Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was MetSSS after 12 weeks. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 2.1), p<0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (-1.9 kg (-2.0 to -0.34)), p=0.006 and wellbeing, assessed by the SF-36 quality of life questionnaire, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.

Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.

Food systems in Africa are under pressure from climate change, conflicts, health pandemics such as COVID-19 and rising food prices. The COVID-19 pandemic highlighted weaknesses in global food systems and indeed Africa’s was not spared. Although COVID-19 mortality and morbidity in Africa were relatively low in comparison to other regions, the containment measures employed by countries amplified a rather dire situation. Disruptions were seen in livelihoods, food value chains, increases in food prices and loss of income. These changes affected access to nutritious foods. A resilient food system that can withstand and recover from disruption and shocks will be important for ensuring access to healthy diets for all. This review paper assesses the state of food insecurity and malnutrition situation pre-COVID-19 and the impact of COVID-19 on Africa’s food systems and access to healthy diet. To put Africa on a path to accelerated recovery, a resilient and sustainable food system will be crucial. The following recommendations are made: (i) increasing agriculture productivity, with special attention to the foods that contribute to healthy diets – fruits and vegetables, and animal source foods (ii) promoting the production and consumption of nutritious African traditional and indigenous foods (iii) transforming Africa’s food systems to be gender-sensitive (iv) investing in well-targeted social protection programmes (v) supporting food environments that protect healthy diets and (vi) employing data and information to monitor food systems transformation.

Multimorbidity, the existence of two or more concurrent chronic conditions in a single individual, represents a major global health challenge. The Nutrition Society’s 2023 Winter Conference at the Royal Society, London focused on the topic of ‘Diet and lifestyle strategies for prevention and management of multimorbidity’, with symposia designed to explore pathways for prevention of multimorbidity across the lifecourse, the role of ageing, the gut-brain-heart connection and lifestyle strategies for prevention and management of multimorbidity. It also considered machine learning and precision nutrition approaches for addressing research challenges in multimorbidity. The opening plenary lecture discussed advancing diet and lifestyle research to address the increasing burden and complexity of multimorbidity. The two-day programme concluded with a plenary which addressed the key dietary risk factors and policies in multimorbidity prevention.

In the United Kingdom (UK), the population of the very old (TVO) aged 85 and over has increased by 186% between 1981 and 2021(1). As life expectancy rises, ensuring optimal nutrition in TVO becomes essential to reduce the prevalence of chronic diseases(2).

The Newcastle 85+ study is a cohort of 793 participants which aimed to assess the spectrum of health in TVO(3). Dietary intake data were collected using two non-consecutive 24-hour dietary recalls. The study presented here aimed to characterise the dietary intake of TVO using the NOVA food classification system. Foods were classified into four NOVA categories: 1) unprocessed/minimally processed foods, 2) processed culinary ingredients, 3) processed foods, and 4) ultra-processed foods (UPF) and were categorised into tertiles based on percentage energy consumed as UPF. Macronutrient intakes between tertiles of UPF consumption were examined using Analysis of Variance.

The average daily total energy intake (TE) was 1681.8 kcal (SD = 512.8) and 26.3% of TE came from NOVA 1, 6.86% from NOVA 2, 15.2% from NOVA 3 and 51.7% from NOVA 4 (UPF). Among macronutrient contributions from UPF of TE, carbohydrates contributed 57.3% (SD = 10.2), protein contributed 12.5% (SD = 3.4), and fat contributed to 32.0% (SD = 8.9). The average fibre intake from UPF was 48.6% of the mean total fibre intake (SD = 3.5).

Significant differences in macronutrient intake were shown across tertiles of UPF intake of TE. Energy intake declined across tertiles but did not reach statistical significance (p = 0.081), with means of 1730.1 kcal, 1684.2 kcal, and 1630.9 kcal in the 1st, 2nd, and 3rd tertiles, respectively. Carbohydrate intake as percentage of TE was significantly higher in the highest UPF tertile (50.2%) compared to the lowest (45.6%, p < 0.001). Conversely, protein contribution to TE showed the greatest decline across tertiles (14.8%, p < 0.001). Similarly, fat intake decreased significantly across tertiles (36%, p < 0.05). Fibre intake was significantly lower in the highest tertile when expressed as grams per day (p < 0.05).

Foods from the UPF group which contributed the highest amount of percentage TE from carbohydrates, was white bread (17.4%), wholemeal bread (11.5%), and breakfast cereals (9.7%). Protein sources included white bread (13.3%), bacon and ham (11.3%), and wholemeal bread (10.7%), while fat intake was dominated by fat spreads (10.3%), sweet biscuits (7.6%), and pies and pastries (7.2%).

These findings show the potential reliance on UPF as sources of dietary energy and fibre to the diet of 85 year olds. These outcomes reflect a distinct dietary profile compared to cohorts of adults aged 18 and over.

Chronic constipation is a prevalent disorder representing a significant public health problem. The management of chronic constipation remains challenging, with people reporting dissatisfaction with available treatment options (1). Current clinical guidelines offer limited dietary recommendations only, and there is a lack of comprehensive evidence-based guidelines for the dietary management of chronic constipation. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults via a systematic literature review and a Delphi consensus process among an expert steering committee.

The scope of the guidelines included dietary supplements, foods and drinks, and whole diets in adults with chronic constipation. Four systematic reviews and meta-analyses were performed to identify eligible randomised controlled trials (RCTs)(2-5). The findings generated from the meta-analysis of RCTs were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multi-disciplinary expert steering committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life. Statements were generated based on the findings only where ≥2 RCTs contributed to the meta-analysis (2-5). The “strength of recommendation” was assessed using the GRADE approach. Once statements were generated, they underwent consensus voting amongst the expert steering committee using a modified Delphi survey approach. Recommendation statements with ≥85% agreement were accepted.

The four systematic reviews included a total of 75 RCTs (2-5). Based upon these, 59 dietary recommendation statements were generated and accepted through the Delphi survey. In terms of dietary supplements, 15 recommendation statements related to fibre supplements (overall and specific types), 20 related to probiotics (overall and specific species or strains), 2 to synbiotics (overall), 5 to magnesium oxide, 2 to senna, and 3 to kiwifruit supplements. In terms of foods, 3 recommendation statements related to kiwifruits, 2 to prunes, and 2 to rye bread. In terms of drinks, 5 recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to lack of evidence. Ten statements had a very low level of evidence, 41 had low level of evidence, and 8 had moderate evidence. Twenty-seven statements were strong recommendations and 32 were qualified recommendations.

These are the first ever comprehensive evidence-based dietary guidelines for the management of constipation. Recommendations were made for several dietary supplements, foods and drinks that have never been previously included in clinical guidelines. These guidelines offer new evidence-based dietary recommendations that can be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

Accurate dietary assessment is crucial for effective public health strategies, yet there are challenges with current methods(1). The ‘Standardised and Objective Dietary Intake Assessment Tool’ (SODIAT)-1 study aimed to assess the effectiveness of a combination of emerging objective and self-report measures to more accurately monitor dietary intake(2). For this study, eNutri, a web-based food frequency questionnaire (FFQ) from the University of Reading, was adapted to assess intake over four days instead of its usual four weeks(3). This analysis aimed to evaluate dietary intakes recorded by eNutri against the known intakes of two 4-day highly-controlled diets and evaluate eNutri’s usability.

This randomised controlled crossover trial recruited 33 UK adults (aged 18-70 years, BMI 20-30kg/m2). Within the clinical units at the University of Reading and Hammersmith Hospital, participants consumed two 4-day controlled diets (non-compliant/compliant with UK guidelines, Diet A/B, respectively) in a randomly-allocated order, with at least one- week washout between diets. Dietary intake was self-reported using eNutri at the end of day 4, for each test period. After first use of eNutri, participants completed the System Usability Scale (SUS) (higher scores represent greater usability, with scores >70 classified as “acceptable” (4)), and rated the overall user-friendliness on a scale from “1: worst imaginable” to “7: best imaginable”. Mean daily nutrient compositions of the test diets were calculated directly from food labels. Since test diets were identical for all participants, the calculated nutrient intakes for Diets A/B with those determined by eNutri were compared using a one sample t-test. Nutrients analysed were: energy (kcal/d), carbohydrate (g/d), fibre (g/d), total and free sugars (g/d), fat (g/d), saturated fat (SFA; g/d), protein (g/d) and sodium (mg/d).

Of 33 participants recruited, 30 completed at least one 4-day eNutri (57% female, mean age (SD)=42(16) years, mean (SD) BMI=24.2(2.7) kg/m2). eNutri reported 10.9% lower free sugars and 13.3% lower SFA than Diet A (p<0.05). eNutri estimated 25.3-62.6% higher SFA, protein and sodium compared to Diet B (p<0.05). No significant differences for energy or other macronutrients were detected for either diet. The mean (SD) SUS score for eNutri was “acceptable” at 73.3 (12.1) and 77% rated the user-friendliness as “good” to “best imaginable”.

eNutri provided promising dietary intake estimates over 4-days, where energy, carbohydrate, total sugars, fibre, and fat closely aligned with test diets, particularly for the diet non-compliant with UK guidelines (Diet A). Notable discrepancies were observed for SFA in both diets, especially for the compliant diet (Diet B). Usability was acceptable, with most participants finding eNutri user-friendly. Further analysis will explore diet order effects and adjust for food leftovers.

Chinese immigrants living in Western countries are at a higher risk of developing chronic diseases compared to those in China, due to the development of unhealthy dietary patterns during the process of acculturation(1). Australia, with 2.3% of its population being Chinese-born(2), serves as a representative country to explore Chinese immigrants’ food choice determinants. Food choice determinants have been widely researched, with numerous factors identified such as affordability, taste preferences and hunger/satiety. Contento (2018) developed a comprehensive framework which identified and categorised over 30 determinants into four socio-ecological groups(3). Therefore, the focus of current research is not the identification of food choice determinants but to explore the interactions among these determinants. Understanding the cultural influence on food choice is vital for target groups with a shared ethnic background. This study aimed to qualitatively explore the similarities and differences in food choice determinants between Chinese people in mainland China and those living in Australia. Ethical approval for this study was obtained from Monash University Human Research Ethics Committee. Eighteen participants were recruited for semi structured in-depth interviews from June 2021 to March 2022, with eight from Australia and ten from mainland China. Convenience and snowball sampling methods were employed to ensure a diverse sample regarding socio-economic background, occupation, health status, age, and education level. Interviews were conducted in Mandarin via in-person or video/voice calls and were audio-recorded and transcribed verbatim. Thematic analysis and investigator triangulation were used for data analysis. Four themes were identified. (a) Food choice determinants were influenced by nutrition perceptions and personal food philosophy. Chinese Australian immigrants were influenced by Western nutrition beliefs to a greater extent than their counterparts living in mainland China. Non-scientific or controversial nutrition beliefs were common. Personal food philosophy (e.g., eating food is for survival only, or for enjoyment, or for health) profoundly influences food choices. (b) Chinese people adjusted their dietary habits in response to clinical symptoms or self-observed physiological changes, such as, gaining weight or digestive issues. (c) Convenience was a predominant food choice determinant due to factors like long working hours, lack of motivation to cook, lack of cooking skills, time restrictions, and viewing cooking as a chore. (d) Different food environments in China and Australia lead to distinctive food choices. Chinese Australians were more price-sensitive, had more food safety concerns, and cooked more frequently at home than mainland Chinese, due to differences in food affordability, accessibility and information exposure between these two countries. Importantly, nostalgia for childhood foods had a unique influence on certain food choice behaviours in Chinese Australians. These cultural characteristics in food choice determinants should be considered by health educators, nutrition professionals, and policymakers when developing culturally appropriate health interventions for Chinese people.

Oceania is currently facing a substantial challenge: to provide sustainable and ethical food systems that support nutrition and health across land and water. The Nutrition Society of Australia and the Nutrition Society of New Zealand held a joint 2023 Annual Scientific Meeting on ‘Nutrition and Wellbeing in Oceania’ attended by 408 delegates. This was a timely conference focussing on nutrition challenges across the Pacific, emphasising the importance of nutrition across land and water, education settings, women’s health and gut health. Cutting-edge, multi-disciplinary and collaborative research was presented in a 4-day programme of keynote presentations, workshops, oral and poster sessions, breakfast and lunch symposiums and early career researcher sessions. The conference highlighted the importance of collaboration between nations to address the challenge facing nutrition and wellbeing across Oceania. A systems approach of collaboration among scientists, industry and government is vital for finding solutions to this challenge.

The impact of Human Milk (HM) bioactive compounds and microbiota on infant health is crucial yet complex. Current research highlights their role in immune system development and disease prevention (1-6). This review aims to synthesize existing literature on the role of HM’s bioactive compounds in the onset of diagnosed allergies, immunological diseases, and responses to infectious diseases in infants, along with related biomarkers.

The systematic review adhered to Synthesis without Meta-Analysis (SWiM), focusing on clinically defined allergies and immunological conditions, and responses to infectious diseases by infants and children up to 18 years. Studies analyzing HM microbiota and bioactive compounds of mothers in mother-infant pairs have been included. A comprehensive search strategy was employed across PubMed, Web of Science, SCOPUS, Scientific Electronic Library Online (SciELO), Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and LIVIVO. Quality assessment utilized Joanna Briggs Institute checklists for various study designs.

The systematic review encompassed 32 studies ranging from 1983 to 2023, representing a total of 7,888 mother-infant dyads focusing on HM bioactive compounds and microbiota’s impact on clinically defined immunological conditions in infants. More than 90% of the literature had been conducted in upper-middle- and high-income countries. In low- and middle-income countries, including Gambia, Bangladesh, and Nicaragua, only 3 studies were conducted. We identified that allergic and autoimmune conditions, investigated in 25 articles, particularly food allergy, sensitization, and atopic dermatitis, were inversely associated with HM linolenic and linoleic acid. Furthermore, infectious and immunological conditions, primarily diarrhea and Group B Streptococcus (GBS) infections, investigated in 7 studies, revealed significant inverse associations with human milk oligosaccharides (HMOs) (2'-fucosyllactose (2′-FL), lacto-N-difucohexaose I (LDFH-I)) and immunoglobulins (Anti-GBS secretory immunoglobulin A (SIgA), Anti-lipopolysaccharide immunoglobulin A (Anti-LPS IgA), Anti-cholera toxin immunoglobulin A (Anti-cholera toxin IgA)), respectively. Upper and lower respiratory tract infections, otitis media, and dental caries were inversely associated with galectins and galectin-3, lacto-N-tetraose (LNT), 2′-FL, and Haemophilus influenzae, suggesting potential protective effects of HM bioactive compounds.

Data shows that HM bioactive compounds such as polyunsaturated fatty acids (PUFAs), HMOs, and a number of specific immunoglobulin A (IgA) antibodies, might be protective for infants, possibly preventing the onset of symptoms and helping to avoid bacterial and parasitic infections, respectively. In this review, we address the increase in mechanistic knowledge about the protective effects of breastfeeding.

With the global population set to reach 9.8 billion by 2050, including a doubling of adults aged ≥60 years old(1,2), sustainable dietary transitions are increasingly urgent. One postulated solution is controlled environment agriculture (CEA) vertical farming (VF), defined as plant factories in which environmental conditions are intricately controllable(3).

VF affords opportunities to reduce climate impact, such as reductions in water and land use(4). Further, it allows for tailoring the nutritional profiles of food through methods such as light manipulation and agronomic biofortification(5,6). This is especially relevant to older adults, with their inherent specific nutritional needs and the role of diet in healthy ageing(7). However, older adults have high rates of food neophobia(8) that may hinder acceptance of novel VF produce. This study assessed the acceptability of VF in UK older adults.

An online survey within a UK older adult cohort (≥60 years old) (n=680) assessed knowledge, sentiment scores (SS), and attitudes (Likert scales) towards VF. Willingness to pay (WTP) and purchasing likelihood for VF products were also assessed. Sentiment scores were generated using text highlighting(9). Data were analysed across genders and the index of multiple deprivation (IMD). Mann-Whitney and Kruskal-Wallis were used for non-normally distributed data. Two-way repeated measures ANOVA and two-factor MANOVA were used where applicable. Purchasing likelihood was evaluated using ordinal regression.

Knowledge of VF was low (44%), with fewer participants (23.6%) understanding CEA VF. Total SS were ambivalent (8.8), with no significant gender or IMD differences. However, sentences concerning sustainable benefits, e.g. yield, land and water use, were positive (range; 14-23). Females showed more positive SS for tailoring VF to support older adults’ nutritional needs (p=0.012). Attitudes (from Likert scale) were mostly neutral, with females slightly more favourable towards environmental concerns (p=0.008) and food fortification (p=0.03). WTP for VF produce was slightly higher (£0.016) than for conventionally produced foods (p < 0.001), with no significant differences between genders and IMD. 43% of participants were more likely to purchase VF produce, while 10% were less likely. Lower-income households (0.59 OR; 0.40–0.88, p=0.008); lack of knowledge of food fortification (0.62 OR; 0.42–0.89, p=0.011) and those with the more negative SS, SS Q1 (0.45 OR; 0.29 – 0.71, p=0.046) and SS Q2 (0.65 OR; 0.43 – 0.99, p<0.001) where significantly less likely to purchase VF produce.

Low knowledge and negative sentiment towards VF, coupled with low WTP, pose significant barriers to adopting VF food products in older adults. Socio-economic factors like income also affect purchasing likelihood, potentially exacerbating current health gaps. Increasing VF awareness and improving attitudes whilst reducing VF production costs could help promote its adoption in this demographic.

Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition and oral and systemic diseases that contribute to multimorbidity. Diet- and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables and nutrient-poor diets which are similar to diet- and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility and swallowing. Oral dysfunction makes it difficult to eat nutrient-dense whole grains, fruits and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our ‘canary in the coal mine’ for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy-dense, nutrient-poor foods – typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multimorbidities. Disruption of this pathway will reduce the risk of multimorbidities and enable individuals to fully engage in society throughout the lifespan.

Vegan and vegetarian dietary patterns are known to beneficially modulate risk factors for cardiovascular disease; however, the current literature does not differentiate between various plant-based diets(1). This study aimed to examine the association between various plant-based diets and plasma lipids and glycaemic indices compared to a regular meat-eating diet. A cross-sectional study of Australian adults (n = 230) aged 30–75yrs habitually consuming the following were recruited: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat-eater. Multivariable regression analyses was used to adjust for covariates. Compared to regular meat-eaters, vegans had significantly lower total cholesterol (−0.77 mmol/L, 95% CI −1.15, −0.39, p < 0.001), low-density lipoprotein cholesterol (LDL-C, −0.71 mmol/L, 95% CI −1.05, −0.38, p < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C, −0.75 mmol/L, 95% CI −1.11, −0.39, p < 0.001), total cholesterol/HDL-C-ratio (−0.49 mmol/L, 95% CI −0.87, −0.11, p = 0.012), fasting blood glucose (FBG, −0.29 mmol/L, 95% CI −0.53, −0.06, p = 0.014), haemoglobin A1C (−1.85 mmol/mol, 95% CI −3.00, −0.71, p = 0.002) and insulin (−1.76 mU/L, 95% CI −3.26, −0.26, p = 0.021) concentrations. Semi-vegetarians had significantly lower LDL-C (−0.41 mmol/L, 95% CI −0.74, −0.08, p = 0.041) and non-HDL-C (−0.40 mmol/L, 95% CI −0.76, −0.05, p = 0.026) and lacto-ovo vegetarians had significantly lower FBG (−0.34 mmol/L, 95% CI −0.56, −0.11, p = 0.003) compared to regular meat-eaters. There were no differences in HDL-C and triglycerides between plant-based and regular-meat diets. Plasma lipaemic and glycaemic measures as a collective were more favourable among vegans, whereas among lacto-ovo vegetarians and semi-vegetarians, only some measures were favourable.

This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.

School food has a major influence on children’s diet quality and has the potential to reduce diet inequalities and non-communicable disease risk. Funded by the UK Prevention Research Partnership, we have established a UK school food system network. The overarching aim was to build a community to work towards a more health-promoting food and nutrition system in UK schools. The network has brought together a team from a range of disciplines, while the inclusion of non-academic users and other stakeholders, such as pupils and parents, has allowed the co-development of research priorities and questions. This network has used a combination of workshops, working groups and pump-priming projects to explore the school food system, as well as creating a systems map of the UK school food system and conducting network analysis of the newly established network. Through understanding the current food system and building network expertise, we hope to advance research and policy around food in schools. Further funding has been achieved based on these findings, working in partnership with policymakers and schools, while a Nutrition Society Special Interest Group has been established to ensure maximum engagement and future sustainability of the network. This review will describe the key findings and progress to date based on the work of the network, as well as a summary of the current literature, identification of knowledge gaps and areas of debate, according to key elements of the school food system.

The rising prevalence of type 2 diabetes highlights the need for effective dietary strategies to manage postprandial glycaemia (1). Plant-based compounds such as plant proteins and polyphenol-rich berries are gaining increasing attention for their potential to modulate glucose metabolism. Blueberries, rich in anthocyanins, have been shown to reduce postprandial glucose spikes by delaying starch digestion. This effect is largely attributed to their ability to inhibit carbohydrate digestive enzymes (α-amylase and α-glucosidase) and glucose transporters (2). It is hypothesised that the presence of undigested starch in the lower gastrointestinal tract can stimulate the secretion of gut hormones thereby promoting satiety and regulating glucose homeostasis (2). Pea protein, on the other hand, has independently been shown to reduce postprandial glucose levels, modulate insulin response, and stimulate gut hormone release (3). A targeted combination of both, protein and anthocyanin-rich blueberries could therefore provide a more efficient intervention.

In a randomised, controlled, double blinded crossover study, 10 healthy participants consumed one of four test beverages accompanied by 50 g of available carbohydrate from white bread: flavoured water (CHO), blueberries (BB), pea protein (PP), and a combination of pea protein and blueberries (BBPP). Postprandial responses were assessed over 180 minutes using continuous glucose monitoring (CGM) for glucose levels and Visual Analogue Scale (VAS) ratings for satiety, both recorded at 30-minute intervals.

The effect of the interventions on peak postprandial glucose responses and satiety levels were evaluated using a two-factor repeated measures ANOVA. All statistical analyses were performed using GraphPad Prism with a statistical difference of p < 0.05 considered as significant.

All test drinks resulted in lower postprandial glucose levels compared to the control (CHO), with the greatest reduction observed in the BBPP group. Peak glucose levels were significantly lower in the BBPP group (0.9 mmol/L, p<0.05) compared to CHO (1.5 mmol/L), BB (1.3 mmol/L), and PP (1.1 mmol/L). Additionally, the BBPP group exhibited the lowest incremental area under the curve (iAUC = 88.58 mmol·min/L, p < 0.05), while the other groups had similar iAUC values around 130 mmol·min/L. Both the PP and BBPP groups showed delayed times to peak glucose (Tmax = 90 min) compared to the CHO and BB groups (Tmax = 75 min), indicating a slower and more gradual glucose response. In terms of satiety, both the PP and BBPP interventions significantly increased subjective satiety ratings (80–90%) compared to the CHO and BB groups (50–60%) 60min post meal, although the difference between BBPP and PP was not statistically significant.

Combining Pea protein with blueberry polyphenols synergistic benefits in reducing postprandial glucose excursions. These findings provide promising evidence to support the development of functional foods aimed at improving glucose management and metabolic health.

‘I just don’t know what to eat!’ is a frequent statement from people seeking nutrition support. With a magnitude of information available, confusion and limited confidence is a common complaint. People face myriad challenges in their attempts to have a healthy diet, including cost and time constraints, challenging food environments, and limited knowledge and skills(1). Challenges about eating well are often raised, yet enablers to eating well are not as readily discussed. Intention for healthy behaviours, self-efficacy and social support are examples of favourable elements which support healthy diets(1,2). As such, existing knowledge, skills, and positive influences should also be considered. As part of a wider qualitative study, and using an interpretive description approach, we sought to identify enablers to healthy eating perceived by people engaged with Green Prescription (GRx) and Active Families programmes. Nineteen clients aged 18 years and over, engaged with six GRx services were interviewed between May and October 2023. Eighteen whānau (family) members, (19-53 years) attending Active Families sessions facilitated in the Waitematā area participated in focus group discussions during May-August 2024. Participants were asked in these discussions (kōrero) to share what helps them and their whānau to eat well. Braun and Clarke’s(3) thematic analysis approach was used to analyse responses from these kōrero through data familiarisation, coding, and cyclical review of thematic relationships. Several themes were identified in this analysis: ‘confidence in personal skills,’ ‘supportive environments’, and ‘being open and willing’. Personal skills such as planning meals, managing household budget and efforts to procure ‘good’ food were identified as strengths. These wider food skills have been suggested as potentially more important to enhancing dietary behaviours than cooking skills(4). Participants relayed experiences of developing skills that improved their confidence in eating well including growing, gathering and preserving food, experimenting with recipes, and knowing where to find affordable, nutritious food. Environments where people learned food and cooking skills and household members supported their endeavours to eat well were described as influential to encourage people in their efforts. Participants also expressed that being open to trying new foods and ways of eating led to inspiration and new knowledge. This attitude resulted in increased variety in the diet and further enhanced confidence to seek recipes and food information and spurred on efforts to make changes. People who have sought nutrition advice have often expressed challenges and uncertainty impacting their efforts to eat well. Nevertheless, there are also strengths which have meaningful impact on their eating. In nutrition advice provision, it would be beneficial to thoroughly explore the strengths people exhibit to support healthy eating. Identifying these insights may powerfully effect people’s confidence to eat well and identify more effective support and information provision.

There is mounting interest in the dual health and environmental benefits of plant-based diets. Such diets prioritise whole foods of plant origin and moderate (though occasionally exclude) animal-sourced foods. However, the evidence base on plant-based diets and health outcomes in Australasia is limited and diverse, making it unsuitable for systematic review. This review aimed to assess the current state of play, identify research gaps and suggest good practice recommendations. The consulted evidence base included key studies on plant-based diets and cardiometabolic health or mortality outcomes in Australian and New Zealand adults. Most studies were observational, conducted in Australia, published within the last decade, and relied on a single dietary assessment about 10–30 years ago. Plant-based diets were often examined using categories of vegetarianism, intake of plant or animal protein, or dietary indices. Health outcomes included mortality, type 2 diabetes and insulin resistance, obesity, CVD and metabolic syndrome. While Australia has an emerging and generally favourable evidence base on plant-based diets and health outcomes, New Zealand’s evidence base is still nascent. The lack of similar studies hinders the ability to judge the overall certainty of evidence, which could otherwise inform public health policies and strategies without relying on international studies with unconfirmed applicability. The proportional role of plant- and animal-sourced foods in healthy, sustainable diets in Australasia is an underexplored research area with potentially far-reaching implications, especially concerning nutrient adequacy and the combined health and environmental impacts.

Plant-based diets, with limited quantities of animal foods, are increasingly promoted for sustainability and health. In many countries, animal-source foods provide the majority of several micronutrients at a population level; in the UK, milk and dairy products contribute around one third of total calcium, vitamin B12 and iodine intake in adults. Recommendations for a predominantly plant-based diet may have the unintended consequence of reducing intake of micronutrients, particularly in groups with an already-low intake of these nutrients, such as women of reproductive age. Furthermore, young women are the group most likely to replace dairy products with plant-based alternatives. Milk alternatives are often fortified to match the nutrient content of cows’ milk for some micronutrients (e.g. calcium), but not of others (e.g. iodine or vitamin B2). Unfortified alternatives have an iodine concentration that is just 2 % of that of UK cows’ milk, and the rise in popularity of these products may increase iodine-deficiency risk in consumers. Low nutrient intake is of concern prior to, and during, pregnancy, when many of the micronutrients at risk (iron/calcium/iodine) are essential for foetal development. While there may be awareness of some at-risk nutrients on a plant-based diet, this may not be the case for all. At-risk nutrients should be considered in nutrition guidelines and advice given by healthcare professionals to ensure that the diets are well planned and supplemented when necessary. This review focuses on the provision of micronutrients (particularly iodine) from plant-based diets in the UK.

Globally, the burden of skin diseases is considerable, being the fourth largest cause of disability (1). Diet is a modifiable risk factor for many dermatological conditions and one of the mechanisms by which nutrition influences skin health is via the gut microbiome. Oral probiotics, prebiotics and synbiotics may have the potential to improve functional indicators of skin health and delay skin ageing (2).

This scoping review aimed to map the body of literature on the role of oral probiotics, prebiotics and synbiotics in maintaining and optimising skin health and function, and preventing and managing skin conditions, through the life course. The first stage of the scoping review, reported here, was the mapping of systematic reviews. The ongoing second stage involves the mapping of experimental and observational studies.

The scoping review was conducted in accordance with the JBI methodology for scoping reviews (3). Six electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus and Web of Science) were systematically searched without limits on language or date, along with sources of grey literature. All sources were considered for inclusion by two reviewers based on previously established criteria using the participants, concept and context framework.

The titles and abstracts of 8,972 studies were screened and subsequently 1,034 full texts were retrieved. Finally, 521 studies were included in the scoping review of which 72 were systematic reviews and are analysed here.

Most reviews analysed the efficacy of oral probiotics (93%), with 13% and 18% of reviews considering oral prebiotics and oral synbiotics respectively. These interventions were most reviewed in infants aged 0-12 months (78%), pregnant mothers (47%), and/or younger children (43%) inclusively. Only 28% and 19% of reviews considered adults up to, and above, 60 years respectively. Most systematic reviews included participants who were either diagnosed with (42%), or at risk of a skin disease (28%) with just 4% reviewing effects in primarily healthy populations (24% did not confirm the included populations).

Outcomes related to preventing and managing a skin condition were studied by 97% of reviews; just 2 reviews examined optimising skin health and function (namely skin hydration, and epidermal thickness) in healthy populations. Atopic dermatitis (AD) was the most studied skin disease; 33 of 36 meta-analyses indicated a positive effect on its prevention, compared to 19 of 26 meta-analyses on AD severity. The remaining reviews investigated psoriasis (n=2), urticaria (n=2), and acne (n=2).

This review has identified a plethora of evidence synthesis on oral probiotics, prebiotics and synbiotics in AD, particularly in infants and children, and a paucity of evidence synthesis in healthy populations. The second stage of the review considering the underlying experimental and observational evidence will determine the scope for further evidence synthesis or confirm gaps in the experimental data to inform future research.