bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Dietetic attitudes and practice towards bolus feeding
Authors: Reynolds L. , Egan G. , O’Neill J.L. , Hovey J. , Wilkinson S. 
Published: December 2024

Bolus feeding is the administration of feed to a patient as a series of smaller volumes of enteral nutrition given at regular intervals via an enteral feeding tube.(1) It is currently estimated that approximately 2,000 people are receiving home enteral tube feeding (HETF) in Ireland.(2) However, there is limited evidence surrounding the use of bolus feeding in enterally fed patients.The aim of this study is to investigate Irish dietitians’ attitudes and usage of bolus feeding in their adult patients.Survey Monkey was used to create an eighteen-question survey which was distributed by the ‘Irish Nutrition and Dietetic Institute’ in their online newsletter and the ‘Irish Nutrition Jobs’ Facebook page. Descriptive statistics were performed using IBM SPSS® v27 to determine percentages. Dietitians that worked with adult patients and reccommended bolus feeding to patients were eligible to take part in the survey.Out of 100 respondents, 74 dietitians fit the eligibility criteria for data analysis. Of the 74 participants recommending bolus feeding in adult patients, they primarily worked in hospitals (64%, n = 47) and in the community (35%, n = 26) with 20% (n = 15) specialising in oncology. Just over half (58%, n = 43) of dietitians agreed that the number of patients being bolus fed has increased over the last 5 years with 26% (n = 19) reporting that more than half of their enterally fed patient case load receive bolus tube feeding. The majority of dietitians (99%, n = 73), routinely use the syringing method when administering a bolus feed.Dietitians commonly recommend bolus feeding in oncology patients (65%, n = 48), those with neurodisability (46%, n = 34) and in adults with gastrointestinal diseases (19%, n = 14). When choosing to administer a bolus feed, 53% (n = 39) of dietitians aim for 400kcal per feed, with 200ml ONS being the most popular bolus feed format (62%, n = 46). Almost all dietitians (96%, n = 71), decide to use bolus feeding with their patients as it suits their lifestyles as well as 81% (n = 60) reporting that it is favoured for its convenience.Many of the dietitians (61%, n = 45) are of the opinion that feeds designed in a format for bolus feeding would improve patient experience. To further improve their training, dietitians reported there is a need for additional practice guidelines (47%, n = 35) and practical workshops (46%, n = 34) on bolus feeding.This study found that dietitians are recommending bolus feeding for patients more often in the last 5 years (2019-2024). Participants reported that bolus feeding suits patients’ lifestyles as it’s convenient and it suits their social circumstances. There is a need for a specific format for bolus feeding products as well as specific bolus feeds to improve patient experience. Dietitians agree that additional resources such as practical workshops and guidelines are needed to further support them with bolus feeding.
A content and thematic analysis of Welsh school food menu design and healthiness compared to present government guidelines
Authors: Gilmour A.S. , Fairchild R.M. 
Published: December 2024

All four United Kingdom (UK) nations have School Food Standards (SFS) which schools and local authorities must adhere to. Since the Welsh SFS were updated in 2013(1), the UK government has updated its healthy eating guidelines according to advice from the Scientific Advisory Committee on Nutrition (SACN)(2). The Welsh government is committed to revising their SFS to reflect the most up-to-date scientific evidence for nutrients and food. This study aimed to quantitatively and qualitatively content analyse (CA) school food provision (i.e., menus and/or price lists) pan-Wales to determine the extent to which it meets the latest healthy eating government recommendations for school-aged children. Secondly, menu design was thematically analysed (TA) to ascertain the language used and design elements(3).Menus and/or price lists were collected cross-sectionally for the autumn 2023 term and 79% of the total population was sampled (n = 82/104). Welsh language documentation was translated into English via an online translation website prior to CA. The study protocol received approval from the Cardiff Metropolitan University School of Sport and Health Sciences ethics committee. The researchers developed an assessment tool inclusive of healthiness criteria based on SACN guidelines as well as the Welsh SFS and used this tool to CA and TA all 82 menus.Local authority organised primary school food provision was most likely to meet the predetermined healthiness criteria. Most secondary schools lacked fruit-based desserts (64%), red meat (95%) and milk (55%). Moreover, occasionally secondaries exceeded the allotted frequency for processed meat (11%), potatoes cooked in oil (22%) and high in fat, salt and sugar mid-morning snacks (18%). Instances were found where the healthiness criteria, identical to the current Welsh SFS, were not fulfilled. Regarding the TA of menu and/or price lists, four key themes were identified: (i) language, (ii) signalling, (iii) imagery and (iv) design. 12% menus featured the Welsh language. Descriptive language was apparent for cooking methods (‘freshly filled,’ ‘oven-baked’) or to popularise dishes (‘veggie-dawgs,’ ‘meatball wrapstar’). An array of keys and icons were employed to signal non-meat items or nutritionally balanced dishes. Logos, photos and illustrations were evident across most menus, yet the imagery could be seemingly unrelated to the school food provision. In particular, primary school menus were bright and colour was utilised to emphasise different weeks of the menu cycle. Issues around clarity were observed on secondary school price lists which could be overly long and include complex pricing structures.This study has established the current school food and drink provision pan-Wales and provides policymakers with a baseline from which the SFS may be updated and include a formal monitoring process. Improvement in the amount and clarity of information on menus could also be considered at this stage.