Unhealthy dietary patterns stand as the foremost risk factor for noncommunicable disease- associated morbidity and mortality(1). As widely accessible healthcare providers, pharmacy professionals’ potential to catalyze improvements in public health nutrition is substantial, offering a means to combat the escalating epidemic of obesity and NCDs through tailored interventions, services, and education(2,3).

Our study employed a mixed-methods approach to assess the role of pharmacy professionals in promoting nutrition advice and healthy dietary practices.

An online questionnaire (N=200) was designed and conducted to evaluate pharmacy professionals’ nutrition knowledge, the advice given in various diet-related conditions (e.g. obesity, type 2 diabetes, cardiovascular disease risk factors, malnutrition, sustainable diets), practices in delivering diet- related guidance within their routine practice and perceived roles and future ambitions of pharmacy professionals towards nutrition counselling, yielding both quantitative and qualitative insights.

Subsequently, qualitative interviews and focus group discussions (N=19) were conducted, engaging pharmacists, nutritionists and dietitians to gather insights essential for the development of a comprehensive nutrition toolkit tailored for pharmacy practice.

These interviews delved deeper into the subject, with the goal of designing a nutrition toolkit that empowers pharmacists with the knowledge, tools, and resources needed to play a more active and impactful role in promoting nutrition and healthy lifestyle practices among their patients. Thematic analysis was conducted, and emerging themes and subthemes were identified.

Our findings indicate that a significant portion of participants in our study are involved in providing nutrition and diet advice for various health conditions. The majority of pharmacists considered diabetes programmes having a high level of importance (84%), followed by weight management services (78%), hypertension management (86%), and healthy diet campaigns (63.5%). However, our knowledge and confidence rating questions revealed a significant gap in training and a clear need for educational materials tailored for pharmacists to enhance their ability to provide nutrition advice effectively. Key themes identified in open-text questions were referrals and collaboration, training and education needs, wider needs (changes in the public health system, materials/resources, integration and implementation of nutrition in pharmacy practice) and perceived roles as pharmacists in providing nutrition advice (patient support, feeling responsible, specialised focus areas).

Qualitative findings underscore the pressing demand for nutrition training and education to deliver comprehensive services, as well as the necessity for collaborative efforts with dietitians and nutritionists to ensure effective care and the improvement of referral pathways in pharmacy practice.

This research contributes to the advancement of public health nutrition by recognizing the potential role of pharmacy professionals as key players in the dissemination of nutrition knowledge and fostering healthy behaviours within the community. The results will guide us in the collaborative development of a nutrition toolkit tailored for pharmacy practice, employing a co-design approach.

Telehealth, which involves the remote delivery of healthcare services through virtual technologies, has been shown to have benefits such as reducing hospitalisations and length of stay for patients (1,2). The global COVID-19 pandemic has greatly accelerated the adoption of telehealth among clinical nutritionists. For instance, in the USA, telehealth usage for nutritional care has increased from 37% to 78% among clinical nutritionists (3), while in Italy, the adoption of telenutrition services by Registered Dieticians (RDNs) has risen from 16% to 63% (4). These statistics highlight the rapid integration of telehealth into dietetics practices as a response to the global health crisis, reflecting a growing trend towards virtual care delivery as an effective method for providing nutritional care. While telehealth has made progress in Saudi Arabia (5), there is a research gap regarding its prevalence and effectiveness in dietetics practice. This study aims to evaluate the current implementation of telehealth in dietetics practice during the COVID-19 pandemic in Saudi Arabia.

In this cross-sectional, a web-based online survey was used from mid-December 2022 to mid-May 2023. The study was distributed in several Saudi Arabian regions including (central, western, eastern, south, and north) and was completed by 306 clinical Registered Dietitians (RDNs) in public and private healthcare facilities who met the study’s inclusion criteria. The survey consisted of 28 questions divided into four sections, covering sociodemographic information, past or current experiences, obstacles and challenges of telehealth usage, and the future prospects of telehealth. In this study, participants were requested to reflect on their current observations and previous experiences pertaining to the utilisation of telehealth in the field of dietetics. To ensure the validity and relevance of the survey, it was reviewed by a panel of experienced dietitians in Saudi Arabia to obtain their feedback before being used to collect data.

Our research findings reveal that 76% of RDNs in Saudi Arabia utilize telehealth in their practice. The most common obstacles reported by RDNs using telehealth include internet connectivity issues (21.9%), patient disengagement and lack of enthusiasm (21.3%), and difficulties in coordinating with patients (21%). Telehealth interventions used by RDNs primarily involve diet recall (33.7%), weight- related measurements (30.6%), lab findings (26%), and only 8% reported using telehealth for vital signs. A majority of participants (69.4%) believed that telehealth could improve patient accessibility and help reduce no-show rates (68.9%). Additionally, over 70% of participants agreed that telehealth offers them flexibility in inpatient consultations.

In conclusion, telehealth is widely utilised among RDNs in Saudi Arabia, with potential benefits such as decreased no-show rates. Further research is needed to gain a better understanding of telehealth usage among RDNs in Saudi Arabia.

Plant-based foods encompass all food products derived from plant sources, such as fruits, vegetables, grains, legumes, herbs and spices, and nuts and seeds, plant-based fats and oils (e.g. olive oil) and plant-based beverages (e.g. tea and coffee). Consumption of diverse plant-based foods is a dietary pattern that has gained significant attention amongst the public, due to its perceived benefits for maintenance of health(1). Plant-based foods provide a rich source of macronutrients, micronutrients and non-nutrient bio-actives that are often reported to improve health outcomes. Despite this, there are no standard definitions of plant-based diversity, or consensus on methods of measurement in nutrition research studies. The objective of the current research was to conduct a scoping review of the literature to identify studies investigating plant-based food diversity and it’s impact on human health outcomes, and to subsequently characterize a) definitions of plant-based diversity used, b) methods used to assess plant-based food intake, c) methods used to assess plant- based food diversity, and d) health outcomes assessed and key findings.

Eligible studies were those investigating the relationship or impact of plant-based food diversity on any health related or lifestyle outcome, by any study design, in high income countries only. Studies were identified by systematic searches of two electronic databases and manual searches of reference lists. No restrictions were applied for language or year of publication. The review was performed in line with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (2).

Forty-four studies were eligible for inclusion in this review. The majority of studies were observational in design (39/44; 87%) and included fruits and vegetables only in their definitions of plant-based food diversity (32/44, 72%). Methods of measurement of both plant-based food intake and diversity varied greatly among studies, with only four studies (9%) utilizing a tool validated for assessment of plant-based food diversity in their population of interest. Health outcomes included dietary intake and behaviour, socioeconomic factors, cardiometabolic risk factors, and cancer risk,. No randomized controlled trials investigating the impact of plant food diversity on health outcomes were identified.

There is a need for a consensus definition of “diverse plant-based foods” incorporating all relevant foods from plant sources (e.g. legumes, nuts, herbs). Robust measurement tools and reporting guidelines for the assessment of plant-based food diversity in nutrition research studies will help to standardize research in this area. Within countries, an assessment of standard levels of intake of plant-based foods would be beneficial, in identifying whether diverse plant-based eating may be a target for dietary improvement. Observational studies report associations between plant-based food diversity and health outcomes, that warrant investigation in future randomized controlled trials.

In Cartan’s PhD thesis, there is a formula defining a certain rank 8 vector distribution in dimension 15, whose algebra of authomorphism is the split real form of the simple exceptional complex Lie algebra $\mathfrak {f}_4$. Cartan’s formula is written in the standard Cartesian coordinates in $\mathbb {R}^{15}$. In the present paper, we explain how to find analogous formulae for the flat models of any bracket generating distribution $\mathcal D$ whose symbol algebra $\mathfrak {n}({\mathcal D})$ is constant and 2-step graded, $\mathfrak {n}({\mathcal D})=\mathfrak {n}_{-2}\oplus \mathfrak {n}_{-1}$.

The formula is given in terms of a solution to a certain system of linear algebraic equations determined by two representations $(\rho ,\mathfrak {n}_{-1})$ and $(\tau ,\mathfrak {n}_{-2})$ of a Lie algebra $\mathfrak {n}_{00}$ contained in the $0$th order Tanaka prolongation $\mathfrak {n}_0$ of $\mathfrak {n}({\mathcal D})$.

Numerous examples are provided, with particular emphasis put on the distributions with symmetries being real forms of simple exceptional Lie algebras $\mathfrak {f}_4$ and $\mathfrak {e}_6$.

Playful practices have been linked to increased motivation, engagement, learning and skill development. However, limited research has explored what playful music learning might look like for primary schools, and how teachers might incorporate a range of playful music practices within their classrooms. Our conceptual model for playful music learning amalgamates and builds upon previous philosophy, theory and research in the education and music education spheres. In doing so, it extends musical play across a continuum of ownership as has been proposed by Zosh et al. (2017) in the realm of playful learning more generally. Playful elements associated with the work of music education pedagogues Kodály and Kokas and other researchers in the field are outlined. Examples of musical games-play and guided musical play for primary classrooms are illustrated, and some recommendations are provided to support teachers in facilitating increasingly playful music learning.

Multiple-long term conditions (MLTCs), also known as multimorbidity, are commonly defined as the presence of two or more long-term medical conditions in one individual(1). More than half of all adults over 60 years are affected by multimorbidity worldwide(2) and its increasing prevalence demands a shift in focus for research and healthcare towards multiple clusters of disease, rather than single conditions(3).

Current epidemiological evidence on diet as preventative lifestyle factor in relation to MLTCs is limited(4). Therefore we reviewed the existing evidence to summarise methods of assessment of diet and multimorbidity measure to identify further research needs in a scoping review.

Medline, Embase, CINAHL, Web of Science and Scopus were searched systematically following the methodological approach for scoping reviews by PRISMA. The protocol was published on Open Science Framework under DOI10.17605/OSF.IO/9FP5D. The search yielded a total of 10,937 results. After de-duplication, title and abstract screening and a final inclusion round of in-text screening by two reviewers, 53 articles met the inclusion criteria. Observational studies were included if they examined the relationship between any dietary factor and the prevalence/or development of MLTCs in community-dwelling adults.

Publication dates of included research papers ranged from 2014 to 2023, with over half of studies published in the last three years. There was high variability between dietary assessment methods used: in the majority of studies (n=21, 39.6%) fruit and vegetable intake was the only diet-related variable reported. A priori diet quality scores were used in n=15 (28.3%) studies and n=6 (11.3%) studies used a posteriori approaches to identify dietary patterns, n=11 used other methods (20.8%). Only n=3 (5.7%) studies also focussed on micronutrients. MLTCs were generally defined as presence of ≥2 chronic conditions by most papers, however the number of qualifying conditions ranged from 2-60 conditions.

Overall, 60.4% (n=32) of studies were cross-sectional with various dietary components and patterns showing either mixed results, (n=10, 31.3%), no association (n=5, 15.6%) or inverse associations (n=12, 37.5%), i.e. higher diet score/adherence/consumption of diet components was associated with lower MLTCs, to positive relationships e.g. individuals with MLTCs consumed higher intakes of fruit and vegetables (n=5, 15.6%). Varying results were also found in longitudinal studies (n= 21, 39.6%). Some studies found inverse associations (n=8, 38.1%) i.e. higher adherence/more healthy food consumption was associated with lower MLTCs. However, other studies showed either no significant association (n=4, 19%), mixed results (n=5, 23.8%) or positive associations (n=4, 19.1%).

The evidence relating MLTCs to dietary intakes is relatively recent with most studies being reported within the last 3 years. Studies showed various outcomes and more detailed information is needed on the effect of dietary patterns and their compounds on the prevalence and development of multimorbidity. Following a standardized method of multimorbidity-quantification is highly important.

Atopic diseases, including asthma and eczema, represent a substantial public health problem in children and adolescents globally; asthma is the commonest chronic disorder of childhood(1). Research suggests that the origins of childhood asthma lie in utero, and several components of the maternal diet during pregnancy have been investigated in relation to atopic outcomes in children. Epidemiological evidence suggests that a higher intake of sugar during pregnancy is associated with a higher risk of childhood asthma and atopy(2,3). However, randomised trial evidence supporting such a link is lacking.

Aims

1. 1. To examine whether a low glycaemic index (GI) dietary intervention during pregnancy decreases the risk of asthma and eczema in childhood.

2. 2. To assess observationally whether maternal intake of sugar during pregnancy is positively associated with asthma and eczema in childhood.

This is a secondary analysis of children from the ROLO trial. Healthy women were randomised to receive an intervention of low GI dietary advice or routine antenatal care from early pregnancy. All women completed a 3-day food diary in each trimester of pregnancy. Estimates of maternal intake of sugar in each trimester were averaged to provide mean intakes during pregnancy. Mothers reported current doctor-diagnosed eczema in their children at 2-years of age (n=271), and current doctor-diagnosed asthma and eczema in their children at 5 (n=357) and 9-11 years (n=391) of age. Multivariable logistic regression models were used a) to test the effect of the intervention on child outcomes overall, and stratified by maternal education level (with, versus without, a complete tertiary level education), and b), in observational analyses, to analyse the relation between sugar and carbohydrate intake in pregnancy and child outcomes.

There was weak evidence overall for a reduction in asthma at 5-years of age in children whose mothers received the low GI dietary intervention during pregnancy compared to usual care [adjusted odds ratio (OR) 0.43 (95% CI 0.18, 1.03); P=0.06]. However, in stratified analyses the intervention was associated with a marked reduction in risk of asthma at 5-years of age in children born to mothers with lower educational attainment [adjusted OR 0.16 (0.03, 0.85); P=0.032]. Intake of sugar during pregnancy was positively associated with the development of asthma at any time point in childhood [adjusted OR per quartile of mean sugar intake 1.40 (0.99, 1.97), P-trend=0.048] and at 5-years of age [adjusted OR per quartile 1.55 (1.00, 2.40), P-trend=0.046]. No associations with eczema outcomes were found.

This novel study provides stronger evidence that higher sugar intake during pregnancy is associated with an increased risk of asthma among offspring. An intervention to reduce sugar intake in pregnancy may have potential as a primary prevention strategy, particularly amongst children born to mothers with lower educational attainment.

Research studies suggest that date-palm (Phoenix dactylifera L.) fruits provide a superior nutritional and health benefits, compared to other fruits (1). They are rich source of many essential nutrients including carbohydrates, dietary fibre, vitamins, minerals, phytochemicals, and antioxidants. The date palm fruits are produced in many countries around the world and about 10-15% of the total production is lost or sold extremely at low prices (2, 3). Despite these, date fruits have been rarely used as an ingredient in commercially available energy bars. The aim of this study is to investigate the impact of newly formulated date-based energy bar (DBEB) (4) intake on subjective appetite, postprandial metabolism, energy substrate oxidation and diet-induced thermogenesis (DIT).

Twenty-seven healthy male adults (mean ± SD, aged 20.8 ± 3.5 years with body weight of 66 ± 8 kg) participated in a randomised crossover design study. Each participant conducted two experimental arms and was investigated prior to (baseline) and for three-hours after consumption of either a date- based energy bar (DBEB) or an isocaloric and macronutrient matched mixed fruit-based energy bar (FBEB) as control arm. The DBEB contained significantly less fructose and glucose, but more sucrose and fibre than FBEB. Both experimental arms involved blood sampling, subjective appetite, and indirect calorimetry measurements. At the end of each experiment, an ad libitum buffet meal was provided. Data analysis used descriptive statistics, paired t-test, and two-way ANOVA.

Time-averaged composite appetite and satiety scores were not significantly different between control (FBEB) and DBEB arms. Energy intake during ad libitum buffet was also not different between arms. Metabolic rate measured at baseline and during post-ingestion of the bars were not significantly different between FBEB and DBEB arms (arm effect, P>0.05). Thermic effect of bars calculated as percentage increase in metabolic rate above RMR during whole postprandial duration was (mean ± SE) 9.5 ± 1.6 % in DBEB arm and 8.7 ± 1.3 % in the FBEB arm (arm effect, P>0.05). Rates of carbohydrate and fat oxidation were also not different between the two arms (arm effect, P>0.05) Time-averaged concentrations of blood glucose, insulin and triglycerides were similar between the study arms.

The obtained results suggest that energy bars based on dates or mixed fruits produce similar effects on postprandial appetite, fat and carbohydrate oxidation, thermic effect and cardiometabolic risk factors. Date fruits can be used as rich source for carbohydrate and energy. However, future research should investigate the impact of date-based energy bars on antioxidant capacity and other health related markers.

Diet is an important modifiable lifestyle factor for human health, and plant-rich dietary patterns are associated with lower risk of non-communicable diseases in numerous studies. However, objective assessment of plant-rich dietary exposure in nutritional epidemiology studies remains challenging. This study aimed to develop and evaluate metabolic signatures of the most widely used plant-rich dietary patterns using a targeted metabolomics method comprising of 108 plant food metabolites.

A total of 218 healthy participants from the POLYNTAKE cohort were included, aged 51.5 ± 17.7 years, with 24h urine samples measured using ultra-high-performance liquid chromatography–mass spectrometry. The validation dataset employed three sample types to test the robustness of the signature, including 24h urine (ABP cohort, n = 88), plasma (POLYNTAKE cohort, n = 195), and spot urine (TwinsUK cohort, n = 198). Adherence to the plant-rich diet was assessed using a priori plant- rich dietary patterns. A combination of metabolites that evaluates the adherence and metabolic response to a specific diet was identified as metabolic signature. We applied linear regression analysis to select the metabolites significantly associated with dietary patterns (adjusting energy intake), and ridge regression to estimate penalized weights of each candidate metabolite. The correlation between metabolic signature and the dietary pattern was assessed by Spearman analysis (FDR < 0.05).

The metabolic signatures consisting of 42, 22, 35, 15, 33, and 33 predictive metabolites across different subclasses were found to be associated with adherence to Amended Mediterranean Score (A-MED), Original MED (O-MED), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), healthy Plant-based Diet Index (hPDI) and unhealthy PDI (uDPI), respectively. The overlapping and distinct predictive metabolites across six dietary patterns predominantly consisted of phenolic acids (n = 38), including 14 cinnamic acids, 14 hydroxybenzoic acids, seven phenylacetic acids, and three hippuric acids. Six metabolites were included in all signatures, including two lignans: enterolactone-glucuronide, enterolactone-sulfate, and four phenolic acids: cinnamic acid, cinnamic acid-4'-sulfate, 2'- hydroxycinnamic acid, and 4-methoxybenzoic acid-3-sulfate. The established signatures were robustly correlated with dietary patterns in validation dataset (r = 0.13 - 0.40, FDR < 0.05).

We developed and evaluated a set of metabolic signatures that robustly reflected the adherence and metabolic response to plant-rich dietary patterns, suggesting the potential of these signatures to serve as an objective assessment of free-living eating habits.

Steatotic liver disease, defined as >5% of hepatic fat content, is a major contributor to global morbidity and mortality, in particular due to its category metabolic associated steatotic liver disease (MASLD)(1). While its prevention focuses on promoting physical activity and maintaining a healthy weight and balanced diet, the associations between dietary fatty acids and liver fat remain unclear(2,3). The aim of this study was to examine the associations between dietary fatty acids and liver fat in the absence of excessive alcohol intake, independently of energy intake.

Analyses were conducted on 9,268 non-diabetic participants from the UK Biobank with no pre- existing liver chronic illness or cardiovascular disease at baseline, and without excessive alcohol consumption. Dietary intake of total fat, saturated fatty acids (SFAs), polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) was measured using the mean of ≥2 Oxford WebQ 24-hr dietary assessments, responded to between 2009 and 2012. Liver proton density fat fraction (LPDFF) was measured by magnetic resonance imaging between 2016 and 2020. Multivariable linear regression models were calculated to assess the associations between fatty acid intakes and LPDFF, adjusting for key demographic and lifestyle confounders. In addition, associations between LPDFF and 10 individual SFAs, 7 PUFAs, and 4 MUFAs were also examined. Sensitivity analyses were carried out including participants who responded ≥4 dietary assessments (N=2,828).

After fully adjusting for confounders, no significant associations between LPDFF (%) and MUFAs were found. Inverse associations with LPDFF were observed for PUFAs (−5.8% relative difference [95% confidence interval −0.6, −1.9]), per 5% increase in intake, while SFAs were positively associated with LPDFF (5.8% [3.3, 8.3]). Positive associations were observed per 1 SD increase in intake of individual fatty acids SFA stearic acid (4.20% [2.84, 5.57]) and palmitic acid (3.15% [1.78, 4.54]). Negative associations were observed for PUFAs alpha-linoleic acid (−2.32% [−3.47, −1.17]) and docosahexaenoic acid (−2.14% [−3.23, −1.0.3], and for MUFA erucic acid (−2.52% [−3.61, −1.43]). Sensitivity analyses presented similar results, and the associations between PUFAs and liver fat became slightly stronger (−10.73%, [−17.58, −3.32]).

This observational study suggests that SFAs and PUFAs are associated with liver fat in opposite directions, independently of energy intake. While total MUFAs did not present significant associations with LPDFF, erucic acid was inversely associated with liver fat, highlighting the value of studying individual fatty acids. These different associations provide valuable information for the design of dietary trials that compare interventions with different types of fatty acids. These further studies would allow a better understanding of the ideal dietary advice to prevent liver steatosis and its global health impact.

Parkinson’s Disease (PD) is a neurodegenerative disorder in which dopaminergic neurons of the substantia nigra, a region of the brain that controls movement, are lost over time (1). This results in motor symptoms, such as bradykinesia, and non-motor symptoms such as depression (2). Evidence- based resources and programmes utilising exercise for symptom management are widely available (3). However, despite emerging evidence showing that diet changes can improve quality of life and reduce disease severity (4), there are few dietary guidelines and programmes. This study aims to address a current literature gap in qualitative studies assessing the opinions of healthcare professionals (HCPs) towards diet and exercise in PD care, and to identify barriers and facilitators of this in care.

A qualitative design was used to assess the views and beliefs of HCPs. Semi-structured interviews were conducted via telephone, using a topic guide developed by the research team, consisting of 20 questions. The data were analysed using the six-phase process of Reflexive Thematic analysis to determine key themes in the data (5).

Five HCPs participated in this study. One main theme and two subthemes were identified. The main theme was that provisions of care and dietary advice are limited by a lack of knowledge of evidence- based, PD-specific, dietary guidelines. Subtheme 1 was that evidence-based exercise guidelines have been important facilitators in supporting care provision. Subtheme 2 was that lack of dietary guidance has been a barrier to optimum care provision and self-efficacy of HCPs.

HCPs were less likely to discuss diet, due to barriers including lack of available resources or knowledge thereof, self-efficacy to recommend dietary changes, time constraints in the clinic, and less well-established referral pathways for dietitians. HCPs were unaware of the influence of diet in PD treatment, despite diet’s impact on symptoms being discussed in clinic. However, HCPs agreed that evidence-based resources would benefit HCPs’ practice, to improve symptom severity and nutritional status of patients. Exercise was more likely to be discussed, as evidence-based guidelines and empirical understanding meant HCPs were more aware of the beneficial effects on symptoms.

While limited by small numbers, these findings suggest that a lack of knowledge, low self-efficacy, and time pressures mean that patients may not receive dietary guidelines which may be beneficial to their care. Self-efficacy of HCPs should be improved through PD-specific nutritional education, development and dissemination of PD-specific nutrition guidelines and resources. Future research should aim to determine the effectiveness of relevant dietary strategies’ in managing and caring for PD.

Restriction of energy intake is an effective strategy for achieving body mass loss(1). However, it leads to gastrointestinal appetite hormonal changes, which are expected to enhance hunger, reduce satiety, and possibly impair the ability to comply with prescribed intervention(2). Exercise interventions, on the other hand, did not modify gastrointestinal appetite hormones(3) and there is some evidence that postprandial appetite hormone responses after a low carbohydrate-high fat meal (LCHF) are more favorable than after high carbohydrate-low fat meal (HCLF) meal (4). This study investigated how energy-restricted diets based on LCHF and HCLF meals and combined with exercise affect body weight, and gastrointestinal appetite hormones and explored the relationship between body mass changes and changes in gastrointestinal appetite hormones.

Twenty-seven overweight and obese females (age: 35 ± 9.35 years, BMI: 31.64 ± 5.08 kg/m2) completed a randomized parallel design study and underwent a 4-week intervention consisting of brisk walking combined with either consumption of calorie-restricted HCLF or LCHF diet. Participants underwent a 5-hour experimental trial before and after the interventions, which included body weight measurements and fasting and postprandial blood sample collection for gastrointestinal appetite hormone measurements.

Both interventions significantly reduced body mass (HCLF group, −2.1 ± 1.7 Kg: LCHF group, -1.7 ± 1.7 Kg, P < 0.05 for both groups), but changes between the groups were not significant (P>0.05). Body mass changes were individual and ranged from -0.4 kg to −5.3 kg and from +1 kg to −4.4 kg in the HCLF and LCHF groups, respectively. The interventions had no impact on mean values of time- averaged postprandial concentrations of ghrelin, PYY, and GLP-1 but there was large individual variability in changes of these hormones. Results combined from both groups revealed that changes in ghrelin ranged from +549.3 to -407.7 pg/ml, in PYY from −132.5 to + 96.4 pg/ml and in GLP-1 from −6.6 to +19.5 pg/ml. Correlation, investigated on the data from both groups combined, between changes in body mass and changes in ghrelin (r = −0.18, P= 0.41), PYY (r = −0.04, P =0.87), and GLP-1 (r = 0.11, P = 0.64) were not significant.

In conclusion, the extent of body mass loss during interventions based on restricted energy intake diets combined with exercise is not related to the carbohydrate and fat content of the diet. Our findings also suggest that the success of body mass loss cannot be predicted by changes in postprandial concentrations of gastrointestinal appetite hormones.

Sales of plant-based meat alternatives (PBMAs) are increasing(1). While these products are becoming more popular, little is known about their impact on health(2). Therefore, the aim of this work was to systematically review the evidence on PBMA consumption and associated health outcomes.

A wider systematic review looking at the environmental impact, ingredient composition, nutritional impact and health outcomes associated with PBMAs was conducted. A search strategy combined terms “meat alternatives” AND “environment” OR “ingredients” OR “nutrition” OR “health.” Five databases were searched, MEDLINE, EMBASE, Web of Science, Scopus and Greenfile, as well as reference lists of relevant articles. All study designs reporting primary data were included, except for animal studies and in vitro studies. Non-English studies and studies published before 2011 were excluded (PROSPERO Registration Number: CRD42021250541).

2184 papers were identified, 1802 papers remained after duplicates were removed, 1536 were excluded at title and abstract screen stage, 266 full texts were assessed for eligibility and 54 papers were included in the analysis for all outcomes investigated. Ten studies examined the impact of PBMA vs. meat consumption on health outcomes. Three studies measured postprandial response to single test meals(3–5), four studies were longer-term RCTs(6–8) with two further separate publications reporting on different outcomes for the same RCT(9,10). One study was a prospective cohort(11) and one a cross-sectional study(12).

Of the single test meal studies, no significant differences were observed for glucose levels in 2/2 studies (100%)(3,5), PYY and GLP-1 levels in 2/2 studies (100%)(3,4) and self-reported hunger/fullness in 3/3 studies (100%)(3–5). Significantly lower insulin concentrations and subsequent energy intakes were both reported in 1/2 studies (50%) following consumption of mycoprotein vs. chicken meals(3).

Longer-term full and partial replacement of meat with PBMAs resulted in significantly lower body weight (kg) in 2/2 studies (100%)(6,10), significantly lower saturated fat intakes in 2/2 studies (100%) (6,10), significantly higher fibre intakes in 2/3 studies (67%)(6,7), improvements in plasma lipid profile in 2/3 studies (67%)(7,10) and positive changes in gut microbiota in 1/2 studies (50%)(8) compared to meat diet phases/control groups with no restrictions on meat intakes. There were no significant differences in protein intakes in 3/3 studies (100%)(6,7,10), energy, total fat and carbohydrate intakes in 2/2 studies (100%) (6,7), blood pressure in 2/2 studies (100%)(6,10), glucose levels in 2/2 studies (100%) (7,10) and insulin levels in 2/2 studies (100%)(7,10).

No definitive conclusions can be made on the impact of PBMAs on health outcomes due to the small number of studies and variation in study designs, outcomes measured and the type of PBMA used. From the limited evidence available, no negative health effects from PBMA consumption were observed, however, further longer-term RCTs are needed to confirm this.

Fructose-containing sugars can exaggerate postprandial lipaemia and stimulate hepatic de novo lipogenesis (DNL) when compared to glucose-based carbohydrates(1). Galactose has recently been shown to increase postprandial lipaemia compared to glucose(2), but mechanisms remain uncharacterised. The aim of this study was to assess the effect and mechanisms of lactose-induced lipaemia.

Twenty-four non-obese adults (12 male and 12 female) completed three trials in a randomised, crossover design (28 ± 7-day washout). During trials, participants consumed test drinks containing 50 g fat with 100 g of carbohydrate. The control carbohydrate was a glucose polymer (maltodextrin), the experimental carbohydrate was galactose-containing carbohydrate (lactose) and the active comparator was fructose-containing carbohydrate (sucrose). Hepatic DNL was assessed by the 2H2O method and [U-13C]-palmitate was added to the test drink to trace the fate of the ingested fat. Blood and breath samples were taken to determine plasma metabolite and hormone concentrations, in addition to plasma and breath 2H and 13C enrichments. Data were converted into incremental under the curve (iAUC) and were checked for normality by visual inspection of residuals. Differences between trials were assessed by one-way ANOVA. Where a main effect of trial was detected, post- hoc t-tests were performed to determine which trials differed from lactose according to the principle of closed-loop testing.

The plasma triacylglycerol iAUC (mean ± SD) in response to maltodextrin was 51 ± 68 mmol/L*360 min. Following lactose ingestion, plasma triacylglycerol iAUC increased to 98 ± 88 mmol/L*360 min (p<0.001 vs maltodextrin), which was comparable to sucrose [90 ± 95 mmol/L*360 min (p=0.41 vs lactose)]. Hepatic DNL in response to maltodextrin was 6.6 ± 3.0%. Following ingestion of lactose, hepatic DNL increased to 12.4 ± 6.9% (p=0.02 vs maltodextrin), which was comparable to sucrose [12.2 ± 6.9% (p=0.96 vs lactose)]. Exhaled 13CO2 in response to maltodextrin was 10.4 ± 4.1 mmol/kgFFM*360 min. Following ingestion of lactose, exhaled 13CO2 was 8.8 ± 4.9 mmol/kgFFM*360 min (p=0.09 vs maltodextrin), which was lower than sucrose [11.1 ± 3.9 mmol/kgFFM*360 min (p=0.01 vs lactose)].

These data are consistent with the hypothesis that hepatic de novo lipogenesis contributes to both lactose and sucrose-induced lipaemia and provide a rationale to investigate the longer-term effects of lactose and sucrose on metabolism.

Doctors’ and nurses’ (DNs) wellbeing in the National Health Service is important for safe healthcare for those in need. However, their demanding duties, including irregular shift work, can significantly impact their health. Unfortunately, irregular working patterns are associated with higher sickness rates and stress among healthcare professionals due to the inherent challenges of the work(1,2). For example, shift work disrupts sleep and impairs cognitive function and performance, leading to poorer physiological and cardiovascular health(3), workforce shortages and difficulties adapting to a consistently demanding workload, which can impact patient care delivery(4). Despite the importance of workplace health and nutrition for DNs, our understanding of their dietary practices during shift work remains limited. Therefore, gaining insights into DNs’ eating habits during shifts is imperative to supporting their health. Our research aimed to understand DNs’ eating practices during their work, including the types of food consumed throughout the day.

Online semi-structured interviews (n=16) were conducted with a convenience sample of current practising medical doctors (n=11) and nurses (n=5) in England. This provided an opportunity to compare and contrast the research data between DNs on workplace nutrition. All participants did shift work, encompassing varied working patterns, including day and night shifts, short and long days and weekends. Following Braun and Clarke’s(5) approach, an inductive thematic analysis presented the findings.

Results elucidate six areas of DNs’ eating practices and dietary intake: before and during shifts, on long shifts, after shifts, during night shifts, and on non-working days. Our data suggests that DNs prioritise their clinical responsibilities over their dietary intake at work. Consequently, they often miss eating opportunities and consume caffeine to stay alert during their shifts. Furthermore, DNs viewed night shifts as involving less healthy food choices. While participants expressed their intention to eat healthily during their shifts, their clinical responsibilities made maintaining regular and nutritious dietary practices throughout the day challenging. Nevertheless, DNs value their meal after a shift as the most important, as this could be the only meal they eat throughout the day.

Our results suggest that DNs’ eating practices and dietary intake are sub-optimal to recommended dietary guidelines. It also suggests that eating practices are varied, individualised and not applicable to all, considering the many environmental and occupational factors contributing to DNs’ nutritional behaviours. Therefore, dietary workplace interventions are recommended to improve DNs’ dietary behaviours at work. Future research should explore DNs’ eating practices through follow-up interviews at various time points. This approach will provide valuable insights into DNs’ dietary and nutritional behaviours during shift work, helping to uncover additional barriers and challenges beyond DNs’ daily experiences.

The development of multiple long-term conditions (MLTC) has been shown to be associated with low-grade chronic inflammation(1). The Dietary Inflammatory Index (DII®) is a literature-based dietary score that was developed to measure the potential impact of diet on the inflammatory status of an individual(2). In this study, we aimed to validate the DII® score against biomarkers, including high- sensitivity C-reactive protein (hs-CRP), and plasma concentrations of vitamin C, retinol and α- tocopherol in European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk participants, aged 39–79 years at baseline(3).

The DII® score was calculated using a 130-item Food Frequency Questionnaire collected at baseline, between 1993 and 1997. The dietary intakes were adjusted to a 2000 kcal/day diet, to assess diet quality independently of diet quantity. Non-fasting serum cholesterol, hs-CRP, and plasma α- tocopherol, vitamin C and retinol concentrations were also measured at this time-point. Data collected via a self-administered Health and Lifestyle Questionnaire were used to establish classification of a number of variables. Analyses were conducted on sub-samples with a DII® score and measures of hs-CRP (8,034 men and 9,861 women), and concentrations of vitamin C (9,866 men and 11,702 women), retinol (3,673 men and 3,517 women) and cholesterol-adjusted α- tocopherol (3,623 men and 3,476 women). Analysis of covariance and linear regression were used to study associations across sex-specific quintiles of the DII® score (adjusted for age, BMI, smoking status, physical activity, social class and educational level), where a higher score indicates a more pro-inflammatory diet.

Mean concentrations in men and women were 2.99 and 3.09 mg/L for hs-crp, 47 and 59 μmol/L for vitamin C, 53 and 50 μg/dL for retinol and 4.34 and 4.42 μmol/mmol for cholesterol-adjusted α- tocopherol, respectively. In both men and women, mean hs-CRP was higher if the diet was more pro-inflammatory (p-trend = 0.02 in men and 0.07 in women), while concentrations of vitamin C, retinol and α-tocopherol were significantly lower (p-trend < 0.001). Positive associations for hs-CRP, but negative associations for plasma concentrations of vitamin C, retinol and α-tocopherol were evident in both men and women, after adjustments for covariates (p-trend < 0.001). The differences between Q1 and Q5 adjusted means for hs-CRP, vitamin C, retinol and α-tocopherol were +9.4%, -22.1%, -3.9% and -8.6% in men and +7.9%, -17.5%, -4.8% and -7.6% in women, respectively.

We observed statistically significant positive associations between the DII® score and hs-CRP, a well-known inflammatory biomarker, whilst significant negative associations were found for circulating concentrations of three anti-inflammatory vitamins, after adjustment for covariates. These findings indicate that the DII® score is a valid measure of the inflammatory potential of diet in these middle-aged and old adults, making it possible to study the inflammatory role of diet in MLTC development.

The fungal cell wall facilitates an immune response and may be involved in intestinal immune training (1,2). It is also fermentable by the gut microbiome, thus, consumption of fungi changes gut microbial ecology (3). Yet, the specific effects of consuming fungal foods on the gut mycobiota (i.e., gut fungi) have not been well studied. An interesting case study is mycoprotein, a fungal based protein produced from Fusarium Venenatum (4). We have previously reported that mycoprotein consumption attenuates faecal water genotoxicity, a surrogate marker of colorectal cancer risk, as well as modulates faecal metabolite excretion and gut bacterial composition (5). Here, we aimed to evaluate the impact of consuming a diet high in mycoprotein on gut mycobial ecology, and to explore relationships between mycobial composition and faecal genotoxicity.

Here we leverage stool samples from Mycomeat: a randomised crossover-controlled trial, recruiting 20 healthy male adults to adhere to 2-week diets comprising 240 g/day of mycoprotein based foods or red and processed meat, separated by a 4-week washout. Internal transcriber spacer (ITS) sequencing was performed to characterise the mycobiota. Alpha diversity before and after study phases was compared using Wilcoxon tests. Beta diversity was compared by permutational multivariate analysis of variance (PERMANOVA) based on Bay-Curtis dissimilarities. Differences in mycobial taxa within and between study phases were compared using Wilcoxon tests. Changes in mycobiota composition was then regressed against faecal excretion of metabolites using mixed- effects models to understand the impact of myco-ecology on the wider colonic environment. Finally, given the abundance of mycobial genotoxins in nature, we regressed mycobial taxa against faecal water genotoxicity.

There were significant shifts in the abundance of several taxa following both diets. Notably, mycoprotein consumption was associated with an increase in the abundance of Malasseziales sp. (P = 0.02) and a reduction in Candida Albicans (P = 0.01). Meat consumption was associated with an increase in Phaeoacremonium Tuscanum (P = 0.01) and Rhodotorula Mucilaginosa (P = 0.008), and reduction in Penicillium Commune (P = 0.02). In addition, Aspergillus Caesiellus was associated with lower faecal genotoxicity (P = 0.04), whereas Penicillium Commune (P = 0.04) and Penicillium Olsonii (P = 0.03) were both associated with higher genotoxicity. Regressing mycobial taxa against faecal metabolites revealed a number of significant associations, including between Penicillium Commune and austdiol, a putative mycotoxin (P < 0.001) as well as 1-methyladenine, a methylated DNA base with cytotoxic properties (P = 0.001).

The gut mycobiota is malleable through a fungi rich diet alongside changes within the wider microbiome. Members of the gut mycobiota predicted faecal genotoxicity and faecal excretion of toxins in this model, and there may be value in further exploring the gut mycobiota and the contribution of mycotoxins in gut health and colorectal cancer risk.

Approximately 40% of cancers in the UK are attributable to modifiable, lifestyle risk factors such as overweight and obesity and low dietary fibre intake(1). The WCRF and AICR published ten lifestyle- based Cancer Prevention Recommendations with the aim of reducing the risk of cancer and other non-communicable diseases(2). In the UK Biobank cohort, we have found reduced risk of cancer overall and of breast and colorectal cancers with greater adherence to these Cancer Prevention Recommendations (i.e., healthier lifestyles). The present study aimed to investigate whether the magnitude of these associations is modified by the presence of co-morbidities, such as diabetes and cardiovascular disease, at baseline.

We used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank prospective cohort study, recruited between 2006 and 2010 and free from cancer at baseline. Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations was calculated from dietary, physical activity, and body composition data using a standardised score(3). Multimorbidity (list of 43 chronic diseases) was self-reported at baseline and categorised into: 0, 1, 2, or 3+ chronic illnesses. Incident cancer cases were identified using population-based cancer registries available until July 2019 for England and Wales and October 2015 for Scotland. Participants were categorised into approximate score tertiles, and the lowest tertile (lowest adherence, 0-3.5 points) was used as the reference category. Cox proportional hazard models were used to investigate associations between total score and incidence of cancer, adjusting for confounders, and to test for an interaction between total score and multimorbidity.

55,191 (58%) participants had one chronic illness at baseline and 8,430 (9%) had ≥3. Mean total 2018 WCRF/AICR score was 3.8 (SD 1.0) points, and participants with the presence of chronic illnesses had a significantly lower total score (mean for ≥3 illnesses = 3.58 points vs 3.96 points for participants without chronic illness, p<0.001). During a median follow-up of 8 years, 3,303 individuals developed cancer. When investigating associations between score tertiles and the risk of cancer overall, there was a significant interaction between the total score and multimorbidity (HR for interaction: 1.59, p=0.002). There was also evidence for an interaction between total score and multimorbidity with breast cancer risk (HR for interaction: 1.23, p=0.030), but no evidence of an interaction between total score and multimorbidity for risk of colorectal cancer.

We found stronger associations between total adherence score and the risk of cancer in participants with ≥3 chronic illnesses. This suggests that the chemoprotective effects of greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may be particularly beneficial for individuals with multimorbidity.

Muscle strength and mass decline as we age, typically starting around 35–40 years, and can eventually lead to the development of sarcopenia(1). There are currently no effective drug treatments available for either the prevention or treatment of this condition(2) and whilst resistance exercise has efficacy(3) its effectiveness is limited due to issues with uptake and adherence(4). However, emerging research suggests that nutrition may offer a potentially effective approach to delay the age-related decline in muscle mass and function among older individuals(5), with LCn-3 PUFA emerging as a strong candidate.

The main objective of the current study was to perform a systematic literature review with the purpose of exploring the impact of long-chain n-3 polyunsaturated fatty acid (LCn-3 PUFA) relative to control oil supplementation on muscle strength, with secondary outcomes of muscle mass and physical function in older individuals under conditions of habitual physical activity/exercise.

The review protocol was registered with PROSPERO (CRD42021267011) and followed the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement(6). The search for relevant studies was performed utilizing databases such as PubMed, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2023. Randomized controlled trials (RCTs) in older adults comparing the effects of LCn-3 PUFA with a control oil supplement on muscle strength were included.

Five studies(7,8,9,10,11) involving a total of 488 participants (348 females and 140 males) were identified that met the specified inclusion criteria and were included. Upon analyzing the collective data from these studies, it was observed that supplementation with LCn-3 PUFA did not have a significant impact on grip strength (standardized mean difference (SMD) 0.61, 95% confidence interval [−0.05, 1.27]; p = 0.07) in comparison to the control group. However, there was a considerable level of heterogeneity among the studies (I2 = 90%; p < 0.001). As secondary outcomes were only measured in a few studies, with significant heterogeneity in methods, meta-analyses of muscle mass and functional abilities were not performed. Papers with measures of knee extensor muscle mass as an outcome (n = 3) found increases with LCn-3 PUFA supplementation, but studies measuring whole body lean/muscle mass (n = 2) and functional abilities (n = 4) reported mixed results.

With a limited number of studies, our data indicate that LCn-3 PUFA supplementation has no effect on muscle strength or functional abilities in older adults but may increase muscle mass, although, with only a few studies and considerable heterogeneity, further work is needed to confirm these findings.

Adequate nutrition is necessary for overall health and development(1). Prisoners in general lack autonomy over their diet, in addition to being a population with a high risk of poor health outcomes(2, 3). It is important therefore that prisons are offered menus which meet dietary reference values (DRVs), as set by the UK government, aiming for equity with the general population, and that prisoners choose food options that are beneficial for their health. The aim of this study was to conduct a nutritional analysis of prisoners’ food diaries to determine whether dietary recommendations were being met.

Seven-day food diaries were collected from prisoners eating the normal food supplied by three young offender institutions in 2009. Food eaten was analysed using DietPlan6 version 6.0 (Forestfield Software Ltd). Individual nutrient data were tested for normality and compared against the UK DRVs and NDNS data from 2008/9 using either the one-sample T-test, or one-sample Wilcoxon Signed Rank Test. Data in the results is presented as (Mean ± SD).

There were n=466 diaries analysed, from male participants aged between 16 to 24 years. Twenty- eight nutrients were compared with their respective DRVs by age categories: 16-18y (n=156), 19-24y (n=310), and 16-24y (n=466).

For ages 16-24y, chloride (5556 ± 1692mg), folate (302 ± 112ug), iodine (195 ± 81ug), monounsaturated fat (35 ± 10g), potassium (3667 ± 1161mg), sodium (3899 ± 1392mg), sugar (136 ± 73g), riboflavin (2 ± 1mg), vitamin B12 (6 ± 4ug), vitamin C (92 ± 63mg), and zinc (11 ± 3mg) exceeded DRV requirements (P<0.01). Carbohydrates (53 ± 5%E), saturated fat (12 ± 5%E), and sugar (19 ± 9%E) all exceeded their DRVs (P<0.05). Vitamin A (553 ± 531ug) and fibre (15 ± 6g) were found 24% and 18% lower than the DRVs, respectively (P<0.01). Fat (34 ± 5%E), polyunsaturated fat (6 ± 1%E), and protein (14 ± 2%E), as a percent of energy, were below the DRV by 3%, 8%, and 7% respectively (P<0.01). Magnesium (301 ± 107mg) was equal to the DRV (P=0.81).

For 16-18, and 19-24 respectively, calcium (1286 ± 928mg; 1337 ± 489mg), copper (1 ± 0.6mg; 2 ± 0.6mg), iron (14 ± 5mg; 15 ± 6mg), niacin (19 ± 7mg; 21 ± 7mg), phosphorus (1545 ± 381mg; 1620 ± 493mg), protein (96 ± 24g; 100 ± 29g), thiamine (2 ± 0.6mg; 2 ± 0.7mg), and vitamin B6 (2.3 ± 0.7ug; 3 ± 0.9ug) exceeded their DRV (P<0.01). For 16-18y, energy (kcals) was equal to the DRV (2748 ± 787kcal, P=0.91). For years 19-24y, energy (kcal) exceeded the DRV (2931 ± 939kcal, P<0.01).

This study represents the largest assessment of dietary intake of prisoners and demonstrates that the prison catering, for the most part, met the DRVs. However, sugar, fat, and energy intake exceeded their DRV target, posing clear risks to health by possibly contributing to later obesity, hypertension, Type 2 diabetes and heart disease.