Many people with rheumatoid arthritis (RA) believe that certain foods may influence disease activity. Elimination reintroduction diets and oral food challenges are dietary strategies used to identify foods that may exacerbate symptoms. This review summarises and appraises the literature on elimination diet interventions that include food reintroductions or oral food challenges in adults with RA. It describes study design, measures used to assess the effects of food exclusion and challenge, foods identified that may affect RA symptoms, and the measures used to assess the outcome of excluding those foods. A search of five databases, two thesis repositories and Open Grey was conducted to identify records published from inception to January 2025, using terms related to RA, elimination diets and food sensitivity. Eligible records were screened independently by two reviewers, and data extraction followed Joanna Briggs Institute guidelines. Data are presented using a narrative synthesis approach with descriptive data analysis. In total, forty-eight records met inclusion criteria comprising twenty intervention studies (sample sizes 4–94) and seventeen case studies, conducted across twelve countries (1949–2024). Interventions included single-food exclusions, few-food diets, low-allergen meal replacements and fasting protocols. Reintroduction methods varied from a single-food challenge to multiple reintroductions, with five studies using blinded challenges. Outcome measures included physician- or participant-observed symptom changes, clinical assessments and laboratory measures, though these were heterogeneous. Findings reveal a lack of standardised protocols, dated methodologies and limited contemporary research. Controlled studies are needed to establish evidence-based protocols, investigate mechanisms, and guide dietary strategies as adjuncts to RA pharmacological treatment.

The concept of the protein transition represents a shift from a diet rich in animal proteins to one richer in plant-based alternatives, largely in response to environmental sustainability concerns. However, a simple swap by replacing dairy protein with plant protein will lead to lower protein quality and a lower intake of key micronutrients that sit naturally within the dairy matrix. Owing to antagonistic effects within the plant food matrix, micronutrients in plant sources exhibit lower bioavailability which is not reflected in food composition data or dietary guidelines. The dairy matrix effect includes moderation of blood lipid levels in which calcium plays a key role. Protein recommendations often take a muscle-centric approach. Hence, strategies to increase the anabolic potential of plant proteins have focused on increasing total protein intake to counter the suboptimal amino acid composition relative to dairy protein or leucine fortification. However, emerging evidence indicates a role for nutrient interactions and non-nutrient components (milk exosomes, bioactive peptides) of the dairy matrix in modulating postprandial muscle protein synthesis rates. To ensure the food system transformation is environmentally sustainable and optimal from a nutrition perspective, consideration needs to be given to complementary benefits of different food matrices and the holistic evaluation of foods in the protein transition. This narrative review critically examines the role of dairy in the protein transition, emphasising the importance of the food matrix in nutrient bioavailability and muscle health. By considering both nutritional and sustainability perspectives, we provide a holistic evaluation of dairy’s contribution within evolving dietary patterns.

Adolescent girls are vulnerable and deserve the utmost attention to complement their nutrition. This scoping review endeavours to identify the determinants of malnutrition among adolescent girls in Pakistan and to comprehend the interventions to improve their health and nutritional status. This review of the literature was conducted using Google Scholar, PubMed/Medline, Scopus and Web of Science for articles published between 2015 and 2024. MeSH terms used for search were as follows: adolescent, youth, health, malnutrition, nutrition interventions, systems approach. In addition, reports from the WHO, the UN, the World Bank, the Government of Pakistan and other organisations were also critically reviewed. Moreover, this paper has used the Pathways framework, which advocates multi-sectoral approaches for poverty reduction. In most developing countries, the compromised nutritional status of adolescent girls, compounded by poverty, has life-long health and economic consequences, as well as their infants having nutritional deficits. They are expected to grow as stunted children. Abundant evidence has shown that nutrition-sensitive and nutrition-specific interventions can improve their nutritional status and that of subsequent generations. There is a dire need to involve key stakeholders from health, education, nutrition, population, women’s development, social welfare and other relevant sectors. It is imperative to design interventions for adolescent girls in each country’s context to break the intergenerational cycle of malnutrition and to improve economic productivity. Political commitment and effective governance along with policy coherence are required for their healthy transitions into adulthood.

Weaning and introduction to a solid diet result in physiological stress in piglets. This can be offset by using complex diets. The terms ‘complexity’ and ‘complex diets’ are used in practice and academia but are not precisely defined. The aim of this review was to identify the ingredients in weaner diets, their inclusion levels and how the number of ingredients or complexity of diets influences weaner performance, intestinal and systemic health, environmental sustainability and antibiotic use. Not all diets are formulated equally. Some prioritise meeting the weaner’s nutritional needs, while other diets seek to align health promotion and adaptation to the environment. As diet composition is of vital importance for young piglets, the components needed in these complex diets must be defined. Healthy, environmentally adapted pigs have excellent growth performance. We therefore recommend use of a new term, ‘gut health supporting diets’, to encompass the many concepts associated with diet complexity.

To achieve infectivity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, must first traverse the upper respiratory tract mucosal barrier. Once infection is established, the cascading complexities of the pathophysiology of COVID-19 makes intervention extremely difficult. Thus, enhancing the defensive properties of the mucosal linings of the upper respiratory tract may reduce infection by SARS-CoV-2 and indeed by other viruses such as influenza, which have been responsible for the two major pandemics of the last century. In this review we summarise potential opportunities for foods and nutrients to promote an adequate mucosal immune preparedness with an aim to assist protection against infection by SARS-CoV-2, to maximise the mucosal vaccination (IgA inducing) response to existing systemic vaccines, and to play a role as adjuvants to intranasal vaccines. We identify opportunities for vitamins A and D, zinc, probiotics, bovine colostrum and resistant starch to promote mucosal immunity and enhance the mucosal response to systemic vaccines, and for vitamin A to also improve the mucosal response to intranasal vaccination. It is possible that an entirely different virus may in the future, by way of convergent evolution, utilise a similar upper respiratory tract infection pathway. A greater research focus on mucosal lymphoid immune protection in partnership with nutrition would result in greater preparedness for such an event.

Firefighters face significantly elevated cancer risks due to chronic exposure to carcinogenic fire effluents and occupational stressors. In 2022, the World Health Organization classified firefighting as a carcinogenic occupation, linking it to increased incidences of cancers, including mesothelioma, bladder, prostate, colon and melanoma. Drawing on UK-specific data where possible, this narrative review explores how dietary strategies, particularly the Mediterranean diet, may complement existing protective measures in mitigating these risks. It investigates specific food-based nutrients that show promise in addressing risks associated with fire effluent contaminants, examining nutrient-mediated mechanisms and their relevance to firefighter health. The review also highlights the distinct combination of challenges firefighters face in adopting healthier dietary patterns, including disrupted routines, group eating cultures and gaps in nutritional education. While the evidence for firefighter-specific dietary interventions is still emerging, this review highlights the potential of sustainable dietary strategies to significantly reduce cancer risks and improve long-term health outcomes. Finally, it calls for targeted research and interventions to refine these strategies and deliver tangible health benefits for firefighters worldwide.

Vitamins B6 (that is, pyridoxin and its analogues) and B7 (that is, biotin or vitamin H) are essential molecules for many physiological processes. In addition to their well-known involvement in several enzymatic reactions, recent discoveries revealed their participation in other processes, for example, in gene expression via epigenetic processes, such as biotinylation of proteins in the case of biotin. Plants, fungi, archaea and most bacteria synthesise both vitamins, whereas animals and humans lack enzymes for their biosynthesis and depend on their exogenous supply. At least in the case of biotin, human gastrointestinal microbiota can likely partly satisfy the need. Both vitamins are water soluble and require a transporter for efficient absorption after oral administration; they can be rapidly excreted; hence, they are considered largely non-toxic. In addition to physiological and kinetic aspects of vitamin B6 and biotin, this review, which is based on a search in PubMed up to 2023, covers sources of these vitamins, the impact of food treatment on their content, causes and symptoms of deficiency and specific mutations related to their function. Currently available literature on the analytical determination of these vitamins in biological fluids, possible pharmacological uses and symptoms of toxicity, although rare, are also included.

Several dietary strategies are designed to achieve optimal glycaemic control in managing gestational diabetes mellitus (GDM), considering factors such as energy needs, the glycaemic index, high fibre content and the reduction or exclusion of sugary foods and drinks. However, in achieving therapeutic goals, there is a lack of consensus in the formulation of uniform recommendations. This article reviews the literature to assess the impact of dietary interventions on GDM risk – measured by the percentage of at-risk women who develop GDM – and on the progression of GDM pregnancies, including weight gain, hyperglycaemia severity, insulin requirements and perinatal outcomes such as macrosomia, hypertensive disorders, caesarean delivery and neonatal size. We conducted a thorough search of PubMed and the Cochrane Library, focusing on randomised controlled trials, cohort studies, systematic reviews and meta-analyses involving women either at risk of or diagnosed with GDM. These search criteria yielded 2800 articles, whose titles and abstracts were reviewed to determine their relevance to the research objective. In the initial search, 192 relevant articles met the inclusion criteria. The comprehensive analysis of these studies highlights the current uncertainty regarding the long-term consequences of recommended diets during pregnancy, especially among women with GDM. While the available literature is substantial, conclusions drawn from various methodologies and study populations have not yielded a consensus on the most effective diet for reducing perinatal complications. Nonetheless, it is reasonable to advocate for the early initiation of dietary interventions, particularly during pregnancy planning, especially among women exhibiting risk factors for GDM.

The health benefits of the long-chain omega-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been known for over 50 years and underpin the UK population recommendation to consume >450 mg EPA + DHA per day. These recommendations, last revised in 2004, are based mainly on epidemiological evidence. Much research has been conducted in the interim. Most randomised controlled trials (RCT) use doses of EPA + DHA of 840 mg/d or more. For anti-inflammatory, triacylglycerol-lowering and anti-hypertensive effects, >1.5 g EPA + DHA per day is needed. Cognitive benefits are also likely to require these higher intakes. Farmed salmon now contains considerably less EPA + DHA relative to farmed fish of 20 years ago, meaning one portion per week will no longer provide the equivalent of 450 mg EPA + DHA per day. Oily fish alone can only provide a fraction of the EPA + DHA required to meet global needs. Furthermore, there is low global oily fish consumption, with typical intakes of <200 mg EPA + DHA per day, and limited intakes in vegans and vegetarians. Therefore, there is an urgent need for affordable, acceptable, alternative EPA + DHA sources, including vegan/vegetarian friendly options, such as bio-enriched poultry, red meat and milk products; fortified foods; enriched oilseeds (for example, genetically modified Camelina sativa); algae and algal oils; and approaches which enhance endogenous EPA/DHA synthesis. In this narrative review, we suggest that current EPA + DHA intake recommendations are too low, consider EPA/DHA from a holistic health-sustainability perspective and identify research, policy and knowledge mobilisation areas which need attention.

This review summarises findings from studies in companion animals with chronic diseases receiving omega-3 supplementation. Investigated conditions included dermatopathies (dogs n = 7), osteoarthritis (dogs n = 7, cats n = 2), cardiovascular diseases (dogs n = 7), dyslipidaemias (dogs n = 1), gastroenteropathies (dogs n = 2), chronic kidney disease (dogs n = 2, cats n = 3), cognitive impairment (dogs n = 4, cats n = 1), and behavioural disorders (dogs n = 3). When possible, dosages were standardised to mg/kg using available data on food intake and EPA/DHA concentrations. The minimum and maximum ranges of EPA and DHA, along with their ratios, were as follows: for dermatology 0·99–43 mg/kg EPA and 0·66–30 mg/kg DHA (ratio 1·4–3·4); for osteoarthritis 48–100 mg/kg EPA and 20–32 mg/kg DHA (ratio 1·5–3·4); cardiology 27–54·2 mg/kg EPA and 18–40·6 mg/kg DHA (ratio 1·3–1·5); dyslipidaemia 58·8 mg/kg EPA and 45·4 mg/kg DHA (ratio 1·3); cognition (1/5 studies) 225 mg/kg EPA and 90 mg/kg DHA (ratio 2·5); behaviour (1/3) 31 mg/kg EPA and 45 mg/kg DHA (ratio 0·7). Nephrology and oncology studies lacked sufficient data for calculation. Gastrointestinal diseases do not appear to benefit from omega-3 supplementation, likely due to inflammation-related malabsorption, although few adverse effects were reported in dogs. Other enteropathy studies were low-quality (case reports/series). The lowest omega-6/omega-3 ratio with anti-inflammatory effect was 1:3·75, and the highest was 5·5:1. In conclusion, the reviewed EPA and DHA doses appear effective for atopic dermatitis, osteoarthritis, cardiac disease, hyperlipidaemia, and cognitive and behavioural disorders. Further research is needed to clarify efficacy in gastrointestinal and oncological conditions.

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.

Impaired glycaemic control is a major risk factor for developing type 2 diabetes (T2D), a worldwide health epidemic intrinsically linked to diet and obesity. Whey proteins (WP) are increasingly popular supplements that are a rich source of branched-chain amino acids (BCAA), essential for muscle protein synthesis and metabolic regulation. In humans, fasting plasma concentrations of BCAA are maintained around 350 µM but become chronically elevated by 10–25% in persons with T2D. Little is known about whether BCAA from WP impacts circulating BCAA concentrations and contributes to this phenomenon. This narrative review used a systematic search approach with relevant keywords to identify evidence from randomised controlled trials in normoglycaemic humans and those with insulin resistance or T2D, on the effects of WP intake on plasma BCAA and glycaemic control. This review is, to the authors’ knowledge, the first to specifically examine the effects of WP intake on plasma BCAA concentrations in relation to glycaemic control. Whilst the majority of acute studies identified (n = 6) reported that WP consumption between 10 and 50 g significantly elevates postprandial BCAA and insulin responses (as evidenced by peak concentration and/or area under the curve), evidence from chronic studies (n = 3) report inconsistent findings on the impact of 9–51 g of WP/d on fasting BCAA and glycaemic control (for example, fasting glucose and insulin, insulin clearance). Findings from this literature review highlight the need for further studies that investigate the relationship between WP consumption with BCAA and glycaemic control, and to determine underlying mechanisms of action.

Lipids are essential for child development. Nutritional recommendations are numerous, evolving over time and are often based on expert opinions more than evidence-based medicine. The objective of this review is to critically analyse the evolution of current nutritional recommendations, identify existing knowledge gaps and propose avenues for improvement to optimise infant nutrition and development. A narrative literature review on Pubmed, EMBASE and Cochrane databases (2001–22) was conducted with the keywords: ‘alpha-linolenic acid, arachidonic acid, children, cholesterol, docosahexaenoic acid, eicosapentaenoic acid, guidelines, infant, long-chain (LC) PUFA, linoleic acid, lipids and dietary intakes, newborn, palmitic acid and toddler’. Among 861 articles identified, 133 were selected. The main current recommendations are issued by the French Agency for Food Safety (AFSSA), French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and the Food and Agriculture Organization and World Health Organization (FAO-WHO). In infants from 0 to 3 years of age the main challenge is to increase lipid intake while maintaining an optimal omega 6/omega 3 ratio. Current recommendations are focused on polyunsaturated fatty acids, emphasising the intake of linoleic, eicosapentaenoic and docosahexaenoic acids without any specific recommendation for arachidonic acid before the age of 6 months. Points of interest, but without any recommendation, are the incorporation of milk fat, cholesterol, monounsaturated fatty acids, and saturated fatty acids for infants under 6 months. In conclusion, this article identifies knowledge gaps regarding the structural aspect of lipids and the integration of new categories of lipids in future recommendations to promote the quality of infant formulas.