The UK government launched a two-component sugar-reduction programme in 2016, one component is the taxation of sugar-sweetened beverages, the Soft Drinks Industry Levy, and the second is a voluntary sugar reduction programme for products contributing most to children’s sugar intakes. These policies provided incentives both for industry to change the products they sell and for people to change their food and beverage choices through a ‘signalling’ effect that has raised awareness of excess sugar intakes in the population. In this study, we aimed to identify the relative contributions of the supply- and demand-side drivers of changes in the sugar density of food and beverages purchased in Great Britain. While we found that both supply- and demand-side drivers contributed to decreasing the sugar density of beverage purchases (reformulation led to a 19 % reduction, product renewal 14 %, and consumer switching between products 8 %), for food products it was mostly supply-side drivers (reformulation and product renewal). Reformulation contributed consistently to a decrease in the sugar density of purchases across households, whereas changes in consumer choices were generally in the opposite direction, offsetting benefits of reformulation. We studied the social gradient of sugar density reduction for breakfast cereals, achieved mostly by reformulation, and found increased reductions in sugar purchased by households of lower socio-economic status. Conversely, there was no social gradient for soft drinks. We conclude that taxes and reformulation incentives are complementary and combining them in a programme to improve the nutritional quality of foods increases the probability of improvements in diet quality.

Children hospitalised with severe malnutrition have high mortality and readmission rates post-discharge. Current milk-based formulations target restoring ponderal growth but not the modification of gut barrier integrity or microbiome which increases the risk of gram-negative sepsis and poor outcomes. We propose that legume-based feeds rich in fermentable carbohydrates will promote better gut health and improve overall outcomes. We conducted an open-label phase II trial at Mbale and Soroti Regional Referral Hospitals, Uganda, involving 160 children aged 6 months to 5 years with severe malnutrition (mid-upper arm circumference (MUAC) < 11·5 cm and/or nutritional oedema). Children were randomised to a lactose-free, chickpea-enriched legume paste feed (LF) (n 80) v. WHO standard F75/F100 feeds (n 80). Co-primary outcomes were change in MUAC and mortality to day 90. Secondary outcomes included weight gain (> 5 g/kg/d), de novo development of diarrhoea, time to diarrhoea and oedema resolution. Day 90 MUAC increase was marginally lower in LF v. WHO arm (1·1 cm (interquartile range (IQR) 1·1) v. 1·4 cm (IQR 1·40), P = 0·09); day 90 mortality was similar (11/80 (13·8 %) v. 12/80 (15 %), respectively, OR 0·91 (95 % CI 0·40, 2·07), P = 0·83). There were no differences in any of the other secondary outcomes. Owing to initial poor palatability of the LF, ten children switched to WHO feeds. Per-protocol analysis indicated a trend to lower day 90 mortality and readmission rates in the LF (6/60 (10 %) and 2/60(3 %)) v. WHO feeds (12/71(17·5 %) and 4/71(6 %)). Further refinement of LF and clinical trials are warranted, given the poor outcomes in children with severe malnutrition.

Mycoprotein is a fungal-based ingredient rich in fibre and protein used in meat substitutes called Quorn. Fibre and protein positively regulate glycaemia, lipidaemia and energy intake which are non-communicable diseases’ (NCD) markers. We performed a cross-sectional study to investigate the association of mycoprotein intake with diet quality, nutrient, energy intake and NCD risk within 5507 UK free-living adults from the National Diet and Nutrition Survey from years 2008/2009 to 2016/2017. Dietary approaches to stop hypertension (DASH) and healthy diet index (HDI) were calculated to estimate diet quality. Comparison between mycoprotein consumers (>1 % kcal) and non-consumers, and associations between consumers and nutrient intakes, NCD’s risk markers and diet quality were investigated using a survey-adjusted general linear model adjusted for sex, age, BMI, ethnicity, socio-economic, smoking status, region of residency, total energy, energy density, HDI and non-mycoprotein fibre intake. Mycoprotein consumers (3·44 % of the cohort) had a higher intake of dietary fibre (+22·18 %, P < 0·001), DASH score (+23·33 %) and HDI (+8·89 %) (P < 0·001, both) and lower BMI (−4·77 %, P = 0·00) v. non-consumers. There was an association (P = 0·00) between mycoprotein consumers and diet quality scores (+0·19 and +0·26), high fibre (+3·17 g), total and food energy (+3·09 and +0·22 kcal), but low energy density intakes (−0·08 kcal/g, P = 0·04). Consumers were negatively associated with fasting blood glucose (−0·31 mmol/l, P = 0·00) and glycated HbA1c (−0·15 %, P = 0·01). In conclusion, mycoprotein intake is associated with lower glycaemic markers and energy density intake, and high fibre, energy intake and diet quality scores.

Online dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale prospective studies. We developed an online 24-h recall (myfood24) with automated estimation of associated nutrient intake, and assessed validity against reference recovery, predictive and concentration biomarkers. Validity of the online tool was then compared with that of traditional interviewer-administered multiple-pass 24-h recalls and presented as the expected attenuation of any diet-disease associations estimated with the tool.

Metabolically stable adults were recruited and completed the new online dietary recall, a traditional interviewer-based multiple-pass recall and provided samples of blood and urine for a range of reference biomarkers. Longer-term dietary intake was estimated from up to three recalls taken two weeks apart. Estimated intakes of protein, total sugars, potassium and sodium were compared with urinary biomarker concentrations. Estimated energy intake was compared with energy expenditure measured by three-plane accelerometry and open-circuit indirect calorimetry. Validity against these biomarkers was also compared to that estimated for traditional interviewer-administered multiple-pass 24-hour recalls.

At least one biomarker sample was received from each of 212 participants. Compared to reference biomarkers, both the online 24-hour recall and interviewer-based recall led to attenuation of diet-disease associations. The online tool resulted in attenuation factors of around 0.2–0.3 which could have important effects on estimated risks. For example, if the true relative risk of a diet-disease association was 2.0, an attenuation factor of 0.3 would reduce the relative risk to 1.23. Ranking using intakes against repeated biomarkers as an estimate of truth, resulted in higher attenuation factors of approximately 0.3–0.4, with a smaller impact on risk estimates. Attenuation improved substantially on repeated application of the tool. Validity of the interviewer-based recall found similar attenuation factors, but it was more administratively burdensome and expensive to implement. The online tool typically provided 10–20% lower nutrient estimates compared to the interviewer-administered tool.

Our findings show that, whilst results from both automated online and traditional interviewer-based dietary recalls are attenuated compared to objective biomarker measures, the myfood24 online 24-hour recall is comparable to the more time-consuming and costly traditional interviewer-based 24-hour recall across a wide range of measures. The less burdensome implementation of the online tool, with automated nutrient coding and easy replication over a longer time period with associated gains in precision, makes it well-placed for repeated use in large-scale prospective studies.

In an effort to promote population health, governments and businesses are promoting food reformulation initiatives. In most instances, these initiatives have focused on reducing the amount of individual nutrients such as trans-fatty acids (TFA) or sodium, and generally they have been successful at doing so. However, the impact of single-nutrient reformulation on the broader nutrient profile of foods, and on the overall quality of people's diet, remains unclear. We have undertaken a systematic review of evidence of the impact of single-nutrient reformulation on the overall nutrient profile of foods, covering both peer-reviewed studies and grey literature. The outcome of interest was the nutrient composition of the reformulated food or food category. Only 17 studies reported the effect of initiatives on reformulated products’ nutrient profile (44 studies reported on only the targeted nutrient). Results are heterogeneous. Six studies investigated the impact of TFA reduction initiatives, showing different impacts on the reformulated products’ fat profile, with saturated fats (SFA) decreasing in parallel in some studies, but increasing in others. Similarly, when sodium was reduced, sugar, SFA and calories changed in different directions in different studies. Six studies assessed the effect of mandatory calorie labelling in restaurants, two leading to a reduction in energy intake, one to an increase in sugar and a decrease in unsaturated fatty acids, suggesting a worsened nutrient profile. Of the companies participating in England's sugar reformulation initiative, only 13% also reduced total energy. Results highlight the limited research on the effect of reformulation strategies on the overall nutrient composition of foods. Only 28% of the studies that analyse the impact of policies incentivising single nutrient reformulation report the effect on the foods’ complete nutrient profile after reformulation. Over a third of the studies show that reducing the targeted nutrient comes at a cost – namely other nutrients may be increased. To produce the desire health impact, reformulation policies must incentivise improvements of the overall nutrient profile of products.

Mycoprotein is a food high in both dietary fibre and non-animal-derived protein. Global mycoprotein consumption is increasing, although its effect on human health has not yet been systematically reviewed. This study aims to systematically review the effects of mycoprotein on glycaemic control and energy intake in humans. A literature search of randomised controlled trials was performed in PubMed, Embase, Web of Science, Google Scholar and hand search. A total of twenty-one studies were identified of which only five studies, totalling 122 participants, met the inclusion criteria. All five studies were acute studies of which one reported outcomes on glycaemia and insulinaemia, two reported on energy intake and two reported on all of these outcomes. Data were extracted, and risk-of-bias assessment was then conducted. The results did not show a clear effect of acute mycoprotein on blood glucose levels, but it showed a decrease in insulin levels. Acute mycoprotein intake also showed to decrease energy intake at an ad libitum meal and post-24 h in healthy lean, overweight and obese humans. In conclusion, the acute ingestion of mycoprotein reduces energy intake and insulinaemia, whereas its impact on glycaemia is currently unclear. However, evidence comes from a very limited number of heterogeneous studies. Further well-controlled studies are needed to elucidate the short- and long-term effects of mycoprotein intake on glycaemic control and energy intake, as well as the mechanisms underpinning these effects.

A case study of hard disk drives (HDDs) and rare-earth magnets is presented to show the use of decision support tools to identify and assess the barriers and opportunities for circular business models. Pilot demonstration projects, which showcased HDD circular recovery strategies, were useful as a low-risk opportunity for business model experimentation and to build trust among key supply chain actors.

A case study of hard disk drives and rare-earth magnets is presented to show the use of decision support tools (DSTs) to assess the complex interaction of variables that must be considered when demonstrating the viability of circular business models (CBMs). A mix of quantitative and qualitative DSTs such as life cycle assessment, techno-economic assessment, Ostrom's Framework for social-ecological systems, decision trees, and others were implemented by the iNEMI Value Recovery Project team to overcome many of the identified barriers to circular economy. The DSTs were used to guide stakeholder coordination, create and share environmental, logistical and financial data, and generate decision-making flowcharts which promote circular economic strategies. Demonstration projects were used as a low-risk opportunity for business model experimentation and to build trust among key supply chain actors. The tools highlighted by this case study could be useful for establishing or expanding CBMs for other electronic products or components, especially components containing critical materials.

CVD is the leading cause of death worldwide. Diet is a key modifiable component in the development of CVD. No official UK diet quality index exists for use in UK nutritional epidemiological studies. The aims of this study are to: (i) develop a diet quality index based on components of UK dietary reference values (DRV) and (ii) determine the association between the index, the existing UK nutrient profile (NP) model and a comprehensive range of cardiometabolic risk markers among a British adult population. A cross-sectional analysis was conducted using data from the Airwave Health Monitoring Study (n 5848). Dietary intake was measured by 7-d food diary and metabolic risk using waist circumference, BMI, blood lipid profile, glycated Hb (HbA1c) and blood pressure measurements. Diet quality was assessed using the novel DRV index and NP model. Associations between diet and cardiometabolic risk were analysed via multivariate linear models and logistic regression. A two-point increase in NP score was associated with total cholesterol (β −0·33 mmol/l, P<0·0001) and HbA1c (β −0·01 %, P<0·0001). A two-point increase in DRV score was associated with waist circumference (β −0·56 cm, P<0·0001), BMI (β −0·15 kg/m2, P<0·0001), total cholesterol (β −0·06 mmol/l, P<0·0001) and HbA1c (β −0·02 %, P=0·002). A one-point increase in DRV score was associated with type 2 diabetes (T2D) (OR 0·94, P=0·01) and obesity (OR 0·95, P<0·0001). The DRV index is associated with overall diet quality and risk factors for CVD and T2D, supporting its application in nutritional epidemiological studies investigating CVD risk in a UK population.

Dietary mycoprotein decreases energy intake in lean individuals. The effects in overweight individuals are unclear, and the mechanisms remain to be elucidated. This study aimed to investigate the effect of mycoprotein on energy intake, appetite regulation, and the metabolic phenotype in overweight and obese volunteers. In two randomised-controlled trials, fifty-five volunteers (age: 31 (95 % CI 27, 35) years), BMI: 28·0 (95 % CI 27·3, 28·7) kg/m2) consumed a test meal containing low (44 g), medium (88 g) or high (132 g) mycoprotein or isoenergetic chicken meals. Visual analogue scales and blood samples were collected to measure appetite, glucose, insulin, peptide tyrosine-tyrosine (PYY) and glucagon-like peptide-1 (GLP-1). Ad libitum energy intake was assessed after 3 h in part A (n 36). Gastric emptying by the paracetamol method, resting energy expenditure and substrate oxidation were recorded in part B (n 14). Metabonomics was used to compare plasma and urine samples in response to the test meals. Mycoprotein reduced energy intake by 10 % (280 kJ (67 kcal)) compared with chicken at the high content (P=0·009). All mycoprotein meals reduced insulin concentrations compared with chicken (incremental AUClow (IAUClow): −8 %, IAUCmedium: −12 %, IAUChigh: −21 %, P=0·004). There was no significant difference in glucose, PYY, GLP-1, gastric emptying rate and energy expenditure. Following chicken intake, paracetamol-glucuronide was positively associated with fullness. After mycoprotein, creatinine and the deamination product of isoleucine, α-keto-β-methyl-N-valerate, were inversely related to fullness, whereas the ketone body, β-hydroxybutyrate, was positively associated. In conclusion, mycoprotein reduces energy intake and insulin release in overweight volunteers. The mechanism does not involve changes in PYY and GLP-1. The metabonomics analysis may bring new understanding to the appetite regulatory properties of food.

A major limitation in nutritional science is the lack of understanding of the nutritional intake of free-living people. There is an inverse relationship between accuracy of reporting of energy intake by all current nutritional methodologies and body weight. In this pilot study we aim to explore whether using a novel lightweight, wearable micro-camera improves the accuracy of dietary intake assessment. Doubly labelled water (DLW) was used to estimate energy expenditure and intake over a 14-d period, over which time participants (n 6) completed a food diary and wore a micro-camera on 2 of the days. Comparisons were made between the estimated energy intake from the reported food diary alone and together with the images from the micro-camera recordings. There was an average daily deficit of 3912 kJ using food diaries to estimate energy intake compared with estimated energy expenditure from DLW (P=0·0118), representing an under-reporting rate of 34 %. Analysis of food diaries alone showed a significant deficit in estimated daily energy intake compared with estimated intake from food diary analysis with images from the micro-camera recordings (405 kJ). Use of the micro-camera images in conjunction with food diaries improves the accuracy of dietary assessment and provides valuable information on macronutrient intake and eating rate. There is a need to develop this recording technique to remove user and assessor bias.

Prospective cohort studies have shown inverse associations between fibre intake and CVD, possibly mediated by blood pressure (BP). However, little is known about the impact of types of fibre on BP. We examined cross-sectional associations with BP of total, insoluble and soluble fibre intakes. Data were used from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) study, including 2195 men and women aged between 40 and 59 years from the USA. During four visits, eight BP, four 24 h dietary recalls and two 24 h urine samples were collected. Linear regression models adjusted for lifestyle and dietary confounders to estimate BP differences per 2 sd higher intakes of total and individual types of fibre were calculated. After multivariable adjustment, total fibre intake higher by 6·8 g/4184 kJ (6·8 g/1000 kcal) was associated with a 1·69 mmHg lower systolic blood pressure (SBP; 95 % CI −2·97, −0·41) and attenuated to −1·01 mmHg (95 % CI −2·35, 0·34) after adjustment for urinary K. Insoluble fibre intake higher by 4·6 g/4184 kJ (4·6 g/1000 kcal) was associated with a 1·81 mmHg lower SBP (95 % CI −3·65, 0·04), additionally adjusted for soluble fibre and urinary K excretion, whereas soluble fibre was not associated with BP. Raw fruit was the main source of total and insoluble fibre, followed by whole grains and vegetables. In conclusion, higher intakes of fibre, especially insoluble, may contribute to lower BP, independent of nutrients associated with higher intakes of fibre-rich foods.

There is evidence for health benefits from ‘Palaeolithic’ diets; however, there are a few data on the acute effects of rationally designed Palaeolithic-type meals. In the present study, we used Palaeolithic diet principles to construct meals comprising readily available ingredients: fish and a variety of plants, selected to be rich in fibre and phyto-nutrients. We investigated the acute effects of two Palaeolithic-type meals (PAL 1 and PAL 2) and a reference meal based on WHO guidelines (REF), on blood glucose control, gut hormone responses and appetite regulation. Using a randomised cross-over trial design, healthy subjects were given three meals on separate occasions. PAL2 and REF were matched for energy, protein, fat and carbohydrates; PAL1 contained more protein and energy. Plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY) concentrations were measured over a period of 180 min. Satiation was assessed using electronic visual analogue scale (EVAS) scores. GLP-1 and PYY concentrations were significantly increased across 180 min for both PAL1 (P= 0·001 and P< 0·001) and PAL2 (P= 0·011 and P= 0·003) compared with the REF. Concomitant EVAS scores showed increased satiety. By contrast, GIP concentration was significantly suppressed. Positive incremental AUC over 120 min for glucose and insulin did not differ between the meals. Consumption of meals based on Palaeolithic diet principles resulted in significant increases in incretin and anorectic gut hormones and increased perceived satiety. Surprisingly, this was independent of the energy or protein content of the meal and therefore suggests potential benefits for reduced risk of obesity.

In recent years, there has been a renewed interest in the role of dietary fibre in obesity management. Much of this interest stems from animal and human studies which suggest that an increased intake of fermentable fibre can suppress appetite and improve weight management. A growing number of reports have demonstrated that the principal products of colonic fermentation of dietary fibre, SCFA, contribute to energy homeostasis via effects on multiple cellular metabolic pathways and receptor-mediated mechanisms. In particular, over the past decade it has been identified that a widespread receptor system exists for SCFA. These G-protein-coupled receptors, free fatty acid receptor (FFAR) 2 and FFAR3 are expressed in numerous tissue sites, including the gut epithelium and adipose tissue. Investigations using FFAR2- or FFAR3-deficient animal models suggest that SCFA-mediated stimulation of these receptors enhances the release of the anorectic hormones peptide tyrosine tyrosine and glucagon-like peptide-1 from colonic L cells and leptin from adipocytes. In addition, the SCFA acetate has recently been shown to have a direct role in central appetite regulation. Furthermore, the SCFA propionate is a known precursor for hepatic glucose production, which has been reported to suppress feeding behaviour in ruminant studies through the stimulation of hepatic vagal afferents. The present review therefore proposes that an elevated colonic production of SCFA could stimulate numerous hormonal and neural signals at different organ and tissue sites that would cumulatively suppress short-term appetite and energy intake.

Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troops deployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the British and US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigate the changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related to physical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition were estimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expenditure measured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. The mean body mass of volunteers decreased over the first half of the deployment ( − 4·6 (sd 3·7) %), predominately reflecting fat loss. Body mass partially recovered (mean +2·2 (sd 2·9) %) between the mid- and post-deployment periods (P< 0·05). Daily EI (mean 10 590 (sd 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (sd 1883) kJ) measured in a subgroup of volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for British military personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriate nutrition in harsh operational environments must remain a priority.

Excess body adiposity, especially abdominal obesity and ectopic fat accumulation, are key risk factors in the development of a number of chronic diseases. The advent of in vivo imaging methodologies that allow direct assessment of total body fat and its distribution have been pivotal in this process. They have helped to identify a number of sub-phenotypes in the general population whose metabolic risk factors are not commensurate with their BMI. At least two such sub-phenotypes have been identified: subjects with normal BMI, but excess intra-abdominal (visceral) fat (with or without increased ectopic fat) and subjects with elevated BMI (> 25 kg/m2) but low visceral and ectopic fat. The former sub-phenotype is associated with adverse metabolic profiles, while the latter is associated with a metabolically normal phenotype, despite a high BMI. Here, examples of these phenotypes are presented and the value of carrying out enhanced phenotypical characterisation of subjects in interventional studies discussed.