Osteoporosis is a degenerative disease of the bone. The rate of bone loss is accelerated during the first postmenopausal years in women which results in their disproportionate prevalence of osteoporosis(2). Some of the factors contributing to the development and maintenance of bone mineral density (BMD) relate to diet, particularly the intake of protein, calcium and other micronutrients that play a crucial role in bone composition(3). The most common method of measuring BMD is dual-energy X-ray absorptiometry (DXA) which generates a two-dimensional image of the scan site (typically spine, hip and/or forearm) to determine areal BMD (aBMD). However, new methods have recently emerged, including High Resolution peripheral Quantitative Computed Tomography (HRpQCT), that offer more accurate three-dimensional measurements of volumetric BMD (vBMD) and microstructure of distal tibia and radius(4). The aim of this study was to examine the differences in the dietary intake of nutrients that represent organic or inorganic components of the bone, in early postmenopausal women with different spine aBMD and tibia and radius vBMD levels. One hundred and fourteen healthy early postmenopausal women with a lumbar spine or total hip BMD T score > −2.5 (measured by DXA) were recruited as part of a larger interventional study. Dietary intake was recorded using a 297-point self-reported validated food frequency questionnaire(5) for assessing the intake of energy, macro and micronutrients. Physical activity was self-reported using the validated Active Australia Questionnaire. Years since menopause were self-reported. DXA and HRpQCT scans measured L1-L4 spine, proximal femur aBMD, and distal tibia and radius vBMD respectively. Non-parametric statistical tests examined differences in dietary intake and physical activity levels between women at different levels of aBMD and vBMD. Data reported as median and interquartile ranges. There were no significant differences observed in the total sample between tertiles of aBMD and vBMD, regarding nutrient intake. However, for women with less than 3 years since menopause (i.e., the time-period of accelerated bone loss), lower dietary intakes of energy [8,658(3,324) vs 10,068(3,688) kJ/day; p = 0.047], protein [94(29) vs 103(32) g/day; (p = 0.044)], sodium [1,927(992) vs 2,625(2,185) mg/d; (p = 0.044)], potassium [4,064(1,373) vs 5,121(2,377) mg/d; (p = 0.041)], calcium [969(325) vs 1,214(652) mg/d; (p = 0.028)] and zinc [10(3) vs 12(4) mg/d; (p = 0.005)] were observed for women with osteopenia (−1< L1-L4 aBMD T-score <2.5) compared to those with normal L1-L4 aBMD (i.e., T-score > −1). No significant differences were observed for women with more than 3 years since menopause, with the only exception of alcohol intake (p = 0.033), which was found to be lower in women with osteopenia compared to those with normal aBMD. These findings highlight the importance of targeting osteopenic women within the first 3 years following menopause as candidates for tailored dietary intervention programs for preventing osteoporosis.

Complementary feeding describes the transition from milk feeding to family foods or ‘solids’ and should occur around six months of age(1). Diet in the early years can influence health in later life by shaping food preferences1 and may increase the risk of obesity and metabolic disorders later in life(2,3). Parents can find the period of complementary feeding stressful due to experiencing a lack of support for parents during this stage(4). This study investigated how parents of infants under two years of age engaged with information about complementary feeding using qualitative methods informed by critical realism and information behaviour theories.

Dyadic, semi-structured interviews were conducted with parents of infants aged four to twentyfour months in southwest England to explore their information needs. Interviews were conducted in person or online at the convenience of the participant. Data were recorded and transcribed verbatim and analysed using thematic analysis.

Ten interviews were conducted and four overarching themes were identified:

1. 1) “I don’t really remember them giving advice about weaning”

Although parents initially relied on NHS resources, gaps led them to seek additional guidance from online platforms or commercial sources. They required both practical support for infant feeding but also emotional support as transitioning onto solids could be a stressful experience.

1. 2) “Just done what you’re expected to do”

Parents’ perceptions of societal expectations regarding infant feeding could influence their feeding practices. This sometimes conflicted with their knowledge of complementary feeding, leading to dual beliefs and behaviours, such as altering feeding behaviours in public to adhere to social norms.

1. 3) “This is what works for us”

Parents found that following complementary feeding guidance was challenging. Many parents followed their child’s appetite and discussed finding balance in their children’s diets. Parents also referred to balancing the idealised version of complementary feeding they strived for while remaining realistic to practicalities.

1. 4) “I had done the research and he just kinda went along with it”

Complementary feeding practices were linked to perceptions of good parenting. Mothers, in particular, adhere to societal norms and ideals of infant care, which influenced their informationseeking patterns. This adherence to societal constructs often resulted in gendered disparities, with mothers primarily responsible for seeking information while fathers played a supportive role.

Findings suggest that current services are not meeting parents’ information needs about complementary feeding. Accessible information from credible sources is required to enable parents to make informed feeding decisions and to follow them confidently during the critical phase of complementary feeding. Policymakers should address the impact of social media and commercial baby food companies, considering parental emotional well-being and ensuring information accessibility regardless of gender.

Inadequate dietary intakes are widespread amongst pre-school aged children, with 56% of preschool children worldwide suffering from a deficiency in at least one of iron, zinc or vitamin A(1). The neurological and physical development of children is sensitive to changes in micronutrient status, with nutrient deficiencies at this age likely to have irreversible effects on childhood development(2). This study aims to evaluate the major influences on the dietary patterns, feeding practices and eating behaviours of young children in Ireland.

A self-administered, web-based survey was administered to parents/guardians of 18-36 months old children. The survey consisted of 103 questions, delivered across 5 sub-sections (demographics, parental nutrition knowledge, feeding practice, barriers to healthy eating and dietary patterns). Validated questionnaires were used to assess fussy eating (Child Eating Behaviour Questionnaire, CEBQ) and parental feeding practice (Child Feeding Questionnaire,

CFQ)(3–5). Adherence with the 2020 FSAI Scientific Recommendations for Food-Based Dietary Guidelines for 1-5-Year-Olds in Ireland was evaluated using FFQ-style questions to estimate consumption patterns of food groups.

Parents/guardians (n = 1141) answered with respect to 608 male and 529 female toddlers, with a mean ( ± SD) age of 26.2± 5.8 months. The greatest barriers to healthy eating reported by parents/guardians were food fussiness (49%), time to prepare healthy foods (47%), provision of unhealthy foods by caregivers outside the home (47%), the short shelf life of “healthy foods” (42%) and the marketing of unhealthy foods to children (42%). The children’s food pyramid was recognised by 76% of parents. A large number of toddlers met the FSAI’s dietary recommendations for consumption of fish (70%) and fruit and vegetables (97%). Fewer children met the FSAI’s recommendations for consumption of processed meat (24%), beverages (40%), red meat (52%) and confectionary (57%).

Using the CEBQ food fussiness scale, 36% had a score indicative of moderate to severe fussy eating (Score ≥ 3). Higher levels of food fussiness were noted among children who did not meet recommendations for consumption of red meat (2.81 vs 2.64, p = 0.001), fish (2.82 vs 2.68, p = 0.010) and confectionary (2.85 vs 2.62, p<0.001). The nutrition knowledge assessment showed that parents had a mean ( ± SD) knowledge score of 58.0± 14.6%. Higher knowledge scores were observed among parents/guardians of toddlers who met the dietary recommendations for dairy (64% vs 47%), fish (59% vs 56%), red meat (59% vs 57%), confectionary (59% vs 57%) and fruit and vegetables (58% vs 55%) (all p<0.05).

This study highlights a multitude of interrelated and dynamic factors, particularly fussy eating and parental nutrition knowledge, that influence the dietary intakes and patterns of toddlers. Understanding these factors may help to guide the development of targeted multi-factorial interventions to improve dietary quality among toddlers.

Consumption of 300 mg of a New Zealand berry extract containing 105 mg anthocyanins for 7 days has been shown to increase running distance during repeated sprints to exhaustion(1). The supplemented group also displayed higher blood lactate concentration over the first thirty minutes of recovery time(1). However, there is limited research available on the acute effects of berry-derived anthocyanins on sports performance. We aimed to evaluate the effect of a single dose of 12 g of a New Zealand berry anthocyanin-enriched powder (NZBP) supplement containing 120 mg of anthocyanins on sprint performance in a randomised controlled crossover trial using the modified Loughborough Intermittent Shuttle Test (m-LIST). The m-LIST protocol consisted of 6 x 15-min blocks divided into four blocks of “prescribed-pace” activity (blocks 1 - 4) (participants exercise based on audible signals) followed by two blocks of “self-paced” (blocks 5, 6) running (no audible signals) with a 3-min rest period between each block. Each block consisted of repeated sequences of 3x20 m walks at 5.4 km/h, 1x15 m sprint, 3x20 m run and 3x20 m jog. Fourteen recreationally active males (mean ± SD age: 29.53 ± 9.35 years, height: 170.84 ± 24.13 cm, weight: 76.24 ± 8.26 kg, V˙O2max: 46.64 ± 4.40 mL∙kg-1∙min-1) participated in three indoor sessions. The first session focused on a multistage fitness test (beep test) to determine V˙O2max and the run and jog prescribed speeds for blocks 1 to 4. For the main trial visits (minimum 7-day wash-out period in between), participants consumed a body weight adjusted standardised dinner (lasagna, garlic bread, banana, and salad greens) and arrived at the laboratory fasted the next morning (between 6-7:30 am). They then consumed the study supplement (NZBP supplement or placebo mixed with 100 ml water) along with the standardised breakfast (100 g yogurt, 50 g granola, and 30 ml milk). One hour after breakfast the participants undertook a 10-min standardised warm-up, followed by the m-LIST protocol. No significant differences (two-way repeated measures ANOVA; p = 0.286) were found in average sprint speed from blocks 1 to 6 within or between NZBP and placebo groups. No effect of supplementation and no interaction effect was observed for sprint distance, sprint time, heart rate, reaction time, movement, or blood lactate concentration. The observed changes induced by repeated sprints on ratings of feeling scale, felt arousal scale, and perceived exertion (p = <0.001, all) were also not affected by supplementation (p = 0.679, p = 0.288, p = 0.327 respectively). Thus, an acute dose of NZBP containing 120 mg anthocyanins under the conditions reported here did not improve repeated sprint performance in recreationally active males.

The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.

Optimal nutrition during infancy and early childhood is crucial for promoting healthy growth, development, and overall well-being(1). Concerns arise regarding commercially available Food Products for Infants and Young Children (FIYC) due to potential imbalances in sugar, salt, fat content, and inappropriate promotion. The World Health Organization’s (WHO) Nutrient and Promotion Profile Model (NPPM) assesses the nutritional quality and promotional practices of commercial baby foods for children under 36 months. This study evaluates and compares the compliance of FIYC products in the UK and Kyrgyzstan with the NPPM guidelines.

This study evaluated the compliance of FIYC products in the UK and Kyrgyzstan with the WHO’s NPPM guidelines. Data on commercially available FIYC products for children aged 6-36 months were collected from both countries (UK: n = 469 products, 21 brands; Kyrgyzstan: n = 203 products, 20 brands). The NPPM website was utilized to assess nutritional composition (energy, sugar, protein, salt) against WHO guidelines and evaluate labelling information (ingredient lists, nutrient/health/marketing claims, breastfeeding recommendations) for adherence to NPPM criteria(2). Data analysis for comparison across the two countries employed SPSS v29.

Analysis of 672 FIYC products using the NPPM website revealed distinctly different compositions between the UK (n = 469) and Kyrgyzstan (n = 203). The UK dataset contained a higher proportion of meals (38%) compared to fruits and vegetables (30%). Conversely, Kyrgyzstan had a higher percentage of fruits and vegetables (52%) and cereals (26%). Nutrient assessments displayed varying pass rates. Pass rates for products in the model were higher for the UK compared to Kyrgyzstan for energy density (75% vs. 47%), total fat (98% vs. 67%), and sodium (69% vs. 10%). However, Kyrgyzstan had a higher protein pass rate (96% vs. 94%). Regarding sugars, the UK achieved a 50% pass rate for total sugar compared to only 7% in Kyrgyzstan, with free sugar addition pass rates of 81% and 73% respectively. Promotion assessments revealed a similar compliance for the lower age recommendation (from 6 months) (85% UK, 76% Kyrgyzstan). However, all products failed the total marketing, health, and promotional claims evaluation. Breastfeeding instruction compliance was also low, with only 5% (UK) and 35% (Kyrgyzstan) passing.

In conclusion, the study identified both strengths and weaknesses in FIYC product compositions and nutritional profiles across the UK and Kyrgyzstan. However, more work is needed in adhering to marketing, health claims, and breastfeeding instruction guidelines in both countries. Stronger policies to improve FIYC are needed across the WHO European Region promoting child health and reducing future disease risk.

The prevalence of food allergies in New Zealand infants is unknown; however, it is thought to be similar to Australia, where the prevalence is over 10% of 1-year-olds(1). Current New Zealand recommendations for reducing the risk of food allergies are to: offer all infants major food allergens (age appropriate texture) at the start of complementary feeding (around 6 months); ensure major allergens are given to all infants before 1 year; once a major allergen is tolerated, maintain tolerance by regularly (approximately twice a week) offering the allergen food; and continue breastfeeding while introducing complementary foods(2). To our knowledge, there is no research investigating whether parents follow these recommendations. Therefore, this study aimed to explore parental offering of major food allergens to infants during complementary feeding and parental-reported food allergies. The cross-sectional study included 625 parent-infant dyads from the multi-centred (Auckland and Dunedin) First Foods New Zealand study. Infants were 7-10 months of age and participants were recruited in 2020-2022. This secondary analysis included the use of a study questionnaire and 24-hour diet recall data. The questionnaire included determining whether the infant was currently breastfed, whether major food allergens were offered to the infant, whether parents intended to avoid any foods during the first year of life, whether the infant had any known food allergies, and if so, how they were diagnosed. For assessing consumers of major food allergens, 24-hour diet recall data was used (2 days per infant). The questionnaire was used to determine that all major food allergens were offered to 17% of infants aged 9-10 months. On the diet recall days, dairy (94.4%) and wheat (91.2%) were the most common major food allergens consumed. Breastfed infants (n = 414) were more likely to consume sesame than non-breastfed infants (n = 211) (48.8% vs 33.7%, p≤0.001). Overall, 12.6% of infants had a parental-reported food allergy, with egg allergy being the most common (45.6% of the parents who reported a food allergy). A symptomatic response after exposure was the most common diagnostic tool. In conclusion, only 17% of infants were offered all major food allergens by 9-10 months of age. More guidance may be required to ensure current recommendations are followed and that all major food allergens are introduced by 1 year of age. These results provide critical insight into parents’ current practices, which is essential in determining whether more targeted advice regarding allergy prevention and diagnosis is required.

Childhood obesity is a serious public health concern worldwide. One in five children are overweight or obese in Ireland1. Suboptimal growth, either in pregnancy or infancy, can increase the risk of obesity in childhood2. National policy fails to recognise early life exposures as potential contributors to Ireland’s obesity epidemic. This research examines the impact of ‘Labour and Birth’, ‘Birth Weight Status’, and ‘Maternal BMI’ on infant growth in the first weeks of life.

This research is a secondary analysis of data collected as part of the WellFed study, a randomised placebo-controlled trial investigating the effect of a maternal dietary supplement comprised of a milk protein hydrolysate and yeast beta-glucan (Wellmune®) (LS-23-07-OSullivan). The supplement does not influence the present findings. Mother and infant anthropometrics were measured during two study visits, at approximately 4 and 8-weeks postpartum. Participants completed a series of questionnaires to obtain basic demographic, birth and lifestyle data. Infant weight and length percentiles were calculated using the UK-WHO 0-2 years: weight-for-age percentiles and the UK-WHO 0-2 Years: length-for-age percentiles for both males and females. Statistical analysis was performed using IBM SPSS Statistics (version 27).

Data from 51 mother-infant dyads show infants delivered via cesarean section weighed less at the 4-week (4.1± 0.4 vs 4.5± 0.5 kg, p = 0.015) and 8-week follow-up (5.1± 0.5 vs 5.5± 0.6 kg, p = 0.021) and were shorter at the 8-week follow-up (56.3± 1.9 vs 57.7± 2.0 cm, p = 0.030) compared to infants born vaginally. Infants born following induction were significantly heavier at the 8-week follow-up compared to those not-induced (5.8± 0.7 vs 5.2± 0.5 kg, p = 0.006). In this cohort, 40% of infants were classified as large-for-gestational-age (LGA). Across the 8-week study period, 50% of LGA infants dropped two or more growth percentiles.

Observations from this study highlight a high prevalence of LGA infants in this cohort which raises concern for the national prevalence of LGA infants in Ireland. Interventions during labour and birth were shown to influence infant growth in this study. These findings highlight the need for further investigation into the relationship between early life exposures and growth during infancy and childhood. Implementing healthcare policies focusing on reducing the number of elective birthing procedures performed and targeting obesity amongst women of reproductive age are possible measures that can be implemented to help tackle the obesity crisis in Ireland.

Hospital placement is essential training for medical interns, involving shift work and high-pressure environments. This can increase physiological and psychological stress, which may be mediated by metabolites of microbial digestion(1). Nutrients of interest include those accessible to microbial digestion and associated with altered signalling within the microbiota-gut-brain axis (MGBA)(1). Fibre is fermented by gut microbes to produce short-chain fatty acids(2) and is associated with improved psychological outcomes(3). Tryptophan, a precursor to gut-derived serotonin(2), has been negatively associated with anxiety(4). Processed foods contain food additives, excess sugars, and saturated fats that may disrupt gut homeostasis(1) and impact psychological well-being(4). Lastly, total energy intake may determine the level of substrate available for microbial fermentation(2). Therefore, this research explores how microbiota-accessible food components interact with physical and psychological well-being in a cohort of medical interns undertaking their first-year of hospital placement. Participants were healthy medical interns, during first-year hospital placement (n = 21) from the Hunter New England Local Health District, NSW, Australia. Participants completed diet and wellbeing surveys at baseline and every 2 months over a 10-month period. 24-hour diet diaries were self-recorded from participants using a mobile application (Easy Diet Diary) and analysed using AusNut and the NOVA classification system of ultra-processed foods (ULP). Wellbeing surveys include depression, anxiety, stress scale (DASS), and PROMIS survey for mental (M), physical (P), and sleep well-being. Current data represents an ‘in-progress’ of the longitudinal data collection. This study utilised Spearman correlation and Tukey’s post hoc test for mixed methods analysis. From baseline to timepoint 3 (T3, 4 months) daily energy intake was consistent with cohort estimated energy requirements (EER). However, consumption ranged from 37% to 167% of EER, indicating a large variation of intakes. Energy consumed from ULP ranged from 30% to 34% (p = 0.6875). Baseline tryptophan intake (x¯ = 1139mg) was within the suggested target, whilst fibre intake (x¯ = 23g) was below the recommended intake. Neither saw significant changes from baseline to T3. Fibre intake was positively correlated with mental and physical well-being at baseline (x¯ = 23.1g, M: r = 0.474, p = 0.04, P: r = 0.608, p = 0.007), and timepoint 2 (x¯ = 31.5g, M: r = 0.647,p = 0.026, P: r = 0.780, p = 0.004) but not at T3. In addition, baseline consumption of sugar (x¯ = 18g) and poly-unsaturated fats (x¯ = 15g) were both negatively correlated with mental and physical well-being. Overall, no significant dietary changes were evident from baseline to mid-year collection in a first-year medical intern cohort during hospital placements. Fibre was significantly associated with mental and physical well-being, building on current understanding of fibre’s role in the MGBA. Planned metabolite analysis will explore the mechanisms of proposed microbiome-accessible nutrients alongside diet, well-being, and microbiota data. Findings from this study will identify how diet-microbiome interactions change under stress, with wider positive implications on intense workplace environments with the aim to preserve individual wellbeing.

Cow’s Milk Allergy (CMA) is estimated to affect 2-3% of infants, typically developing in the first year of life(1). The risks of misdiagnosing CMA include acute reactions, micronutrient deficiencies, growth faltering, increased burden on healthcare systems, and reduced quality of life for infants and caregivers(2). The guidelines for diagnosis and management are not always followed due to lack of awareness, or difficulties with implementation(1,3). The aim of this study was to obtain parent-reported data on the diagnosis and management of CMA in Ireland.

A 23-item questionnaire was developed and distributed through an online parenting club, targeting parents of infants aged 0-12 months with CMA. The quantitative and qualitative data was analysed on SPSS (V29) using descriptive statistics and cross-tabulation tests.

A total of 62 parents with an infant under 12 months responded that their infant currently has (n = 56) or previously had CMA (n = 6). Five cases were self-diagnosed and were partially excluded from analysis. General practitioners (42%) and paediatricians (39%) were the most common healthcare professionals (HCPs) to diagnose CMA.

The number of visits it took before receiving a CMA diagnosis ranged from 1-15 visits, with a median of 2 visits. Some infants were diagnosed on their first appointment (n = 11) while others took 4-5 months before being diagnosed (n = 2). Only 23% of infants underwent a skin-prick/blood test, suggesting most HCPs were using symptom resolution to decipher a diagnosis.

An extensively hydrolysed formula (EHF) was recommended as first-line management to most formula-fed infants (82%, n = 40), while 14% (n = 7) were initially recommended an amino acid formula (AAF). Of the 17 suspected non-IgE infants who did not exclusively breastfeed, only 41% were given advice to reintroduce standard infant formula after 2-4 weeks of being on a hypoallergenic formula, to assess if symptoms reappeared. Of this 41%, only 57% followed this advice. Of breastfeeding mothers (n = 30), 87% were advised to eliminate cow’s milk from the maternal diet, however 57% were not advised on reintroduction upon symptom resolution(1). Faltering growth was reported in 11% (n = 5) of formula-fed infants and all were prescribed an EHF, despite guidelines recommending an AAF if faltering growth is evident(1). After diagnosis, 26 infants (46%) had no follow-up with their HCP. Of the 22 infants diagnosed by a paediatrician, 77% received a follow-up appointment which was significantly greater compared to follow-up rates from other HCPs (P = 0.006). Limitations include the use of a small convenience cohort and selfreporting of data.

These results indicate a clear gap between CMA diagnosis and management guidelines, and their practical implementation within the Irish healthcare setting. Any strategy to further educate and support HCPs in this specialist area of healthcare could mitigate risk of misdiagnosis, delayed diagnosis, and inappropriate management.

Suboptimal feeding practices in the first two years of life are risk factors for poor child growth and development(1). Sociodemographic predictors of infant and young child feeding (IYCF) practices are well documented (maternal age, education, marital status, sociodemographic status)(2). However, psychosocial factors have received less attention, and few studies have considered complementary feeding practices. Therefore, this study aimed to explore associations between maternal depression, exposure to intimate partner violence, perceived social support, and stimulating home environments, and IYCF practices among mother-infant dyads in Malawi.

Khula is a longitudinal birth cohort that aims to characterise brain development across the first 1,000 days of life(3). At the third study visit, when infants were approximately 10–16 months of age, mothers completed a series of psychosocial questionnaires: Edinburgh Postnatal Depression Scale (EPDS; score 0–30), Intimate Partner Violence Questionnaire (IPV), Multidimensional Scale of Perceived Social Support (MSPSS). The Family Care Indicators (FCI) was used to assess stimulation and support for early learning within the home (score 0–17). Information on infant’s dietary intakes during the previous 24 hours was used to determine the WHO IYCF indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)(4). Logistic regression modelling was used to identify significant associations between maternal psychosocial measures and IYCF indicators.

Data were analysed for 153 dyads. Mean maternal age was 27.0 ± 6.0 years, 84.1% were married, 52.8% had some/completed secondary education, and the majority were either employed (45.1%) or housewives (41.7%). The median (Q1, Q3) EPDS score was 2 (0, 6), 12% of women had been exposed to IPV in the previous 12 months, and mothers reported medium levels of perceived social support. The median FCI total score was 6 (5, 8). Among infants (mean age 13.3 ± 1.7 months), 97.4% were still being breastfed, and 54.2%, 73.2% and 45.1% achieved MDD, MMF and MAD, respectively. Women with higher EPDS scores were less likely to breastfeed at around 1 year (OR 0.53, 95% CI 0.29, 0.96; p = 0.04). However, this relationship was not significant after controlling for maternal age, education, marital status, and socioeconomic status. Exposure to IPV in the previous 12 months, MSPSS score and FCI total score were not associated with any IYCF indicators. Stimulation within the home environment was positively associated with dietary diversity score in unadjusted multiple regression (β 0.17, 95% CI −0.002, 0.15; p = 0.05), although this was no longer significant in adjusted analyses.

In this study, we found little evidence of associations between psychosocial factors and IYCF practices. Early screening for postnatal depression may benefit women and infants and should potentially be considered during infant feeding counselling in low-resource settings. The indications of improved dietary diversity with greater familial interactions should be examined in larger, diverse populations.

Intake of free sugars is associated with a risk of non-communicable diseases including dental caries, and authoritative organisations recommend limiting intake to <5% energy intake (E) or lower (1, 2). National surveys of schoolchildren in India indicate the prevalence of obesity is rising >10%/year(3) and that 52.5% of young adolescents are affected with dental caries(4), yet, there is a dearth of data on dietary intake of sugars by this population. The objective of this research was to assess the intake of total and free sugars, and the contribution of food sources to free sugars intake, in a random sample of 11–13-year-old schoolchildren in Delhi, India. The study was approved by The University of Adelaide Human Research Ethics Committee and the Independent Ethics Committee of the Centre for Chronic Disease Control, New Delhi. The target sample size of 360 was based on a ± 5% margin of error in estimated sugars intake. A statistician external to the research team generated a random sample of 150 schools stratified by district (n = 11). Schools were recruited in turn from the list until 10 schools had consented. Teachers shared study information with parents who were invited to complete an online consent form. Child assent was obtained before data collection. Participants recorded all food and drink consumed over three consecutive days, including one weekend day, in a food diary. The information recorded was entered into an online dietary assessment tool, Intake24 (Southeast Asia version), during an interview with each participant during which portion size was ascertained with reference to the database of over 2400 food photographs of more than 100 foods. The Intake24 database converted food and drink reported into the intake of total and free sugars through integrated food compositional tables. Of 514 pupils providing consent, 393 participants (76.5%) (169 girls, 224 boys) completed the study. In girls, the median (IQR) daily intakes of total and free sugars were 95.0 (70.1-120.2) g/day and 43.0 (28.1-68.5) g/day respectively. The corresponding values in boys were significantly higher at 104.0 (80.2-138.7) g/day and 53.1 (34.1-76.5) g/day (p = 0.004). No between-gender difference was observed in the median percent contribution of sugars to E: total and free sugars contributed 14.9% (IQR 11.4-18.1%) and 7.1% (IQR 4.8-10.1%) respectively. The percent contribution of the main sources of sugars to free sugars intake were: (i) Sugars Preserves and Syrups (31.2% (IQR. 9.6-51.7%)); (ii) Cakes and Biscuits (13.7% (IQR 0-26.4%)); (iii) Desserts (5.4% (0-17.5%)) and (iv) Sugar-Sweetened Beverages and Juices (2.1% (IQR 0-15.7%)). In conclusion, in this sample of 11-13-year-old schoolchildren from Delhi, free sugars intake was above the WHO <5% E threshold. Forms of sugars that are added to foods by the consumer made the largest contribution to intake.

Acute Appendicitis (AA) is an inflammatory condition of the vermiform appendix in the caecum of the colon. Genetic polymorphisms have been suggested as risk factors predisposing to AA susceptibility but have remained relatively unknown, due to insufficient sample size in previous analyses. Therefore, the primary research aim was to identify genetic variants associated with AA. It was hypothesised that gene polymorphisms associated with AA will provide a connection to other diet-related inflammatory diseases. Genetic variants associated with AA were studied via a Genome-Wide Association Scan (GWAS) using the Global Biobank Meta-Analysis Initiative (GBMI). The GBMI is a collaborative consortium of 23 biobanks with a publicly released repository of de-identified genetic data linked with digital health records spanning 4 continents with a study population size of over 2.2 million consented individuals of multiple ancestral backgrounds1. A linear regression model was used to estimate the association between single nucleotide polymorphisms (SNPs), across the human genome, and AA by each contributing biobank. The results were then meta-analysed with a total of 32,706 cases and 1,075,763 controls. In the present study, the free open-source Complex Traits Genetic Virtual Lab (CTG-VL) platform was used to access, analyse, and visualise the GWAS summary statistics of AA2. Genome-wide significantly associated SNPs (p-value < 5 x 10-8) were further searched for their associations with health-related traits in publicly available GWAS summary statistics. Upon analysis, significantly associated SNPs for AA were identified within or nearby nine genes. HLX, NKX2-3, LTBR, and DLEU1 are genes involved in immune responses; IRF8 associated with maturation of myeloid cells; OSR-1 responsible for transmembrane ion transporter activity; NCALD a regulator of G protein-coupled signal transduction. In addition, based on the hypothesis, the SNP of key clinical importance was the HLA-C rs2524046 (p-value = 2.38 x 10-8), with the AA risk-increasing allele C being also strongly associated with a higher risk of coeliac disease (CD). The CD is an autoimmune condition where gluten, a protein present in grains such as barley, rye, and wheat, elicits an inflammatory response that results in damage to the small intestine lining. Considering how both AA and CD share the same SNP, it is possible to speculate whether gluten initiates a similar pathophysiological mechanism that exacerbates inflammation in the vermiform appendix in AA. In conclusion, the top AA associated SNPs suggests its development could be due to immunological responses influenced by dietary nutrient intake. The HLA-C SNP is common to AA and CD, suggesting that the gluten protein found in certain cereal grains possibly contributes to the pathophysiology of AA like CD. This warrants further investigations into whether dietary gluten could play a key role in AA development.

The significant rise in childhood obesity is a public health challenge, and it is estimated that nearly 25% of children in England start school with overweight or obesity1; those from ethnic minorities and more disadvantaged areas are disproportionately affected2. The transition from exclusive milk feeding to the introduction of solid foods is an important stage in a child’s growth and development as eating habits and behaviours established in early life have been shown to continue into late childhood3. Given the increase in prevalence of childhood obesity, the aim of this study was to describe the weaning diet of infants and explore associations between sociodemographic characteristics.

The analysis included mother-infant pairs from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), an antenatal diet and physical activity intervention which recruited women with obesity from ethnically diverse inner-city settings4. Maternal sociodemographic characteristics were recorded at baseline (15-18 weeks’ gestation). Infant dietary patterns were derived using factor analysis of a parent reported interviewer-administered food-frequency questionnaire at 6-months of age. To explore relationships between infant dietary patterns and sociodemographic characteristics, a multiple linear regression model was developed and included the following maternal exposures; age, body mass index (BMI), time spent in education, ethnicity, parity, smoking and breastfeeding prevalence at the 6-month follow-up. The model was also adjusted for age of introduction of solids and the UPBEAT intervention arm.

720 mother-infant pairs were recruited at 6-months postpartum, and 542 were included in this analysis as weaning had started. There was no effect of the UPBEAT intervention on infant dietary patterns. The average age of introduction of solid foods was 5 ± 0.87 months. Two dietary patterns were identified in the infants. The first pattern defined as ‘Processed’ was high in rusks, baby pouches, porridge, fruit puree, yoghurt, juice, desserts, snacks and meat, fish or savoury-based meals. The second pattern, defined as ‘Healthy’ was high in breakfast cereals, potatoes, yoghurt, biscuits, fruit, vegetables, bread, meat and fish-based meals and pasta. The Processed pattern in the infant was associated with lower maternal age (beta-coefficient −0.01; 95% confidence interval −0.03, −0.003), higher maternal BMI (0.02; 0.003, 0.04), less time spent in education (−0.06; −0.09, −0.02), lower breastfeeding prevalence (−0.28; −0.51, −0.05) and a lower infant age of introduction of solid foods (−0.20, −0.30, −0.10). Women of Black ethnicity were less likely to adhere to a Healthy pattern (−0.40, −0.63, −0.15).

A processed dietary pattern at 6-months of age is associated with several maternal sociodemographic factors, including lower educational attainment, lower age at birth and higher BMI. These results support the need to for targeted public health programmes which promote healthier weaning practices.

The introduction of complementary foods, also known as 'weaning', refers to the process of introducing solid foods into an infant’s diet, alongside breast milk or infant formula milk(1). According to the Food Safety Authority of Ireland (FSAI) guidelines, weaning should commence around 6 months of age, with no earlier or later than 17 or 26 weeks, respectively(2). These guidelines provide evidence-based recommendations aimed at promoting optimal infant health, growth, and development(3). The aim of this study was to gain an insight into parental attitudes towards weaning and the common challenges faced when introducing solids.

Data was collected using a 16-item questionnaire. Parents of infants aged 0–12 months were recruited through an online parenting club and descriptive statistics were performed using IBM SPSS (V29) to determine percentages.

Of the 215 participants, 64% (n = 137) had initiated solid food introduction to their infants, with the age of these infants ranging from 4-12 months. Of those, the majority (80%, n = 109) followed FSAI guidelines(2), introducing new foods daily or every few days. The main factors guiding this decision were signs of readiness and developmental milestones, cited by 76% of respondents (n = 104). Among those who began weaning (n = 137), 70% reported a positive experience, though the majority (92%, n = 126) encountered challenges along the way. These included infant’s refusal to eat (34%, n = 47), allergy concerns (41%, n = 56), and difficulty determining appropriate portion sizes (48%, n = 66). Our findings showed that 12% (n = 16) of infants aged 6-9 months and 2% (n = 3) of infants aged 10-12 months had not yet been introduced to meat, poultry, or fish. Additionally, 4% of parents (n = 6) waited until their infants were at least 9 months old to introduce these foods, despite guidelines recommending early exposure to iron-rich foods(2).

Most parents with infants aged 0-6 months (64%, n = 78) had not started weaning. Among them, 26% (n = 20) felt very confident about beginning the process, while 25% (n = 19) lacked confidence in introducing solid foods to their infants.

Among all participants, information on weaning commonly came from family/friends (68%, n = 147), healthcare professionals (60%, n = 128), and social media (46%, n = 99). When asked about resources they would like access to, nearly two-thirds of parents (64%, n = 138) expressed interest in weaning recipe ideas. Additionally, 53% (n = 114) highlighted the need for guidelines on the appropriate amount of milk to give during weaning.

In conclusion, our findings indicate that while most parents appear compliant with the recommended timing of weaning, challenges still persist. Moreover, there is a notable reliance on various sources for weaning information, with a demand for resources like weaning recipes and milk quantity guidelines. These insights highlight the importance of tailored support and education to facilitate a positive weaning experience for both parents and infants.

With continuing population growth and increased urbanisation, the prevalence of apartment living will also increase. The food practices and diet of apartment residents may differ to those in lower density, detached or semi-detached housing. Food practices may be impacted by physical constraints of apartment kitchens (size, storage, cooking facilities) and the influence of the surrounding community food environment, particularly in smaller apartments. High-rise apartment residents spend a larger proportion of their weekly household budget on eating foods prepared out of the home 1. This is concerning given meals prepared outside the home tend to be of lower diet quality 2 and are associated with higher body weight 3. This study investigated how kitchens, residents’ food practices and hypothesised barriers to healthy eating were portrayed on popular TikTok videos associated with hashtags denoting small apartments. Using the keyword ‘microapartment’, the top four most viewed hashtags relevant to the topic were identified: #studioapartment (190.5 million views), #smallapartment (152.5 million views), #tinyapartment (62 million views), and #microapartment/ #microapartments (4.9 million views combined). The most liked videos (n = 50) from each of these four hashtags and #apartment (as a comparator) were selected for investigation. Using a REDCap survey, two researchers independently coded a random sample of 15 videos, with comparison and discussion to tighten codebook definitions and reduce ambiguity. Subsequently over half of all videos were coded by at least two researchers, achieving acceptable inter-rater reliability (Cohen’s kappa >0.8). Each video was coded for engagement characteristics, user profile, and characteristics of individuals appearing. Further coding included apartment size, kitchen features displayed or mentioned, and food practices (grocery shopping, cooking at home, and eating foods prepared out of the home). Videos were categorised as having positive sentiment if they depicted the apartment in an explicitly positive way, including promoting or encouraging an aspect of apartment living or indicating support for a behaviour. Conversely, videos were coded as being of negative sentiment where they depicted a clear negative position on an aspect of apartment living. Else, the video was coded as neutral sentiment. The majority of videos (87%) portrayed apartment living with a positive or neutral sentiment; with only 2% of videos portraying kitchen size or function negatively. The expected physical constraints of small apartment kitchens were not evident in the videos, nor were interactions with the food environment surrounding the apartment. Indeed, in the small number of videos portraying the food practices of cooking, shopping and eating, the videos highlighted the ability to undertake these practices despite limitations of size and facilities. As the food practices of residents of small apartments are not well researched, it is not known whether their portrayal on TikTok may indeed reflect reality, or may be a glamorisation.

In 2020, the Food Safety Authority of Ireland (FSAI) published, for the first time, food-based dietary guidelines for 1 to 5-year-olds. The guidelines highlight suboptimal intakes of vitamin D (VitD) and iron in toddlers and preschoolers. To help parents meet their child’s daily nutrient requirements, the FSAI recommends parents of 1-5 year-olds offer their child (1) a low-dose (5 μg/day) VitD-only supplement during the extended winter months (2) 30 g red meat three days a week and (3) 30 g ready-to-eat cereals (RTECs) with added iron (≥ 12 mg iron per 100 g) five days a week(1). Findings from our previous survey of parents of 1- to 5-year-olds (n=185) revealed low awareness of, and adherence to, the FSAI recommendations (2). The present qualitative study aimed to gain insight into factors influencing parental guideline adherence.

One-to-one, online, semi-structured interviews were conducted among a sample of 15 parents of 1to-5-year-olds who had completed our online survey (2). Participants were college-educated mothers, with the majority being Irish and within the age range of 36 to 45 years old. The interviews investigated participants’ attitudes towards the recommended items and perceived barriers and facilitators of adherence to the recommendations. Qualitative data were analysed using Braun and Clarke’s six-phase thematic analysis framework (3), facilitated by NVivo 12 Plus software.

Thematic analysis identified five themes capturing factors that were perceived to influence guideline uptake by parents: (1) Perceptions of healthy eating (i.e., eating a varied, balanced, and nutrient-dense diet); (2) Impact of the community food environment on the accessibility of the recommended items (i.e., food price and availability in community settings); (3) The interplay between family members’ dietary preferences and meal choices within the familial food setting (e.g., child food dislikes and picky eating habits, as well as parents’ preferences and experiences about the recommended items); (4) Convenience in food preparation and supplement use (i.e., time, energy, and skills required to adhere to the recommendations); and (5) Gaps in communicating the guidelines and opportunities to promote them (i.e., visibility of credible nutrition-related information).

Overall, this study showed that guideline adherence is a complex, multi-dimensional phenomenon that is affected by individual factors, the food and nutrition environment. It highlights the need for implementing a holistic approach, such as the socio-ecological model, to improve guideline adherence that involves families, healthcare professionals, policymakers, and the food industry to create a supportive, positive food environment for parents.

The eight well-known food security indicators were developed in 1997 using a stepwise process that involved five focus group interviews (one Māori, one Pakeha, two Pacific, and one mixed ethnicity) of 8-16 people, all of whom were either on a low income or were government beneficiaries(1). As part of the development of the tools and methods for a future New Zealand National Nutrition Survey, these eight indicators were considered for inclusion. The Māori and Technical Advisory Groups convened for the development of the National Nutrition Survey foresaw issues with the interpretation of some of the questions given the changes in the food environment and sources of food assistance in the last 25 years and recommended that cognitive testing should be conducted to see if changes were required. Participants were recruited through two community organisations, a local marae, and community Facebook pages. Participants were given the option of participating in a one-on-one interview or as part of a focus group. During each session, participants were asked five (three original and two new) questions relating to food security (running out of basics, use of food assistance, household food preparation and storage resources). After each question, the participants were asked a series of additional probing questions to ascertain whether they had interpreted the question as intended. All interviews were audio recorded and transcribed, and a qualitative analysis was performed on the transcripts to determine areas of concern with each question. A total of 46 participants completed the cognitive testing of the food security questions, including 26 aged 18-64 years, and 20 aged 65+ years. Participants also spanned a range of ethnicities including 8 Māori, 15 Pasifika, 15 Asian, and 8 New Zealand European or Other. Just over half of the participants (n=24) reported themselves to be financially secure, 16 participants reported that their financial security was borderline, 1 participant reported that they were not at all financially secure, and 5 participants declined to answer. Variable interpretations of terms by participants were found in all questions that were tested. Therefore, answers to the food security questions may have not reflected the actual experience of participants. This study also identified other dimensions of food security not assessed by the current eight indicators (e.g., lack of time, poor accessibility). These findings indicate that the food security questions need to be improved to ensure they are interpreted as intended and that new questions are needed that considers all dimensions of food insecurity (i.e., access, availability, utilisation, and stability). These new and amended questions should be cognitively tested in groups that are more likely to be experiencing food insecurity.

Food environments around secondary schools are a strong influence on adolescents’ food purchasing habits1. We conducted a repeat cross-sectional study using Google Street View to examine school food environments in regional and metropolitan NSW, Australia over 17-years. Findings showed that unhealthful food outlets such as fast-food franchises, consistently dominated school food environments over 2007-2023. Increasing levels of poor nutrition among youth has been raised as a concern2 by the Health Advisory Panel for Youth at the University of Sydney [HAPYUS] - an established group of 16 adolescents aged 13-18 years residing in NSW3. To gain further insight into the study findings and how it may impact adolescents’ health, it is critical to include voices of adolescents in this research. The aim of this sub-study was to engage with members of our youth advisory group and conduct a consultation exercise on these study findings, drawing upon their lived experiences of school food environments. In Aug-2023, we engaged four youth advisors from HAPYUS. Study authors provided an overview of the study and its findings to the youth advisors via a Zoom call. Youth advisors formulated a 500-word statement on their perspectives and lived experiences of food environments surrounding their high schools over the subsequent 4 weeks. Adolescents agreed that physical proximity to unhealthy food outlets around schools was a key contributor to unhealthy eating habits however also recognised social and economic factors which play a significant role in shaping poor diets. The following quotes from their combined statement reflect social and economic concerns: i) “[We] observed on a daily basis young people were opting to travel to the closest food court for fast food, or in some extreme cases, even order fast food via a meal delivery app, to be delivered to the school - as opposed to choosing the closest outlet” ii) “Overpriced foods in schools with some drinks costing 2x more than a heavily discounted KFC meal, no meaningful difference between foods sold at canteens and those sold at fast food outlets - heavily processed, packaged snacks, pre-made reheated foods” iii) “Most unhealthy food outlets choose a location that is not only close to schools but also close to major shopping centres and food courts… ideal for an after-school social catchup as it appears to accommodate the needs of a large group of people.” Consultation findings revealed the importance of social and economic factors that must be analysed in addition to adolescents’ physical proximity to food outlets around their schools. Youth advisors call for governments to take immediate action to implement policies that ensure schools have cheap and healthy foods at canteens to mitigate against the purchase of foods from nearby unhealthy food outlets.

A period of the life course where optimal nutrition and food security are crucial for the life-long health and wellbeing of women/birthing parents and infants is preconception, pregnancy, and infancy.(1) It is estimated that nearly one in every four households with pre-school children (0-4 years) experience food insecurity (FI) in the UK.(2) Yet, we lack an evidence-base exploring experiences of FI in this life course stage.(3,4) This study aimed to explore women’s experiences of food insecurity during and after pregnancy, including its influence on infant feeding decisions.

This study was ethically approved (Ref No: LRS/DP-23/24-39437) and pre-registered on OSF Registries (https://osf.io/9hn6r). Semi-structured mixed format individual interviews were conducted between November 2023 and February 2024. Pregnant individuals, those who had given birth ≤12 months ago, ≥18 years old, food insecure, residing in South London and with recourse to public funds were recruited through purposive sampling. The topic guide was informed by FI, pregnancy and postpartum related literature and piloted (n = 2). Interviews were audiorecorded and professionally transcribed. Demographic data was summarised using SPSS. Inductive thematic analysis was used to analyse the data and was completed using NVivo.

Eleven food insecure participants (2 pregnant, 9 new mothers; 2 White European, 9 Black African/Caribbean/British women) participated in the study. Six women were 0-6 months postpartum, and 3 women were between 6-12 months postpartum. The preliminary findings are represented by three themes: 1) A dichotomy: knowing vs affording, 2) Adaptive food coping strategies, and 3) Infant feeding practices. Participants shared detailed accounts of valuing a healthy diet and adapting food practices, yet they still were unable to meet their dietary needs and desires during and after pregnancy. Participants described worry around breastmilk supply; quality and quantity. Complimentary feeding was also identified as a source of worry. “She is still breastfeeding fully. I don’t want to change to milk, which maybe, sometimes, I might not be able to afford it…I won’t stop until she is 1.”Whilst the cost of formula feeding was a driver of a more severe experience of FI.

Policy and practice recommendations include enhancing local breastfeeding support to address FI specific concerns around breastmilk supply and at national level, advocating for greater support for adequate healthy food provision and for a price cap on infant formula. Future interventions must support maternal mental health given the high cognitive stress identified with living with FI during and after pregnancy. Further high-quality research is needed 1) amongst asylum seekers and refugees and non-English speakers who may also experience FI, and 2) exploring cultural influences on breastfeeding and the relationship with FI.