bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating dietary intakes of pregnant women in an outpatient department using the FIGO Nutrition Checklist and assessing the acceptability of the checklist for use in routine antenatal care
Authors: Murphy L. , Hokey E. , Killeen SL. , O’Sullivan E. , McAuliffe F.
Published: December 2024

Many adverse outcomes for both mother and baby can result from suboptimal maternal nutrition during pregnancy(1). Pregnancy is seen as an opportunity to encourage beneficial lifestyle changes(2). The Health Service Executive published nutritional guidelines for pregnancy in Ireland(3), however there is no standardised approach for assessment in antenatal care. The FIGO Nutrition Checklist is a tool which asks “yes/no” questions about dietary intakes in pregnant women with the goal of identifying deficits compared to recommendations. A “no” answer to one or more questions indicates a possible nutrition risk in the diet. Implementation of the Nutrition Checklist during pregnancy would benefit both mother and baby. The aim of this study is to assess the nutritional intakes of pregnant women attending the public outpatient clinic in the National Maternity Hospital, Dublin using the FIGO Nutrition Checklist, and assess the acceptability of the tool for use as part of routine antenatal care.

This observational cross-sectional study used two self-administered questionnaires to (i) assess women’s nutritional intakes to identify those at nutritional risk, and (ii) assess the acceptability of the Nutrition Checklist as part of routine antenatal care. Recruitment took place from December 2023 to February 2024. All English-speaking women of any gestation or parity attending the public outpatient department of NMH were eligible to take part. Baseline characteristics were obtained through their hospital records on the electronic chart system. Statistical analysis was completed using IBM SPSS.

A total of 102 pregnant women were recruited during routine antenatal clinics in the public outpatients department in the NMH, Dublin, Ireland. Most (88.7%) declined following a special diet. The majority (85.7%) answered “No” to at least one diet quality question, highlighting potential nutritional risk. Only 43.9% reported eating at least one portion of fish per week and 20.4% reported consuming <1 serving of wholegrains per day. Current folic acid intakes were high among the cohort, however 16.3% answered “No” to currently taking folic acid. The acceptability of the checklist was excellent. Most (70.6%) women strongly agreed that the checklist was easy to complete, with 80% recommending using it in practice and most (81.4%) of the women who took part in the survey agreed that the checklist contained useful information, with only 1% disagreeing.

The FIGO Nutrition Checklist identified numerous nutritional concerns and the acceptability of the checklist was excellent. This suggests that using the tool as part of routine antenatal care should be considered.
Insights into knowledge, perceptions, and lifestyle barriers in obesity and type 2 diabetes prevention and management among Indian men: a small-scale survey
Authors: Patel F. , Farhat G.
Published: December 2024

People from south Asian heritage are underrepresented in health research globally(1). They have a lower threshold for obesity and are at a higher risk of type 2 diabetes mellitus (T2DM) compared to the White population(2). While south Asian women are often more included in research, there is a gap in understanding men’s perceptions and knowledge regarding obesity and T2DM, as well as barriers to adhering to dietary and physical activity recommendations. Understanding these barriers will help design appropriate interventions to tackle the unique challenge of T2DM in this community. The aim of this survey was to explore perceptions and knowledge regarding obesity and T2DM, as well as barriers to adopting a healthy lifestyle amongst Indian adult men (>18 years) living in the UK.

An online survey was distributed in English language. Survey questions were based on the Health belied model (HBM). Participants rated statements on their perceptions and knowledge of obesity and T2DM as well as lifestyle barriers. Ordinal logistic regression was used to assess the impact of place of birth and educational level on the outcomes.

A total of 102 Indian men completed this survey. While most respondents are aware of the risks associated with obesity and T2DM and recognised the significance of diet and physical activity in lowering these risks, 27.5% of respondents did not believe in their effectiveness. Additionally, 24% perceived T2DM as difficult to control once it is diagnosed. Interestingly, 46.1% of participants do not think that their ethnicity puts them at a higher risk of T2DM. Perceived barriers to following a healthy diet and physical activity regimen were cultural and traditional dietary preferences (18.6%), lack of motivation and willpower (18%), lack of knowledge about healthy diet (17.6%) and limited access to healthy food options (16.4%). Furthermore, 57.8% of respondents do not feel that they have enough support to help them reduce obesity and T2DM risk. When asked about the most effective measure to reduce the risk of obesity and T2DM, 64.7% responded “regular visits to the GP”. Additional respondents emphasized the importance of education, access to information regarding healthier options to traditional Indian foods as well as routine medical assessment. Birthplace (British-born vs. non-British-born) and educational level did not seem to impact perceptions and knowledge, but this outcome may be limited by the small sample size.

This small-scale survey highlights the importance of education in understanding obesity and diabetes risk, although it may not be the primary barrier for the lack of adherence to a healthy lifestyle. Rather, developing culturally specific health interventions and increased support can help overcome barriers and improve men’s health in this population. Larger scale surveys may be able to corroborate these findings.
Sensory evaluation of pea and milk protein hydrolysates used to develop protein-fortified tomato soup
Authors: Jamshidvand Mahrokh , FitzGerald Richard J. , Dermiki Maria
Published: December 2024

Protein is a required macronutrient for maintenance of muscle mass. Current guidelines recommend daily intake of 0.8 g of dietary protein per kilogram body weight (kg bw), regardless of age(1). However, factors such as age and physiological changes may increase this requirement to 1.5g/ kg bw/day for older adults with sarcopenia(2). Therefore, protein-fortified foods are used to enhance the protein intake of older adults. Milk protein concentrate (MPC) and pea protein isolate (PPI) ingredients are used to increase the protein content of different foods(3–6). However, their addition changes the functional and sensory properties of the final protein-fortified product(7). Therefore, enzymatic hydrolysis is employed to improve the techno-functional properties of these ingredients, however, the bitterness of the resulting hydrolysates limits their application. This study aimed to investigate the effect of hydrolytic enzyme preparation on the taste properties of MPC and PPI hydrolysates when incorporated as ingredients in protein-fortified tomato soup.

Solutions of MPC and PPI containing 3% total solids (w/w) were hydrolyzed at 50°C for 30 min using Neutrase®, Umamizyme and Protease AN “Amano” 100SD at an enzyme-to-substrate ratio of 1%. Bitterness in the hydrolysates was assessed with 16 semi-trained participants using labeled magnitude scales (LMS) and by 44 participants using a ranking test. Both tests showed that the least bitter hydrolysates were those generated using Umamizyme and Protease AN “Amano” 100SD. These hydrolysates were used to develop protein-fortified tomato soup with 3% of protein powders, that were characterised by 38 naïve consumers using hybrid quantitative descriptive profiling.

ANOVA on the bitter taste revealed that soups containing hydrolysed MPC (regardless of the hydrolytic enzyme used) were significantly more bitter compared to the control unhydrolyzed protein-fortified tomato soup (p<0.001). Bitterness in the protein-fortified tomato soup was masked using various ingredients, applying the principle of taste-taste interactions. A ranking test with 43 naïve participants showed that a combination of tomato puree and sucrose successfully reduced bitterness.

Overall, the enzyme preparation used affected the bitterness of the MPC and PPI hydrolysates and consequently the taste of the protein-fortified tomato soup. The use of Umamizyme and Protease AN Amano resulted in less bitter protein hydrolysates (both PPI and MPC) compared to Neutrase (p<0.001). Taste-taste interactions resulting from a combination of ingredients could successfully be employed to reduce bitterness in the protein-fortified tomato soup. Since these soups are aimed to be consumed by older people, further work will aim to test their preference.
“Are ham sandwiches as good for you as they say? “A review of the compliance of nutrition and health claims on breads and deli meats on the Irish market
Authors: Hogan M.G. , Nic Sheoin S. , Clarke N. , Farrell L. , Grimes C. , Walsh S. , O’Mahony S. , O’Donovan C.B.
Published: December 2024

Regulation (EC) No 1924/2006 outlines the rules for nutrition and health claims (NHCs), permitted in the European Union (EU)(1). Previously, the Food Safety Authority of Ireland (FSAI) completed work on the compliance of NHCs with Regulation 1924/2006 on yoghurts(2). Potential noncompliant rates of 1.5% for nutrition claims and 74% for health claims were reported. The study highlighted further research in this area was needed to understand the overall rates of NHCs compliance of food products on the Irish market. Therefore, the aim of this study was to assess the compliance of NHCs made on delicatessen meats and similar (DM) and bread products (BP) on the Irish market.

Food product label and composition information was collected from the Irish market in 2021 as part of the EU Joint Action Best-ReMaP project. The inclusion criteria for this study were the presence of an Irish address and NHCs on the product label. Based on these criteria, 14.6% of DM and 47.9% of BP were eligible for inclusion in this study. A representative sample of 100 products per category were randomly selected, using the RAND Excel function, and compliance was assessed against Regulation 1924/2006. NHCs were considered either compliant, non-compliant or potentially non-compliant. Where definitive compliance could not be established using the Regulation, a claim was deemed potentially non-compliant. Analysis was conducted using Microsoft Excel.

There were 205 claims identified on the 100 DM products. The compliance rate of these claims was 85.4% (n = 175) and the non-compliance rate was 14.6% (n = 30). Of the 30 non-compliant claims observed across 9 DM products, 28 of these were non-compliant as the amount of the claimed nutrient was not labelled. The other 2 non-compliant claims were general health claims which were not linked to an authorised health claim. There were 293 claims on the 100 BP with a compliance rate of 85.3% (n = 250), a non-compliance rate of 12.9% (n = 38) and a potentially non-compliant rate of 1.7% (n = 5). The 43 non-compliant and potentially non-compliant claims were observed across 23 products. Most (n = 24) of which were due to non-compliant general health claims. The overall compliance of products was 91% (n = 91) for DM and 77% (n = 77) for BP.

Overall, this study demonstrates that there is a high rate of compliance for nutrition claims on DM and BP while identifying some key areas of non-compliance in health claims. This work provides important information for the FSAI as it identifies the issues faced by businesses in complying with the legislation and assists in understanding what compliance building resources are needed. Future work in this area is needed to assess the level of compliance of NHCs on other food categories on the Irish market.
Reducing free sugar intakes: the effects of dietary sweet taste modification on sweet taste perceptions and sweet food intake
Authors: Bielat A. D. , Rogers P. J. , Appleton K. M.
Published: December 2024

The World Health Organisation currently recommends a global reduction of free sugar intakes to reduce diet-related ill-health(1). One of the proposed strategies to achieve this reduction is to limit the consumption of all sweet-tasting foods and beverages, based on a rationale that regular exposure to dietary sweet taste increases preferences for all sweet-tasting foods and beverages, including those which contain free sugars(2). Limited studies, however, have directly examined the effects of repeated dietary sweet taste exposure on subsequent preferences and intakes of sweettasting foods and beverages, with the existing literature exhibiting contradictions and failing to investigate the effects of whole-diet-sweet taste exposure on the outcomes of interest(3).

This randomized controlled trial aimed to assess the effects of a whole-diet, six-day dietary sweet food and beverage intervention on sweet taste perceptions and intakes of sweet-tasting foods and beverages. A total of 104 adults were recruited and randomized to either: a) increase their sweet food intake (n = 40); b) decrease their sweet food intake (n = 43); or c) make no dietary change (n = 21); for six consecutive days. On day 0 (baseline) and day 7 (end), pleasantness, desire to eat, and sweet taste intensity were rated for six dietary items, and sweet food intake was measured in a buffet meal, as percentage weight and percentage energy consumed from sweet foods and beverages, weight of sugar consumed and percentage energy consumed from sugars.

Intention-to-treat analyses found no statistically-significant dietary exposure x time interactions for perceived pleasantness (F(2, 101) = 2.04, p = .14, np2 = .04), desire to eat (F(2, 101) = 1.49, p = .23, np2 = .03) or any measure of sweet food intake (largest F = 2.53, p = .09). A significant dietary exposure x time interaction was detected for sweet taste intensity (F(2, 101) = 4.10, p = .02, np2 = .08), which showed that for participants in the decrease sweet food consumption group, sweet foods tasted sweeter post-intervention compared to baseline (t(42) = 3.36, p < .01, Mdiff = 6, SE = 2). No effects were found in the increase sweet food consumption or no diet change groups (largest t(39) = .38, p = .70).

Our findings contradict the predictions made by public health institutions that dietary sweet taste exposure influences the intake of sweet-tasting foods and beverages, and that reduced exposure leads to reduced intakes(2). They also suggest that, whilst the extent of dietary exposure to sweettasting foods and beverages affects sweet taste intensity, it does not affect the perceived pleasantness of or desire to eat other sweet-tasting foods.
Global Trends in Vitamin D Fortified Food Product Launches
Authors: McCarthy SN , Kiely ME
Published: December 2024

The challenge of meeting nutritional requirements for vitamin D because of low supply in the food system means that substantial proportions of the population have low vitamin D intakes and status(1). Naturally rich sources such as oily fish are consumed infrequently and foods such as eggs do not have sufficient quantities to meet Dietary Reference Values. Usually, fortification is voluntary and a premium price can be achieved for the fortified product. Hence, there may be a role for mandatory fortification to ensure equal access to healthy, fortified foods for all.

The aim of this study was to profile food product launches to the global market over the last 15 years to determine if product launches can potentially meet Vitamin D requirement. The GlobalData(2) is an industry specific intelligence planform that can be accessed to identify and analyse food product launches based on specific inputs such food-type, country, nutrients, health claim etc. This database was mined to retrieve and analyse all food products launched in the 15year period from January 2009 to March 2024 with at least 0.01ug of vitamin D listed in the nutritional content.

The search returned a database with a total of 2,203 products launches. From 2009, there was a steady increase in product launches until it peaked in 2012 with 320 products. Thereafter it decreased with a low in 2016 at 50 product launches. Although not exceeding the high in 2012, there has been a steady increase since 2016 with 150 launches reported for 2023. The top three countries for product launches were USA at 11.8% (n = 261) followed by UK at 7.2% (n = 159) and India at 6.6% (n = 146). The market is dominated by dairy foods with nearly half of all launches this category (47%). This was followed by drinks (15%), bakery and cereals (15%) and baby foods (10%).

Countries such as the USA and India have voluntary fortification strategies in place which may explain higher proportion of product launches seen in these countries(3,4). The implementation of a national vitamin D food fortification strategy may help to increase the launch/supply of fortified foods on the market to increase the potential to achieve recommended intakes. The dominance of vitamin D fortification within a small number of food categories such as dairy(5) highlights the opportunities and untapped potential for other food categories such as pasta and sauces to also undertake fortification. It is also important to accommodate the diversity of the diet and provide vitamin D fortified foods for non dairy consumers. Studies have shown that food fortification can increase vitamin D status(6) Therefore additional and more diverse food fortification should be considered to improve vitamin D intakes in the population.
Prevalence of vitamin D insufficiency and associations between 25(OH)D concentrations and health outcomes in children aged 4 – 11 years in the north of Ireland
Authors: Royle Emily , McSorley Emeir M. , Kirsty Pourshahidi L. , Armstrong David , Magee Pamela J.
Published: December 2024

Optimal vitamin D status is important for growth and development during childhood(1). Children with a circulating concentration of 25-hydroxyvitamin D [25(OH)D] below 25 nmol/L are at increased risk of rickets. In order to maintain 25(OH)D > 25nmol/L, a dietary intake of 10µg/d vitamin D is recommended for children aged 4 years and above(2,3). The aim of this study was to determine vitamin D status in healthy children and to investigate associations between 25(OH)D concentrations and muscle health, cognitive function, and parental knowledge of vitamin D, vitamin D habits, perceptions, and practices.

A cross-sectional study of healthy children aged 4 – 11 years conducted between 2019 – 2023 examined vitamin D status by measuring plasma 25(OH)D via the gold standard liquid chromatography tandem mass spectrometry and parathyroid hormone concentrations. Muscle strength (hand grip and balance) was determined by dynamometer, single and tandem stance balancing whilst cognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery. Parents completed questionnaires to assess vitamin D knowledge, and perceptions, habits, and attitude towards vitamin D.

A total of 192 children (91 boys; 101 girls) with an average age of 8.2 years were recruited. Plasma 25(OH)D concentrations were 61.10 ± 18.75 nmol/L (n = 190), with 68.4% of children defined as vitamin D sufficient (25(OH)D>50nmol/L). When stratified by winter months, only 58% of children were vitamin D sufficient. In single linear regression, plasma 25(OH)D concentrations were positively associated with dominant hand grip strength, single leg balance and the cognitive test ‘5choice movement time’ (p<0.05). Overall, there was a reported mean score of 41.9% for parental vitamin D knowledge and 68% of parents thought there was no harm in giving their child vitamin D fortified foods.

Approximately 70% of this sample of children were vitamin D sufficient, however insufficiency was prevalent in almost half of the cohort during the winter months. Benefits of optimal vitamin D for muscle and cognitive function were evident. These results support the promotion of the existing vitamin D dietary recommendations during the winter months for optimal child growth and development.
Gender-specific effects of 3-month nutrition intervention on lipid profiles and insulin sensitivity
Authors: Samiilenko N. , Mazanko K. , Bielokoz H. , Shpak S. , Zinchenko O. , Muzyra Y. , Zubach D. , Aleksieieva O. , Tsomko D. , Bocharova O.
Published: December 2024

Dyslipidemia and insulin resistance are pivotal in diabetes mellitus and cardiovascular disease (CVD) pathogenesis, underscoring the necessity for lifestyle interventions(1). Previous research has highlighted the efficacy of dietary modifications in improving metabolic parameters and reducing CVD risk(2,3). However, understanding the gender-specific responses to such interventions remains underexplored. This study aims to investigate the gender-specific effects of a 3-month nutrition intervention, aimed at improving lipid profiles and insulin sensitivity in patients with dyslipidemia and insulin resistance.

107 patients (pts), 53 men (49,5%), 54 women (50,5%), mean age 44,6 ± 11,3, mean BMI 33,1 ± 6,8, with dyslipidemia and insulin resistance were studied, 58 pts (54,2%) were with obesity. During the intervention, participants were provided with a dietary plan consisting of 3 meals, each of which contained vegetables (starchy and non-starchy), carbohydrates (whole grains, fruits, berries), proteins (poultry, fish, seafood, eggs, legumes, dairy products) and fats (olive oil, flax seeds, tree nuts). Pts were restricted on red and processed meat, butter, milk, trans fat, sugar, white flour products, and alcohol. The dietary intervention durated 12 weeks, during which pts maintained selfreported diet records to monitor their dietary intake. No pharmaceutical interventions were employed throughout this duration. Statistical analysis were based on using paired t-test with assessment of the dynamics of clinical indicators with 95% CI and calculation of the standardized effect size based on mean comparison.

Among women after 12 weeks the mean reduction in serum low-density lipoprotein cholesterol (LDL-C) was −0.79 mmol/L (from 4.16 ± 0.85 to 3.37 ± 0.72) or -18.9%; triglycerides −0.33 mmol/L (from 1.51 ± 0.77 to 1.18 ± 0.45) or -21,85%; Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index decreased on -2,23 or -43,47% (from 5.13 ± 4.59 to 2.9 ± 2.56), insulin level dropped by 35,25% (from 17.87 ± 12.76 to 11.57 ± 7.89).

Among men the reduction in values was the following: for LDL-C -0,85 mmol/L or -18,44% (from 4.16 ± 1.08 to 3.76 ± 0.88); for triglycerides -0,68 mmol/L or 33,66% (from 2.02 ± 1.07 to 1.34 ± 0.52); for HOMA-IR index -2,03 or -38,01% (from 5.34 ± 4.34 to 3.31 ± 2.74), for insulin -8,17 or -39,78% (from 20.54 ± 15.26 to 12.37 ± 8.66).

The dynamics for these indicators are statistically significant (p < 0.05).

Dietary intervention led to significant reductions in serum LDL-C, triglycerides, HOMA-IR index, and insulin levels among both women and men, highlighting the effectiveness of dietary modification in improving lipid profiles and insulin sensitivity.
Weight Recurrence Trends Among Participants Post Laparoscopic Sleeve Gastrectomy: A 13-Year Single-Centre Retrospective Study in Kuwait
Authors: Alfailakawi A. , Al-Sabah S. , Nlebedim V. , Moore J.B. , Moore S.
Published: December 2024

Weight recurrence (WR) is a frequent complication in patients post metabolic and bariatric surgery (MBS)(1). However, there is no consensus on WR definitions(2). Patients’ preoperative characteristics are believed to have an association with WR(1). This study aimed to evaluate WR 3 to 13 years after laparoscopic sleeve gastrectomy (LSG) using three commonly used definitions and investigate potential risk factors.

A retrospective analysis examined data from patients’ medical records who underwent primary LSG between 2008 and 2019. Inclusion criteria were patients aged 18 years or older, eligible for MBS, and with at least three years of follow-up. Those with previous MBS, revised surgical procedures post-LSG, or who had the surgery in 2019 were excluded. Dividing the analysis into three post-LSG periods (1st year, 2nd year and >2nd year). The primary outcome was WR over time utilizing three definitions: >10% increase in nadir weight, >10% increase in nadir weight (nadir 1 to 2 years), and percentage of excess weight loss (EWL) <50% with a body mass index (BMI) >35 kg/m2. Survival analysis techniques were used to assess the occurrence and timing of WR. Potential risk factors of WR including age, gender, BMI, obesity-related comorbidities, duration post-LSG, and attendance to follow-up visits were assessed using binary logistic regression.

Only 219 out of 2982 patients met the inclusion criteria and were included in the analysis. Patients’ mean age and BMI were 37.21 ± 10.44 years and 45.92 ± 6.99 kg/m2, respectively, with females constituting the majority (64%). Weight recurrence varied between different definitions, ranging from 31% to 61%. The estimated median time for WR was significant starting from 9 years when applying the nadir weight definitions while from 6 years when EWL<50% & BMI>35 kg/m2 definition was used. Binary logistic regression analysis identified several risk factors for WR considering the definition of EWL <50% with BMI >35 kg/m2: older age [OR 1.104, 95% CI (1.0591.151), p-value <0.001] and higher preoperative BMI [OR 1.352, 95% CI (1.242-1.473), p-value <0.001]; while male gender [OR 0.314, 95% CI (0.137−0.720), p-value 0.006] and frequent follow-up visits [OR 0.528, 95% CI (0.382−0.730), p-value <0.001] were protective factors against WR. Other definitions did not demonstrate significant associations except for a longer duration post-LSG as a risk factor for WR when applying the definition of >10% increase from nadir weight (nadir weight 1 to 2 years) [OR 1.153, 95% CI (1.050-1.267), p-value 0.003].

This study explored factors that influenced WR post-LSG. Potential risk factors including age, gender, BMI, and time varied according to the WR definition applied. More research is necessary to establish a consensus on a suggested definition that aligns with the clinical parameters and comorbidity status of patients for application in upcoming research and clinical settings.
Comparing compliance of the UK and Kyrgyzstan baby food products with WHO Nutrient and Promotion Profile Model guidelines
Authors: Bozkir C. , Esin K. , Threapleton D. , Rippin H.L. , Wickramasinghe K. , Aidralieva N. , Tilenbaeva N. , Mamyrbaeva T. , Artykbaeva J. , Gumagulova G. , Cade J.E.
Published: December 2024

Optimal nutrition during infancy and early childhood is crucial for promoting healthy growth, development, and overall well-being(1). Concerns arise regarding commercially available Food Products for Infants and Young Children (FIYC) due to potential imbalances in sugar, salt, fat content, and inappropriate promotion. The World Health Organization’s (WHO) Nutrient and Promotion Profile Model (NPPM) assesses the nutritional quality and promotional practices of commercial baby foods for children under 36 months. This study evaluates and compares the compliance of FIYC products in the UK and Kyrgyzstan with the NPPM guidelines.

This study evaluated the compliance of FIYC products in the UK and Kyrgyzstan with the WHO’s NPPM guidelines. Data on commercially available FIYC products for children aged 6-36 months were collected from both countries (UK: n = 469 products, 21 brands; Kyrgyzstan: n = 203 products, 20 brands). The NPPM website was utilized to assess nutritional composition (energy, sugar, protein, salt) against WHO guidelines and evaluate labelling information (ingredient lists, nutrient/health/marketing claims, breastfeeding recommendations) for adherence to NPPM criteria(2). Data analysis for comparison across the two countries employed SPSS v29.

Analysis of 672 FIYC products using the NPPM website revealed distinctly different compositions between the UK (n = 469) and Kyrgyzstan (n = 203). The UK dataset contained a higher proportion of meals (38%) compared to fruits and vegetables (30%). Conversely, Kyrgyzstan had a higher percentage of fruits and vegetables (52%) and cereals (26%). Nutrient assessments displayed varying pass rates. Pass rates for products in the model were higher for the UK compared to Kyrgyzstan for energy density (75% vs. 47%), total fat (98% vs. 67%), and sodium (69% vs. 10%). However, Kyrgyzstan had a higher protein pass rate (96% vs. 94%). Regarding sugars, the UK achieved a 50% pass rate for total sugar compared to only 7% in Kyrgyzstan, with free sugar addition pass rates of 81% and 73% respectively. Promotion assessments revealed a similar compliance for the lower age recommendation (from 6 months) (85% UK, 76% Kyrgyzstan). However, all products failed the total marketing, health, and promotional claims evaluation. Breastfeeding instruction compliance was also low, with only 5% (UK) and 35% (Kyrgyzstan) passing.

In conclusion, the study identified both strengths and weaknesses in FIYC product compositions and nutritional profiles across the UK and Kyrgyzstan. However, more work is needed in adhering to marketing, health claims, and breastfeeding instruction guidelines in both countries. Stronger policies to improve FIYC are needed across the WHO European Region promoting child health and reducing future disease risk.
Adherence to a healthful plant-based diet and risk of chronic kidney disease among individuals with diabetes: A prospective cohort study
Authors: Thompson A. S. , Tresserra-Rimbau A. , Jennings A. , Bondonno N. P. , Candussi C. J. , O’Neill J. K. , Hill C. , Gaggl M. , Cassidy A. , Kühn T.
Published: December 2024

Chronic kidney disease (CKD) is highly prevalent among people with diabetes(1,2). While identifying modifiable risk factors to prevent a decline in kidney function among those living with diabetes is pivotal, there is limited evidence on dietary risk factors for CKD. In this study we examined the associations between healthy and less healthy plant-based diets (PBDs) and the risk of CKD among those with diabetes, and to identify potential underlying mechanisms.

We conducted a prospective analysis among 7,747 UK Biobank participants with prevalent diabetes (Type 1 and Type 2). Multivariable Cox proportional hazard regression models were used to examine the associations between healthful and unhealthful plant-based indices (hPDI and uPDI) and the risk of CKD. Fruits, legumes, nuts, tea and coffee, vegetables and whole grains were classified as healthy plant-based foods, whereas fruit juice, potatoes, refined grains, sugary drinks as well as sweets and desserts were classified as unhealthy plant-based foods. Animal-based foods used for the PDIs were grouped into meat, eggs, dairy products, animal fat, seafood or fish, and miscellaneous animal-based foods. Causal mediation analyses were further employed to explore the underlying mechanisms of the observed associations.

Among 7,747 study participants with diabetes, 1,030 developed incident CKD over 10.2 years of follow-up. The mean (SD) age was 58.8 (7.2) years, 6,910 (89.2%) were White, and 3,829 (49.4%) had a BMI over ≥30kg/m2. Higher adherence to a healthy PBD was associated with a 24% lower CKD risk (HRQ4 versus Q1: 0.76 [95%CI: 0.63−0.92], ptrend = 0.002), while higher adherence to an unhealthy PBD was associated with a 35% higher risk (HRQ4 versus Q1: 1.35 [95%CI: 1.11-1.65], ptrend = 0.006). The observed associations were predominantly mediated by markers of body fatness (proportion mediated: 11-25%) and kidney function (23-89%).

In this prospective cohort study of UK adults with diabetes, adherence to a healthy PBD was associated with lower CKD risk, whereas adherence to an unhealthy PBD was associated with a higher CKD risk. Associations were primarily mediated by markers of lower body fatness and improved kidney function.
Malnutrition and its Risk Factors in Renal Patients on Dialysis
Authors: AbiKharma J. , ElNakouzi J. , Abboud M. , Wehbe N. , Bassil M.
Published: December 2024

Patients with end stage kidney disease (ESKD) on hemodialysis (HD) should follow a strict diet during the inter-dialytic period(1). Compliance to treatment, including diet, is key for optimal disease management and health outcomes and to protect against malnutrition(2,3). The objective of this study was to assess renal nutrition-related knowledge, compliance with dietary guidelines, adherence to treatment and risk of malnutrition among patients with ESKD in Lebanon.

A convenience sample of 119 patients with ESKD on HD was recruited from the dialysis units of the Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH) and Hammoud Hospital University Medical Center (HHUMC) in Lebanon. Demographic characteristics, 24 hour-recall and a validated food frequency questionnaire(4) were collected from participants, while anthropometrics including weight status in the past 3 months, as well as biochemical data were collected from medical charts. Bioelectrical impedance tests were conducted on the patients, 30 mins after HD hemodialysis session, to assess body composition. Nutrition knowledge was assessed using a validated questionnaire(5), whereby “poor knowledge” corresponds to <70% correct answers. Compliance to treatment (HD sessions, medications, fluids, and diet) was collected from participants using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ)(6)) (Kim et al., 2010) and scored using the tool guide. Accordingly, adherence was classified as “poor” (scores <500), “moderate” (scores: 500-799), or “good” (scores: 800-1000).

100 of the 119 participants (85.5%) were found to have malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria(7). Malnourished patients were mostly found with lower education (57%), poor nutrition knowledge (68%), poor to moderate overall compliance (82%), and with no adequate caloric intake (67%). Weight loss was the most common phenotypic criterion among malnourished patients, whereby 22% of malnourished patients had weight loss of > 3Kg in the past 3 months. Malnourished patients with weight loss had a higher (p = 0.008) prevalence of poor overall compliance (36%), compared to those with mild or no weight loss (14%). Additionally, malnourished people with poor compliance tended to be younger (<55 years of age) and with lower levels of income and education (p<0.05).

Malnutrition rates are alarmingly high among patients with ESKD in our sample and are linked with low nutrition knowledge and poor adherence to treatment, including dietary compliance. Future studies with a larger more representative cohort are required to confirm our results. Accordingly, intervention trials targeting knowledge and adherence among ESKD patients in Lebanon are warranted to prevent malnutrition and to achieve better clinical outcomes.
Associations between n-3 index and systemic lupus erythematosus disease activity
Authors: Henry Cealan O , McSorley Emeir M , Armstrong David J , Strain J J , Allsopp Philip J
Published: December 2024

Higher consumption of n-3 polyunsaturated fatty acids (PUFAs) is associated with reduced severity of cardiovascular disease (CVD) and autoimmunity(1). The n-3 index (O3I), which correlates to n-3 PUFA habitual intake, is a useful clinical biomarker in determining cardiovascular risk(2). Individuals with an O3I <4% are considered to have higher cardiovascular risk, with 4-8% characterised as medium risk. The desirable O3I is >8% and deemed low risk for a cardiovascular event(3). Yet, little is known about O3I in systemic lupus erythematosus (SLE) patients who have a higher risk of CVD associated with their disease. This analysis aimed to determine the O3I of SLE patients, and its associations with disease activity.

A non-fasted blood sample was collected from SLE patients (n = 15) and healthy participants (n = 15). Isolated red blood cells were used to determine O3I and expressed as %. Habitual intake of fish, a rich source of n-3 PUFAs was assessed by questionnaire. Disease activity of SLE patients was assessed by a clinician using the British Isle Lupus Assessment Group (BILAG), Systemic Lupus Activity Measure-Revised (SLAM-R) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Mann-Whitney U was used to evaluate O3I differences between SLE patients and healthy participants. Spearman’s rank coefficient assessed associations between O3I and SLE disease activity.

SLE patients had an O3I of 4.38% and categorised to have a medium risk of a cardiovascular event, which was significantly lower compared to healthy participants for cardiovascular risk (5.48%; p<0.01). Some 67% SLE patients (n = 10) reported to never/rarely consume fish (≤1 portion per month) whereas 53% healthy participants (n = 8) reported that they consumer >2 portions of fish per month. Correlation analysis showed O3I was negatively associated with BILAG (rho = −0.061), SLAM-R (rho = −0.215) and SLEDAI (rho = −0.122); albeit these associations were not significant (p>0.05).

This is the first report of O3I in SLE patients and identified lower O3I compared to healthy participants, suggesting that SLE patients might benefit from increasing fish consumption to reduce their risk of CVD. Further research is required to fully elucidate associations between O3I and SLE disease activity.
Diversity of plant-based food and beverages consumption in the UK adult population: a cross-sectional analysis of the National Diet and Nutrition Survey Year 9
Authors: Dimidi E. , Creedon A. , Arulpragasam M.G. , McCall N. , Foyle L. , Gibson R.
Published: December 2024

There is a considerable body of evidence supporting the effects of increasing quantity of plantbased food consumption on health. Recently, there has been interest in the importance of diversity of plant-based food consumption, however, this remains less well understood(1). This study aims to (1) characterize the quantity and diversity of plant-based foods consumed, and (2) determine the association between plant-based food diversity, nutrient intake and demographic characteristics, in a nationally representative UK adult population.

This is a cross-sectional study using the National Diet and Nutrition Survey Year 9 (2016/2017) adult cohort. Participants completed estimated food and drink diaries over four days, which were then analysed to determine the intake of 258 distinct plant-based items within 2,202 discrete and composite foods. Items in all plant food categories (fruits, vegetables, grains, herbs, spices, nuts, seeds, fats, oils and beverages) were included. The mean daily diversity count was calculated by dividing total diversity counts by the number of food-diary days completed. Diversity was categorised into terciles to estimate low, moderate and high plant-based food diversity.

Multivariate regression analyses were conducted to identify predictors of diversity of plant-based food consumption.

Overall, 677 adults were included (58% female, 91% white, 29% with a degree). The median diversity of plant-based food intake was 8 counts/d (IQR 4). Diversity of plant-based food intake was categorised into the following terciles: low (median 5.5, IQR 1.8 counts/d), moderate (median 8.1, IQR 1.3 counts/d), and high diversity (median 11.0, IQR 2.3 counts/d). Vegetables were the largest contributors (22%) to diversity, followed by fats and oils (19%), and fruit (18%). The high diversity tercile had a higher fibre intake, compared to low diversity (median 11.5, IQR 4.9 g/d vs median 9.5 vs 4.0 g/d; p<0.001), and a lower trans fat intake (median 0.5, IQR 0.3 g/d vs median 0.6, IQR 0.4 g/d; p = 0.031). Higher annual income (+0.2 diversity counts/d per £5,000 increments, 95% CI 0.1−0.3; p<0.001), higher qualification levels (p<0.001), and following a vegetarian dietary pattern (p = 0.008) were significantly associated with higher daily diversity.

This is the first study to characterise plant-food diversity intake in the UK, showing the UK population consumes on average eight different plant foods a day. Higher plant-food diversity is linked to improved nutritional intake, and may offer an alternative strategy to optimise healthy diets. However, this remains to be confirmed in high quality randomised controlled trials, and the potential socio-economic disparities in relation to such a nutritional public health intervention need to be explored.
Evaluating the prevalence of high fat sugar salt (HFSS) products and labelling characteristics of foods sold in-store Restricted Areas: A survey in three UK supermarkets following the 2022 implementation of The Food (Promotion and Placement) Regulations
Authors: Hurst E. , Moore S. , Wallis L.
Published: December 2024

Regulations restricting promotion of some High Fat, Sugar, Salt (HFSS) products within “restricted areas” (RAs) (e.g. end of aisles) of eligible supermarket stores came into force in October 2022 in England.

To evaluate the prevalence of HFSS products, Front-of-Pack Nutrition Labelling (FOPNL) characteristics and categories of foods sold within RAs in a sample of supermarket stores, with respect to the Food (Promotion and Placement) Regulations 2021.

A cross-sectional survey of products in RAs in three supermarkets.

Following the manual identification of each supermarket’s RAs, from November 2022-January 2023, these were photographed and the display of products and their Front-of-Pack Nutrition Labelling (FOPNL) recorded. Products were identified using corresponding online supermarket webpages, from which data collected included product name, nutrition, and ingredients. This information was used to allocate each product to a category (e.g. ready meals) that was either in or out of scope of the Regulations. Evaluation of each product’s healthfulness was performed using the UK Nutrient Profiling Model (to determine HFSS status) and UK Multiple Traffic Light criteria to calculate number of inherent (i.e. possessed regardless of their display) Red Traffic Lights (iRTL). Prevalence of HFSS, FOPNL and iRTL were calculated as a proportion (%) of total products displayed in the included RAs. Associations between the prevalence of these characteristics were performed using chi-squared tests.

Across the three stores, 86 RAs were identified, with data collected from 32 RAs displaying 679 food products, most of which fell into product categories considered out-of-scope of the Regulations (64%, n = 435). Across included RAs, the prevalence of HFSS products within all in and out-of-scope categories, was 42 % (n = 282). Half of all products (53%, n = 357) displayed FOPNL, and 16% possessed 1, 2 or 3 iRTL, including both HFSS and non-HFSS items. Across those product categories in-scope of the Regulations (n = 245), prevalence of HFSS was 17% (n = 42). These HFSS products were less likely to display FOPNL compared to non-HFSS products (2 = 25.01, p < 0.001).

Following the implementation of The Food (Promotion and Placement) Regulations, intended to create healthier food retail environments, products sold across Restricted Areas of three eligible supermarkets included those in categories in and out of scope of Regulations with varied prevalence of less-healthy (HFSS) products, display of FOPNL, and possession of iRTL across both. This study is a first researcher-led evaluation of the recently regulated consumer-facing instore environment, with implications for future policy impact evaluation.
UK Dietitians’ and Nutritionists’ Perceptions of Low-Calorie Sweeteners in Obesity and Type 2 Diabetes Management: A Cross-Sectional Survey
Authors: Gorbatenko A. , Farhat G.
Published: December 2024

Low-calorie sweeteners (LCS), also known as non-nutritive sweeteners, are suggested to reduce sugar and calorie intake, potentially serving as a useful strategy for weight loss and management of type 2 diabetes (T2D)(1). However, inconsistencies in scientific research and conflicting guidelines regarding the benefits and risks of LCS rendered professionals uncertain about their safety and effectiveness in the management of obesity and T2D(2). Dietitians and nutritionists play a crucial role in preventing and managing obesity and T2D. Understanding their perceptions and knowledge of LCS is essential for developing strategies to keep them updated with the latest evidence. This survey aimed to assess the perceptions and knowledge of LCS among HCPC registered dietitians and nutritionists living and working in the UK.

An online cross-sectional survey was distributed to nutritionists and HCPC registered dietitians in the UK through social media and workplaces such as gyms, hospitals, and universities. Participants rated statements on their perceptions and knowledge of LCS use in obesity and T2D management, their risks, benefits, and government regulations. Ordinal logistic regression was used to investigate the impact of educational level and occupation (dietitians versus nutritionists) on the outcomes.

A total of 200 participants (136 dietitians and 54 nutritionists) responded to the survey. While 99% of respondents were familiar with LCS, only 62.5% were confident about advising clients/patients on their appropriate use. Additionally, 69.9% believed that LCS are helpful for weight loss and 67.8% stated that they can help manage T2D. Some respondents viewed LCS negatively: 15.5% considered it harmful, 39% deemed it unsafe, while 42.5% saw its benefits outweighing risks. Interestingly, 41.5% of respondents were not aware of the regulations surrounding the use of LCS. Open-ended questions revealed that some participants expressed concerns about the negative health effects of aspartame, with many considering stevia to be a healthier alternative due to its natural origin. Further analysis revealed that professionals with a doctorate degree in Nutrition/Dietetics were less likely to believe that LCS are bad for health when compared to those with an undergraduate degree (Wald χ2(1) =4.209, p=0.04). Compared to nutritionists, dietitians were more likely to express concerns regarding the impact of LCS on weight gain (p=0.029), yet the latter outcome is limited by the unequal sample size between the 2 groups.

While the majority of respondents recognize LCS as a valuable tool in managing obesity and T2D, a research and educational knowledge gap remains. Perceptions and knowledge of LCS could be further explored in a larger survey. It is crucial for professional and regulatory bodies to disseminate accessible information, ensuring that healthcare professionals provide the public with evidencebased guidance on the use of LCS in addressing obesity and T2D.