Proceedings of the Nutrition Society最新文献

The aim of this review is to examine why cultural food security and cultural food sovereignty should be prioritised and embedded within conventional food security frameworks. It demonstrates how culturally grounded, community-driven approaches foster more just, sustainable, and empowering food systems for ethnically diverse, Indigenous, and local communities, while highlighting the limitations of conventional metrics that overlook socio-cultural, political, and ecological dimensions essential to resilience. Conventional food security focuses on access to sufficient, safe, and nutritious food, often sidelining access to culturally appropriate and spiritually meaningful foods that are integral to cultural identity and tradition (cultural food security) and the authority and decision-making power held by local people over their foodways (cultural food sovereignty). Its market-based, individualistic measurement paradigms further neglect collectivist, traditional, and spiritual food values, resulting in assessments that may conform to global standards yet produce flawed outcomes, misaligned interventions, and continued marginalisation of ethnically diverse, Indigenous and local communities. Drawing on socio-cultural, political, economic, and environmental frameworks, the review demonstrates how food sovereignty and cultural food security provide more sustainable, equitable, and empowering pathways for communities. It underscores the need for community-driven, culturally grounded food policies.

It is increasingly acknowledged that the transition from animal- to plant-based proteins confers substantial benefits for both human health and environmental sustainability. This review provides a critical examination of the necessity to consider not only the degree of processing applied to plant protein-based foods, particularly those derived from legume seeds, but also the nutritional quality of the resulting products. While it is well established that plant proteins exhibit a lower environmental footprint compared with their animal-derived counterparts, their digestibility is often reduced, primarily due to the matrix composition of raw ingredients. To improve protein digestibility and reduce the antinutrient content in these raw materials, a variety of processing methods are used, encompassing thermal and biological treatments (e.g. extrusion and fermentation, respectively). However, processing methods may also introduce unintended adverse effects, including protein oxidation and formation of undesirable compounds. Therefore, this review explores the paradox of sustainable processing, where process conditions may simultaneously confer environmental advantages while compromising nutritional quality. In this context, food classification systems such as NOVA are critically examined, highlighting the absence of an evidence-based system that integrates both processing conditions and product formulation in the classification of plant-based foods. Current approaches categorizing plant-based options as ultra-processed foods without accounting for the nutritional quality of their ingredients, and their ultimate digestibility, may mislead consumers and discourage the consumption of nutritionally adequate plant-based alternatives. Finally, the review emphasizes the need for the adoption of processing technologies that address the sustainability challenge and the nutritional quality of plant protein-based foods.

Infant and young child feeding (IYCF) is a critical public health priority during emergencies, yet remains poorly integrated into emergency preparedness planning in many high-income countries (HICs). Despite the availability of international guidance, such as the Operational Guidance on IYCF in Emergencies the implementation of these tools in national systems has been inconsistent within HICs. This review examines recent emergencies in HICs to identify policy and operational gaps affecting breastfeeding support, the management of commercial milk formula (CMF), and the distribution of commercially available complementary foods (CACFs). The present review focuses on the practical translation of Infant and young child feeding in Emergencies (IYCF-E) guidance into emergency responses across a range of contexts. This review highlights widespread failures to protect breastfeeding during crises, often due to a lack of trained personnel, inadequate shelter infrastructure, and limited integration of IYCF into emergency protocols. CMF was frequently distributed without needs assessment or support, undermining breastfeeding and introducing risks related to hygiene and preparation. CACFs were often age-inappropriate, ultra-processed, or culturally unsuitable, with potential long-term implications for child health. Even in countries with strong health systems, IYCF-E was often fragmented, under-resourced, or absent from preparedness frameworks. To build nutritional resilience, IYCF-E must be embedded within public health and disaster planning, supported by legal protections, trained personnel, regulated product distribution, and coordinated communication. This requires a shift in policy and perception, recognising that the right to safe and appropriate feeding in emergencies applies equally in all settings.

Anorexia of ageing - the age-related reduction in appetite and food intake - is a public health concern for an ageing global population. However, current understanding of the aetiology of the condition is limited. In this review, evidence of gut hormone responses to feeding in older adults is reviewed, and it is proposed that a dysregulation of this process is a mechanism driving low appetite in later life. The evidence is synthesised to critically present this case, spotlighting recent data demonstrating a highly anorexigenic gut hormone profile in older adults exhibiting low appetite, which is not observed in older adults exhibiting a "healthy" appetite. These findings and this theory are interrogated with an appreciation that appetite control is complex and multifactorial, not least in the context of anorexia of ageing; it is posited that changes in gut hormone secretions are a mechanism rather than the mechanism, but propose that this may explain certain presentations of anorexia of ageing. The current knowledge base is contextualised for practical implications and priorities for future research are highlighted.

This review synthesizes current evidence linking alterations in the gut microbiome to menopausal transition. The gut microbiota plays a crucial role in numerous physiological processes, particularly due to its bidirectional communication with the brain via multiple neural, endocrine, and immune pathways. Menopause-associated oestrogen decline disrupts this axis, influencing not only gastrointestinal function and microbial diversity but also mood, cognition, and inflammation.The estrobolome is a community of gut bacteria capable of modulating circulating estrogen levels. Taken together, research suggests a complex dynamic interplay between the intestinal microbiota and sex hormones, potentially contributing to menopausal symptoms and related comorbidities.Understanding these interactions offers promising avenues for intervention, as dietary strategies (such as isoflavones), lifestyle modifications, and targeted probiotic and prebiotic therapies may help restore balance within the gut-brain axis and optimize brain health by influencing neurotransmitter synthesis, stress responses, and hormonal regulation during and after the menopausal transition.Here, we highlight the importance of an integrative, microbiome-informed approach to midlife women's health, emphasizing innovative, non-pharmacological strategies to promote long-term well-being in women.

Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31-87%, depending on tumour site and disease stage. Driven by a combination of nutrition-impact symptoms, reduced oral intake, and systemic inflammation, leading to poor treatment tolerance, diminished quality of life, and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes such as sarcopenia, cachexia, and myosteatosis, which may coexist with overweight or obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation, and muscle wasting. Although obesity is an established cancer risk factor, 40-60% of patients remain overweight or obese during treatment, even those with metastatic disease. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers, and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently "at risk" of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.

Nutrition plays a pivotal role in cancer survivorship, influencing not only long-term health outcomes but also quality of life and risk of recurrence. As advances in early detection and treatment have led to a growing global population of cancer survivors, attention has increasingly shifted from acute care to the promotion of sustained well-being and prevention of secondary health challenges. Despite growing evidence linking dietary patterns, body composition and metabolic health with survivorship outcomes, there remains significant variability in nutritional guidance, access to evidence-based interventions and integration of nutrition into oncology care. This review explores the current state of knowledge on nutrition in cancer survivorship, highlights key challenges faced by healthcare systems and patients and presents a new proposed model of care to optimise nutrition within survivorship care, bridging the evidence-practice gap.

Iodine deficiency is now a significant public-health concern in the UK. Data from the National Diet and Nutrition Survey (NDNS; 2019-2023) shows that several populations groups are now classified as mildly iodine deficient, including women of childbearing age. This is a change from previous NDNS data where these groups were iodine sufficient. As iodine is needed for thyroid-hormone production, which are essential for brain development, iodine deficiency prior to, and during, pregnancy may have implications for child cognition - including lower IQ. However, the evidence base for the health effects of mild deficiency is not as strong as in severe deficiency. The World Health Organization recommends salt iodisation to control iodine deficiency in a population but such a policy was never introduced in the UK and iodised salt is not widely available. While UK milk is rich in iodine and is the principal source, the rise in popularity of plant-based milk alternatives may increase the risk of iodine deficiency. It may be necessary to give personalised advice to those with low iodine intake, but identify those at risk is challenging owing to a lack of a biomarker for iodine in an individual. Population-wide approaches may be required in the UK - for example, fortification of bread with iodised salt or mandatory iodine-fortification of plant-based dairy alternatives. This review will critically discuss (i) the data on iodine deficiency (ii) the evidence base for the health implications of mild deficiency, and (iii) the potential public-health solutions.

Biliary atresia is a rare bile duct disease resulting in intestinal bile salt depletion due to poor bile flow. Medium-chain triglyceride (MCT) supplementation is widely recommended and used as the main dietary management in infants, however evidence for its use is limited and there is uncertainty regarding the optimal percentage (proportion of total fat that is MCT) and dose (grams/kilogram/day, g/kg/d). The aim was to review the evidence for the impact of MCT on fat absorption, growth, nutritional status and clinical outcomes in infants with biliary atresia and the optimal nutrition profile of MCT supplementation. A scoping review found that the mostly observational, historic evidence for MCT supplementation pointed to greater fat absorption during MCT supplementation compared to no supplementation, but also some evidence of a risk of essential fatty acid deficiency with very high MCT percentage. Only six studies have investigated MCT percentages and only three reported MCT dose. One analysis of MCT in the largest cohort of biliary atresia patients ever presented (n = 200), found no association between MCT percentage with growth, nutritional status or clinical outcomes. Counterintuitively, there was an unexpected inverse association between MCT dose and growth. A possible interpretation was that increased MCT was a consequence of poor growth rather than a cause, as infants either drank more or dietitians prescribed more MCT as fat malabsorption worsened. In conclusion, MCT is widely recommended, however, the evidence for its use is lacking and there remains uncertainty about the optimum percentage and dose for infants with biliary atresia.

In the UK, approximately 64,000 individuals are living with an ileostomy. This surgery creates an opening in the abdominal wall (stoma), allowing for diversion of egesta into a disposable pouch. This procedure impacts nutrient absorption meaning people living with an ileostomy may be subject to sub-optimal nutrition, often compounded by the low-fibre diet - which is frequently encouraged post-operatively. This review explores the restrictive dietary patterns of this population and their effects on nutrition and quality of life, alongside current approaches to improve dietary management and health outcomes. Dietary restriction beyond the post-operative period is frequently reported, with avoidance of high-fibre foods (e.g., fruits and vegetables) being most prevalent. These long-term dietary changes are presumed to impact nutritional status, with current evidence suggesting diminished bone mineral density and vitamin B12. High-output stoma (HOS) and dehydration are significant issues for people living with an ileostomy, and dietary management of stoma output and other ileostomy-related symptoms is a major contributor to food avoidance. The efficacy of oral rehydration solutions (ORS) in management of HOS is well-established; however, due to high concentrations of glucose and sodium, the palatability of such treatments is poor, impacting patient adherence. Encouragingly, personalised dietary advice has shown some positive effects on both quality of life and nutritional outcomes for people living with an ileostomy. However, a greater understanding of dietary management is needed, and there remains scope to improve current dietary advice and enable people living with an ileostomy to benefit from a more complete and unrestricted diet.