetes-related chronic kidney disease, retinopathy, nephropathy, and lower limb amputation.2 While the findings from the studies of low energy total meal replacement diets have stimulated great interest, their use in Aotearoa New Zealand has not been considered. The purpose of this primary-care led intervention therefore was to consider the acceptability and efficacy of such a weight loss programme, DiRECT, in Aotearoa New Zealand. Te Kāika DiRECT is a 12-month study conducted within a Māori primary healthcare provider in O¯tepoti Dunedin. The DiRECT protocol is three months of total meal replacement for rapid weight loss followed by food reintroduction and a longer period of supported weight loss maintenance. Participants were adults with prediabetes or T2 diabetes and obesity wanting to lose weight. Twenty participants (70% female, age 46 (SD 10), BMI 41 (9), HbA1c 51 (11)) were randomised to receive the DiRECT protocol, twenty more (70% female, age 50 (SD 8), BMI 40 (7), HbA1c 54 (14)) were randomised to receive best practice weight loss support (usual care). All participants had the same number of visits with the in-house Dietitian and free access to the onsite gym. Participants in the control group also received regular grocery vouchers to purchase the foods encouraged by healthy eating guidelines. Recruitment began in February, 2022. After the initial three month study period, DiRECT participants reported consuming 3.0MJ (95% CI 1.2 to 4.8MJ) less energy per day than those in usual care. Mean weight loss was 6kg (2.3-9.6kg) greater for DiRECT participants than usual care participants, while medication use and systolic blood pressure (12mmHg (0-24mmHg)) were lower. Continuous glucose monitoring identified that at baseline, participants on average only spent 10% of the day with a blood glucose reading under 8mmol/L (normoglycaemia). After three months, the usual care group spent on average 48% of the day within the normoglycaemic range, while DiRECT participants spent 78% of the day within the normoglycaemic range. Results at 12 months will enable comment on longer term markers of blood glucose control (HbA1c) and diabetes remission rates, as well as indicate if the body weight, medication, and blood pressure improvements observed at three months are sustained.

There is uncertainty about the impact of replacing meats by dairy products (milk, yogurt, cheese) on the risk of coronary heart disease (CHD)(1,2). Our objective was to examine the modelled replacement of red meat (unprocessed), processed meat, and poultry meat by milk, yogurt, and cheese in relation to CHD incidence in the UK adult population.

Prospective longitudinal data were used of 117,216 participants in the UK Biobank Study, who were free of CHD at entry, had completed at least two 24hr dietary assessments and had complete covariate data. We modelled the replacement of 1 serving of red meat (unprocessed) (100 g/d) or processed meat (50 g/d) or poultry meat (100 g/d) by 1 serving of milk (200 g/d), yogurt (120 g/d) and cheese (30 g/d). These portion sizes were chosen based on previously reported portion sizes(3). Information on the incident cases of non-fatal or fatal CHD events were obtained from hospital inpatient admissions and death registries. The hazard ratios (HR) and 95% confidence intervals (CI) were derived from Cox regression models and multivariable adjustments included sociodemographic, lifestyle, family history, total energy, dietary factors, and BMI.

In our study population, 57% were female. The mean ± SD was 56 ± 7.8 years for age and 26.6 ± 4.6 kg/m2 for BMI. During a median follow-up of 11 years, a total of 7060 cases of incident CHD were found. There was a lower risk of CHD for the modelled replacement of 1 serving of red meat (unprocessed) by 1 serving of cheese (HR: 0.90; 95% CI: 0.84, 0.97), but not by milk (0.93; 0.87, 1.00) or yogurt (0.94; 0.87, 1.02). Similarly, replacement of 1 serving of poultry meat by 1 serving of cheese was associated with lower risk of CHD (0.92; 0.85, 0.98) and no significant associations were observed with replacement by milk (0.97; 0.90, 1.04) or yogurt (0.98; 0.90, 1.05). Replacing 1 serving of processed meat by 1 serving of milk (0.92; 0.87, 0.97), yogurt (0.93; 0.87, 0.99) or cheese (0.87; 0.82, 0.92) was associated with lower CHD incidence.

Our study findings support current recommendations for CVD prevention of limiting intake of meats, especially processed meat. Data suggest benefits of dairy foods, in comparison with meats, for reducing the risk of CHD. These findings should be replicated in other cohorts with different intake ranges.

Dairy foods offer essential nutrients and bioactive compounds crucial for growth and development(1), as such they are an important component of a balanced diet. However, despite their benefits, the consumption of dairy has declined in recent years, especially among adolescents(2–4). In this regard, this study aims to evaluate the nutritional contribution of dairy intakes to the diets of adolescents in Ireland.

Analyses were based on data from the nationally representative National Teens’ Food Survey II (NTFS II; 2019-2020) in Ireland (www.iuna.net) (n = 428; 13-18yrs, 50% female). Food and beverage intake data were collected using a four-day weighed food diary. Dairy intake was classified as the intake of milk, yogurt and cheese and calcium fortified non-dairy alternatives in line with the Irish food based dietary guidelines. Whole foods that contain milk, cheese and yogurt and any relevant dairy components of composite dishes were included in the estimation of dairy intakes. Diet quality was assessed using the Diet Quality Index for Adolescents(5). Descriptive statistics and covariateadjusted univariate general linear models were used to analyse dietary intakes. Trend analysis was conducted to identify patterns in nutrient intakes and anthropometric measurements across tertiles of dairy intake.

Overall, 98% of Irish adolescents consumed dairy products and the mean daily total dairy intake was 245 ± 227 g/d, with males having higher intakes per day compared to females (319 ± 272g/d vs 171 ± 152g/d respectively). The average daily servings of dairy were 1.9 servings/d, with only 4% of teenagers achieving the recommended intake of 5 servings of dairy per day. Dairy contributed to the majority of nutrients investigated and was a high contributor to intakes of micronutrients calcium (36%), vitamin B12 (31%) and iodine (49%). Higher consumers of dairy had significantly greater mean daily intakes of protein, total sugar, saturated fat, trans fat, folate, vitamin B12, calcium, iodine, magnesium, potassium, and phosphorus compared to those in the lowest tertile of dairy intake (p <0.001). Higher consumers of dairy also had an overall higher diet quality compared to low consumers (48.0 versus 39.4%; p <0.001). No differences were noted in body weight, body mass index, percentage body fat or waist and hip circumference across tertiles of dairy consumption.

In summary, while almost all Irish adolescents consumed dairy, only 4% achieved the recommended 5 servings of dairy per day. In those consuming higher amounts of dairy, a significantly higher diet quality was observed. While this study offers valuable insights into adolescents’ intake of dairy products, its cross-sectional nature highlights the need for continued monitoring of dairy consumption patterns and nutrient intakes in this population, particularly due to the observed decline in dairy consumption noted in this age group across Europe.

The UK Diabetes Remission Clinical Trial (DiRECT) demonstrated that a weight loss strategy consisting of: (1) 12 weeks total diet replacement; (2) 4 to 6 weeks food reintroduction; and (3) a longer period of weight loss maintenance, is effective in reducing body weight, improving glycaemic control, and facilitating type 2 diabetes remission(1). The DiRECT protocol is now funded for type 2 diabetes management in the UK(2). Type 2 diabetes is a growing problem in Aotearoa New Zealand(3), but the acceptability and feasibility of the DiRECT intervention in our diverse sociocultural context remains unclear. We conducted a randomised controlled trial of DiRECT within a Māori primary healthcare provider in O¯tepoti Dunedin. Forty participants with diabetes and obesity who wanted to lose weight were randomised to receive the DiRECT intervention or usual care. Both groups received the same level of individualised support from an in-house dietitian. We conducted individual, semi-structured interviews with 26 participants after 3 months. Questions explored perspectives and experiences, barriers and facilitators, and future expectations regarding dietary habits and weight loss. Interview transcripts were analysed using inductive thematic analysis(4). Participants struggled with weight management prior to the study. Advice from doctors, friends and whānau, and the internet was prolific, yet often impractical or unclear. The DiRECT intervention was mentally and physically challenging, but rapid weight loss and an improved sense of health and wellbeing enhanced motivation. Participants identified strategies which supported adaptation and adherence. Food reintroduction beyond 3 months was an exciting milestone, but the risk of reverting to previous habits was daunting. Participants feared weight regain and felt ongoing guidance was required for a successful transition to a real-food diet. Conversely, usual care participants described a gradual and ongoing process of health-focused dietary modification. While this approach did support behaviour change, a perceived slow rate of weight loss was often frustrating. Across both interventions, self-motivation and whānau support contributed to perceived success, whereas busy lifestyles, social and cultural norms, and financial concerns presented additional challenges. The role of individualised and non-judgemental dietetic support was a central theme across both groups. In addition to nutrition education and practical guidance, the in-house dietitian offered encouragement and promoted self-acceptance among participants. At 3 months, positive shifts in perspectives surrounding food, health, and sense of self were identified, which participants largely attributed to the level of nutrition support received: a new experience for many. The DiRECT protocol appears an acceptable weight loss approach among New Zealanders with diabetes and obesity, but tailored dietetic and behavioural support must be prioritised in its implementation. Future research should examine the broader health benefits associated with providing greater dietetic support and the cost-effectiveness of employing nutrition-trained health professionals within the primary care workforce.

Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305 Australia.Cardiovascular disease (CVD) remains a major cause of global mortality. Poor diet quality, characterised by excessive consumption of energy-dense, nutrient-poor foods and insufficient intake of fruits, vegetables, and whole grains, is associated with an increased risk of CVD(1). This study compares the impact of two short-term dietary interventions, a Healthy Australian Diet adhering to national guidelines and a Typical Australian Diet representing current national consumption patterns, on several cardiometabolic outcomes. These outcomes include body weight, waist circumference (WC), body fat percentage (BFP), blood pressure (BP), fasting blood lipids and glucose concentrations. Data from an eight-week randomised, cross-over feeding study involving 34 adults (53% female, age 38.4 ± 18.1 years) were analysed, with participants randomly assigned to consume each diet for two weeks, separated by a two-week washout period. During each feeding phase, all food items were provided to ensure compliance. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3), with saturated fat limited to ≤10% of energy. The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4), setting total fat intake at 40% of energy and total saturated fat at 15% of energy. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Trained personnel measured WC using a tensible tape, while body weight and BFP measurements were obtained using bioimpedance analysis (Inbody 270; Biospace Co, Seoul, Korea). Blood pressure was recorded using the Uscom BP+ supra-systolic oscillometric central blood pressure device. Blood glucose and lipid (triglycerides, total-, low-density lipoprotein- [LDL] and high-density lipoprotein- [HDL] cholesterol) concentrations were measured after a 12-hour fast by an accredited pathology service. Differential changes in cardiometabolic variables between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. There were no significant differences between the Healthy Australian Diet and the Typical Australian Diet with respect to weight, BFP, WC, blood triglycerides, systolic and diastolic BP. However, the Healthy Australian Diet led to a significantly greater decrease in total-, LDL-, HDL- and non-HDL cholesterol, and fasting blood glucose relative to the Typical Australian Diet (p<0.001). The results underscore the importance of promoting dietary intakes that align with Australian Dietary Guidelines for optimising the risk of CVD and impaired glucose tolerance. Conversely, the Typical Australian Dietary pattern demonstrated detrimental cardiometabolic effects over a short period of just two weeks.

Despite national dietary guidelines, dairy intakes remain low in China, partially because of high prevalence of lactose malabsorption1. The fibre intake adequacy is also low comparing to the recommendation in China2. Milk-N is a new range of fortified and non-fortified low-lactose/highfibre milk products. In this study we analyzed the associations between consumption of Milk-N products and nutritional status using diet modelling3.

We used data from China Health and Nutrition Survey-20114, participants above 20y were included in the analysis (n = 12127, 47% men, 53% women). Nutrient intakes were estimated through 3 days dietary record and household food inventory. Two diet scenarios were modelled: A) Adding a serving (200ml) of generic milk or of Milk-N to participants not meeting the dairy recommendation, and B) Substituting dairy food intakes with Milk-N in equivalent amount for dairy consuming participants. Paired t-test and Pearson’s Chi-squared test were used to compare the amount of intake and prevalence of nutrient intake adequacy between the two types of addition, and before and after the substitution.

Overall, 17.4% of participants consumed dairy foods with an average intake of 160.5g/day, among those 81.2% consumed milk. Only 1.1% of the population met dairy intake recommendations.

In the addition scenario, compared to the addition of generic milk, adding one serving of fortified or non-fortified Milk-N increased fibre intake by 25-35% (from 17.6g/day to 22-23.8 g/day), leading to increased fibre intake adequacy from 16.4% to 27.0-32.8%, i.e. 65-100% increase. Addition of fortified Milk-N improved daily average intakes of calcium, iron, zinc, vitamins A and C by 27-31%, 9%, 8%, 3%, and 16%, respectively. Consequently, the proportion of the population with inadequate intakes decreased (p<0.01) for generic milk vs fortified Milk-N as follows, for calcium (66.3% vs. 23.4-29.6%), iron (5.5% vs. 2.2%), zinc (28.1% vs. 18.9%), vitamin A (61.7% vs. 52.7%) and vitamin C (62.4% vs. 51.5%).

In the substitution scenario, replacing current dairy food intake with fortified or non-fortified Milk-N increased fibre intake by 20-27% (from 18.4 to 22.0-23.4g/day), leading to increased proportion of dairy consumers with adequate fibre intake from 18.7% to 28.2-32.3%, i.e., 51-73% increase. Substitution with fortified Milk-N improved intakes of calcium, iron, zinc, vitamins A and C by 2327%, 7%, 7%, 10%, and 12%, respectively. Consequently, the proportion of dairy consumers with inadequate micronutrient intakes significantly decreased (p<0.01) for calcium (from 72.9% to 50.353.3%), iron (from 7.5% to 4.7%), zinc (from 33.0% to 26.1%), vitamin A (from 56.9% to 47.4%), and vitamin C (from 60.2% to 50.8%).

In addition to the reduced lactose that helps to address lactose malabsorption, consumption of any Milk-N alternative could improve fibre intake, while fortified Milk-N could also contribute to reducing micronutrient inadequacies in Chinese adults.

Cows’ milk (CM) and plant-based beverages (PBB), used as milk alternatives, are not nutritionally equivalent(1) and PBB composition is highly varied(2). However, assessing the potential nutritional risk for UK populations after dietary replacement of milk with PBB is challenging, because analytical determination of PBBs’ nutrient profiles is lacking(3). This study determined and compared the mineral concentrations of milk and PBB in the UK market.

Ultra-heat treated and pasteurised samples (n = 178), including 20 brands of semi-skimmed milks and 69 brands of fortified PBBs (based on almond (17; ALMO), coconut (14; COCO), oat (19; OAT) and soya (20; SOYA)) were collected in summer 2023 and winter 2024. All PBB samples had added Ca and Na, but only 62 were fortified with I. Minerals concentration was determined using microwave assisted digestion, inductively coupled plasma-optical emission spectrometry (for microminerals) and inductively coupled plasma and mass spectrometry (for trace elements and heavy metals). Data were analysed using Minitab®22.1, with linear mixed effects models using ingredient, thermal treatment and season, and their interactions, as fixed factors, and brand ID as a random factor.

The main ingredient affected all mineral concentrations (p<0.001), except Ca and Co. SOYA had more Mg than milk (+27.5mg/kg), and milk had more Mg than ALMO, COCO, and OAT (+41.783.3mg/kg). Milk and SOYA had more P and K than other PBB (P, +411 mg/kg and +381mg/kg; K, +920 mg/kg, and +631 mg/kg, respectively). Milk had less Na than PBB (-126-64 mg/kg) with the exception of COCO. Milk contained more I (+157-200.4 µg/kg) and Zn (+1.41-3.71 mg/kg) than PBB. SOYA contained more Cu, Mg, and Mo than other PBB (for Cu 65-70 mg/kg; for Mn +1.00-1.06 mg/kg; for Mo +46-93.5 µg/kg, respectively) and milk (Cu +0.77 mg/kg; Mn +1.44 mg/kg; Mo +84.1 µg/kg). Overall, SOYA contained the most Cd, Cr, and Ni (although difference to OAT was not significant for Cr and Ni), while milk had the lowest concentration of Cd. Concentrations of Mg, P, Cu, I, Mn, Mo, and Co varied according to season (P<0.05). When compared with summer, winter PBB and milk had more Mg (+4.4 mg/kg), Cu (+0.04 mg/kg), I (+41 µg/kg), and Mo (+9.8 µg/kg), but less P (-76 mg/kg), Mn (−0.08 mg/kg), Zn (−0.21 mg/kg), and Co (-5.21 μg/kg). There were no differences in mineral concentrations due to thermal processing (UHT, pasteurisation; P>0.05).

The minerals composition of fortified PBB varied between main ingredient, and compared to milk, and seasonal variation was high. To prevent micronutrient inadequacies from the substitution of milk for PBB (in particular for I and Zn), consumers should be aware of differences in the intrinsic nutrient composition between PBB derived from different ingredients and milk, as this study showed and adopt suitable dietary and supplementation adjustments.

Obesity and COVID-19 are global pandemics listed by World Health Organization, which need urgent attention. Obesity involves low grade chronic inflammation, which is characterised by sustained pro-inflammatory innate immune responses mediated through activation of the NLR family pyrin domain-containing 3 (NLRP3) inflammasome/IL-1 axis, and is a strong risk factor for Diabetes and Heart diseases(1). Dietary fats provide energy, satiety, source of fat-soluble vitamins and essential fatty acids – Omega 3 (n-3) and Omega 6 (n-6) fatty acids, but must be consumed in right amounts and ratios. Essential fatty acids (EFA) deficiency and n-6/n-3 imbalance is linked with chronic illnesses such as, heart attacks, cancer, insulin resistance, stroke, obesity, and diabetes(2). Excess dietary fat intake and imbalance of fatty acids, contribute to obesity, inflammation, comorbidities and faster disease progression. A cross-sectional survey aimed to understand the fatty food frequency of overweight and obese middle age adults from Mumbai, India during the COVID-19 outbreak. Using purposive sampling, 100 adults (30-60 years), a questionnaire (demographics, anthropometrics and fat food frequency questionnaire) was administered. Data was analysed using SPSS 26.0. As per BMI standards, 60.2% participants were overweight, 12.6% were obese and 27.1% had normal BMI. For visible fat consumption, sunflower oil (47.6%), ghee (38.8%), rice bran oil (34%) groundnut oil (11.7%) and invisible fats – milk (100%). Other dairy products, nuts and oilseeds were consumed weekly. twice a week, majority (92.3%) consumed packaged high fat foods as compared to eating deep-fried items (58.9%). We concluded that excess dietary fat intake is high risk factor for obesity and related comorbidities diabetes, and hypertension. High BMI increases the risk for non-communicable diseases (NCDs) such as obesity, cardiovascular disease (CVD), insulin resistance and type 2 diabetes. People with co-morbidities are high risk groups for COVID-19 infection susceptibility. Hence, managing weight could be a cost-effective preventive strategy to help in delaying the onset and progression of NCDs, thereby lowering the susceptibility to COVID-19. Our findings have important implications in working towards adopting healthy fats and reducing mortality and reducing the global burden of pandemic. High dietary fat intake is a modifiable risk factor for overweight and obesity. Comorbidities increased risk for COVID-19 infection, disease severity and mortality. Hence, there is a need to understand the dietary fat consumption patterns in obesity and COVID-19. Dietary carbohydrate, sugar and fat quality in relation to obesity and pandemic such as, COVID-19 could be explored in future studies.