Nutrition has long been investigated with respect to its influence on human health. With the availability of various omics data, such as metagenomics and metabolomics, novel insights have been obtained into the influence of nutrition, particularly concerning the gut microbiome. The gut microbiome plays an important role in the breakdown of food-derived compounds and in producing essential bioactive metabolites required for human health. However, this wealth of information made the interactions between nutrition and human health increasingly intricate, and unravelling these links is complex. This review covers the concepts of genome-scale metabolic modelling as a tool to understand the links between nutrition, the gut microbiome and human metabolism and its applications. Genome-scale metabolic modelling treats metabolism as a mathematical problem which was used to develop models of human metabolism that incorporate physiology and organ-specific metabolism, known as whole-body metabolic models (WBMs). WBMs can incorporate physiological data, such as sex, weight and body fat percentage, as well as nutrition in the form of its metabolite constituents. Finally, the gut microbiome can also be incorporated through a mathematical representation of the species present, based on stool metagenomics. WBMs have already been applied to understand gut microbiome–host co-metabolism in various non-communicable diseases. However, challenges remain, as metabolites measured in food items in public databases typically cover only common metabolites, and engagement with end-users such as nutritionists and policymakers is limited. Nevertheless, WBMs represent a promising step towards digital metabolic twins and thus personalised nutrition and medicine.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver condition worldwide, affecting approximately 30% of the population globally. MASLD often coexists with hypertension, central obesity, type 2 diabetes and dyslipidaemia, yet globally, national treatment strategies are still being established. Pharmacological options are limited and lifestyle modification to achieve weight loss through combining diet, physical activity (PA) and structured exercise remains the cornerstone of MASLD management. The Mediterranean diet (MedDiet) is an evidence-based dietary approach for MASLD prevention and treatment; however, its application in culturally and linguistically diverse, non-Mediterranean populations requires adaptation. In fact, the need for cultural adaptation for all lifestyle interventions (diet, PA and sleep) needs better acknowledgement and implementation. There are limited interventions which combine all lifestyle behaviours and even fewer that consider cultural safety and appropriateness. Furthermore, limited healthcare staffing resources, geographical location and health system pressures highlight the need for more accessible and cost-effective delivery methods. This review summarises evidence on MedDiet for MASLD in multicultural populations, explores the synergistic benefits of combining with PA and sleep interventions and provides practical recommendations for culturally tailored approaches. Finally, we outline future directions for research and healthcare delivery, emphasising the urgent need for holistic, culturally safe, culturally responsive, efficient and digitally enabled strategies to address the growing global burden of MASLD.

The aim of this review is to provide an overview of the evidence to date and several key considerations regarding addressing undernutrition in older adults with plant-based products. Undernutrition, resulting from inadequate protein and energy intake is common among older adults, and is associated with poor health and quality of life. Ensuring adequate protein and energy intake is a key component of strategies aiming to prevent and/or treat undernutrition. Increasing diversity of protein intake to include more sustainable plant-based sources is encouraged in the general population. However, to support healthy ageing, it is important to consider factors such as the impact of greater consumption of plant-based products on appetite and nutritional status, muscle protein synthesis and skeletal muscle mass. Although the literature in older adults is limited, the current evidence suggests no significant differences when comparing effects of plant to animal-based products/diets on a range of outcomes including appetite, nutritional status, longer-term muscle protein synthesis and muscle mass. Furthermore, there is evidence of improvements in nutritional status and muscle protein synthesis following plant protein supplementation compared to before supplementation or lower protein intakes. Therefore, greater intake of certain plant-based products could assist in enhancing sustainability of food systems and meeting nutritional requirements to prevent undernutrition. Among other factors, the plant protein source, the food matrix and presence of other nutrients need consideration. Further studies are needed in several areas, including investigating the effects of greater intake of plant-based products on the gut microbiome, and in the treatment of undernutrition.

Poor nutrition and the rise in inequalities in diet and obesity during childhood and adolescence are of concern in Ireland and globally. Food insecurity among families is also on the rise and impacts children and youth beyond the effects of poverty alone. The social, structural and commercial determinants of health help to explain why dietary and health inequalities exist yet the solutions to such inequity have been slow, delayed and difficult to implement. This review takes a health promotion approach to the diet of children and adolescents, drawing on evidence in the Republic of Ireland and beyond to emphasise a need for supportive environments and health-promoting public policy. Schools are a key setting to improve dietary habits and diet-related diseases. The impact of food environments on dietary habits both within and external to schools is clear with evidence supporting the implementation of universal school meal provision and the use of planning regulations to enable healthier environments. Evidence of how best to support children and adolescent’s diet out-of-term time is needed, especially within the Irish context. There is a clear need for upstream measures to support healthy dietary habits such as legislation to enforce restrictions of food marketing to children and extension of taxation of foods. Children and adolescents have the right and capacity to be involved in changes needed to our food system so that the marketing, availability and affordability of healthy foods becomes the norm for children and adolescents.

The potential of obesity medications to serve as viable alternatives to bariatric surgery to treat obesity remains an open question. This review examines whether contemporary anti-obesity pharmacotherapy can replace metabolic and bariatric surgery in the management of obesity, by critically comparing their mechanisms of action, weight loss outcomes, durability, safety profiles and roles in long-term disease control. While metabolic/bariatric surgery has been the gold standard for substantial and sustained weight loss, advancements in pharmacotherapy are producing weight loss approaching surgical outcomes without associated risks, complications and recovery time. New drug therapies demonstrate previously unattainable efficacy and long-term control of obesity. Surgery, however, induces superior short- and long-term weight loss via profound hormonal, neurological and metabolic shifts, resulting in durable outcomes without ongoing intervention, though it remains difficult to scale. Pharmacotherapy is scalable and increasingly effective but requires sustained adherence, with loss of treatment-mediated control and weight regain upon cessation. It also does not have as extensive established research on safety as surgery. While obesity medications cannot fully replicate the multifactorial physiological impacts of metabolic/bariatric surgery, they offer a scalable, less invasive treatment path that broadens patient options. So far, pharmacotherapy will not replace surgery, as there are patients who will respond better to it, while others to medication only. However, combining both surgical and pharmacological options can increase the penetrance of treatments to manage the chronic complexities of obesity.

Within Public Health Nutrition, the preconception phase, has emerged as a particularly important window for promoting a healthy diet, as it affects both current and future health as well as health in the next generation. Different approaches are used to support dietary change in this phase, and digital interventions are viewed as particularly promising. In this review, we describe digital interventions addressing preconception diet, discuss challenges in targeting the preconception population and highlight issues related to digital designs and measuring intervention effects. We draw upon six digital interventions with dietary outcomes, in different target populations. Only two of the interventions were found to be effective in improving relevant aspects of the participants’ diet, and these targeted specific and narrow groups or a single dietary component. Most of the intervention studies faced considerable challenges with recruitment. High attrition further complicated evaluation. In addition, there were difficulties related to participant engagement with the digital interventions. Challenges with lack of engagement, recruitment and attrition are not new insights within public health research, and we need to acknowledge the need for new approaches to recruitment, intervention development and evaluation. Alternative approaches such as citizen science and participatory action research in which the researchers work closely with the target population and other stakeholders during the whole process, should be explored. Moreover, as the current behavioural interventions that rely heavily on individual agency seem largely unsuccessful, future interventions should consider targeting more upstream and structural determinants of diet, rather than individual behaviour alone.

Gestational weight gain (GWG) can be defined as the total weight gained throughout pregnancy and is required for healthy fetal growth; however, gaining excessive weight during pregnancy has been linked with several adverse effects. This review aims to consider the evidence on weight management during pregnancy, with a focus on the key challenges surrounding GWG and the practical considerations related to assessing weight changes. It is estimated that nearly 50% of women gain excessive weight during pregnancy; nevertheless, this can be difficult to quantify due to the lack of global consensus on recommended GWG guidelines. Currently, there are no GWG guidelines in the UK and Ireland, as reiterated in the recent National Institute for Health and Care Excellence guidelines, due to the lack of evidence about what the optimal total weight change in pregnancy should be. This is further complicated by the conflicting results of interventions aimed at preventing excessive GWG and their resultant inconsistent effects on adverse pregnancy outcomes. Accurate calculation of GWG requires measurement of pre-pregnancy weight and weight prior to the onset of labour. However, several practical considerations are associated with obtaining these weights, as in practice, estimated or self-recalled weights are often used as an alternate, thereby introducing variability into the measurement of GWG and the potential for inaccuracies in analysis. These limitations highlight the need for a more uniform approach in assessing GWG. The WHO is in the process of developing global GWG standards, and this could potentially establish a uniform gold standard for assessing GWG and reintroduce routine weighing.

Various strategies across food systems are needed for a systemic change, with dietary shifts representing a meaningful pathway – particularly in high-income nations. Plant-based analogues (PBA) that mimic animal-based foods represent a promising strategy to facilitate such shifts because they require minimal behaviour adjustments. This review aims to synthesise nutritional, health and environmental evidence on PBA by examining their benefits, challenges and research gaps to inform and support evidence-based policy and practice. PBA generally have lower greenhouse gas emissions, land use and water use than their animal-based counterparts. Nutritionally, PBA are complex, varying across product brands, product types, processing techniques and primary ingredients. The limited health evidence shows that consumption of plant-based meat analogues tends to be associated with positive health outcomes, while consumption of some plant-based drinks can be linked to micronutrient deficiencies. Fortified PBA can contribute to daily recommended intakes and sometimes provide more micronutrients than their animal-based counterparts, while also providing more fibre and less energy and saturated fat. Despite these potential benefits, debates persist around processing classifications and their health implications. Given this complex landscape, assessing what kind of role PBA could play in our food systems will demand product-specific evaluation, targeted dietary recommendations and expanding the range of healthier PBA. To advance the field and accelerate dietary shifts without unintended consequences, critical considerations include strengthening the nutritional evidence base, classifying PBA further for dietary recommendations and informed regulatory approaches, understanding processing effects and use of additives, and standardising environmental outcomes and research beyond single ingredients.

The aim of this review is to examine why cultural food security and cultural food sovereignty should be prioritised and embedded within conventional food security frameworks. It demonstrates how culturally grounded, community-driven approaches foster more just, sustainable and empowering food systems for ethnically diverse, Indigenous and local communities, while highlighting the limitations of conventional metrics that overlook socio-cultural, political and ecological dimensions essential to resilience. Conventional food security focuses on access to sufficient, safe and nutritious food, often sidelining access to culturally appropriate and spiritually meaningful foods that are integral to cultural identity and tradition (cultural food security) and the authority and decision-making power held by local people over their foodways (cultural food sovereignty). Its market-based, individualistic measurement paradigms further neglect collectivist, traditional and spiritual food values, resulting in assessments that may conform to global standards yet produce flawed outcomes, misaligned interventions and continued marginalisation of ethnically diverse, Indigenous and local communities. Drawing on socio-cultural, political, economic and environmental frameworks, the review demonstrates how food sovereignty and cultural food security provide more sustainable, equitable and empowering pathways for communities. It underscores the need for community-driven, culturally grounded food policies.

It is increasingly acknowledged that the transition from animal- to plant-based proteins confers substantial benefits for both human health and environmental sustainability. This review provides a critical examination of the necessity to consider not only the degree of processing applied to plant protein-based foods, particularly those derived from legume seeds, but also the nutritional quality of the resulting products. While it is well established that plant proteins exhibit a lower environmental footprint compared with their animal-derived counterparts, their digestibility is often reduced, primarily due to the matrix composition of raw ingredients. To improve protein digestibility and reduce the antinutrient content in these raw materials, a variety of processing methods are used, encompassing thermal and biological treatments (e.g. extrusion and fermentation, respectively). However, processing methods may also introduce unintended adverse effects, including protein oxidation and formation of undesirable compounds. Therefore, this review explores the paradox of sustainable processing, where process conditions may simultaneously confer environmental advantages while compromising nutritional quality. In this context, food classification systems such as NOVA are critically examined, highlighting the absence of an evidence-based system that integrates both processing conditions and product formulation in the classification of plant-based foods. Current approaches categorizing plant-based options as ultra-processed foods without accounting for the nutritional quality of their ingredients, and their ultimate digestibility, may mislead consumers and discourage the consumption of nutritionally adequate plant-based alternatives. Finally, the review emphasizes the need for the adoption of processing technologies that address the sustainability challenge and the nutritional quality of plant protein-based foods.

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

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

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

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

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