Biliary atresia is a rare bile duct disease resulting in intestinal bile salt depletion due to poor bile flow. Medium-chain triglyceride (MCT) supplementation is widely recommended and used as the main dietary management in infants, however evidence for its use is limited and there is uncertainty regarding the optimal percentage (proportion of total fat that is MCT) and dose (grams/kilogram/day, g/kg/d). The aim was to review the evidence for the impact of MCT on fat absorption, growth, nutritional status and clinical outcomes in infants with biliary atresia and the optimal nutrition profile of MCT supplementation. A scoping review found that the mostly observational, historic evidence for MCT supplementation pointed to greater fat absorption during MCT supplementation compared to no supplementation, but also some evidence of a risk of essential fatty acid deficiency with very high MCT percentage. Only six studies have investigated MCT percentages and only three reported MCT dose. One analysis of MCT in the largest cohort of biliary atresia patients ever presented (n = 200), found no association between MCT percentage with growth, nutritional status or clinical outcomes. Counterintuitively, there was an unexpected inverse association between MCT dose and growth. A possible interpretation was that increased MCT was a consequence of poor growth rather than a cause, as infants either drank more or dietitians prescribed more MCT as fat malabsorption worsened. In conclusion, MCT is widely recommended, however, the evidence for its use is lacking and there remains uncertainty about the optimum percentage and dose for infants with biliary atresia.

UK food system transformation is urgently needed, but to date, minimal research has investigated ‘blue foods’ probably because they are ethically nuanced. There exists a paradox whereby materially deprived communities should be eating more fish to meet nutritional requirements, yet there is a global ‘red flag’ around global overfishing. New collaborative and creative solutions are, therefore, needed to tackle such food system inequities. By working together, all voices can be equally heard when decisions are being made to improve the system. Similarly, innovation and disruption of established supply chains will enable better access to healthy, affordable and tasty food that will support better nutrition, health and wellbeing. This review paper will present a critique of the ‘The Plymouth Fish Finger’ as a collaborative social innovation case study. Part of the FoodSEqual research project, this exploratory pilot project championed ‘co-production’ approaches to achieve multiple (potential) impacts. This review will critically explore how this social innovation case study has exemplified the complex interplay between factors driving distortions in access to and availability of fish within the local food system. Through collaborative multi-stakeholder (transdisciplinary) processes, using participatory creative methods, new strategies and recommendations for research, practice, action and policy are informed, all of which offer great potential for progressive and transformative systemic (blue) food system change.

Positive food consumption remains one of the most common challenges among older adults in the UK with at least 10% in community settings and up to 45% in care homes affected by malnutrition. It is strongly associated with frailty, functional and health decline. Tracking and understanding the impact of diet is not easy. There are problems with monitoring diet and malnutrition screening such as difficulty remembering, lack of time, or needing a dietician to interpret the results. Computerised tailored education may be a positive solution to these issues. Due to the rise in smartphone ownership the use of technology to monitor diet is becoming more popular. This review paper will aim to look at the issues with current methods of dietary monitoring particularly in older adults, it will present the benefits and barriers of using to monitor food intake. It will discuss how a photo food monitoring app was developed to address the current issues with technology and how it was tested with older adults living in community and care settings. The prototype was co-developed and incorporated automated food classification to monitor dietary intake and food preferences and tested with older adults. The prototype was usable to both older adults and care workers and feedback on how to improve its use was collected. Key design improvements to make it quicker and more accurate were suggested for future testing in this population. With adaptions this prototype could be beneficial to older adults living in both community and care settings.

Ensuring adequate food intake among older people is essential for maintaining health and preventing malnutrition. This review explores strategies to enhance dietary intake in this population group. Several key interventions are highlighted, including offering high-energy and protein-fortified meals and snacks, optimising the visual appeal and presentation of foods, enhancing flavours, and providing finger foods or modified textures to support consumption. Familiarity with fortified foods may encourage acceptance and increase intake, while improving food aesthetics and incorporating varied flavours can enhance enjoyment and promote consumption. Flavour enhancement may help compensate for decline in smell and taste sensitivity often experienced by older people, helping to sustain interest in food and promote greater intake. Finger foods present a practical solution for older adults with physical impairments, allowing for easier handling and self-feeding. Additionally, for individuals with dysphagia or chewing difficulties, texture-modified diets tailored to their needs support safe food intake. Research suggests that refining food presentation through techniques such as moulding and 3D printing may improve palatability and appeal, potentially boosting consumption among older adults. Addressing sensory preferences and physical challenges associated with eating is critical to ensuring adequate nutrition and promoting overall wellbeing in the elderly population. This review underscores the importance of multifaceted dietary strategies, advocating for personalised interventions that align with older individuals’ needs and preferences to enhance food intake and nutritional status.

To determine values for the digestible indispensable amino acid score (DIAAS), it is recommended that ileal amino acid (AA) digestibility values obtained in growing pigs are used to characterise protein quality in different foods. Therefore, an experiment was conducted to determine the standardised ileal digestibility (SID) of AA in eight energy ingredients (barley, sorghum, wheat, brown rice, rice bran, wheat bran, cassava and paddy rice) fed to pigs, where SID values in pigs can be used to calculate approximate DIAAS values in humans. Among the data obtained for all energy ingredients, significant variations (P < 0·01) in CP and AA composition were observed. Rice bran and wheat bran had the highest CP (16·43 % and 18·16 %, respectively) and DIAAS scores of 81–88 for adult, qualifying as ‘good’ protein sources (> 75). Cassava, with the lowest CP (2·74 %), was limited by sulphur amino acid (54). Lysine (Lys) was the first-limiting AA in barley (74), sorghum (51) and wheat (49), with SID values lowest in wheat (71·04 %). Brown rice and paddy rice showed higher SIDLys (87·51 % and 78·13 %, respectively). These findings highlight the potential of bran-based ingredients and Lys fortification to improve protein quality in grain-dependent diets, providing the scientific basis to combat protein malnutrition.

Food texture influences eating rate (ER), and slower ERs are associated with reduced energy intake within a meal. However, it remains unclear whether this acute effect of ER on intake is sustained over time. We investigated whether texture-based differences in meal ER can have a sustained effect on food and energy intake across 11 consecutive days. In a randomised cross-over feeding trial, Dutch adults (n 20) were randomised to an 11-d ‘fast’ and an 11-d ‘slow’ ER diet, followed by a 17-d washout period before completing the alternate diet-arm. Participants consumed ad libitum breakfast and dinners of which ER was manipulated using food texture and received the same lunch meals on both diets served in regular-sized fixed portions. Diets were matched for served total weight (gram), energy (kcal) and energy density (kcal/gram) and were equivalent for visual volume, meal liking and meal variety. Meal ER on the ‘slow diet’ was on average 32 % slower compared with the ‘fast diet’ (P < 0·01). On days when texture led to significant differences in ER, food intake was reduced by 121 (se 24) g/d (P < 0·001), and this effect did not attenuate over time (P = 0·25). Cumulative food intake was 6 % lower for the slow compared with the fast diet (P < 0·001) with no significant difference in energy intake. On 8 of the 11 test days, meal texture reduced ER and supported a consistent reduction in food intake. Further research should test whether a whole diet approach to lowering ER by modifying meal textures could help to moderate food and energy intakes.

The measurement of sodium excretion in 24-h urine samples is the recommended method to assess dietary salt intake to monitor salt-related public health policies. Ensuring complete collection of 24-h urine samples is important for the accurate assessment of salt intake. We compare the use of the objective biomarker, recovery of para-aminobenzoic acid (PABA), to self-reported 24-h urine completeness. Data collected from 868 men and women aged 19–64 years from the England Sodium Survey 2018/2019 (part of the UK National Diet and Nutrition Survey (NDNS)) were used to compare self-reported 24-h urine completeness based on a collection duration of 23–25 h, no missed urine collections/voids and a minimum urine volume of > 0·4 L against completeness based on the urinary recovery of oral doses of PABA. Two-thirds (69 %; 561/812) of participants who adhered to the PABA protocol provided a complete 24-h urine collection. Assessed by self-report, 71 % (619/868) of participants provided a complete 24-h urine collection. Sodium excretion was (geometric mean (interquartile range)) 127 (97–170) mmol/24 h with PABA and 126 (97–169) mmol/24 h by self-report; salt intake was 7·40 (5·65–9·94) g/d and 7·38 (4·53–8·83) g/d, respectively. The proportion of participants above the UK-recommended salt intake of 6 g/d was 70 % by both PABA and self-report. This study shows that the use of self-report of 24-h urine collection completeness provides an assessment of sodium excretion and dietary salt intake with the same accuracy as when PABA recovery is used to assess completeness.

High-amylose maize starch (HAMS) can lead to succinate accumulation in the rat colon depending on the colonic microbiota. Since succinate is primarily produced via the vitamin B12 (VB12)-dependent succinate pathway, limited VB12 availability in the colon may impair fermentation. While a portion of dietary VB12 may reach the colon, most of it is absorbed in the upper gastrointestinal tract, potentially resulting in an insufficient supply for colonic bacteria. This study aimed to determine the minimum caecal VB12 concentration required to prevent succinate accumulation and to assess whether dietary cobalt (Co), a structural component of VB12 and its analogues, promotes microbial VB12 analogue synthesis. Sprague-Dawley male rats were used in three experiments. In Experiment 1, HAMS-fed rats were given diets with increasing VB12 doses. Caecal succinate concentrations decreased dose-dependently, with a predicted threshold of 74 pmol/g VB12 required to prevent accumulation. In Experiment 2, rats were fed HAMS diets with varying Co levels. Co supplementation significantly increased VB12-equivalent concentrations, measured by microbiological assay, from 27 to 915 pmol/g without altering cobalamin concentrations, suggesting enhanced microbial synthesis of VB12 analogues. Caecal succinate levels decreased with increasing Co intake, mimicking the effects of dietary VB12. In Experiment 3, rats were fed HAMS diets with or without high-dose Co to confirm these effects and assess microbiota changes. Co supplementation restored the abundance of Akkermansia, which utilises VB12 and its analogues. These findings suggest that maintaining sufficient colonic VB12 – through direct supplementation or Co-stimulated microbial production – may help mitigate HAMS-induced succinate accumulation and support balanced colonic fermentation.

Eating duration and shift work can both influence metabolic regulation, but their joint associations with diabetes are unknown. We aimed to examine the independent and joint associations of eating duration and shift work with diabetes in a cross-sectional study using a nationally representative sample of US workers. We included 14852 eligible participants from the National Health and Nutrition Examination Survey, 2005–2010 and 2017–2020. Eating duration was calculated based on first and last eating occasions from 24-h dietary recalls. Long eating duration (LED: ≥ 13 h) v. short eating duration (SED: < 13 h) was defined based on the median. Workers were classified as engaging in shift work (SW, n 5140) v. non-shift work (NSW, n 8945) based on self-report. Logistic regressions were used to examine the associations of LED and SW with diabetes, independently and jointly with stratification by age. LED was associated with higher odds of diabetes among workers aged < 45 years (OR, 1·51; 95 % CI, 1·05–2·19) but not among workers aged ≥ 45 years (OR, 0·98; 95 % CI, 0·79–1·20). SW was associated with higher odds of diabetes among both younger (OR, 1·28; 95 % CI, 0·88–1·85) and older workers (OR, 1·28; 95 % CI, 1·04–1·58). There was suggestive evidence that workers with both LED and SW had higher odds of diabetes compared with those with SED and NSW, but the association was stronger among younger (OR, 1·40; 95 % CI, 0·85–2·28) than older workers (OR, 1·28; 95 % CI, 0·99–1·66). LED and SW were independently associated with increased odds of diabetes with suggestive evidence on their joint associations, but associations varied by workers’ age.

Nutrient gaps are differences between recommended and actual intakes and are often based on the estimated average requirement (EAR), the average daily intake estimated to meet the requirement of 50% of healthy individuals. While nutrient gaps have been established in the general population, their presence in exercising adults has not been extensively investigated. In the present analyses, 681 dietary recalls were obtained from 226 healthy exercising adults (154 F, 72 M) using the Automated Self-Administered 24-h (ASA24®) Dietary Assessment Tool. Intakes of seventeen vitamins and minerals were compared to corresponding EAR values to determine if nutrient gaps were present. Additionally, the potential for sex differences in absolute and relative nutrient intakes was examined. Median intakes of vitamin D fell below the EAR in both female and male adults, with the median intake of vitamin E below the EAR in female adults only (p ≤ 0.003 for each). In female participants, >50% exhibited intakes below the EAR for calcium, folate, magnesium, vitamin A, vitamin C, vitamin D, and vitamin E. In male participants, >50% exhibited intakes below the EAR for vitamin C, vitamin D, and vitamin E. Sex differences were present for intakes in sixteen of seventeen micronutrients (p < 0.001 for each), with lower intakes observed in female adults. Collectively, the present analyses indicate underconsumption of some micronutrients, particularly in exercising female adults. The potential to improve vitamin and mineral intakes and attendant health and performance outcomes through targeted interventions in exercising adults should be explored in future research.

A short FFQ was developed for online assessment of adherence to the Dutch Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND-NL) diet, a culturally adapted version of the original American MIND diet. This study aimed to evaluate the relative validity of this short FFQ for assessing adherence to the MIND-NL diet, as scored by the MIND-NL score, compared with 3-d food records among community-dwelling older adults at risk of cognitive decline (n 1078; 67·4 (sd 4·6) years; 64 % female). A combination of statistical methods was used to assess the relative validity: presence of bias by Bland–Altman analysis; strength of association with Kendall’s Tau-b and Spearman correlation coefficients and levels of agreement with Wilcoxon signed rank test, cross-classification and weighted Kappa (κ) statistics. The Kendall’s Tau-b correlation for the MIND-NL score was 0·33 (95 % CI: 0·29, 0·37; de-attenuated Tau-b: 0·45). Individual MIND-NL diet component score correlations ranged from 0·05 to 0·56, with 12 out of 15 of the MIND-NL diet components adequately correlated (> 0·20). The average MIND-NL scores for the short FFQ (8·4 (sd 1·8) points) and food records (6·7 (sd 1·7) points) showed to be significantly different (P < 0·001). The Kappa (κ) coefficient for tertile classification of the MIND-NL score was 0·29 (95 % CI: 0·25, 0·33), indicating an acceptable level of agreement in ranking participants beyond chance. Acceptable agreements (κ > 0·20) were observed for 10 out of 15 MIND-NL diet components. Taking all analyses together, the short FFQ showed acceptable validity for ranking older adults at risk of cognitive decline according to their adherence to the MIND-NL diet.

Oxidative stress is an important pathomechanism in psoriasis, and the oxidative balance score (OBS) serves as a standardised metric for assessing systemic oxidative status, but its association with psoriasis is unclear. This study included 18 023 adults from the National Health and Nutrition Examination Survey to investigate the relationship between OBS and psoriasis. After using a complex sampling weighting method, we performed multi-model logistic regression and stratified analysis with OBS as the exposure and psoriasis as the outcome for the primary analysis. Restricted cubic spline (RCS) plots were used to evaluate potential non-linear associations between OBS and psoriasis. In addition, we performed replication analyses using two 24-h dietary records data as a sensitivity test to ensure robustness of the results. Multi-model logistic regression analyses revealed no statistically meaningful link between OBS and psoriasis prevalence when accounting for all confounders (P > 0·05), but in stratified analyses, OBS demonstrated a significant association with reduced risk of psoriasis in individuals aged 60–80 years (OR = 0·27–0·35, P < 0·05). As part of the overall OBS, moderate dietary OBS demonstrated an association with reduced psoriasis risk in 60- to 80-year-olds (OR = 0·39–0·43, P < 0·05). Lifestyle OBS (LOBS) indicates a significant negative correlation with psoriasis risk among the ‘Other Hispanic’ group. (Q3 OR = 0·23, P < 0·05). The RCS showed a non-linear relationship between LOBS and psoriasis (non-linear P = 0·013). This study provides the first systematic confirmation of an association between OBS and a reduced risk of psoriasis in elderly populations and specific ethnic groups. These findings offer new insights and directions for the prevention and treatment of psoriasis.

Surface anthropometric measures are commonly used to assess body composition in trained individuals. Standardised pre-test guidelines (morning, fasted) present logistical concerns. The impact of daily activities on skinfold (SKF) assessment has been established in males; however, there is a lack of research examining females. The aim of this study was to assess the within-day agreement between standardised and non-standardised surface anthropometric measures in trained females. Measures including body mass, eight SKF and six circumferences were collected by an International Society for the Advancement of Kinanthropometry level 1 anthropometrist on forty trained females (twenty naturally menstruating and twenty using a contraceptive) under standardised conditions (morning, fasted, rested and hydrated) and non-standardised conditions (9–10 h later after free-living) on the same day. The menstrual or contraceptive pill phase was not controlled for. The intra-class correlation coefficient and typical error were calculated to assess reliability. Overall group means were compared to assess if a significant change occurred. The sum of eight SKF sites (∑8 SKF) displayed excellent reliability, and no significant difference was noted between conditions. Greater levels of disagreement were represented by those with ∑8 SKF > 136 mm. Significant differences in group means were recorded for body mass and waist circumference. All other five circumference sites remained unchanged throughout the day. Findings suggest that if accuracy is required, body mass and waist circumference should be collected in a standardised state. SKF and all five other circumferences can be collected in trained females at any time of day without considering pre-test standard guidelines.

Adequate protein intake is crucial for preventing frailty and sarcopenia in older adults, but conventional dietary assessments are time-consuming. Developing a rapid screening tool for identifying those at risk of low protein intake is essential; however, no such tool exists for Asian populations. This study developed a prediction model to identify older adults in Japan at risk of low protein intake using a simple food intake questionnaire. The model was developed using data from 4,085 older adults aged ≥65 years from the 2013 and 2017 National Health and Nutrition Surveys. Protein intake was assessed using a one-day dietary record with a semi-weighted method. A multivariable logistic regression model was developed to predict low protein intake (<1.0 g/kg adjusted body weight/day), incorporating sex, age, adjusted body weight, and food intake frequency of nine food groups. Model performance was evaluated using the area under the receiver operator characteristic (ROC) curve and a calibration plot, both adjusted for optimism through bootstrap resampling. Participants had a mean age of 74.1 years (standard deviation = 6.6), and 55.5% of all participants were female. The prevalence of low protein intake was 21.8%. Internal validation showed a bootstrap optimism-corrected ROC area of 0.695 and a calibration slope of 0.921. We developed a 12-item prediction model for identifying older adults at risk of low protein intake. The model provides a practical tool to identify older adults at high risk of low protein intake and is expected to be used in public health settings.