Awareness of the ancestral human diet might advance traditional nutrition science. The human genome has hardly changed since the emergence of behaviourally-modern humans in East Africa 100–50×103 years ago; genetically, man remains adapted for the foods consumed then. The best available estimates suggest that those ancestors obtained about 35% of their dietary energy from fats, 35% from carbohydrates and 30% from protein. Saturated fats contributed approximately 7·5% total energy and harmful trans-fatty acids contributed negligible amounts. Polyunsaturated fat intake was high, with n−6:n−3 approaching 2:1 (v. 10:1 today). Cholesterol consumption was substantial, perhaps 480 mg/d. Carbohydrate came from uncultivated fruits and vegetables, approximately 50% energy intake as compared with the present level of 16% energy intake for Americans. High fruit and vegetable intake and minimal grain and dairy consumption made ancestral diets base-yielding, unlike today's acid-producing pattern. Honey comprised 2–3% energy intake as compared with the 15% added sugars contribute currently. Fibre consumption was high, perhaps 100 g/d, but phytate content was minimal. Vitamin, mineral and (probably) phytochemical intake was typically 1·5 to eight times that of today except for that of Na, generally <1000 mg/d, i.e. much less than that of K. The field of nutrition science suffers from the absence of a unifying hypothesis on which to build a dietary strategy for prevention; there is no Kuhnian paradigm, which some researchers believe to be a prerequisite for progress in any scientific discipline. An understanding of human evolutionary experience and its relevance to contemporary nutritional requirements may address this critical deficiency.

In the last 50 years science has provided new perspectives on the ancient art of herbal medicine. The present article discusses ways in which the evidence base for the professional use of 'Western' herbal medicine, as therapy to treat disease, known as phytotherapy, can be strengthened and developed. The evidence base for phytotherapy is small and lags behind that for the nutritional sciences, mainly because phytochemicals are ingested as complex mixtures that are incompletely characterised and have only relatively recently been subject to scientific scrutiny. While some methodologies developed for the nutritional sciences can inform phytotherapy research, opportunities for observational studies are more limited, although greater use could be made of patient case notes. Randomised clinical trials of single-herb interventions are relatively easy to undertake and increasing numbers of such studies are being published. Indeed, enough data are available on three herbs (ginkgo (Ginkgo biloba), St John's wort (Hypericum perforatum) and saw palmetto (Serenoa repens)) for meta-analyses to have been undertaken. However, phytotherapy is holistic therapy, using lifestyle advice, nutrition and individually-prescribed mixtures of herbs aimed at reinstating homeostasis. While clinical experience shows that this approach is applicable to a wide range of conditions, including chronic disease, evidence of its efficacy is scarce. Strategies for investigating the full holistic approach of phytotherapy and its main elements are discussed and illustrated through the author's studies at the University of Reading.

Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.

Plant biotechnology can make important contributions to food security and nutritional improvement. For example, the development of ‘Golden Rice’ by Professor Ingo Potrykus was a milestone in the application of gene technology to deliver both increased nutritional qualities and health improvement to wide sections of the human population. Mineral nutrient and protein deficiency as well as food security remain the most important challenges for developing countries. Current projects are addressing these issues in two major staple crops, cassava (Manihot esculenta Crantz) and rice. The tropical root crop cassava is a major source of food for approximately 600 million of the population worldwide. In sub-Saharan Africa >200 million of the population rely on cassava as their major source of dietary energy. The nutritional quality of the cassava root is not sufficient to meet all dietary needs. Rice is the staple food for half the world population, providing approximately 20% of the per capita energy and 13% of the protein for human consumption worldwide. In many developing countries the dietary contributions of rice are substantially greater (29·3% dietary energy and 29·1% dietary protein). The current six most popular ‘mega’ rice varieties (in terms of popularity and acreage), including Chinese hybrid rice, have an incomplete amino acid profile and contain limited amounts of essential micronutrients. Rice lines with improved Fe contents have been developed using genes that have functions in Fe absorption, translocation and accumulation in the plant, as well as improved Fe bioavailability in the human intestine. Current developments in biotechnology-assisted plant improvement are reviewed and the potential of the technology in addressing human nutrition and health are discussed.

The paper discusses the case histories of three patients who have faced the emotional implications of being initiated onto long-term parenteral nutrition (PN). In each case the patient's personal and family history, relationship to their illness and the presence or relative absence of resentments and grievances have influenced their ability to tolerate the training and the transition to home PN (HPN). In addition, the emotional importance of food and feeding from a developmental and social perspective is explored, together with the numerous psychological and social ‘losses’ experienced by all patients on PN and the adaptations required within the family setting. The ‘meaning’ of PN to the individual and the need for both internal and external support are identified and, based on clinical experience, a number of features are described that may be indicative of the relative abilities of different patients to cope with HPN. Finally, the role of a dedicated Psychological Medicine Unit closely allied to a nutrition service is discussed.

The FAO World Food Summit (WFS) in 1996 set the goal of halving the numbers of the global population suffering hunger by the year 2015, which was later incorporated into the UN Millennium Development Goals (MDG) that commit the international community to an expanded vision of development, and one that vigorously promotes human development as the key to sustaining social and economic progress in all countries. The two targets under the first MDG goal to eradicate poverty and hunger call for halving the proportion of individuals who suffer from poverty and from hunger by 2015. This commitment is another instance of the international community through the UN system yet again renewing its efforts and setting a target and a time frame to deal with the global problem of hunger, poverty and malnutrition. To date, the efforts to reduce global hunger in the developing world have fallen far short of the pace required to meet these targets. There has no doubt been some progress and several countries in the developing world have proved that success is possible. The economic and societal costs to developing countries of not taking decisive action, and thus failing to achieve a reduction in hunger and undernutrition, including micronutrient malnutrition costs, are that every year five million children lose their lives, 220 million disability-adjusted life years are lost as a result of childhood and maternal undernutrition and billions of dollars are lost in productivity and incomes in these countries. Alongside this perennial problem in developing societies are emerging new epidemics of diet-related diseases resulting from the profound demographic changes, urbanization and the economic transition that is transforming and globalizing the food systems in these countries. Thus, many developing countries are facing new and additional challenges of co-existing hunger alongside the emergence of other forms of malnutrition. Meeting the WFS and MDG targets of achieving the goal of halving global hunger is urgent, and the question that needs to be addressed is not whether the international community can achieve this goal in time but whether it can afford not to.

Disentangling the neuroendocrine systems that regulate energy homeostasis and adiposity has been a long-standing challenge in pathophysiology, with obesity being an increasingly important public health problem. Adipose tissue is no longer considered a passive bystander in body-weight regulation. It actively secretes a large number of hormones, growth factors, enzymes, cytokines, complement factors and matrix proteins, at the same time as expressing receptors for most of these elements, which influence fuel storage, mobilisation and utilisation at both central and peripheral sites. Thus, an extensive cross talk at a local and systemic level in response to specific external stimuli or metabolic changes underpins the multifunctional characteristics of adipose tissue. In addition to the already-known adipokines, such as IL, TNFα, leptin, resistin and adiponectin, more recently attention has been devoted to ‘newcomers’ to the ‘adipose tissue arena’, which include aquaporin, caveolin, visfatin, serum amyloid A and vascular endothelial growth factor. While in vitro and in vivo experiments have provided extremely valuable information, the advances in genomics, proteomics and metabolomics are offering a level of information not previously attainable to help unlock the molecular basis of obesity. The potential and power of combining pathophysiological observations with the wealth of information provided by the human genome, knock-out models, transgenesis, DNA microarrays, RNA silencing and other emerging technologies offer a new and unprecedented view of a complex disease, conferring novel insights into old questions by identifying new pieces to the unfinished jigsaw puzzle of obesity.

Intervention and prospective studies showing no effect of fibre in protection against colo-rectal cancer have challenged consensus recommendations that population intakes of fibre should be increased to reduce the risk of colo-rectal cancer. The European Prospective Investigation of Cancer and Nutrition (EPIC) of 519 978 individuals aged 25–70 years is the largest prospective study of diet and cancer to date worldwide. It incorporates ten different European countries in order to increase heterogeneity in dietary habits and calibration procedures to reduce measurement error. Data for 1065 reported cases of colo-rectal cancer were reported in 2003. There was a 40% reduction in risk for the highest quintile v. lowest quintile of fibre in food after calibration. It has been suggested that these effects were a result of confounding by folate and other factors. Although there are a number of hypotheses to explain why folate should be protective in colo-rectal cancer, a meta-analysis has shown that folate in food may be protective but there is no effect of total folate (i.e. food plus supplements). In a further analysis of 1826 cases in EPIC, identified in the latest follow-up, the inclusion of an additional 761 cases has confirmed the previously published results, with a strong and significant reduction in colo-rectal cancer of approximately 9% reduction in risk for each uncalibrated quintile increase in fibre (P<0·001 for linear trend) compared with an 8% reduction in the previous report, which had not been adjusted for folate. Inclusion of the other covariates (physical activity, alcohol, smoking and red and processed meat) with folate has confirmed this significant inverse association for colon cancer and strengthened the association with left-sided colon cancer (P<0·001).

Plant foods are the major staples of diets in developing countries, in which the consumption of animal-source foods is often low because of economic and/or religious concerns. However, such plant-based diets are often associated with micronutrient deficits, exacerbated in part by poor micronutrient bioavailability. Diet-related factors in plant foods that affect bioavailability include: the chemical form of the nutrient in food and/or nature of the food matrix; interactions between nutrients and other organic components (e.g. phytate, polyphenols, dietary fibre, oxalic acid, protein, fat, ascorbic acid); pretreatment of food as a result of processing and/or preparation practices. Consequently, household strategies that reduce the content or counteract the inhibiting effects of these factors on micronutrient bioavailability are urgently needed in developing-country settings. Examples of such strategies include: germination, microbial fermentation or soaking to reduce the phytate and polyphenol content of unrefined cereal porridges used for young child feeding; addition of ascorbic acid-containing fruits to enhance non-haem-Fe absorption; heating to destroy heat-labile anti-nutritional factors (e.g. goitrogens, thiaminases) or disrupt carotenoid–protein complexes. Such strategies have been employed in both experimental isotope-absorption and community-based studies. Increases in Fe, Zn and Ca absorption have been reported in adults fed dephytinized cereals compared with cereals containing their native phytate. In community-based studies in rural Malawi improvements in dietary quality and arm-muscle area and reductions in the incidence of anaemia and common infections in young children have been observed.

Pathophysiological stress from acute illness causes metabolic disturbance, including altered hepatic glucose metabolism, increased peripheral insulin resistance and hyperglycaemia. Acute hyperglycaemia is associated with increased morbidity and mortality in patients in intensive care units and patients with acute respiratory disease. The present review will consider mechanisms underlying this association. In normal lungs the glucose concentration of airway secretions is approximately 10-fold lower than that of plasma. Low airway glucose concentrations are maintained against a concentration gradient by active glucose transport. Airway glucose concentrations become elevated if normal homeostasis is disrupted by a rise in blood glucose concentrations or inflammation of the airway epithelium. Elevated airway glucose concentrations are associated with and precede increased isolation of respiratory pathogens, particularly methicillin-resistant Staphylococcus aureus, from bronchial aspirates of patients intubated on intensive care. Markers of elevated airway glucose are associated with similar patterns of respiratory infection in patients admitted with acute exacerbations of chronic obstructive pulmonary disease. Glucose at airway concentrations stimulates the growth of respiratory pathogens, over and above the effect of other nutrients. Elevated airway glucose concentrations may also worsen respiratory disease by promoting local inflammation. Hyperglycaemia may thus promote pulmonary infection, at least in part, by an effect on airway glucose concentrations. Therapeutic options, including systemic control of blood glucose and local manipulation of airway glucose homeostasis, will be considered.

The growth and development of the human skeleton requires an adequate supply of many different nutritional factors. Classical nutrient deficiencies are associated with stunting (e.g. energy, protein, Zn), rickets (e.g. vitamin D) and other bone abnormalities (e.g. Cu, Zn, vitamin C). In recent years there has been interest in the role nutrition may play in bone growth at intakes above those required to prevent classical deficiencies, particularly in relation to optimising peak bone mass and minimising osteoporosis risk. There is evidence to suggest that peak bone mass and later fracture risk are influenced by the pattern of growth in childhood and by nutritional exposures in utero, in infancy and during childhood and adolescence. Of the individual nutrients, particular attention has been paid to Ca, vitamin D, protein and P. There has also been interest in several food groups, particularly dairy products, fruit and vegetables and foods contributing to acid–base balance. However, it is not possible at the present time to define dietary reference values using bone health as a criterion, and the question of what type of diet constitutes the best support for optimal bone growth and development remains open. Prudent recommendations (Department of Health, 1998; World Health Organization/Food and Agriculture Organization, 2003) are the same as those for adults, i.e. to consume a Ca intake close to the reference nutrient intake, optimise vitamin D status through adequate summer sunshine exposure (and diet supplementation where appropriate), be physically active, have a body weight in the healthy range, restrict salt intake and consume plenty of fruit and vegetables.

Se is an essential element for animals. In man low dietary Se intakes are associated with health disorders including oxidative stress-related conditions, reduced fertility and immune functions and an increased risk of cancers. Although the reference nutrient intakes for adult females and males in the UK are 60 and 75 μg Se/d respectively, dietary Se intakes in the UK have declined from >60 μg Se/d in the 1970s to 35 μg Se/d in the 1990s, with a concomitant decline in human Se status. This decline in Se intake and status has been attributed primarily to the replacement of milling wheat having high levels of grain Se and grown on high-Se soils in North America with UK-sourced wheat having low levels of grain Se and grown on low-Se soils. An immediate solution to low dietary Se intake and status is to enrich UK-grown food crops using Se fertilisers (agronomic biofortification). Such a strategy has been adopted with success in Finland. It may also be possible to enrich food crops in the longer term by selecting or breeding crop varieties with enhanced Se-accumulation characteristics (genetic biofortification). The present paper will review the potential for biofortification of UK food crops with Se.

There are a number of ways in which food can influence behaviour, including malnutrition, types of diet, eating habits, pharmacological effects, food allergy, fatty acid deficiency and possibly food additives. The range of behaviour affected is also wide, and includes attention, conduct disorder and mood. A particular focus of interest has been the effects of food on hyperactivity in children. There is some initial evidence that fatty acids may influence hyperactivity in children with specific learning disabilities. The findings also suggest that some food additives (colourings, flavourings and preservatives) may increase hyperactivity in children with behaviour problems. For children showing behaviour problems such as hyperactivity the use of dietary manipulation tends to be a more acceptable approach to treatment than the use of drugs. However, there needs to be awareness of the dangers of the use of unsupervised restriction diets with children, and the use of dietary treatments alone is not likely to be sufficient treatment for many children with attention-deficit hyperactivity disorder. A study is currently underway to investigate the possible effects of additives on behaviour in the general population of children.

Glutamine, the most abundant amino acid in the body, is thought to become conditionally essential in critical illness. Some of the important roles for glutamine are as a carrier for inter-organ N, a preferred fuel for enterocytes and cells of the immune system, a substrate for renal NH3 formation and a precursor for glutathione. Mechanisms by which glutamine could improve recovery include attenuating oxidant damage and inflammatory cytokine production, reducing gut bacterial translocation and improving N balance. The present systematic review has found trends to suggest that parenteral and enteral glutamine supplementation reduce mortality, the development of infection and organ failure in critical illness. Trials of parenteral nutrition containing glutamine with patients after elective surgery also suggest reduction of infection, but it is unlikely that glutamine-containing parenteral nutrition would be used for such patients. The evidence base is limited by the quality of the reported trials and the suggestion that there is publication bias, with trials suggesting reduced infection being more likely to be published.

There is an increasing body of evidence, including that from prospective population studies and epidemiological observational studies, suggesting a strong inverse relationship between increased consumption of wholegrain foods and reduced risk of CVD. This evidence has translated into specific dietary recommendations in the USA to consume at least three servings of whole grain per d, and has informed the development of specific health claims for wholegrain foods both in the USA and in Europe. Wholegrain foods are rich sources of many nutrients and phytochemicals, including complex carbohydrates, dietary fibre, minerals, vitamins, antioxidants and phyto-oestrogens such as lignans. Many of these components are lost from the grain during processing and although some may be replaced (such as in the mandatory fortification of white flour), this practice ignores the possible synergistic effects of the ‘natural’ constituents. The notion that wholegrain foods are simply a source of dietary fibre has been dispelled, although the additional components that contribute to the health benefits have not been clearly identified. In addition, the mechanisms by which wholegrain foods may have their effect are poorly understood. At present there are few strictly-controlled intervention studies that have confirmed a beneficial effect of increased consumption of wholegrain foods, demonstrated the level of consumption required to elicit a beneficial effect or provided evidence of modes of action. Although wholegrain foods are considered amongst the healthiest food choices available, their consumption falls well below current recommendations, which have been based mainly on epidemiological evidence. Well-controlled intervention studies are needed to provide more detailed mechanistic evidence to support the health claims and findings which can be used to develop effective public health strategies to promote whole-grain consumption.

Simplification of human diets associated with increased accessibility of inexpensive agricultural commodities and erosion of agrobiodiversity leads to nutrient deficiencies and excess energy consumption. Non-communicable diseases are growing causes of death and disability worldwide. Successful food systems in transition effectively draw on locally-available foods, food variety and traditional food cultures. In practice this process involves empirical research, public policy, promotion and applied action in support of multi-sectoral, community-based strategies linking rural producers and urban consumers, subsistence and market economies, and traditional and modern food systems. Implementation of the International Plant Genetic Resources Institute's Global Nutrition Strategy in Sub-Saharan Africa offers a useful case study. Relevant policy platforms, in which biodiversity conservation and nutrition are and should be linked, include the Millennium Development Goals, Millennium Ecosystem Assessment, Convention on Biological Diversity, Global Strategy on Diet, Physical Activity and Health, Food-Based Dietary Guidelines, Right to Adequate Food and UN Human Rights Commission's Permanent Forum on Indigenous Issues. The largely unexplored health benefits of cultivated and wild plants include micronutrient intake and functions related to energy density, glycaemic control, oxidative stress and immuno-stimulation. Research on the properties of neglected and underutilized species and local varieties deserves higher priority. In tests of the hypothesis that biodiversity is essential for dietary diversity and health, quantitative indicators of dietary and biological diversity can be combined with nutrition and health outcomes at the population level. That traditional systems once lost are hard to recreate underlines the imperative for timely documentation, compilation and dissemination of eroding knowledge of biodiversity and the use of food culture for promoting positive behaviours.

Presented are longitudinal studies, extending from infancy (n 180) to 2 years of age (n 130) and 6 years of age (>70% participation) of diet and Fe status in a population with high birth weight, high frequency of breast-feeding and, at the time of the study, high intake of cow's milk during the weaning period. The association between socio-demographic and dietary factors was also studied, together with Fe status in early childhood and developmental status at 6 years. Fe status was found to be poorer than in the neighbouring Nordic countries. Every fifth 1-year-old was Fe-deficient (serum ferritin <12 μg/l and mean corpuscular volume <74 fl). It was demonstrated by regression analysis that Fe status was negatively associated with cow's milk consumption at 9–12 months (significant at >460 g/d) and was weakly positively associated with fish, meat and Fe-fortified cereal consumption. Fe-deficient infants had a shorter duration of breast-feeding, and breast-feeding was related to slower growth, which can protect from worsening Fe status. Fe deficiency was less common at ages 2 and 6 years. Maternal factors associated with lower adherence to the recommended infant diet were less education, lower age and smoking. In a multiple stepwise regression analysis that included food factors, socio-demographic factors were not found to be associated with Fe status. Fe-depleted and Fe-deficient 1-year-olds had lower fine motor scores when they were 6 years old than those who were not Fe-deficient or Fe-depleted. The findings of these studies have already led to changes in the local recommendations for diet in infancy. The results suggest that Fe deficiency at 12 months of age affects development at 6 years of age. The studies indicated that mothers with less education, who smoked and who were younger needed more guidance concerning recommendations about diet in infancy.

During critical illness free radical production may increase as a result of, for example, sepsis or tissue trauma. In addition, because of a potential for increased losses, and the possibility of inadequate nutrition, the antioxidant defences of the body may become compromised. Thus, the delicate balance between free radicals and antioxidants may be disturbed. Various nutritional and pharmacological strategies to enhance antioxidant defences have been proposed, which aim either to maintain or enhance endogenous antioxidant stores or to provide alternative antioxidant agents. Trace elements and amino acids are particularly important, and their synergistic role in the maintenance of the body's antioxidant defence network will be discussed.

Vegetarian diets do not contain meat, poultry or fish; vegan diets further exclude dairy products and eggs. Vegetarian and vegan diets can vary widely, but the empirical evidence largely relates to the nutritional content and health effects of the average diet of well-educated vegetarians living in Western countries, together with some information on vegetarians in non-Western countries. In general, vegetarian diets provide relatively large amounts of cereals, pulses, nuts, fruits and vegetables. In terms of nutrients, vegetarian diets are usually rich in carbohydrates, n−6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E and Mg, and relatively low in protein, saturated fat, long-chain n−3 fatty acids, retinol, vitamin B12 and Zn; vegans may have particularly low intakes of vitamin B12 and low intakes of Ca. Cross-sectional studies of vegetarians and vegans have shown that on average they have a relatively low BMI and a low plasma cholesterol concentration; recent studies have also shown higher plasma homocysteine concentrations than in non-vegetarians. Cohort studies of vegetarians have shown a moderate reduction in mortality from IHD but little difference in other major causes of death or all-cause mortality in comparison with health-conscious non-vegetarians from the same population. Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians. More data are needed, particularly on the health of vegans and on the possible impacts on health of low intakes of long-chain n−3 fatty acids and vitamin B12. Overall, the data suggest that the health of Western vegetarians is good and similar to that of comparable non-vegetarians.