The RDA for dietary protein is likely insufficient for individuals with cystic fibrosis (CF). This study sought to characterise protein intake and diet quality in adults with cystic fibrosis (awCF), before and after elexacaftor/tezacaftor/ivacaftor (ETI) therapy, compared with healthy controls. Dietary intake was assessed by diet diary in awCF at baseline (BL, n 40) and at follow-up > 3 months post ETI therapy (follow-up (FUP), n 40) and in age-matched healthy controls (CON, n 80) free from known disease at a single time point. Protein intake dose and daily distribution, protein quality, protein source and overall diet quality were calculated for each participant. Both CON (1·39 (sd 0·47) g·kg–1·day–1) and CF (BL: 1·44 (sd 0·52) g·kg–1·day–1, FUP: 1·12 (sd 0·32) g·kg–1·day–1) had a higher mean daily protein intake than the protein RDA of 0·75g·kg–1·day–1. There was a significant reduction in daily protein intake in the CF group at FUP (P = 0·0003, d = 0·73), with levels below the alternative suggested dietary intake of ≥ 1·2 g·kg–1·day–1. There were no sex differences or noticeable effects on protein quality or source following the commencement of ETI therapy when compared with CON (all P > 0·05), although overall diet quality decreased between time points (P = 0·027, d = 0·57). The observed reduction in daily protein intake in the present cohort emphasises the importance of ensuring appropriate dietary protein intake to promote healthy ageing in adults with CF. More research is needed to evidence base dietary protein requirements in this at-risk population.

Diet quality has been linked to socio-economic status. However, evidence within rural and regional populations is lacking. This cross-sectional study examined the relationship between diet quality and socio-economic position in adults living in rural and regional areas of Australia. The Australian Recommended Food Score (ARFS; range 0–73) measured diet quality (total and subscale scores). Area-level socio-economic position was determined by postcode-linked socio-economic index for areas (SEIFA), Index of Relative Social Advantage and Disadvantage scores, stratified into quintiles. The mean total ARFS (34·7; sd = 9·1; n 836) was classified as ‘getting there’. Findings showed significantly lower mean total ARFS between SEIFA quintile 1 (1 = lowest; mean total ARFS = 30·4; sd = 10·2; categorised as ‘needs work’) compared with all other SEIFA quintiles (F (44 831) = 8·44, P ≤ 0·001). Linear regression, adjusting for age, sex, income, education, employment status and household composition demonstrated significantly lower overall diet quality for SEIFA quintile 1 compared with SEIFA quintile 3 (B = –3·9; 95 % CI (–6·2, −1·5); P < 0·001) and lower subscale scores for vegetables (B = –1·6; 95 % CI (–2·7, −0·6); P = 0·003), fruit (B = –0·9; 95 % CI (–1·6, −0·1); P = 0·018) and grains (B = –0·6; 95 % CI (–1·3, −0·0); P = 0·050). After adjusting for individual confounders of diet quality, results indicate that lower area-level socio-economic position remained associated with poorer diet quality in this sample of rural and regional Australian adults. This suggests that broader social and environmental factors unique to these areas may impact diet quality and amplify individual barriers to achieving a healthy diet.

Legume lectins represent a broad class of environmental toxicants that bind to cell surface glycoproteins. Raw red kidney beans (RRKB), a widely consumed common source of dietary protein, are rich in the lectin phytohemagglutinin (PHA). Consumption of improperly cooked (which may require overnight presoaking and boiling at least at 100°C for 45 min) red kidney beans causes severe gastrointestinal symptoms. Since the relationship between lectin toxicity and the cellular chaperone machinery remains unknown, the study aimed to determine the effects of heat-denatured PHA on epithelial barrier function and heat shock protein 70 (HSP70) expression and its function as a molecular chaperone in PHA-treated Caco-2 cells and animals. Twelve male Sprague-Dawley rats were randomised to an ad libitum diet of either standard rat chow or chow containing 26% crude red kidney beans. We measured HSP70 and heat shock factor 1 gene expressions in the small intestine and HSP70 protein expression in Caco-2 cells. In Caco-2 cells, luciferase activity was measured to investigate protein folding. Fluorescein-5-isothiocyanate (FITC)-labelled lectin was used to study its intracellular uptake by Caco-2 cells. PHA lectin reduced transepithelial electrical resistance in Caco-2 cells. FITC-labelled PHA entered Caco-2 cells within 3 h of treatment. PHA treatment significantly reduced HSP70 levels and luciferase activity in Caco-2 cells, which was prevented by HSP70 overexpression. In rats fed RRKB chow consisting of legume lectins, we found reduced levels of HSP70 and heat shock factor 1. These observations suggest that lectins counter the protective function of HSP70 on intestinal barrier function.

Sessile serrated lesions (SSL) are recognised precursors to colorectal cancer. Little is known about risk factors for SSL due to their relatively recent clinical recognition as a cancer precursor and routine documentation of cases. Lifestyle and diet-related information were collected using validated questionnaires in a colonoscopy-based case–control study in Australia (257 SSL cases, 239 conventional adenoma (CA) cases, 180 polyp-free controls). A posteriori dietary patterns were derived from self-reported dietary intake in the past 12 months using principal component analysis. Multivariable-adjusted OR and 95 % CI were used to examine associations between lifestyle factors and dietary patterns on risk of SSL and CA v. polyp-free controls and SSL v. CA using logistic regression modelling. Use of anti-inflammatory medications was associated with reduced SSL risk (OR = 0·61; 95 % CI 0·38, 1·00), while current smoking was associated with increased SSL risk (OR = 1·96; 95 % CI 1·09, 3·53). Unlike CA, SSL risk was not increased by hormone replacement therapy use and current alcohol consumption but was increased by taller height. Higher adherence to a dietary pattern featuring processed meats, ready-made convenience foods and high-energy drinks was associated with increased SSL risk (OR = 2·13; 95 % CI 1·13, 4·00; Ptrend = 0·03) and CA (OR = 2·60; 95 % CI 1·32, 5·09; Ptrend = 0·005). Compared with CA, a dietary pattern featuring wholegrains, low-fat dairy products, nuts, seeds and oily fish was associated with reduced SSL risk (OR = 0·60; 95 % CI 0·36, 0·98; Ptrend = 0·04). This study supports a healthy diet as primary prevention for both SSL and CA and reinforces smoking as a risk factor for SSL.

Vitamin A deficiency (VAD) poses significant health risks and is prevalent in children and adolescents in India. This study aimed to determine the effect of seasonal variation and availability of vitamin A-rich (VA-rich) foods on serum retinol in adolescents. Data on serum retinol levels from adolescents (n 2297, mean age 14 years) from the Comprehensive National Nutrition Survey (2016–2018) in India were analysed, with VAD defined as serum retinol < 0·7 µmol/L. Five states were selected based on a comparable under-five mortality rate and the seasonal spread of the data collection period. Dietary data from adolescents and children ≤ 4 years old were used to assess VA-rich food consumption. A linear mixed model framework was employed to analyse the relationship between serum retinol, month of the year and VA-rich food consumption, with a priori ranking to control for multiple hypothesis testing. Consumption of VA-rich foods, particularly fruits and vegetables/roots and tubers, showed seasonal patterns, with higher consumption during summer and monsoon months. Significant associations were found between serum retinol concentrations and age, month of sampling, consumption of VA-rich foods and fish. VAD prevalence was lowest in August, coinciding with higher consumption of VA-rich fruits and foods. Findings highlight the importance of considering seasonality in assessing VAD prevalence and careful interpretation of survey findings. Intentional design, analysis and reporting of surveys to capture seasonal variation is crucial for accurate assessment and interpretation of VAD prevalence, including during monitoring and evaluation of programmes, and to ensure that public health strategies are appropriately informed.

The composite dietary antioxidant index (CDAI) has been identified as a critical factor in the pathogenesis of certain inflammatory diseases. The study aimed to investigate the relationship between CDAI and Helicobacter pylori infection using cross-sectional design. In this study, participants from the 1999–2000 National Health and Nutrition Examination Survey were analysed using logistic and Cox regression analyses to assess the associations between H. pylori infection and CDAI, encompassing vitamin A, vitamin C, vitamin E, carotene, Zn, Se and Cu. The results demonstrated a negative correlation between CDAI scores and H. pylori infection, revealing a non-linear relationship between the odds of H. pylori infection and CDAI as a continuous variable. Subsequently, a two-sample Mendelian randomisation study was conducted utilising genome-wide association study summary statistics to explore the causal relationship between antioxidant levels and H. pylori infection. We found that the intake of Cu was a protective factor in the occurrence of H. pylori infection but did not support a causal association between circulating Cu levels and H. pylori infection. The prevalence of H. pylori infection was found to be elevated among individuals of older age, lower education levels, limited socio-economic status, smokers, diabetes and those with hypertension. The study suggests that higher CDAI is linked to decreased odds of H. pylori infection, and further prospective studies are needed to confirm the association. Our findings may have significant implications for the prevention and management of H. pylori-related diseases.

Current food systems pose risks to both population and environmental health. Reducing the intake of animal-based foods, such as dairy products, and increasing consumption of plant-based foods align with priorities for addressing climate change and promoting overall health. Plant-based alternatives to cow’s milk can be readily substituted for cow’s milk without altering meal patterns and food habits, making them a popular choice among those reducing animal-product consumption. However, plant-based milk alternatives do not necessarily provide the same nutrients as cow’s milk, particularly essential micronutrients like iodine. While national data indicate that the UK is iodine-replete, certain population subgroups (such as pregnant women, women of reproductive age, and vegans) remain at risk of iodine deficiency. Young women are more likely than other age groups to consume plant-based milk alternatives, heightening public health concerns about iodine insufficiency in this demographic. Current consumers of plant-based milk alternatives in the UK have lower iodine intake and status compared to consumers of cow’s milk. Population-level effects of replacing milk with plant-based alternatives vary and depend on factors such as the role of plant-based milk alternatives in the diet (i.e. in addition to, or as a replacement for milk), the presence of other iodine sources in the diet, the consumer’s life stage, and whether the alternatives are fortified with iodine. This review examines the literature on plant-based milk alternatives and iodine intake, focusing on implications of this dietary shift and strategies to improve iodine intake in those opting for plant-based milk alternatives in the UK population.

Manganese (Mn) is a crucial trace element that actively participates in a diverse array of physiological processes. Mn is maintained at appropriate levels in the body by absorption and excretion by the body. Dysregulation of Mn homeostasis can lead to a variety of diseases, especially the accumulation of Mn in the brain, resulting in toxic side effects. We reviewed the metabolism and distribution of Mn at multiple levels, including organ, cellular and sub-cell levels. Mitochondria are the main sites of Mn metabolism and energy conversion in cells. Enhanced Mn superoxide dismutase activity reduces mitochondrial oxidative stress and inhibits cancer development. In addition, Mn enhances anti-cancer immune responses through the cGAS–STING pathway. We introduced various delivery vectors for Mn delivery to cancer sites for Mn supplementation and anti-cancer immunity. This review aims to provide new research perspectives for the application of Mn in the prevention and treatment of human diseases, especially by enhancing anti-cancer immune responses to inhibit cancer progression.

Interest in probiotics and prebiotics in sports nutrition is growing, but research on Jordanian athletes remains limited. While gut microbiota influences athletic performance, little is known about athletes’ understanding and use of probiotic- and prebiotic-rich foods in this region. This exploratory study investigates the knowledge, dietary habits, and correlations with gastrointestinal (GI) problems among Jordanian athletes to inform future research and interventions. The study provides insights into how awareness and consumption of gut-supportive foods can impact GI health, offering broader nutritional implications for global dietary strategies for athletes. A standardised questionnaire was administered to 324 athletes (ages 18–22) to assess knowledge, dietary practices, and GI symptoms. Descriptive statistics summarised the data, and chi-square tests examined associations among knowledge, diet, and GI symptoms (p < 0.05). Knowledge and diet were scored based on correct responses and reported intake of gut-supporting foods. Results showed that 55.9% of athletes were familiar with probiotics and 32.1% with prebiotics. The majority reported low consumption of probiotic- and prebiotic-rich foods, with 72.2% scoring low on diet intake. Although 60.5% seldom consumed fast food, overall intake of gut-supportive foods was limited. No statistically significant associations were found, but a weak positive trend between dietary habits and GI symptoms was observed, suggesting diet may have a modest influence on GI health. Living arrangements influenced both dietary choices and GI symptoms. This study highlights the need for targeted nutrition education to improve awareness and intake of probiotics and prebiotics, potentially supporting GI health and enhancing athletic performance.