Chronic Kidney Disease (CKD) poses a global health challenge, with dietary protein intake being a key factor in disease management. This review synthesizes evidence on the impact of different protein intake strategies, including low-protein diet (LPD), very low-protein diet (VLPD), high-protein diet (HPD), and plant-based diet (PBD), on CKD progression and patient outcomes. The review explores personalised nutrition strategies and identifies gaps in the literature. A systematic search of PubMed, Cochrane Library, Web of Science, and Scopus was conducted, covering studies published from 1982 to 2024, including randomized controlled trials (RCTs), observational studies, and meta-analyses involving adult CKD patients. The findings suggest that LPDs and VLPDs may slow CKD progression, particularly when supplemented with ketoanalogues, but adherence and long-term benefits remain uncertain. PBDs are associated with reduced renal burden and improved metabolic health, although achieving adequate protein intake from plant sources requires careful planning. HPDs, particularly those rich in animal protein, may exacerbate CKD progression, although recent research indicates that higher protein intake may benefit specific populations, such as older adults with mild to moderate CKD. In conclusion, managing protein intake in CKD is complex and necessitates a personalised approach. While LPD and PBD offer potential benefits, their long-term success is contingent upon patient adherence, individualized dietary management, and further research into their sustained effects. Future research should focus on long-term RCTs and the development of personalised nutrition strategies incorporating emerging technologies and multidisciplinary care to optimise CKD management.

The present narrative review outlines the use of milk products in infant and young child feeding from early history until today and illustrates how research findings and technical innovations contributed to the evolution of milk-based strategies to combat undernutrition in children below the age of 5 years. From the onset of social welfare initiatives, dairy products were provided by maternal and child health services to improve nutrition. During the last century, a number of aetiological theories on oedematous forms of undernutrition were developed and until the 1970s the dogma of protein deficiency was dominant. Thereafter, a multifactorial concept gained acceptance and protein quality was emphasised. During the last decades, research findings demonstrated that the inclusion of dairy products in the management of severe acute malnutrition is most effective. For children suffering from moderate acute malnutrition the evidence for the superiority of milk-based diets is less clear. There is an unmet need for evaluating locally produced milk-free alternatives at lower cost, especially in countries that rely on imported dairy products. New strategies for the dietary management of childhood undernutrition need to be developed on the basis of research findings, current child feeding practices, socio-cultural conditions and local resources. Exclusive and continued breast-feeding supported by community-based nutrition programmes using optimal combinations of locally available complementary foods should be compared with milk product-based interventions.

Diagnosis of metabolic syndrome includes a set of laboratory and physical findings, including central adiposity, elevated TAG, reduced HDL-cholesterol, hypertension and elevated fasting glucose or insulin resistance. While definitions have varied slightly, from a practical point of view, identifying dietary and lifestyle factors, including low levels of physical activity, are important in designing a diet and exercise programme that can help individuals with the metabolic syndrome to reduce the associated detrimental health consequences. Specific features of the metabolic syndrome require intervention, whether dietary or otherwise, to move towards normal ranges. It is important to remember that no one size or treatment fits all. While central obesity is perceived as the hallmark of the metabolic syndrome, other features need to be treated independently if they do not respond to lifestyle change. The future may hold treatments for the metabolic syndrome that involve modulation of inflammation.

Equine Gastric Ulcer Syndrome (EGUS) is extremely prevalent in both racing and non-racing horse populations. The exact aetiology of EGUS is unclear but many stress related risk factors have been implicated including the feeding of grain-based diets. Current treatment techniques often necessitate drug therapy which, when added to feed costs, can be expensive and may have a detrimental effect on digestion due to the mode of action of these therapies. The following experiment set out to investigate if feeding fermented, forage-based feeds (Modified Bio-Fermentation (MBF) lucerne feeds treated with Xanotyde®, registered as FiberProtect® and FiberEdge®; Fiber Fresh Feeds Ltd, Reporoa, New Zealand), could assist in the healing and prevention of ulceration. Nine adult horses with demonstrable and sustained gastric ulceration (diagnosed by gastric endoscopy), were used in a two part study. The first 42 d healing phase investigated the impact of feeding FiberProtect® (FPT) or FiberEdge® (FED) on established gastric ulcers. After 14 d on these diets 44% (4/9) of horses had no ulceration or hyperaemia (inflammation) (EGUC grade 0) and all horses were ulcer free (EGUC grade 0) at d 42. A significant (P < 0.01) relationship was determined between length of time fed and disappearance of ulcers (R2 = 0.9004; DF = 2). The prevention phase utilised the same horses, ulcer-free at d 42, and fed them a grain-based high energy racing diet alongside FPT at 40% and 60% of the total diet (DM basis). The horses were monitored for a further 28 d (d 42 – d 70), and only three showed a recurrence of ulceration throughout this period. At d 70, eight out of nine horses were ulcer free (EGUC grade 0). The findings suggest that FPT and FED can be used to heal and prevent gastric ulceration, and that FPT can be fed alongside a high grain diet to prevent recurrence of gastric ulcers.

Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis.

Currently, the only treatment for any food hypersensitivity (including food allergy) is the dietary avoidance of the causative allergen, using an elimination diet. In addition to being used for the management of food hypersensitivity, an elimination diet may also be used in the diagnosis of food allergy. Dietary exclusion should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. There are three main types of elimination diets: single-food exclusion; multiple-food exclusion; the ‘few-food’ diet, which requires the avoidance of a large number of allergens and therefore concentrates on the foods that can be included rather than the foods that need to be avoided. Any sort of elimination diet is hard to manage. Thus, as well as ensuring that the diet is nutritionally adequate, it is essential that families are given advice and support relevant to their circumstances to aid them in the day-to-day management of the diet, so that it remains varied and enjoyable for food-allergy sufferers. This approach involves advice about which alternative foods are available, provision of ‘free-from’ recipes and guidance on which nutritional supplements are needed to meet their nutritional needs.