Emerging research has highlighted a relationship between diet and genetics, suggesting that individuals may benefit more from personalised dietary recommendations based on their genetic risk for cardiovascular disease (CVD)(1,2). This current study aims to: (1) Measure knowledge of genetics among healthcare professionals (HCPs) working in CVD, (2) Identify HCPs’ attitudes to using genetic risk to tailor dietary interventions, and (3) Identify perceived barriers and enablers to implementing genetics to tailor dietary interventions. In a mixed-methods study, Australian HCPs (dietitians and AHPRA registered healthcare professionals) working with people with CVD were invited to complete an anonymous online survey (REDCap) and an optional interview. Recruitment occurred through social media and relevant professional organisations. Survey questions were underpinned by the theoretical domains framework(3) and data was synthesised descriptively. Semi-structured interviews were undertaken via Zoom. Interview responses were analysed using a thematic analysis approach using Braun & Clarke methodology(4). Survey responders (n = 63, 89% female, mean age 42 ± 14 years) were primarily dietitians (83%), with ≥ 10 years of experience (56%) and spent at least 20% of their time working with people with CVD (n = 55, 87%). Approximately half of respondents were aware that genetic testing for CVD exists (n = 36) and always assess family history of CVD (n = 31). Few respondents reported using genetic testing (n = 5, 8%) or felt confident interpreting and using genetic testing (n = 7, 11%) in practice. Respondents were interested in incorporating genetics into their practice to tailor dietary advice (n = 44, 70%). Primary barriers to using genetic testing included financial costs to patients and negative implications for some patients. Almost all respondents agreed genetic testing will allow for more targeted and personalised approaches for prevention and management of CVD (94%). From the interviews (n = 15, 87% female, 43 ± 17 years, 87% dietitian), three themes were identified: (1) ‘On the periphery of care’—HCPs are aware of the role of genetics in health and are interested in knowing more, but it is not yet part of usual practice; (2) ‘A piece of the puzzle’—using genetic testing could be a tool to help personalise, prioritise and motivate participants; and (3) ‘Whose role is it?’—There is uncertainty regarding HCP roles and knowing exactly whose role it is to educate patients. Healthcare professionals are interested in using genetics to tailor dietary advice for CVD, but potential implications for patients need to be considered. Upskilling is required to increase their knowledge and confidence in this area. Further clarity regarding HCP roles in patient education is needed before this can be implemented in practice.

Lactoferrin (LF), a sialylated iron-binding glycoprotein consisting of multiple sialic acid (Sia) residues attached to N-linked glycan chains, and studies have shown that both the iron and Sia are crucial for early neurodevelopment and cognition.(1) However, there is limited knowledge of the impacts of the iron saturation and sialylation in LF molecule on the early neurodevelopment and cognition. Objectives of the study were to explore the impacts and mechanisms of iron saturation and sialylation in LF molecule on early neurodevelopment and cognition. Maternal dietary intervention with native bovine LF (Native-LF), iron-free bovine LF (Apo-LF), or Sia-free bovine LF (Desia-LF) at a dose of 0.60 g/kg body weight per day was administered throughout the lactation period. Offspring pups were assessed for anxiety, learning, and memory through behavioral tests before being euthanized on postnatal day 63. Brain hippocampal tissue was then analyzed for polysialic acid (polySia), a marker of neurodevelopment and neuroplasticity.(1) The study protocol was approved by the Xiamen University Animal Ethics Committee (AE1640102). Our results showed that Apo-LF pups exhibited a 1.32-fold increase in total distance travelled in the arena compared to both Native-LF and Desia-LF groups, with the overall difference among the groups being statistically significant in the open field test (p = 0.008). Additionally, the frequency of central area entries in the Apo-LF group was 2.00-fold higher than in Desia-LF pups (p = 0.038) and 1.3-fold higher than in Native-LF pups, with a significant overall difference (p = 0.042). No significant differences in total distance travelled or central area entries were observed between Native-LF and Desia-LF groups (p > 0.05). These results suggest that Apo-LF pups demonstrated better anti-anxiety behaviors than both Native-LF and Desia-LF pups. In the Morris water maze test, Apo-LF pups spent significantly more time in the target quadrant compared to both Desia-LF (p = 0.019) and Native-LF pups (p = 0.0009), indicating enhanced short-term memory. Additionally, Apo-LF pups exhibited greater polySia-NCAM expression (1.2.95 ± 0.048) in the hippocampus, a marker associated with neuroplasticity and neurogenesis compared to both Native-LF and Desia-LF pups. We conclude that maternal supplementation with different types of lactoferrin during lactation supports improved learning and memory in offspring through distinct mechanisms, with sialylation playing a crucial role in neurocognitive development.

Maternal asthma increases the risk of adverse perinatal and respiratory outcomes in their infants(1); breastfeeding may mitigate the risk of respiratory outcomes, including wheeze(2,3). However, breastfeeding rates are lower in women with asthma(3) compared to general population data and no studies have examined early data on breastfeeding outcomes in this population. This study aimed to examine infant breastfeeding outcomes in the early postnatal period, including breastfeeding initiation, by maternal asthma exposure and whether any differences were due to adverse perinatal outcomes. Data were extracted from electronic obstetric records (e-Maternity) for pregnant women aged ≥ 18 years with singleton births who attended antenatal clinics in two local health districts in New South Wales, Australia, between 2018 and 2020. The association between breastfeeding outcomes and the exposure (maternal asthma) were estimated using multivariable logistic regression, adjusting for maternal confounders (body mass index, age, ethnicity, smoking, Socio-Economic Index for Areas). Secondly, selected perinatal outcomes were added individually to the models to examine if the effect of asthma on breastfeeding outcomes was mediated via these variable/s. Of 41,297 births, 4553 (11%) were to women with asthma. A lower proportion of the maternal asthma group intended to breastfeed compared to the no asthma group (87% vs 90%, p < 0.001); this was not significant in multivariable models, after adjusting for confounders (adjusted Odds Ratio [adjOR] 0.93, 95% Confidence Interval [CI] 0.84 to 1.03). Breastfeeding initiation was lower in the maternal asthma vs no asthma group (80 vs 84%, p < 0.001), as was infant breastfeeding at discharge from hospital (66% vs 71%, p < 0.001; mean length of stay 2.11 days vs 1.97 days) and at post-partum follow-up (56% vs 63%, p < 0.001). A higher proportion of the maternal asthma group had breastfeeding issues as an inpatient, compared to the no asthma group (44% vs 39%, p < 0.001). In multivariable models, maternal asthma was associated with 12% lower odds of breastfeeding initiation (adjOR 0.88, 95% CI 0.80 to 0.96); 11% and 9% lower odds, respectively, of the infant receiving breastmilk only at birth (adjOR 0.89, 95% CI 0.81 to 0.97) and at the postpartum follow-up (adjOR 0.91, 95% CI 0.83 to 0.99); and 12% higher odds of breastfeeding issues (adjOR 1.12, 95% CI 1.04 to 1.20). None of the potential mediators examined (low birthweight, preterm birth, caesarean section, neonatal intensive care unit admission) changed the effect size of asthma exposure by more than 10% on the OR scale for the selected outcomes (breastfeeding initiation, breastfeeding issues, breastfeeding at postpartum). In this population data analysis, maternal asthma increased the odds of poor breastfeeding outcomes in the immediate postpartum period, but these associations did not appear to be mediated via adverse birth outcomes.

Maternal diet during pregnancy influences the short- and long-term health of mothers and their offspring(1). Pregnant women from culturally and linguistically diverse (CALD) backgrounds potentially have challenges achieving a healthy diet due to language barriers, cultural differences and poor nutrition knowledge. Data from 2021 shows that ~7200 women who gave birth in Australia were of Chinese background(2), however, data on the dietary patterns and nutrition knowledge of pregnant women in Australia from CALD backgrounds are limited. This pilot, cross-sectional study aimed to: assess the food group, nutrient intakes and diet quality of pregnant/recently pregnant women in Australia with Chinese-speaking backgrounds, compare the intakes with national nutrition recommendations, and assess the nutrition knowledge of the women. Participants were recruited in partnership with Hunter New England Local Health District Multicultural and Refugee Health to complete an online survey, which was translated to simplified Chinese language. Eligible participants were pregnant women and women who had given birth in the previous 12-months, who were living in, but not born in Australia, who were ≥ 19 years, and primarily spoke a Chinese language. Dietary intake was assessed via the Australian Eating Survey, diet quality via the Australian Recommended Food Score (ARFS), and nutrition knowledge via a questionnaire adapted from the General Nutrition Knowledge Questionnaire. Food group serves, macronutrient, micronutrient and energy intake, and diet quality were reported as median (IQR) due to non-normal distributions. Intake of food group serves, macronutrients and micronutrients were compared with national nutrition recommendations. The mean (SD) nutrition knowledge score out of 23 was reported. Fifty participants (31.8 ± 4.3 years, mostly pregnant (66%), born in China (66%) with Mandarin as first language (62%)) reported median consumption of all five food groups below recommendations, with the poorest alignment for grain (4%) and dairy foods (4%). Median consumption of carbohydrate (46.5% EI), fat (34.5% EI) and protein (20.0% EI) met recommendations for pregnant women, but not saturated fat (12.5% EI) or dietary fibre (18.6 grams). The alignment of 16 micronutrients from food intake to recommendations was poor, particularly for iron (4%) and iodine (12%). The highest alignment to recommendations was for vitamin C (92%) and retinol (78%). The median (IQR) ARFS was 23 (18, 39) points out of 73, indicating poor overall diet quality. The mean (SD) nutrition knowledge score was 10.2 (2.9) out of 23. This sample of pregnant and recently pregnant women living in Australia with Chinese-speaking background reported suboptimal food group and nutrient intakes and overall diet quality that does not align with national nutrition recommendations. The low nutrition knowledge score suggests poor knowledge of pregnancy dietary recommendations. These findings warrant further investigation in larger samples of pregnant women from CALD backgrounds with regard to dietary intake and nutrition knowledge.

This paper investigates the association between potential serum biomarkers and diabetes status in older Australians by employing traditional and machine learning methods. Data from Sydney Memory and Ageing Study (MAS) were interrogated cross-sectionally in 801 participants aged 70–90 years (n = 801). Twenty-eight serum biomarkers and 6 other factors were investigated as potential indicators that may distinguish diabetes status. Diabetes status was categorised as No-Diabetes, Pre-diabetes, and Type 2 diabetes (T2D). Diabetes is defined as follows when using fasting plasma glucose: no diabetes/ normal: < 5.6 mmol/L; prediabetes: 5.6–6.9 mmol/L; and diabetes: ≥ 7 mmol/L(1). Variable selection was executed using two distinct regression methods (i) multinomial logistic regression with backward selection and (ii) machine learning using elasticNet regression. Multiple imputation was used to address missing data. Age and sex were included as a priori covariates in the multinomial regression model. Using a multinomial logistic regression, Malondialdehyde (MDA), Macrophage inhibiting cytokine 1 (MIC1), and vitamin E were associated with diabetes status. MDA was strongly associated with diabetes with relative risk ratio (RRR) of 4.78 (95% CI = 3.39, 6.75; p < 0.001) when comparing to no diabetes, surpassing usual markers insulin, triglycerides, and waist-to-hip (WHR). Diabetes was associated with lower vitamin E levels, compared to no diabetes, with an RRR of 0.54 (95% CI:0.38, 0.75; p < 0.001). Comparing diabetes to prediabetes, RRR for lower vitamin E levels was 0.71 (95% CI: 0.51, 0.98; p = 0.035). MIC1 distinguished between diabetes and prediabetes status (RRR: 1.84; 95% CI:1.41, 2.41; p < 0.001). Consistent with the traditional methods, machine learning also identified MDA as being associated with T2D, with an odds ratio (OR) of 1.9, followed hierarchically by insulin (OR = 1.23), WHR (OR = 1.22) and triglyceride (OR = 1.13). Higher serum Vitamin E were associated with a lower risk of being in diabetes category (OR = 0.84). MIC1, urate, IL1b, HDL, and carotene were identified by the machine learning model, but showed minimal association. These results suggest that the oxidative stress and inflammation markers distinguish the state of having T2D.

A growing number of Australians are experiencing challenges accessing and affording healthy food due to climate-related disasters, global supply chain disruptions, and rapid inflation that is affecting the cost of healthy food(1). There is limited understanding of how participation community-based food cooperatives can address these challenges and improve food security and dietary intake. This study investigated the motivations for joining and impact of participation in a community-based food cooperative called Box Divvy on self-reported food security status and intake of fruits and vegetables among a sample of Australian adults. A cross-sectional online survey was conducted among Box Divvy members, that measured sociodemographic characteristics, motivations for joining, self-reported fruit and vegetable intake (serves/week), and food insecurity status (USDA 6-item short form(2)) before and while using Box Divvy. Participants were classified as being food secure, or experiencing marginal, moderate, or severe food insecurity. Logistic regression assessed demographic predictors and self-reported change in food security status, and ANOVA examined changes in dietary intake before joining and while using Box Divvy. Of participants (n = 2764, 37% aged 35–44 years, 83% European ethnicity, 92% New South Wales residents), most joined Box Divvy to support local farmers (87.3%), and save money on healthy foods (70.6%). Around half of respondents (50.8%) reported experiencing food insecurity before joining Box Divvy (24.5% marginal, 18.4% moderate, 7.9% severe food insecurity). Univariate logistic regression identified age, household structure, and income as significant predictors of food insecurity (p < 0.001). Participants experiencing food insecurity reported significantly lower consumption of fruits and vegetables prior to joining Box Divvy compared to those who were food secure (p < 0.001). While using Box Divvy, 28.2% of participants reported experiencing food insecurity (16.6% marginal, 9.6% moderate, 2.1% severe food insecurity). The odds of food insecurity while using Box Divvy were 62% lower than before joining (OR: 0.38; 95% CI 0.34–0.43; p < 0.001). On average, participants reported their fruit intake increased by 2.5 ± 5.6 serves/week (p < 0.001), and vegetable intake increased by 3.3 ± 5.7 serves/week (p < 0.001). The mean increase was significantly greater among moderately food insecure (fruit mean difference 3.2 ± 6.5 serves/week; vegetable mean difference 3.9 ± 6.9 serves/week) and severely food insecure groups (fruit mean difference 4.4 ± 6.9 serves/week; vegetable mean difference 5.5 ± 7.7 serves/week; p < 0.001). Participation in Box Divvy significantly improved self-reported food security status and fruit and vegetable intake among a large sample of Australian adults. Notably, fruit and vegetable intake significantly increased among those experiencing moderate and severe food insecurity. This underscores the potential of community-based food cooperatives to improve food security and promote healthier eating habits among Australian adults, especially households experiencing food insecurity.

Malnutrition is a major contributor to poorer health outcomes and continues to be sub-optimally identified and managed(1). The collection and availability of healthcare data is growing rapidly, strategies to harness data for optimal care is evolving(2). A hospital nutrition informatics platform that presents food supply and intake data and categorises risk using energy and protein thresholds has shown potential for identifying malnutrition risk(3). This study aimed to determine the Nutrition Dashboard’s capability to predict malnutrition through analysis of multiple energy and protein thresholds. Data were extracted from medical files and food service records for 267 patients over a four-month period, in a 99-bed hospital. Energy (2500 to 8000 kJ) and protein (30 to 90 g) thresholds were applied for Nutrition Dashboard categorisation by supply and intake of food. Deficits in estimated requirements (105 kJ and 0.75 g/kg/day)(4) were also applied as a comparative screening method. The association between Nutrition Dashboard categories and Malnutrition Screening Tool (MST) score was explored using generalised estimating equations. A total of 267 patients and 1908 days of data were analysed. Patients at risk of malnutrition (MST ≥ 2) was 39.2%, of those patients at increased risk, 57% received a dietitian referral. The use of weight based estimated requirements for Nutrition Dashboard categorisation was not statistically significant predictor of MST ≥ 2. Application of energy (≤ 6000 kJ) and protein (≤ 65 g) thresholds for categorisation was significant (X2 = 9.50, df = 3, p = 0.023). When 5000 kJ and 55 g of protein were used for categorisation, patients were more likely to be at nutritional risk (MST ≥ 2) if they were within low supply (OR 2.11, p = 0.002) and low intake (OR 2.23, p < 0.001) categories. When age, length of stay and weight were added to the modelling as covariates, the upper intake and protein thresholds of 5500 kJ and 60 g protein for Nutrition Dashboard categories one (low supply; OR 1.64, p = 0.046) and two (low intake; OR 1.64, p = 0.041) remained statistically significant predictors of at-risk nutrition status as measured by MST ≥ 2. Age and LOS were not significant predictors of MST ≥ 2, a static weight measure was found to be a predictor of at-risk nutrition screening (OR 0.97, CI = 0.95–0.97, p < 0.001). Nutrition Dashboard supply and intake categories were associated with an increased risk of malnutrition when categorised using thresholds up to 6000 kJ and 65 g protein. The Nutrition Dashboard presents nutrition risk surveillance information directly to dietitians with high reliability in an easily accessed, interactive format. Technologies such as the Nutrition Dashboard present innovative opportunities for dietitians to utilise nutrition informatics to enhance and optimise nutrition care.

Traditional foods are increasingly being incorporated into modern diets. This is largely driven by consumers seeking alternative food sources that have superior nutritional and functional properties. Within Australia, Aboriginal and Torres Strait Islander peoples are looking to develop their traditional foods for commercial markets. However, supporting evidence to suggest these foods are safe for consumption within the wider general population is limited. At the 2022 NSA conference a keynote presentation titled ‘Decolonising food regulatory frameworks to facilitate First Peoples food sovereignty’ was presented. This presentation was followed by a manuscript titled ‘Decolonising food regulatory frameworks: Importance of recognising traditional culture when assessing dietary safety of traditional foods’, which was published in the conference proceedings journal(1). These pieces examined the current regulatory frameworks that are used to assess traditional foods and proposed a way forward that would allow Traditional Custodians to successfully develop their foods for modern markets. Building upon the previously highlighted works, this presentation will showcase best practice Indigenous engagement and collaboration principles in the development of traditionally used food products. To achieve this, we collaborated with a collective of Gamilaraay peoples who are looking to reignite their traditional grain practices and develop grain-based food products. To meet the current food safety regulatory requirements, we needed to understand how this grain would fit into modern diets, which included understanding the history of use, elucidating the nutritional and functional properties that can be attributed to the grain, and developing a safety dossier(2) so that the Traditional Custodians can confidently take their product to market. To aid the Traditional Custodians in performing their due diligence, we have systemically analysed the dietary safety of the selected native grain and compared it side-by-side with commonly consumed wheat in a range of in vitro bioassays and chemical analyses. From a food safety perspective, we show that the native grain is equivalent to commonly consumed wheat. The native grain has been shown to be no more toxic than wheat within our biological screening systems. Chemical analysis showed that the level of contaminants are below tolerable limits, and we were not able to identify any chemical classes of concern. Our initial findings support the history of safe use and suggest that the tested native grain species would be no less safe than commonly consumed wheat. This risk assessment and previously published nutritional study(3) provides an overall indication that the grain is nutritionally superior and viable for commercial development. The learnings from this project can direct the future risk assessment of traditional foods and therefore facilitate the safe market access of a broader range of traditionally used foods. Importantly, the methods presented are culturally safe and financially viable for the small businesses hoping to enter the market.

To achieve infectivity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, must first traverse the upper respiratory tract mucosal barrier. Once infection is established, the cascading complexities of the pathophysiology of COVID-19 makes intervention extremely difficult. Thus, enhancing the defensive properties of the mucosal linings of the upper respiratory tract may reduce infection by SARS-CoV-2 and indeed by other viruses such as influenza, which have been responsible for the two major pandemics of the last century. In this review we summarise potential opportunities for foods and nutrients to promote an adequate mucosal immune preparedness with an aim to assist protection against infection by SARS-CoV-2, to maximise the mucosal vaccination (IgA inducing) response to existing systemic vaccines, and to play a role as adjuvants to intranasal vaccines. We identify opportunities for vitamins A and D, zinc, probiotics, bovine colostrum and resistant starch to promote mucosal immunity and enhance the mucosal response to systemic vaccines, and for vitamin A to also improve the mucosal response to intranasal vaccination. It is possible that an entirely different virus may in the future, by way of convergent evolution, utilise a similar upper respiratory tract infection pathway. A greater research focus on mucosal lymphoid immune protection in partnership with nutrition would result in greater preparedness for such an event.

New South Wales (NSW) Health is committed to enhancing child health and development during the first 2000 days (conception to 5 years)(1). However, in Australia current child health behaviours indicate the need for further improvements. For example, discretionary foods (contributing high amounts of saturated fat, energy, added sodium and sugar) account for approximately 30% of total energy intakes in 2–3 years olds including the consumption of sugar sweetened beverages (SSB)(2). There remains a need to provide all parents raising children with direct and sustained support from birth to maximise health behaviours during this important life stage. Healthy Beginnings for HNEKids (HB4HNEKids) is an innovative text messaging program designed to be integrated into the usual care provided by Child and Family Health Nursing (CFHN) services. The messages were co-designed with key stakeholders to provide age-and-stage relevant preventive health information to parents/carers during the first 2000 days. HB4HNEKids has been piloted within five diverse CFHN services within the Hunter New England (HNE) local health district of NSW, reaching over 6000 families since its launch. However, the efficacy of the program on child health behaviours has not yet been explored. The aim of this study is to explore if families that received the HB4HNEKids program report reduced frequency of child discretionary food intake and a lower prevalence of SSB exposure, compared to families who did not receive the program. A cross-sectional survey of mothers 12–14 months post-partum was conducted between August 2023 and July 2024 including participants that received HB4HNEKids and a concurrent non-randomised comparison group, located in HNE. Mothers were asked to report on the frequency of child discretionary food intake per week, and whether their child had ever received SSB (including sweetened water, cordial, fruit drink, and soft-drinks). We conducted linear regression and logistic regression analyses to explore differences between the intervention and comparison participants. A total of 283 participants completed the survey, including 104 (37%) participants that had received the HB4HNEKids program. In infants aged 12–14 months, the frequency of discretionary food intake was approximately 1 serve per week and was unchanged based on if the family had received the HB4HNEKids program or not. Despite a 6-point prevalence difference in SSB exposure reported between groups (HB4HNEKids: 19.42% vs Comparison: 26.26%), this difference was not statistically significant (OR: 0.68 (95% CI: 0.37, 1.23), p = 0.2). Australian infant feeding guidelines suggest that the consumption of nutrient poor discretionary foods and sugar sweetened beverages should be avoided or limited(3). The HB4HNEKids program demonstrates some promise for improving infant feeding behaviours, however a larger effectiveness trial is required to ensure the evaluation is adequately powered.

This study aimed to investigate the potential effect of PUFA intake on the association between psoriasis and 10-year atherosclerotic CVD (ASCVD) risk. Data of this study were extracted from the National Health and Nutrition Examination Survey database 2003–2006 and 2009–2014. The 10-year ASCVD risk score was calculated based on American College of Cardiology/American Heart Association guidelines, and the subjects were stratified into high 10-year ASCVD risk (≥ 7·5 %) and low 10-year ASCVD risk (< 7·5 %), accordingly. The weighted univariate and multivariate logistic regression models were utilised to evaluate the effect of total PUFA and its subtypes intake on the association between psoriasis and 10-year ASCVD risk. This effect was further evaluated in the subgroup of subjects aged ≥ 60 and < 60 years old. A total of 8705 participants were included, with 41·02 % (n 3571) in the high 10-year ASCVD risk (≥ 7·5 %). We observed subjects with psoriasis (OR 1·65; 95 % CI 1·02, 2·67) and low n-3 intake (OR 1·27; 95 % CI 1·025, 1·53) were associated with high 10-year ASCVD risk; no significant association was found between n-6 and 10-year ASCVD risk. The moderating effect of n-3 intake on the association between psoriasis and 10-year ASCVD risk was observed (OR 2·56; 95 % CI 1·04, 6·26). We also found among the n-3 components, α-linolenic acid (OR 2·72; 95 % CI 1·10, 6·70) had a more significant moderating effect on the association between psoriasis and 10-year ASCVD risk, especially in the subjects aged < 60 years (OR 2·41; 95 % CI 1·36, 4·28). Adequate intake of n-3, especially α-linolenic acid, may have potential benefits on improving cardiovascular health in psoriasis patients.

Global food security challenges, driven by the need to feed an estimated 10 billion people by 2050, require sustainable agricultural practices which strengthen nutritional adequacy while minimising environmental impacts. Yet, decision-making to foster food systems which consider both human and planetary health is growing in complexity. This paper, presented at an International Atomic Energy Agency-supported symposium at the 14th European Nutrition Conference of the Federation of European Nutrition Societies, highlights the potential of stable isotope techniques in generating valuable evidence to help support the development of sustainable food systems. It focuses on three methods: the dual tracer stable isotope technique for measuring protein digestibility, the Fe isotope dilution technique for assessing Fe absorption, loss and balance and the deuterium oxide dose-to-mother technique for estimating breast milk intake. The dual tracer isotope method provides a minimally invasive assessment of protein quality from a diverse variety of crops and novel sources, supporting the transition towards environmentally conscious, protein-rich diets. The Fe isotope dilution technique can be used to address Fe requirements across different population groups and calculate Fe absorption from whole diets or after consuming crops designed to be nutritionally sufficient, thus guiding dietary guidelines and agricultural strategies. Finally, the deuterium oxide dose-to-mother technique provides precise data on breast milk intake, underscoring the role of breastfeeding in sustaining optimal infant nutrition and the conservation of resources. These methods have the ability to generate critical evidence to support policy development and food system innovations that prioritise human health and environmental preservation.

The World Cancer Research Fund and the American Institute for Cancer Research recommend a plant-based diet to cancer survivors, which may reduce chronic inflammation and excess adiposity associated with worse survival. We investigated associations of plant-based dietary patterns with inflammation biomarkers and body composition in the Pathways Study, in which 3659 women with breast cancer provided validated food frequency questionnaires approximately 2 months after diagnosis. We derived three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). We assayed circulating inflammation biomarkers related to systemic inflammation (high-sensitivity C-reactive protein [hsCRP]), pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10, IL-13). We estimated areas (cm2) of muscle and visceral and subcutaneous adipose tissue (VAT and SAT) from computed tomography scans. Using multivariable linear regression, we calculated the differences in inflammation biomarkers and body composition for each index. Per 10-point increase for each index: hsCRP was significantly lower by 6·9 % (95 % CI 1·6%, 11·8%) for PDI and 9·0 % (95 % CI 4·9%, 12·8%) for hPDI but significantly higher by 5·4 % (95 % CI 0·5%, 10·5%) for uPDI, and VAT was significantly lower by 7·8 cm2 (95 % CI 2·0 cm2, 13·6 cm2) for PDI and 8·6 cm2 (95 % CI 4·1 cm2, 13·2 cm2) for hPDI but significantly higher by 6·2 cm2 (95 % CI 1·3 cm2, 11·1 cm2) for uPDI. No significant associations were observed for other inflammation biomarkers, muscle, or SAT. A plant-based diet, especially a healthful plant-based diet, may be associated with reduced inflammation and visceral adiposity among breast cancer survivors.

This study aimed to explore combinations of the Brazilian front-of-package nutrition labelling (FoPNL) (high in added sugar, saturated fat or sodium) and/or three specific food additives with cosmetic functions (colourings, flavourings and non-sugar sweeteners) in packaged foods and beverages marketed in Brazil. This approach intends to strengthen the identification of ultra-processed food products (UPFP) by consumers through the information available on their labels. A cross-sectional study was carried out using data from the list of ingredients and the nutrition facts panel on labels of processed foods and UPFP available in Brazilian supermarkets between April and July 2017, totalling 8436 food items assessed, of which 84·0 % were UPFP. Of the total, 62·7 % of the UPFP would have the FoPNL and 65·1 %, 37·9 % and 12·9 % had flavouring, colouring and non-sugar sweeteners, respectively. Combining criteria for the FoPNL with any one of the three cosmetic additives analysed, 45·9 % of the UPFP were identified, and when considering the presence of the FoPNL, flavouring, colouring or non-sugar sweeteners, the identification increased to 89·9 %. Results showed that the current FoPNL in Brazil does not facilitate the identification of UPFP. In this sense, labels that indicate the presence of food additives with cosmetic functions (which are UPFP markers) could be a public health strategy to reduce the consumption of UPFP. Currently, food labelling regulations in Brazil are not aligned with Brazilian Dietary Guidelines recommendations.

Pregnancy and lactation change women’s body composition (BC), but few longitudinal studies have investigated postpartum BC trajectories. We aimed to investigate maternal and infant predictors of maternal body fat (BF), fat mass (FM), fat-free mass (FFM) and BMI trajectories during lactation. Longitudinal study with 234 Brazilian mother–infant dyads followed at 1·0–3·49, 3·5–5·99 and 6·0–8·5 months postpartum. Maternal BC was estimated using bioelectrical impedance at all follow-up points. Longitudinal mixed–effects models with interaction terms with time (weeks postpartum) were employed. FFM declined significantly over weeks postpartum (β = −0·02 kg; 95 % CI –0·03, −0·01). Pre-pregnancy overweight women experienced an increase in all body components (BF: β = 4·91 %, 95 % CI 3·79, 6·04; FM: β = 6·46 kg, 95 % CI 5·26, 7·67; FFM: β = 3·72 kg, 95 % CI 2·80, 4·65) and BMI (β = 4·51 kg/m2, 95 % CI 3·91, 5·12). Multiparous women showed BMI increases (β = 0·76 kg/m2, 95 % CI 0·11, 1·41), and those who delivered by caesarean had FFM (β = 1·87 kg, 95 % CI 0·67, 3·07) and BMI (β = 1·39 kg/m2, 95 % CI 0·61, 2·18) increases. Women who birthed girls had reductions in FM (β = −1·24 kg, 95 % CI –2·41, −0·07) and FFM (β = −0·93 kg, 95 % CI –1·84, −0·01). Interactions occurred between maternal age ≥ 30 years, higher family income, multiparity and infant sex for BC and BMI trajectories. Maternal age, pre-pregnancy BMI, parity, family income, mode of delivery and infant sex predict maternal BC and BMI trajectories.

Metabolic syndrome (MetS) is associated with deteriorated mental health and health-related quality of life (HRQOL). Curcumin and probiotics improved MetS, mental health and HRQOL. The present study aimed to investigate the effect of curcumin-probiotic (CurPro) co-supplementation in the form of drink powder on mental health and HRQOL in adults with overweight/obesity and MetS. A four-arm, randomised, double-blinded, placebo-controlled clinical trial with factorial design was conducted for adults with overweight/obesity and MetS (n 128). Participants were randomly allocated into four groups to receive one drink powder sachet containing 1 g curcumin, 109 colony-forming unit (CFU) probiotic (Lactobacillus acidophilus and Lactobacillus rhamnosus strains), CurPro (1 g curcumin and 109 CFU probiotic) or placebo along with a low-calorie diet. Participants were assessed for dietary intake, physical activity, mental health and HRQOL before and after the study. After 8 weeks of intervention, 104 participants finished the study. The CurPro intervention reduced stress (P = 0·001) and anxiety (P = 0·019) and improved general health (P = 0·024) and overall HRQOL (P = 0·011) scores of participants in comparison with the Placebo group. Results were NS for depression and HRQOL subdomains such as physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and role limitations due to emotional problems. Curcumin-probiotics co-supplementation could improve the mental health and HRQOL of adults with overweight/obesity and MetS. Further investigations in various populations or with different dosages or durations are recommended.

Pregnant women are at higher risk of vitamin D deficiency due to increased nutritional requirements and limited dietary sources. Fish is the major source of vitamin D, but its availability varies by region. This study aims to assess the availability of vitamin D-rich fish and develop food-based recommendations (FBR) for pregnant women in East Lombok, Indonesia. This comparative cross-sectional study was conducted in East Lombok, Indonesia, which is part of Action Against Stunting cohort of pregnant women. Twenty-five village markets in the area were scored based on availability of vitamin D-rich fish and number of fish sellers in each market and were categorised into high availability (HD) for the highest quartile and low availability (LD) for the lowest quartile. Quantum Geographic Information System software was used to identify each of respondents’ houses using 2·4 km buffer zones to either HD or LD markets. Dietary intake data were collected from 24-h dietary recalls and linear programming analysis using Optifood was used to identify problem nutrient and dietary inadequacy. No significant difference in vitamin D intake was found between HD and LD areas (P = 0·633). While both groups’ FBR ensure adequacy of Fe, Zn, vitamins A, B1, B2, B3, B6 and B12, Ca remain as dietary inadequacy in the LD group, suggesting that availability play a role in ensuring dietary adequacy. Future studies to develop nutrient-dense foods and improved fish availability mapping which consider non-static position of market (mobile vendor) are recommended.

With the widespread use of high-fat diets (HFD) in aquaculture, the adverse effects of HFD on farmed fish are becoming increasingly apparent. Creatine has shown potential as a green feed additive in farmed fish; however, the potential of dietary creatine to attenuate adverse effects caused by high-fat diets remains poorly understood. To address such gaps, this study was conducted to investigate the mitigating effect of dietary creatine on HFD-induced disturbance on growth performance, hepatic lipid metabolism, intestinal health and muscle quality of juvenile largemouth bass. Three diets were formulated: a control diet (10·20 % lipid), a high-fat diet (HFD, 18·31 % lipid) and HFD with 2 % creatine (HFD + creatine). Juvenile largemouth bass (3·73 (sem 0·01) g) were randomly assigned to three diets for 10 weeks. The key findings were as follows: (1) the expression of muscle growth-related genes and proteins was stimulated by dietary creatine, which contributes to ameliorate the adverse effects of HFD on growth performance; (2) dietary creatine alleviates HFD-induced adverse effects on intestinal health by improving intestinal health, which also enhances feed utilisation efficiency; (3) dietary creatine causes excessive lipid deposition, mainly via lipolysis and β-oxidation. Notably, this study also reveals a previously undisclosed effect of creatine supplementation on improving muscle quality. Together, for the first time from a comprehensive multiorgan or tissue perspective, our study provides a feasible approach for developing appropriate nutritional strategies to alleviate the adverse effects of HFD on farmed fish, based on creatine supplementation.

Psoriasis is a chronic debilitating skin disease affecting 2 % of the UK population. The aetiopathogenesis of psoriasis arises from a combination of genetic susceptibly and lifestyle patterns including stress, infections, alcohol misuse, lack of physical activity and adiposity. This unfavourable gene-lifestyle pairing triggers a series of inflammatory responses resulting in the uncontrolled proliferation of skin cells characteristic of psoriasis, which at present is an incurable disease. Concurrent with the systemic nature of the condition, psoriasis has effects beyond the skin with concomitant cardiometabolic complications, arthritis, gastrointestinal diseases and depression, emphasising the need for other strategies beyond pharmaceutical therapies to support psoriasis treatments. The role of diet in psoriasis management has not been clearly established and only two evidence-based recommendations are available for people with psoriasis. This review aims to critically appraise the research examining dietary patterns in psoriasis populations, highlight the gaps in the evidence-base, and present directions for future research.

Weaning and introduction to a solid diet result in physiological stress in piglets. This can be offset by using complex diets. The terms ‘complexity’ and ‘complex diets’ are used in practice and academia but are not precisely defined. The aim of this review was to identify the ingredients in weaner diets, their inclusion levels and how the number of ingredients or complexity of diets influences weaner performance, intestinal and systemic health, environmental sustainability and antibiotic use. Not all diets are formulated equally. Some prioritise meeting the weaner’s nutritional needs, while other diets seek to align health promotion and adaptation to the environment. As diet composition is of vital importance for young piglets, the components needed in these complex diets must be defined. Healthy, environmentally adapted pigs have excellent growth performance. We therefore recommend use of a new term, ‘gut health supporting diets’, to encompass the many concepts associated with diet complexity.