Educational attainment is a key determinant of diet quality. The overarching pathways (i.e. theories and mechanisms) through which educational attainment shapes diet quality remain largely unexplored in the nutrition literature, and the most salient pathways likely differ across time, populations and socio-economic and political contexts. This commentary proposes a research agenda and outlines methodological considerations that are intended to better illuminate the educational attainment–diet quality relationship. From an extensive review of the literature, which led to two publications pertinent to the topic, we identified three major research gaps that should be addressed to better understand how educational attainment stratifies diet quality to guide interventions and inform equity-enhancing policies: (1) interrogating the construct of educational attainment; (2) comparative population–level and subgroup studies; and (3) root cause analyses and structural reforms. We also discuss methodological considerations needed to inform future studies of associations between educational attainment and diet quality.

Infant and young child feeding (IYCF) is a critical public health priority during emergencies, yet remains poorly integrated into emergency preparedness planning in many high-income countries (HICs). Despite the availability of international guidance, such as the Operational Guidance on IYCF in Emergencies the implementation of these tools in national systems has been inconsistent within HICs. This review examines recent emergencies in HICs to identify policy and operational gaps affecting breastfeeding support, the management of commercial milk formula (CMF) and the distribution of commercially available complementary foods (CACFs). The present review focuses on the practical translation of Infant and young child feeding in Emergencies (IYCF-E) guidance into emergency responses across a range of contexts. This review highlights widespread failures to protect breastfeeding during crises, often due to a lack of trained personnel, inadequate shelter infrastructure and limited integration of IYCF into emergency protocols. CMF was frequently distributed without needs assessment or support, undermining breastfeeding and introducing risks related to hygiene and preparation. CACFs were often age-inappropriate, ultra-processed or culturally unsuitable, with potential long-term implications for child health. Even in countries with strong health systems, IYCF-E was often fragmented, under-resourced or absent from preparedness frameworks. To build nutritional resilience, IYCF-E must be embedded within public health and disaster planning, supported by legal protections, trained personnel, regulated product distribution and coordinated communication. This requires a shift in policy and perception, recognising that the right to safe and appropriate feeding in emergencies applies equally in all settings.

Anorexia of ageing – the age-related reduction in appetite and food intake – is a public health concern for an ageing global population. However, current understanding of the aetiology of the condition is limited. In this review, evidence of gut hormone responses to feeding in older adults is reviewed, and it is proposed that a dysregulation of this process is a mechanism driving low appetite in later life. The evidence is synthesised to critically present this case, spotlighting recent data demonstrating a highly anorexigenic gut hormone profile in older adults exhibiting low appetite, which is not observed in older adults exhibiting a “healthy” appetite. These findings and this theory are interrogated with an appreciation that appetite control is complex and multifactorial, not least in the context of anorexia of ageing; it is posited that changes in gut hormone secretions are a mechanism rather than the mechanism, but propose that this may explain certain presentations of anorexia of ageing. The current knowledge base is contextualised for practical implications and priorities for future research are highlighted.

This study investigates the associations between social determinants of health (SDOH) and hypertension prevalence across Wisconsin communities, with particular attention to food environments, economic factors, and transportation patterns. Using data from the 2019–2020 Wisconsin State Inpatient Database (387,047 patients) and the 2020 AHRQ SDOH database, we employed spatial analysis and logistic regression models to examine relationships between hypertension prevalence and neighbourhood characteristics across 597 ZIP codes. Lower-income areas exhibited significantly higher hypertension prevalence (EE = 1.233, 95% CI: 1.128–1.347 for incomes under $14,999), neighbourhoods with greater food resource density showed protective associations (EE = 0.549, 95% CI: 0.474–0.636 for supermarket access). Active transportation patterns were associated with lower hypertension rates (EE = 0.879, 95% CI: 0.829–0.933 for walking). We observed a ‘Hispanic paradox’ in Milwaukee County, where Hispanic populations demonstrated lower hypertension prevalence despite socioeconomic disadvantages, whereas African American populations with similar disadvantages exhibited higher prevalence. Our proposed ‘Food Environment Synergy Model’ helps frame these findings by conceptualising food environments through three interacting dimensions: physical access, economic accessibility, and cultural dietary patterns. This integrated approach highlights how these dimensions collectively relate to unique risk and resilience profiles within communities, challenging conventional binary classifications of ‘food deserts’ versus ‘food secure’ areas. These findings indicate that addressing food access disparities, promoting walkable neighbourhoods, and preserving beneficial cultural dietary traditions may be related to lower hypertension prevalence and advance health equity in diverse communities. However, the analysis is cross-sectional, causality cannot be inferred; further longitudinal studies are needed to establish causal relationships.

Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31–87%, depending on tumour site and disease stage. A combination of nutrition-impact symptoms, reduced oral intake and systemic inflammation lead to poor tolerance to treatment, diminished quality of life and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes (sarcopenia, cachexia and low muscle density) which may coexist with overweight and obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation and muscle wasting. Although obesity is an established cancer risk factor, 40–60% of patients with metastatic disease remain overweight or obese during treatment. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently ‘at-risk’ of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.

Malnutrition remains a major public health issue in Sub-Saharan Africa, with one-third of all malnourished children residing in the region. In Malawi, 37.1% of children under five are stunted, and 63% are anaemic. Poor diets and poverty contribute significantly. Legumes, being rich in protein, fibre, and micronutrients, offer a sustainable food-based approach to improve child nutrition and support local agriculture. This study aimed at assessing the association between legume consumption and nutritional status in children aged 6–59 months in rural Malawi. A community-based cross-sectional study was conducted in Mzimba, Mchinji, and Mangochi districts, involving 1275 children. Data were collected on dietary intake, socioeconomic status, and anthropometry using semi-structured questionnaires. Nutritional status was determined using WHO Anthro, and associations were analysed using logistic regression in Stata. Prevalence of stunting was 42.8%, underweight 17.4%, and wasting 8.4%. Over half of the children did not consume legumes. Pigeon pea consumption significantly reduced odds of wasting (AOR = 0.14), and common beans were associated with lower odds of both wasting and stunting. Conversely, groundnut consumption was linked to increased underweight (AOR = 1.68). Animal food consumption was associated with lower underweight but higher odds of wasting. Legume consumption showed both protective and adverse associations with child malnutrition. In conclusion, this study has shown that promoting dietary diversity and appropriate legume use could enhance nutrition outcomes. Findings highlight the potential of legumes in addressing undernutrition but also the need for targeted nutrition education and interventions in rural Malawi.

Nutrition plays a pivotal role in cancer survivorship, influencing not only long-term health outcomes but also quality of life and risk of recurrence. As advances in early detection and treatment have led to a growing global population of cancer survivors, attention has increasingly shifted from acute care to the promotion of sustained well-being and prevention of secondary health challenges. Despite growing evidence linking dietary patterns, body composition and metabolic health with survivorship outcomes, there remains significant variability in nutritional guidance, access to evidence-based interventions and integration of nutrition into oncology care. This review explores the current state of knowledge on nutrition in cancer survivorship, highlights key challenges faced by healthcare systems and patients and presents a new proposed model of care to optimise nutrition within survivorship care, bridging the evidence-practice gap.

Household food insecurity has previously been associated with psychological distress, and subsequently, poorer diet quality. Further understanding of this relationship is required to improve nutritional outcomes, with food-related concerns suggested as one potential mechanism. Therefore, the current pre-registered (https://osf.io/zd3ak) study conducted cross-sectional secondary analyses of Wave 6 (October 2022–January 2023) of the Food and You 2 survey administered in adults aged 16 years and over across England, Wales, and Northern Ireland (N = 2315), to explore the differential prevalence of food-related concerns in people experiencing food insecurity. Exploratory analyses also identified characteristics of food support users (food bank or social supermarket; N = 467) and quantified associations between food support use and the same food-related concerns. People experiencing marginal (OR = 1.43, p = 0.02) and low food security (OR = 1.51, p = 0.02) (relative to high food security) were significantly more concerned about food prices, but this association was not seen in people experiencing very low food security. Both food bank and social supermarket use were predicted by very low food security (food bank OR = 6.05, p < 0.001; social supermarket OR = 2.40, p = 0.02) and having a long-term health condition (food bank OR = 3.91, p = 0.00; social supermarket OR = 3.17, p = 0.00). Food bank users were less concerned about healthy eating (OR = 0.33, p = 0.00) whereas social supermarket users were less concerned about food prices (relative to non-users) (OR = 0.40, p = 0.01). Food-related concerns, particularly regarding food prices, are differentially associated with food security status and food support use. Findings could support specific interventions to promote better diet quality and improve health and wellbeing in populations experiencing food insecurity.

Childhood obesity is an increasing concern in Indonesia, yet little is known about the content and sources of foods offered in Indonesian school food environments. This study aimed to examine the composition and preparation of foods sold in primary school canteens, and to identify potential modifications to address diet-related obesity risk. A cross-sectional survey of canteen vendors (n = 10) and structured observations of prepared foods (n = 112) sold in canteens were conducted across eight private and public primary schools in Central Java, Indonesia. Foods were categorized by food group, preparation method, and meal type, and associations with factors such as cost, location of sale, and the individual responsible for preparation were analysed using chi-square and t-test analyses. Among all prepared foods observed, 73.2% were classified as main meals and 26.8% as desserts, with parents often playing a central role in food preparation. Nearly half (47.3%) of non-beverage items were deep-fried, and the majority of dishes did not align with Indonesian Balanced Nutrition Guidelines. A compositional analysis of each main meal’s ingredients revealed that 29.3% lacked protein and 90.2% did not contain vegetables. Foods that were not deep-fried were priced significantly higher than deep-fried foods (x̄ = Rp.1846 ($0.11) vs Rp.1406 ($0.09); p < 0.001). Overall, the majority of prepared foods available to schoolchildren were low in nutritional quality, with limited fruits and vegetables and heavy reliance on frying. These findings highlight the need for strategies that combine parent education on healthy food preparation with economic incentives to increase the accessibility of healthier food options within Indonesian school canteens.

Iodine deficiency is now a significant public-health concern in the UK. Data from the National Diet and Nutrition Survey (NDNS; 2019–2023) shows that several population groups are now classified as mildly iodine deficient, including women of childbearing age. This is a change from previous NDNS data where these groups were iodine sufficient. As iodine is needed for thyroid-hormone production, which are essential for brain development, iodine deficiency prior to, and during, pregnancy may have implications for child cognition – including lower IQ. However, the evidence base for the health effects of mild deficiency is not as strong as in severe deficiency. The WHO recommends salt iodisation to control iodine deficiency in a population, but such a policy was never introduced in the UK and iodised salt is not widely available. While UK milk is rich in iodine and is the principal source, the rise in popularity of plant-based milk alternatives may increase the risk of iodine deficiency. It may be necessary to give personalised advice to those with low iodine intake, but identify those at risk is challenging owing to a lack of a biomarker for iodine in an individual. Population-wide approaches may be required in the UK – for example, fortification of bread with iodised salt or mandatory iodine fortification of plant-based dairy alternatives. This review will critically discuss (i) the data on iodine deficiency in the UK (ii) the evidence base for the health implications of mild deficiency and (iii) the potential public-health solutions.

In the UK, approximately 64,000 individuals are living with an ileostomy. This surgery creates an opening in the abdominal wall (stoma), allowing for diversion of egesta into a disposable pouch. This procedure impacts nutrient absorption meaning people living with an ileostomy may be subject to sub-optimal nutrition, often compounded by the low-fibre diet – which is frequently encouraged post-operatively. This review explores the restrictive dietary patterns of this population and their effects on nutrition and quality of life, alongside current approaches to improve dietary management and health outcomes. Dietary restriction beyond the post-operative period is frequently reported, with avoidance of high-fibre foods (e.g., fruits and vegetables) being most prevalent. These long-term dietary changes are presumed to impact nutritional status, with current evidence suggesting diminished bone mineral density and vitamin B12. High-output stoma (HOS) and dehydration are significant issues for people living with an ileostomy, and dietary management of stoma output and other ileostomy-related symptoms is a major contributor to food avoidance. The efficacy of oral rehydration solutions (ORS) in management of HOS is well-established; however, due to high concentrations of glucose and sodium, the palatability of such treatments is poor, impacting patient adherence. Encouragingly, personalised dietary advice has shown some positive effects on both quality of life and nutritional outcomes for people living with an ileostomy. However, a greater understanding of dietary management is needed, and there remains scope to improve current dietary advice and enable people living with an ileostomy to benefit from a more complete and unrestricted diet.