Breakfast is considered to be the most important meal of the day, which significantly contributes to overall dietary quality. Global trends suggest a decline in breakfast consumption frequency in all age groups over the years. Breakfast skipping is associated with increased risk of weight gain, insulin resistance and type 2 diabetes, which are crucial risk factors of cardiovascular diseases (CVD). Regular breakfast consumption as a modifiable risk factor might be of great interest for cardiovascular prevention. Several prospective cohort studies showed contradictory findings on breakfast skipping and CVD risk. To the best knowledge of authors, this topic was not covered by any previous meta-analysis. Therefore, this review aimed to summarise the evidence on the association between breakfast skipping and CVD risk in prospective studies with particular emphasis on dose-response relationship and quality of existing evidence. A comprehensive search of the literature was performed using PubMed and Embase databases until February 2019, with no restriction to language and date. Inclusion criteria were as following: (1) participants aged ≥ 18 years, (2) prospective design, (3) information about breakfast consumption/skipping frequency and (4) outcome is the risk of CVD including coronary heart disease, stroke or heart failure. For high versus low comparison, random effects model was applied using the inverse variance method. Greenland-Longenecker method was used to conduct linear dose-response meta-analysis. Potential nonlinear association were examined using restricted cubic splines model. Heterogeneity was evaluated using the Cochrane Q test and I2 statistic with value > 50% indicating substantial heterogeneity. Quality of evidence was assessed using NutriGrade tool. Out of 877 records identified in the literature search, four prospective cohort studies with 7258 CVD cases were included. Comparing breakfast skipping to regular breakfast consumption, there was a positive association with CVD risk (RR = 1.17 95%CI: 1.02–1.34, I2 = 39%, pheterogenity = 0.14). In linear dose-response meta-analysis, each additional day of breakfast skipping was related to 2% higher risk of CVD (RR = 1.02 95%CI: 1.00–1.04, I2 = 15%, pheterogenity = 0.31, n = 3). No non-linear association was observed (pnon-linearity = 0.53, n = 3). The quality of evidence for these associations was rated as low. This review indicated that breakfast skipping is associated with increased risk of CVD. Potential implementation of these findings in cardiovascular prevention has to consider low trust in existing evidence. Further prospective studies on this topic have to focus on the type of foods and meals consumed during breakfast, as well as BMI mediation.

Recent evidence suggests that synchronizing eating-fasting schedules with body's circadian rhythms or day-night cycles is important for metabolic health. Besides food quantity and quality, food timing may contribute to weight regulation. However, it is unclear if this factor during pregnancy can influence maternal weight retention after childbirth. Using data from a prospective cohort, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study, we examined the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months. We assessed 687 pregnant women for their circadian eating pattern (night-eating, night-fasting and eating episodes) and diet quality (Healthy Eating Index) based on information derived from 24-h dietary recall at 26–28 weeks’ gestation. Night-eating was defined as > 50% of total energy intake during 1900–0659 h; night-fasting duration was determined based on the longest fasting interval between consumption of a calorie-containing food or beverage during 1900–0659 h; eating episodes were defined as events that provided ≥ 210 kJ with time intervals between eating episodes of ≥ 15 min; diet quality was ascertained using the Healthy Eating Index which measures adherence to the Singapore dietary guidelines for pregnant women. PPWR was calculated by subtracting the weight at the first antenatal clinic visit from weight at 18-month postpartum. Substantial PPWR was defined as weight retention of 5 kg or more. Adjusting for maternal age, ethnicity, education, parity, night shift, mood, body mass index and total energy intake, multivariable binary logistic regression analysis was performed to estimate odds ratio (OR) of substantial PPWR in relation to circadian eating pattern and diet quality. Of 687 women, 110 (16%) had substantial PPWR. After confounders adjustment, night-eating (OR 1.95; 95% confidence interval 1.05, 3.62) and lower diet quality (1.91; 1.17, 3.10) were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night-fasting duration and number of eating episodes. During pregnancy, women with higher caloric consumption at night and lower diet quality had a greater likelihood of substantial PPWR. These findings suggest that aligning eating time with day-night cycles and adherence to dietary guidelines during pregnancy may help to alleviate overweight and obesity risk in postpartum life. There is a possibility that these eating patterns persist beyond pregnancy and pose implications for long-term obesity development. Further investigation on this area is required.

The importance of dietary protein for the maintenance of muscle mass and strength is heavily discussed. However, adequate energy intake is an underlying assumption but often not considered. In this study, we investigated the impact of daily intake and meal distribution of both protein and energy on muscle mass and strength. In a cross-sectional study, a total of 184 older individuals (gender: 86F/98M, age: 70.2 ± 3.9 yrs, BMI: 25.4 ± 3.7 kg/m2; means ± SD) were recruited. Participants underwent a 3-day weighed dietary record, Dual-energy X-ray Absorptiometry (DXA) scan, hand-grip strength, and Maximal Voluntary Isometric knee-extension Contraction (MVIC). Participants were divided into two categories: lower (LOW; < 0.83 g/adjusted(a)BW/day) or higher (HIGH; ≥ 1.1 g/aBW/day) protein intake levels analysed by gender to characterize a daily protein and energy intake pattern. Main meal protein and energy intake distributions were calculated, and correlations were made. Further, energy intake at breakfast and lunch divided by total energy intake (energy ratio) was correlated with appendicular skeletal muscle index (ASMI), hand-grip strength, and MVIC were determined using the LOW/HIGH-protein-intake categorization. Further, gender-specific ASMI, hand-grip strength and knee extension were compared based on the following four distinct daily protein intake ranges: < 0.66; ≥ 0.66- < 0.83; ≥ 0.83- < 1.1; ≥ 1.1 g/aBW/day. A positive correlation appeared between protein and energy intake in all main meals (r ≥ 0.57, p < 0.0001). In the LOW category, positive correlations were found between energy ratio and ASMI (r = 0.16, p = 0.048), hand-grip strength (r = 0.40, p = 0.0009), and MVIC (r = 0.36, p = 0.0019), whereas no associations were found in the HIGH category. ASMI, hand grip, and MVIC were similar regardless of the protein intake ranges, though with women being lower than men (p < 0.05) in all outcomes. These results show that total daily protein intake did not affect muscle mass and strength in our cohort. However, our data demonstrate that greater energy intake in breakfast and lunch relative to total energy intake is associated with higher muscle mass and strength, particularly when protein intake is lower than 0.83 g/aBW/day, indicating the potential importance of meal energy content at lower intakes of protein.

Sarcopenia, characterised by loss of skeletal muscle mass and strength with age, is a significant risk factor for loss of mobility and independence. The combination of low muscle mass and high fat mass in sarcopenic obesity is associated with particularly poor outcomes. Micronutrient deficiencies can occur alongside obesity despite total energy surplus, and older individuals may be at greater risk of deficiency. Research suggests vitamin C is important for musculoskeletal health, but the relationship with obesity is underexplored.

This study aimed to investigate associations of plasma vitamin C with obesity status and explore the relationship with the sarcopenic risk factor, low skeletal muscle mass.

EPIC-Norfolk cohort study data were analysed. Bioelectrical impedance analysis-estimated fat free mass (FFM; a proxy for skeletal muscle mass) was adjusted for BMI to give a scaled variable, FFMBMI. A ‘low muscle mass’ category was defined as individuals with the lowest 10% FFMBMI, representing those at high risk of sarcopenia. Plasma vitamin C (ascorbic acid) concentrations were categorised as inadequate (< 50micromol/L) or adequate (≥ 50micromol/L), and obesity status as non-obese (< 30kg/m2) or obese (≥ 30kg/m2).

Individuals were grouped according to vitamin C and obesity status: 1, non-obese and adequate vitamin C; 2, non-obese and inadequate vitamin C; 3, obese and adequate vitamin C; and 4, obese and inadequate vitamin C. Using logistic regression, the odds ratio (OR) of each vitamin/obesity status group was calculated in relation to membership of the ‘low muscle mass’ category. Analyses were sex-stratified and adjusted for age, smoking status, physical activity, social class, menopausal and HRT status in women, statin use, and corticosteroid use.

Data were analysed for 5903 men (mean 62.9 years, SD 9.0) and 7416 women (mean 61.5 years, SD 9.0). Prevalence of vitamin C inadequacy was higher in obese vs non-obese individuals (men 45.8% vs 33.0%; and women 26.0% vs 15.3%). The odds of ‘low muscle mass’ were higher in all vitamin/obesity status groups vs group 1, but the greatest odds were seen for group 4 (combined obesity and inadequate vitamin C) in men (OR 16.5, 95% CI: 12.6–21.6; p < 0.001) and women (OR 30.2, 95% CI: 23.0–39.8; p < 0.001).

In this cohort of older individuals higher prevalence of vitamin C inadequacy is associated with obese individuals. Of importance to musculoskeletal health and our understanding of sarcopenia is the observation that while vitamin C inadequacy and obesity are each independently important, their coexistence is a particularly strong predictor of sarcopenic risk.

Nudge interventions aim at changing people's behaviour by altering the choice architecture of environments. Workplaces provide an appropriate setting for these interventions, since the majority of adults make a remarkable proportion of daily dietary choices there. Using the baseline data of a choice architectural “StopDia at Work” study, we here aim to identify differences in diet quality between various employee groups.

Altogether 1205 employees of 16 Finnish employers answered an anonymous questionnaire comprising items on: 1) work quality (how the employee mainly works: seated, standing or moving a little, moving), 2) habitual eating location (staff restaurant, other restaurant, recreation room/own workstation/etc. place at the workplace, elsewhere), and 3) consumption of vegetables/fruit/berries, unseasoned nuts/almonds/seeds, foods high in salt and fat, foods high in sugar and fat, and water during working hours. A diet quality score was computed based on foods consumed at work. Kruskall-Wallis test was used to assess differences in dietary patterns.

Forty-eight percent of respondents worked mainly seated, 27% by standing or moving a little, and 24% by moving. Twenty-four percent typically ate their main meal in a staff restaurant, 5% in a restaurant outside the workplace, and 67% in a recreation room/own workstation/etc. place at the workplace. Vegetable intake differed depending on work quality (χ2(2) = 25.450, p < 0.001) and eating location (χ2(3) = 27.511, p < 0.001), being the highest among employees working seated, and employees eating in a staff restaurant. Consumption of foods high in salt and fat differed according to work quality (χ2(2) = 22.715, p < 0.001), employees with physical work reporting higher intakes compared to employees working seated (p < 0.001). Consumption of nuts/almonds/seeds, foods high in sugar and fat, and water did not differ between employee groups. Diet quality scores differed depending on work quality (χ2(2) = 22.153, p < 0.001), employees working seated, standing or moving a little scoring higher than employees with physical work (p < 0.01).

Employees with physical work had poorer diet quality than employees with sedentary work. As nudge interventions are assumed to influence behaviour independent of individual's background, they thus provide a potential approach to target also employees with physical work. Consumption of vegetables was lower among employees not eating in a staff restaurant. Therefore, nudge interventions aimed at increasing vegetable intake should be designed also to other workplace settings than staff restaurants, the predominant study setting thus far.

Protein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.

Interesterified (IE) fats are widely used to replace partially-hydrogenated fats as hard fats with functional and sensory properties needed for spreads/margarines, baked goods, and confectionary, while avoiding the health hazards of trans fats. Detailed mechanistic work to determine the metabolic effects of interesterification of commonly-consumed hard fats has not yet been done. Earlier studies using fats less commonly consumed have shown either neutral or a lowering effect on postprandial lipaemia. We investigated postprandial lipaemia, lipoprotein remodelling, and triacylglycerol-rich lipoprotein (TRL) fraction apolipoprotein concentrations following a common IE blend of palm oil/kernel fractions versus its non-IE counterpart, alongside a reference monounsaturated (MUFA) oil. A 3-armed, double blind, randomized controlled trial (clinicaltrials.gov NCT03191513) in healthy adults (n = 20; 10 men, 10 women) aged 45–75 y, assessed effects of single meals (897 kcal, 50 g fat, 16 g protein, 88 g carbohydrate) on postprandial plasma triacylglycerol (TAG) concentrations, lipoprotein profiles, and TRL fraction apolipoprotein B48 and TAG concentrations. Test fats were IE 80:20 palm stearin/palm kernel fat, the equivalent non-IE fat, and a high-MUFA reference oil (rapeseed oil, RO). Blood was collected at baseline and hourly for 8 h. Linear mixed modelling was performed, adjusting for treatment order and baseline values (ver. 24.0; SPSS Inc., Chicago, IL, USA). Total 8 h incremental area under the curves (iAUC) for plasma TAG concentrations were lower following IE and non-IE compared with RO (mean difference in iAUC: non-IE vs. RO -1.8 mmol/L.h (95% CI -3.3, -0.2); IE vs. RO -2.6 mmol/L.h (95% CI -5.3, 0.0)), but iAUCs for IE and non-IE were not significantly different. There were no differences between IE and non-IE for chylomicron fraction apoB48 concentrations nor TAG:apoB48 ratio. No differences were observed between IE and non-IE for lipoprotein (VLDL, HDL, LDL) particle size or sub-class particle concentrations. However, LDL particle diameters were reduced at 5 and 6 h following IE vs RO (P < 0.05). XXL- (including chylomicron remnants and VLDL particles), XL- and L-VLDL particle concentrations (average diameters > 75, 64, and 53.6 nm respectively) were higher following IE and non-IE vs. RO at 6 h (P < 0.05) and 8 h postprandially (P < 0.005–0.05). In conclusion, both IE and non-IE palmitic acid-rich fats generated a greater preponderance of pro-atherogenic large TRL remnant particles in the late postprandial phase relative to an oleic acid-rich oil. However, the process of interesterification did not modify postprandial TAG response or lipoprotein metabolism.

Medium-chain triglycerides (MCT) are lipids which have been shown to yield appetite-suppressing properties compared to long-chain triglycerides (LCT), which are more commonly found in the diet. Conjugated linoleic acid (CLA) has also been shown to increase satiety and decrease subsequent energy intake, although CLA has received much less attention to date. The mechanisms behind the appetite-suppressing properties are yet to be fully elucidated. Furthermore, no study has directly compared these effects or mechanisms in overweight/obese individuals to a group of healthy-weight weight controls.

Fifteen healthy-weight (BMI: 22.7 ± 1.9 kg/m2) and fourteen overweight/obese (BMI: 30.9 ± 3.9 kg/m2) individuals participated in a randomised single-blind cross-over study. Overnight fasted participants were fed smoothie breakfasts containing either 23.06 g vegetable oil (LCT), 25.0 g MCT oil (MCT), or 6.25 g CLA and 16.8 g vegetable oil (CLA) on separate test days. Subjective appetite ratings, peptide YY (PYY), total ghrelin, β-hydroxybutyrate, and gastric emptying (GE) were measured throughout each trial. Energy intake in the laboratory was measured at a buffet meal 3-h after the smoothie breakfast and for the following ~36-h in their free-living environment via food records.

Energy intake and subjective appetite ratings were not affected by weight status, so results are presented as a whole. MCT reduced energy intake compared to LCT over the trial day and whole 48-h period, but not at the ad libitum lunch. There was no difference between CLA and LCT at any time point. There were no differences in postprandial subjective appetite ratings between trials. PYY concentrations were not affected by weight status (P = 0.170), and did not differ between trials (P = 0.743) and total ghrelin was also not affected by weight status (P = 0.306), and concentrations were similar between trials (P = 0.188). β-hydroxybutyrate concentrations were higher in the overweight/obese group compared to the lean group (P = 0.009), and MCT led to increased concentrations compared to both LCT (P = 0.005) and CLA (P < 0.001). MCT delayed GE half-time (P < 0.001), lag-phase (P < 0.001), latency phase (P = 0.01), and ascension time (P < 0.001) compared to LCT, with no differences in GE between LCT and CLA (all P > 0.05).

MCT consumption reduces intake over the subsequent 48-h, whereas CLA has no effect compared to LCT. This does not appear to be related to PYY or total ghrelin, but may be mediated by β-hydroxybutyrate or via a delay of gastric emptying.