Diets low in diverse fibre-rich plant foods contribute to the rise of chronic disease. The BIOME study (NCT06231706; 6-week parallel randomised controlled trial) in 399 adults (35–65 years; BMI 18·5–40 kg/m2; fibre intake < 20 g/d) investigated a whole-food plant blend containing > 30 ingredients, rich in (poly)phenols, fibre and micronutrients. Participants were randomised (1:1:1) to the blend (30 g/d), an isoenergetic control (bread croutons, 28 g/d) or probiotic (Lactobacillus rhamnosus, 15bn CFU/d). Analysts were blinded to allocation. The primary outcome was change in ‘favourable’ and ‘unfavourable’ gut microbiome species (ZOE Microbiome Health Ranking 2025); secondary outcomes included blood metabolites, symptoms, stool output, anthropometry, hunger, sleep, energy and mood. A crossover sub-study explored postprandial glucose, hunger and mood. Of 349 participants analysed (fifty excluded), self-reported adherence was > 98 %. The 30+ plant blend resulted in more species changing relative abundance at 6 weeks v. control (57 v. 14 species-level genome bins (SGB), P < 0·001) and probiotic (57 v. 4 SGB, P < 0·001). There were no significant between-group differences in microbiome health ranks of significantly changing species (increasing or decreasing). Blend participants self-reported reduced indigestion, constipation, heartburn and flatulence and increased energy v. control (all P < 0·05). Six related but no serious adverse events occurred. In the sub-study, adding the blend to a high-carbohydrate meal (v. meal alone) reduced hunger, increased fullness and energy (3-h incremental AUC, all P < 0·05), with no effect on postprandial glucose. This 30+ plant blend represents a simple strategy to modify gut microbiome composition and benefit gastrointestinal symptoms in healthy adults.

Asparagus (Asparagus officinalis) contains bioactive compounds such as polyphenols and saponins, which have been shown to influence cognition, mood, sleep, stress and related biomarkers. However, the evidence from human studies has not been systematically synthesised. To address this, we conducted a systematic review evaluating the effects of asparagus-based products on cognitive, affective, sleep outcomes and related biomarkers in adults. A systematic search of PubMed, Scopus, Web of Science, PsycINFO, Google Scholar and Amino Up Ltd’s website (up to April 2025) identified studies assessing asparagus supplementation in adults, following PRISMA guidelines (PROSPERO registration number: CRD42025636834). Human studies that employed randomised controlled trials or quasi-experimental designs and assessed the effects of orally administered asparagus-based products on cognition, mood, sleep or relevant biomarkers were included. Eighteen studies (thirteen randomised controlled trials and three pre-post-studies; 503 participants) were included. Cognitive improvements were observed in reaction time, accuracy and mental fatigue, while mood and stress-related outcomes showed reductions in anxiety and depressive symptoms. Sleep outcomes consistently demonstrated improvements in sleep quality and duration, while biomarker data showed effects on cortisol levels. Asparagus supplementation may offer modest benefits for cognition, mood and stress-related physiology, with particularly consistent effects on sleep quality. However, the magnitude of benefits varies by population, dose and duration, and the heterogeneity of interventions, small sample sizes and limited studies may constrain the generalisability of findings. Well-powered, long-term clinical trials are needed to determine optimal dosage, clarify mechanisms and assess efficacy across diverse populations.

Consuming fruit juice/smoothies could help overcome barriers to fruit and vegetable (F&V) intake. However, their contribution towards F&V intake within a healthy diet is contentious. We investigated how F&V intake is affected by UK 5-a-day advice, with and without one portion/d of fruit juice/smoothies and explored how these interventions impacted markers of health. Healthy individuals (n 42) with low F&V intake (≤ 2 servings/d) completed a 4-week, parallel-group randomised controlled trial (ClinicalTrials.gov ID: NCT06628401). Participants were randomised to (1) control, (2) whole F&V (FV) or (3) whole F&V plus fruit juice/smoothies (FV + FJ). All groups received weekly financial support (to remove financial barriers to F&V purchase in the intervention groups). FV and FV + FJ also received a co-designed educational booklet. We investigated the intervention effects on self-reported F&V intake (primary outcome), biomarkers of intake and metabolism, mood, gut symptoms and acceptability. Post-intervention F&V intake differed between groups (P < 0·001; ηp2 = 0·62). It was significantly higher in FV ((estimated marginal means (se)); 8·9 (0·64) portions/d, P < 0·001) and FV + FJ (6·6 (0·64), P < 0·001) v. control (2·45 (0·64)), but there was no difference between FV and FV + FJ (P = 0·051). Both interventions showed good acceptability. Depression symptoms differed between groups (P = 0·01; ηp2 = 0·21); they were significantly lower in FV + FJ than control. There were no differences in anxiety or gut symptoms, nor in intake or metabolic biomarkers. A financial and educational intervention based on UK 5-a-day recommendations, with or without fruit juice/smoothies, significantly increased short-term F&V intake and benefited mood without adversely impacting health markers in the short-term. Funder: Fruit Juice Science Centre.

Malnutrition remains a major public health challenge in low- and middle-income countries and disproportionately affecting children under five. Eggs, given their high nutrient density and relative physical or economic accessibility, have been tested for their effect on improving nutritional outcomes in children under five. However, findings from scientific exercises to test the impact of egg-based trials on child growth have not been systhematically pooled and synthesised. Therefore, this meta-analysis aimed to synthesise evidence on the impact of egg-based interventions on the nutritional status of children underfive as determined by weight-for-height Z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ). Research articles of randomised controlled trials published between 2013 and 2023 were identified through a comprehensive search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, Science Direct, Google Scholar, and African Index Medicus data bases. Articles evaluated the effect of egg-based interventions against alternative diets, behaviour-change education, or no alternative intervention were included. Primary outcomes are WHZ, WAZ, and HAZ. Random-effects models were used to pool effect sizes (mean difference), and subgroup analyses and meta-regression explored sources of heterogeneity. Publication bias was assessed using funnel plots and Egger’s test. Seven studies involving 3673 children met the inclusion criteria. Egg-based intervention significantly improved WAZ (MD: 0.33; 95% CI: 0.11–0.55) and WHZ (MD: 0.30; 95% CI: 0.12–0.48). However, no significant effect was observed on HAZ (MD: 0.05; 95% CI: –0.05–0.14). It is figuredout that egg-based interventions can improve weight-related nutritional outcomes (WHZ and HAZ) among children underfive in sub-Saharan Africa, but not linear growth (HAZ).

Individuals with type 2 diabetes are at increased risk for developing CVD. We assessed how dietary counselling on a high-quality, fibre-rich diet influenced cardiometabolic health of patients with type 2 diabetes. In this 6-month trial, 121 patients with type 2 diabetes (67 (sd 8·7) years, 68 % men, BMI 27·8 kg/m2) were assigned to dietary counselling (n 61) or standard care (n 60). Counselling included 4–7 individual sessions with a dietitian, aimed at increasing fibre intake to improve diet quality. The primary outcome was a composite risk score estimating 10-year CVD risk. Secondary outcomes included diet quality, assessed by the Dutch Healthy Eating Index-2015 (DHD15-index), HbA1c, LDL-cholesterol, blood pressure, body weight and medication use. Diet quality score at baseline was 115 (sd 26) and similar across groups. Over 6 months, DHD15-index scores improved by 4·5 points (95 % CI: −0·2, 9·1) in the intervention group v. control, but not significant. The change in 10-year CVD risk across the 6 months of the trial (primary outcome) did not differ between groups −0·1 %, 95 % CI: −0·2, 0·1. Changes over time in HbA1c (–1·1 mmol/mol, 95 % CI: −4·4, 2·3), LDL-cholesterol (0·0 mmol/l, 95 % CI: −0·2, 0·3), blood pressure (–1 mmHg, 95 % CI: −6, 4), body weight (–0·1 kg, 95 % CI: −1·2, 1·1) or medication use did not differ between groups. Dietary counselling for 6 months slightly improved adherence to a high-quality, fibre-rich diet in patients with type 2 diabetes but did not significantly impact cardiometabolic health or medication use.

The planetary health diet (PHD) is a mostly plant-based diet that aims to optimise human health while minimising the environmental impact of food production. Limited data exist on whether the PHD fulfils key nutritional requirements during pregnancy. This research aimed to examine the PHD in early pregnancy and how it aligns with daily nutrient intake and European Food Safety Authority (EFSA) dietary guidelines. Pregnant women (n 678) from two Irish cohorts (ROLO and MicrobeMom) were analysed, and PHD index (PHDI) scores were assigned based on data from 3-d food diaries. Women were dichotomised by the median score to create a ‘High PHDI’ (> 88·99) and a ‘Low PHDI’ group (≤ 88·99). Differences in nutrient intakes and adherence to dietary guidelines between ‘High’ and ‘Low’ PHDI groups were explored. Compared with those with a ‘Low’ score, those with a ‘High’ PHDI score reported higher intakes of dietary fibre (g/d) (17·32 (13·39, 21·08) v. 21·74 (18·28, 25·88), P < 0·001), Fe (mg/d) (10·48 (8·48, 12·82) v. 12·06 (9·48, 14·60), P < 0·001), folate (µg dietary folate equivalent per d) (250·73 (193·88, 312·45) v. 279·57 (219·43, 356·81), P < 0·001) and Ca (mg/d) (837·75 (695·36, 1056·72) v. 956·57 (751·84, 1155·03), P < 0·001). A greater proportion of women in the ‘High PHDI’ group met EFSA recommendations for dietary fibre intake (10·3 % v. 28·9 %, P < 0·001). The PHD may support maternal nutritional adequacy in pregnancy while promoting environmental sustainability. Our findings provide valuable insights that can inform future dietary recommendations for pregnancy, contributing to both maternal health and planetary well-being.

This paper summarises the UK Scientific Advisory Committee on Nutrition’s (SACN) 2023 and 2025 assessments of processed foods and health and its 2025 review of the WHO guideline on non-sugar sweeteners (NSS). On processed foods, SACN sought to identify available evidence on existing processed food classification systems, applying NOVA to UK National Diet and Nutrition Survey data and associations between food processing and health outcomes. For NSS, health outcomes of greatest policy relevance to the UK were considered. The assessments were undertaken in line with SACN’s Framework for the evaluation of evidence. SACN found that NOVA dominated the research literature and ultra-processed food (UPF) constitutes a significant proportion of UK dietary energy intake, especially among children. Higher UPF consumption was consistently associated with increased risks of adverse health outcomes, although not for all subgroups. Important limitations included most evidence being observational and inconsistent adjustment for covariables. For NSS, randomised controlled trials indicate a small reduction in body weight when NSS replace sugars, whereas prospective cohort studies indicate higher NSS intake is associated with higher measures of body fatness and may be associated with a range of adverse health outcomes. The findings were based on low- and/or very low-certainty evidence. SACN concluded that, on balance, most people are likely to benefit from reducing consumption of processed foods high in energy, saturated fat, salt and free sugars and low in fibre. SACN made a precautionary recommendation that intake of NSS be minimised. SACN made a range of recommendations to the government on processed foods and sweeteners.

Parenteral nutrition (PN) is used when sufficient oral or enteral nutrition is not possible or feasible. Current guidelines provide limited practical guidance in emergency surgical patients, and the evidence is sparse. The EATERS trial aims to investigate the effect of early supplemental PN on postoperative infections in major emergency abdominal surgery patients. The EATERS trial is an investigator-initiated, multicentre, randomised controlled trial. The trial will include 342 adults with reduced oral intake after emergency abdominal surgery, randomising them in a 1:1 ratio to early or postponed supplemental PN. The intervention group (early) will receive supplemental PN starting on postoperative day (POD) 2 for up to five days. The control group (postponed) will receive standard care and, if oral intake remains insufficient, will begin supplemental PN on POD5 for up to five days. The primary outcome is the incidence of postoperative nosocomial infections during admission. Outcome assessors and the statistician will be blinded to the treatment allocation. The secondary outcomes include non-infectious complications during admission, length of stay, mortality risk at 30 and 90 d, energy and protein intake, serious adverse events and readmission risk within 30 and 90 d of surgery. Analyses will follow the intention-to-treat principle and logistic regression used for primary outcome analysis. The EATERS trial will provide novel insights into the timing of PN in a high-risk patient population. This protocol and statistical analysis plan will reduce bias and increase transparency in the conduct and analysis of the trial.

Anorexia nervosa (AN) is an eating disorder that is mediated by psychological and metabolic factors, yet it is unclear how these factors interact. The NAMA trial objective is to clarify the metabo–psychiatric interaction and identify how it affects AN patients’ behaviour. This randomised trial will recruit thirty-six treatment-naïve female AN patients, 13–18 years of age, and thirty-six matched healthy controls. Participants will undergo psychiatric assessments followed by 12-h overnight fasting. The next morning, baseline assessments of outcomes will be performed. Patients will be randomly allocated 1:1 to receive a mixture with calories or receive a mixture without calories. Healthy controls will also be allocated to receive mixtures with/without calories. Mixtures will be standardised for taste and appearance, and allocation will be masked. The primary outcome measure is resting-state functional MRI 60 min post-consumption of the mixture. Secondary outcomes include (1) blood samples to study markers reflecting metabolic states, hunger/satiety and stress responses, (2) psychometric evaluations of subjective experiences and (3) assessment, in a second meal 3 h later, of the effects of previous calorie intake on subsequent food consumption. This article describes the study protocol, including the analysis plan, for a randomised controlled trial to comprehensively evaluate the effects of calorie intake in AN. The trial will distinguish psychological and metabolic neuronal networks associated with food intake and uncover how their integration affects food intake and other hallmark symptoms in AN. The aim is to accelerate treatment development by identifying brain mechanisms that drive AN.

This randomised controlled trial examined the effect of a 4-week, high-dose (Lf-High, 600 mg/d) or low-dose (Lf-Low, 200 mg/d) oral lactoferrin (Lf) intervention v. placebo on immune cell responses to respiratory virus, immune cell subsets and systemic inflammation. In healthy older adults (n 103, ≥50 years old), ex vivo cytokine release of interferon (IFN)-α2, IFN-γ, IL-6 and TNF-α from rhinovirus A-16 (RV-16) or influenza A virus (H1N1) stimulated peripheral blood mononuclear cells, circulating immune cell subsets, and plasma IL-6, C-reactive protein (CRP) and TNF-α were assessed. Ninety-seven participants completed the 4-week intervention (Lf-High n 32, Lf-Low n 31, placebo n 34, withdrawals n 6). There was no difference in RV-16 or H1N1-induced IFN-γ release between groups. RV-16-induced IL-6 was lower in Lf-High v. placebo (P = 0·001), and RV-16-induced IFN-α2 was higher in Lf-High v. Lf-Low (P = 0·04). Lf-High increased total T cells (P = 0·03) and CD4+ T cells (P = 0·03) v. placebo. Lf-Low reduced neutrophil (P = 0·04), natural killer cell (P = 0·045), activated CD8+ T cell (P = 0·03) and γδ T cell (P = 0·03) frequency v. placebo. Plasma IL-6 (P = 0·004) and CRP (P = 0·03) were lower following Lf-High v. Lf-Low, but not placebo. Both high- and low-dose Lf altered ex vivo immune cell responses after 4 weeks. High-dose increased T-cell subsets, promoting adaptive immunity, and reduced systemic inflammation, while low-dose reduced proinflammatory and cytotoxic immune cells. High- and low-dose Lf supplements may have immunoceutical benefits in older adults.

Forced displacement heightens mental health risks for children, including psychological, environmental and economic stressors, yet few interventions address whole-family needs within humanitarian contexts. Family-systemic approaches show promise, but evidence on interventions addressing social determinants of mental health remains limited. We will conduct a single-masked, two-arm randomised controlled trial with 550 families in East Amman, Jordan, to evaluate StrongerTogether, a modular whole-family intervention with a financial literacy component. Families experiencing multiple psychosocial challenges will be randomised 1:1 to receive the intervention or enhanced treatment as usual. The trial employs sequential dual outcomes testing, evaluating effectiveness through: (1) upstream improvements in at least one of three primary outcomes (family functioning, parenting practices and caregiver mental health) and (2) direct improvements in adolescent mental health among those with elevated baseline distress. We will also evaluate two implementation tools: ReachNow for family case detection and FamilyACT for facilitator competency assessment. A mixed-methods process evaluation will examine implementation, effectiveness and potential sustainability of core and optional modules. This will be the first rigorous evaluation of an integrated whole-family intervention addressing social and environmental determinants of mental health in humanitarian settings. Findings will inform evidence-based approaches to family mental health support and contribute validated tools for implementation at scale.