The number of people following a plant-based (PB) diet has increased in recent years. This has led to concerns regarding vitamin D intake, as natural dietary sources of vitamin D are primarily animal based(1) and cross-sectional studies have reported lower intakes amongst vegetarians and vegans(2). Some PB foods, primarily dairy alternatives, are now fortified with vitamin D. Whilst vitamin D is synthesised in the skin following exposure to UV light, this does not happen in the autumn and winter months in areas of northern latitude (such as the UK). Hence, dietary supply of vitamin D becomes particularly important. This study aimed to investigate whether it is possible to maintain dietary vitamin D intake when transitioning to a PB diet, through careful choice of PB alternatives.

A subset of 4-day diet diaries, from 81 women (72 Caucasian and 9 South Asian, mean age 52 ± 12y) living in South East England, was randomly selected from those collected for the D-FINES study (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England, 2006–2007; FSA funded Project N05064, NHS REC 06/Q1909/1)(3)and analysed for vitamin D intake. No subjects followed an entirely PB diet at baseline. Data modelling was carried out to substitute animal-based foods with equivalent amounts of PB alternatives. For dairy products, the equivalent fortified PB alternatives were chosen. Meat, fish and eggs were replaced with equivalent amounts of protein from PB sources, such as lentils and tofu, as no fortified direct alternatives were found. The diaries were then re-analysed. Pre- and post-substitution intakes were compared by paired t test, and ethnic groups by independent t test.

There were no differences in Vitamin D intake between ethnicities either at baseline (p = 0.087) or post-substitution (p = 0.361). Vitamin D intake increased in the South Asian group post-substitution (from 2.4 ± 1.3 to 4.3 ± 1.8 µg/day, p = 0.002), with no change observed in the Caucasian group (3.6 ± 2.0 to 3.7 ± 1.8 µg/day, p = 0.660). There was no difference between vitamin D intake pre- and post-substitution overall (3.5 ± 2.0 and 3.8 ± 1.8 µg/day respectively, p = 0.222). Twenty cases decreased by ≥1 µg/day, all in the Caucasian group, with the largest decrease being from 9.6 to 2.2 µg/day.

This study demonstrates that it is possible to move to a PB diet, whilst maintaining existing dietary patterns, without a reduction in vitamin D intake, but it is largely dependent on dairy intake in the original diet, as no meat/fish substitutes in the UK are currently fortified. It also requires care when choosing PB dairy substitutions as many, including organic options, are not fortified. Mean daily intakes, both pre- and post-substitution, were substantially below the recommended intake of 10 µg/day(4), suggesting that supplementation may be necessary, particularly during winter months.

Iodine is an essential trace mineral and a key component of thyroid hormones, which are essential during pregnancy and infancy for brain and neurological development(1). The main dietary sources of iodine in the UK are seafood and dairy products, particularly milk(2). Recently, plant-based alternatives to seafood and dairy products have increased in popularity, particularly among young adults(3). Unless adequately fortified, these alternatives have a lower iodine content than their animal-based counterparts(4). This is a concern because consumers of plant-based alternatives are exposed to highly variable products and might be at risk of iodine deficiency. The number of alternative products on the market is rapidly expanding. Therefore, we aimed to investigate changes in the iodine fortification of plant-based alternatives to milk, yoghurt, cheese, and fish between 2020 and 2023.

This study was a cross-sectional market survey of the eight leading UK supermarkets conducted in four annual waves (2020-2023) to evaluate the availability and composition of plant-based alternatives in the UK. The market was surveyed in December each year using online store data to search for plant-based products (milk, yoghurt, cheese, fish). Data was extracted from the product nutrition information and ingredient list.

We found a 49% increase in plant-based products over the four years. During the 2023 wave, we identified 446 products, including plant-based milk (n 241), yoghurt (n 79), cheese (n 97) and fish alternatives (n 29). The number of products has grown in all categories since 2020, with the largest increase of 141% in plant-based fish alternatives. After excluding organic products, which cannot be fortified, only 35% (n 70) of milk alternatives, 6% (n 4) of yoghurt alternatives and 3% (n 3) of cheese alternatives were fortified with iodine in 2023, compared with 85% (n 169), 52% (n 46), and 55% (n 52), respectively, with calcium. Compared with 2020, there was no significant change in the proportion of milk, cheese or yoghurt alternatives fortified with iodine in 2023 (p>0.05). No fish alternatives were fortified with iodine. The range of iodine fortification of milk alternatives remained stable from 2020 to 2023 (11.3–45 μg/100mL), and the mean fortification all four years (25.4-27.4 μg/100mL) was lower than the average iodine concentration of conventional cow’s milk (30 μg/100mL)(5). Yoghurt and cheese alternatives were fortified at 22.5–45 μg/100g, similar to cow’s milk cheese and yoghurts.

Our study highlights that most plant-based alternatives are not iodine-fortified and that using unfortified alternatives puts consumers at risk of iodine deficiency. Due to their increasing popularity, manufacturers of such alternative products should consider fortifying their products with an appropriate amount of iodine. Consistent and adequate fortification, accurate labelling and nutrition education are needed to help consumers make healthy and informed choices.

Plant-based dairy alternatives (PBDAs) consumption has assumed a more significant role in populations shifting to more sustainable eating habits. However, PBDAs do not necessarily replace the nutrient value of cow’s milk and dairy products, particularly that of essential micronutrients such as iodine(1). Cow’s milk and dairy products are the primary source of iodine in the UK diet(2), and substituting with PBDAs may negatively affect iodine intake. Here, we aimed to (i) investigate the implications for iodine intake and adequacy of partial replacement of milk, cheese, and yoghurt with commercially available PBDAs per UK Net Zero recommendations(3) and (ii) evaluate the potential of introducing bread products made using iodised salt as prophylaxis against iodine deficiency in population intakes due to the proposed changes.

The present study used the dietary modelling software DaDiet(4) to examine iodine intake in the diets of children aged 1.5-13 years and females aged 14-49 years. We used data from the National Diet and Nutrition Survey (2016-2019) and brand-level iodine concentration data(5). Firstly, several scenarios that accounted for the population impact of replacing 20% or 35% of milk and dairy product consumption with PBDAs were modelled. Secondly, we modelled the changes by substituting salt in bread with iodised salt at a 30 µg/kg concentration. Relative to the usual diet, we calculated the change in iodine intake and the proportion with intake below the UK Lower Reference Nutrient Intake (LRNI) or above the Upper Limit (UL).

Replacing 20% of dairy products with PBDAs would result in a meaningful decrease in usual iodine intake in all population groups, except females aged 14-18 years, without impacting the population proportion below the LRNI. A 35% replacement would result in a meaningful decrease in iodine intake (9-20%) compared to the usual diet for all population groups. A 35% replacement would also increase the proportion of females aged 19-49 years with iodine intakes below the LRNI to 21%. Adding iodised salt to bread products would increase the usual iodine intake across all population groups and decrease the proportion of intakes below the LRNI (2-14% change). Particularly for females aged 14-18 years, where 40% increases in iodine intake were observed (97 to 136 µg/day) and would not have a meaningful impact on the proportion above the UL in any population group.

Introducing iodised salt in bread products would counteract the negative effect of PBDAs on iodine intake in all population groups. Replacing milk and dairy products with PBDAs per current UK Net Zero goals would reduce population iodine intake unless measures are implemented to minimise the impact on usual iodine intake. Introducing iodised salt to bread products is one countermeasure that would minimise the impact on iodine intake without increasing the population above the UL.

Pernicious anaemia (PA) is characterised by vitamin B12 deficiency due to autoimmune-mediated loss of gastric parietal cells and intrinsic factor, a specific transporter for the intestinal uptake of vitamin B12. PA is typically managed with lifelong intramuscular hydroxocobalamin injections every 2-3 months. However, this regimen lacks robust scientific validation and fails to account for varied symptomatic responses among patients, with many requiring more frequent injections(1).

The Pernicious Anaemia Society (PAS) is a patient-driven charity that identified 10 research priorities for PA through a James-Lind Alliance Priority Setting Partnership(2). PAS members were surveyed to build a PA Research Repository, exploring diagnostics, treatment, family histories, and comorbidities. This project aims to better understand and manage the condition by addressing these priorities and characterising a cohort of patients.

An online survey was designed using SurveyMonkey comprising 21 questions to collect data on demographics, mode and timing of PA diagnosis, diagnosed comorbidities, family history of PA or other autoimmune conditions, and management (type, regime and patient satisfaction). All questions were compulsory. The survey was sent to 3,482 PAS members (April-September 2022) via the PAS newsletter, email, and website. Chi-square tests were used to investigate associations between gender and survey responses. The study protocol and procedures received a Favourable Ethical Opinion.

Completed surveys were received from 1,191 PAS members (34% response rate). Among these, 971 (81%) had a confirmed PA diagnoses, and the cohort was predominantly UK-based (92%) females (81%) aged 23-90 years, with a wide age of onset (10 to 80 years, mean 49 years). Diagnoses were typically based on low serum B12 (40%), positive intrinsic factor (31%), and/or parietal cell autoantibodies (13%), with 7% diagnosed via the now obsolete Schilling test. Diagnostic delays were common, 39% of participants reported waiting ≥3 years for a diagnosis. Over half (59%) reported other micronutrient deficiencies upon diagnosis. Half reported additional autoimmune diseases, with one-third having family with PA or other autoimmune conditions. Treatment primarily involved hydroxocobalamin intramuscular injections (77%), with 48% following the recommended guidelines and 52% injecting more frequently. Females had higher prevalence rates of Hashimoto’s disease (27% vs 7%), asthma (33% vs 20%), and iron deficiency (49% vs 35%) (all p < 0.05).

This survey has established the first-ever PA research repository of over 1,000 participants offering initial insight into the complexities of PA, from varied age-of-onset and familial clustering to diagnostic challenges and treatment variability. These results support the need for improved diagnostic and treatment strategies, supporting the research recommendations made in the recent vitamin B12 deficiency NICE guidelines(3). It also highlights the potential of collaborative research with a patient-driven charity. Collaborative efforts aim to advance patient-centred PA research, improve treatment evaluation, and develop evidence-based approaches to managing this complex condition.

Vitamin D status has been found to be inversely associated with risk of respiratory tract infections (RTIs)(1). It varies by ethnicity, with several ethnic minority groups in the United Kingdom (UK) reported to be at a higher risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <25 nmol/L) compared to their white counterparts(2, 3). However, the relationship between serum 25(OH)D concentrations and incidence of RTIs by ethnicity in the UK remains unclear. This study aimed to investigate the association between serum 25(OH)D concentrations and likelihood of hospitalisation for RTI in UK ethnic groups.

A nested, case-control study was conducted using data from UK Biobank, which has data for 500k adults for serum 25(OH)D and hospital episodes from linked records. Binary logistic regression models were used to explore the association between serum 25(OH)D concentrations and likelihood of RTIs overall, and by ethnicity.

Of the 36,772 participants included in the analysis, 12,638 (34%) were white Caucasian, 10,311 (28%) Asian, 7,138 (19%) black, 4,034 (11%) other, and 2,651 (7%) of mixed ethnicity. In fully adjusted models, compared to participants with a serum 25(OH)D concentration <15 nmol/L (severe deficiency), those with 25-49 nmol/L, 50-74 nmol/L, and ≥75 nmol/L were found to have statistically significantly lower odds of RTI hospitalisation, with odds ratios (ORs) of 0.53 (95% CI: 0.37, 0.75), 0.61 (95% CI: 0.40, 0.92) and 0.54 (95% CI: 0.30, 0.97), respectively. In the subgroup analysis, ethnic minorities and white individuals with vitamin D deficiency (<25 nmol/L) were more likely to be hospitalised with RTI compared to those that were not deficient, with ORs of 1.36 (95% CI: 1.02, 1.81) and 2.03 (95% CI: 1.30, 3.17), respectively. This association was not statistically significant within ethnic minority subgroups when analysed separately.

Serum 25(OH)D concentrations above 25 nmol/L are associated with lower likelihood of RTI hospitalisation among UK adults. This finding was noted across white and ethnic minority groups, although ethnic minorities with vitamin D deficiency had a lower likelihood of RTIs compared to white individuals. Further studies are warranted to validate these findings and explore the mechanisms underlying the association between vitamin D status and RTIs in different ethnic groups.

Acknowledgements

This project was conducted using the UK Biobank resource under project 15168.

Background: Pituicytoma is a rare, low grade tumour typically of the sellar region. Here we present a pituicytoma located in the third ventricle. Methods: 56 year old female presented with amenorrhea, hyperprolactinemia, and progressive bitemporal hemianopsia. MRI revealed a suprasellar mass located within the third ventricle and appearing separate from the pituitary. A supraciliary and translamina terminalis surgical approach to tumour resection was completed without complication. Post-operatively, she developed transient DI which resolved by post-opertaive day 3 and she was discharged hoem without any neurological deficits. Pathology revealed pituicytoma, WHO grade I. Results: Pituicytomas are rare tumours arising from neuroepithelial cells of the pituitary. The majority of cases are pure sellar or sellar with suprasellar extension, or at least have some connection to the pituitary. In many cases, imaging findings are synonymous to pituitary adenomas. We present a unique case in which the tumour was suprasellar but appeared separate from the pituitary. Surgical intervention is the most highly predictive factor of recurrence, as gross totoal reseciton can be curable. Conclusions: Here we present a unique location of pituictyoma. Due to the exceedingly rare nature of pituicytoma, unique presentations and management help to provide better understanding of the breadth of this disease presentation.

OBJECTIVES/GOALS: The innate immune responses to Multisystem Inflammatory Syndrome in Children (MIS-C) are not fully known. Using samples from MIS-C, we will assess the cellular responses and develop a novel Tri-Specific Killer Engager (TRiKE) that engages innate immune cells to improve those responses. METHODS/STUDY POPULATION: We collected blood samples from 60 pediatric patients from which we isolated plasma and peripheral blood mononuclear cells. We received blood samples from 13 MIS-C, 32 severe acute COVID, 5 COVID-19 asymptomatic, and 15 COVID-19 negative patients. Using plasma, we then performed ELISAs to determine IgG antibody levels against SARS-CoV-2 and plaque reduction neutralization tests to determine neutralizing antibody functions. We isolated DNA to look at Fc receptor genetics. We also utilized utilize flow cytometry assays determine the phagocytosis and killing abilities of the innate cells from these patients. This data will be correlated with clinical outcomes. Additionally, we have developed a novel SARS-CoV-2 TRiKE which directs natural killer (NK) cell killing specifically to of COVID-19 infected cells. RESULTS/ANTICIPATED RESULTS: MIS-C patients had higher IgG antibody titers against SARS-CoV-2 compared to children with symptomatic or asymptomatic COVID. MIS-C patients also neutralized SARS-CoV-2 more effectively than children with acute symptomatic or asymptomatic COVID-19. We found natural killer cells and monocytes are dysfunctional in MIS-C patients and do not kill SARS-CoV-2 infected cells as well. Specifically, NK cells do not kill COVID-19 infected cells as well. To combat this, we have successfully generated and are now testing a Tri-Specific Killer engager (TRiKE) which binds one ends to NK cells, one end to the Spike protein on COVID-19 infected cells and contains IL-15 to improve NK cell function. We anticipate that we can improve NK cell killing of COVID-19 infected cells with this TRiKE. DISCUSSION/SIGNIFICANCE: We found that MIS-C patients have antibodies that can neutralize SARS-CoV-2 but that that innate immune cells that engage antibodies are dysfunctional. We are have successfully developed and are targeting this response with a TRiKE to improve innate immune cell functional; this may serve as an adjunctive therapeutic if proven successful.

Botanical residues recovered from excavations in the Southeast Marketplace of Piedras Negras provide information about the healing and medical activities of the site's Classic period (a.d. 350–900) inhabitants, and point towards the intersection between commerce and medicine for the ancient Maya. The plants were likely exchanged at the market then used on-site for the purposes of healing. The botanical remains are complemented by both architectural and bioarchaeological evidence for healing at this locus, including a high concentration of sweatbaths and evidence for palliative tooth extraction. With the aid of ethnohistory, we identify health care practices potentially associated with the plant remains. However, we expand on basic understandings of “healing” with a critical look at how some medicinal plants may have been ritually invoked, even when never directly ingested or applied topically.