Proceedings of the Nutrition Society最新文献

Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.

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.

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.

The aim of this review is to provide an overview of the history in support of the role of dietary saturated fatty acids (SFA) in the development of cardiovascular disease (CVD), and the controversy and consensus for the evidence in support of guidelines to remove and replace SFA with unsaturated fatty acids. The review will also examine the existence, origins, and implications for CVD risk of variability in serum LDL-cholesterol in response to these guidelines. While the quality of supporting evidence for the efficacy of restricting SFA on CVD risk has attracted controversy, this has helped to increase understanding of the inter-relationships between SFA, LDL-cholesterol and CVD, and reinforce confidence in this dietary recommendation. Nevertheless, there is significant inter-individual variation in serum LDL-C in response to this dietary change. The origins of this variation are multi-factorial and involve both dietary and metabolic traits. If serum biomarkers of more complex metabolic traits underlying LDL-responsiveness can be identified, this would have major implications for the targeting of these dietary guidelines to LDL-responders, to maximise the benefit to their cardiovascular health.

The review aims to explore the potential benefit and risk of high-protein diets (HPD) regarding the comorbidity of sarcopoenia and CVD in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet and weight loss poorly addresses the issue of sarcopoenia. HPD, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPD and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower- and plant-protein diets over higher animal protein, but the evidence is inconsistent. HPD augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPD raise concern regarding renal and bone health, the microbiome, branched chain amino acids and environmental sustainability and findings suggest that plant-based HPD may confer ecological and overall health advantages compared to animal-based HPD. However, incorporating RE with HPD might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed.

This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

Food insecurity (also known as food poverty) is the inability to afford or access a healthy diet. It has become recognised as a public health emergency and is a priority in the context of the environmental, geopolitical and socio-economic implications on businesses, households and civic society. This review paper aims to discuss the merits of collecting food insecurity data and its importance in informing cross-sectoral government and others' understanding, policymaking and action on hunger. The review paper's key findings are that concerted action on measuring and mapping food insecurity with the aim of eliminating or reducing its prevalence represents a triple win for government, business and citizens. However, measurement does not provide solutions to food insecurity but contributes importantly to understanding its extent and severity to inform and evaluate proffered solutions. Government, business and food insecurity researchers and commentators cannot merely continue to simply describe food poverty - but must effect meaningful change amidst our communities to improve life quality in a timely way for those experiencing acute and chronic hunger. This is best done by addressing the structural causes of food insecurity through economically, socially and culturally fair and appropriate policy levers, requiring cross-sectoral collaboration. Ultimately, food insecurity requires a long-term, sustainable solution that addresses the policy issues under focus: low income, under/unemployment, rising food prices and Welfare Reform, informed by routine, Government-supported monitoring and reporting of the extent of food poverty among our citizens.

The over consumption of high fat, sugar, and salt foods increases population risk of overweight, obesity and diet-related noncommunicable diseases. The food environment mediates consumer food choices and thus plays an important role in diet quality and related health outcomes. The built food environment, where most people in high-income countries access their food, has been found to be obesogenic. The aim of this review was to investigate the healthfulness of the supermarket food environment. Supermarkets are an important source of healthy foods in the built food environment. However, there are disparities in access to supermarkets, and in several countries, supermarkets located in areas of higher deprivation have an unhealthier consumer food environment. This double burden limits access to healthy foods amongst lower socio-economic groups, contributing to widening disparities in food-related ill health. There is a strong body of evidence supporting improved purchase of healthy foods by increasing the healthfulness of the supermarket consumer food environment. Voluntary measures co-designed with retailers to improve the healthfulness of the supermarket consumer food environment through restriction of product placement and private label reformulation have led to an increase in healthier food purchases. However, evidence also shows that mandatory, structural changes are most effective for improving disparities in the access to healthy food. Future research and policy related to the food environment should consider equitable access to healthy sustainable foods in built and online supermarkets.

The potential influence of the timing of eating on body weight regulation in humans has attracted substantial research interest. This review aims to critically evaluate the evidence on timed eating for weight loss, considering energetic and behavioural components of the timing of eating in humans. It has been hypothesised that timed eating interventions may alter energy balance in favour of weight loss by enhancing energy expenditure, specifically the thermic effect of food. This energetic effect has been suggested to explain greater weight loss which has been observed with certain timed eating interventions, despite comparable self-reported energy intakes to control diets. However, timed eating interventions have little impact on total daily energy expenditure, and the apparent effect of time of day on the thermic effect of food largely represents an artefact of measurement methods that fail to account for underlying circadian variation in RMR. Differences in weight loss observed in free-living interventions are more likely explainable by real differences in energy intake, notwithstanding similar self-reported energy intakes. In addition, the energetic focus tends to overlook the role of behavioural factors influencing the timing of eating, such as appetite regulation chronotype-environment interactions, which may influence energy intake under free-living conditions. Overall, there is scant evidence that timed eating interventions are superior to general energy restriction for weight loss in humans. However, the role of behavioural factors in influencing energy intake may be relevant for adherence to energy-restricted diets, and this aspect remains understudied in human intervention trials.

The World Health Organisation describes micronutrient deficiencies, or hidden hunger, as a form of malnutrition that occurs due to low intake and/or absorption of minerals and vitamins, putting human development and health at risk. In many cases, emphasis, effort, and even policy, revolves around the prevention of deficiency of one particular micronutrient in isolation. This is understandable as that micronutrient may be among a group of nutrients of public health concern. Vitamin D is a good exemplar. This review will highlight how the actions taken to tackle low vitamin D status have been highly dependent on the generation of new data and/or new approaches to analysis of existing data, to help develop the evidence-base, inform advice/guidelines, and in some cases, translate into policy. Beyond focus on individual micronutrients, there has also been increasing international attention around hidden hunger, or deficiencies of a range of micronutrients, which can exist unaccompanied by obvious clinical signs but can adversely affect human development and health. A widely quoted estimate of the global prevalence of hidden hunger is a staggering two billion people, but this is now over 30 years old. This review will outline how strategic data sharing and generation is seeking to address this key knowledge gap in relation to the true prevalence of hidden hunger in Europe, a key starting point towards defining sustainable and cost-effective, food-based strategies for its prevention. The availability of data on prevalence and food-based strategies can help inform public policy to eradicate micronutrient deficiency in Europe.