Proceedings of the Nutrition Society最新文献

Healthy ageing and longevity have emerged as urgent public health priorities amid global population ageing and declining birth rates. This review synthesises empirical evidence highlighting the essential role of diet and nutrition in preventing chronic diseases and supporting functional independence in later life. The review was organised using a problem-solving approach to address three core questions: 'What' evidence links food and nutrition with positive health outcomes; 'Why' do specific dietary components affect biological ageing - via mechanisms such as nutrient sensing, inflammation modulation and caloric restriction; and 'How' culturally tailored, person-centred dietary interventions should be developed for better adoption. Findings from centenarian populations suggest that low-energy (i.e. foods with low energy density, such as fruit and vegetables, whole grains), nutrient-rich and diverse diets may help prevent or delay age-related diseases, supporting the notion that food could be used as medicine. Moreover, addressing barriers such as food insecurity and limited access to culturally appropriate healthy food options, particularly in low-income and rural communities, is crucial for achieving equitable health outcomes. Finally, the review calls for integrating personalised nutrition strategies into clinical care and public health initiatives. These efforts can enhance healthspan, improve quality of life and reduce the broader social and economic burdens associated with ageing populations.

Personalised nutrition aims to deliver targeted advice to promote dietary behaviours that are beneficial to health based on individual characteristics. Given the financial implications (for providers and participants) of characterising, developing, implementing, communicating and supporting individual behaviour change there remains potential for personalised nutrition to widen health inequalities within populations. Some commentators promote a universal approach to achieve wider population-level benefit. Universal approaches attempt to provide a whole systems perspective with individual outcomes, potentially smaller in scale, impacting at the population level. In the UK the national food-based guidance, the Eatwell Guide, is used to communicate advice on diet consistent with UK government dietary recommendations based on robust, independent assessment of the best available evidence by the Scientific Advisory Committee on Nutrition. Effort was taken in ensuring all UK government recommendations in 2016 (when the UK's national food-based guidance was last reviewed following changes in dietary recommendations on carbohydrates and sugars) could be achieved at a population level based on available and recognised foods. There is evidence that moving towards a diet consistent with national food-based guidelines has positive benefits for health and the environment. There is debate about the cost of a healthy diet and the impact of including elements of sustainability elements. This commentary considers how developments in healthy eating indices may be beneficial as a universal approach could provide opportunities to support individuals move towards healthier diets. It also raises questions about the evidence requirements and timing of any future amendments to the UK's Eatwell Guide.

As the global population ages, the prevalence of cognitive decline is rising, creating urgent demand for proactive strategies that support brain health and healthy ageing. Ergothioneine, a unique dietary amino-thione absorbed via the OCTN1 transporter, has recently gained attention for its potential as a neuroprotective, longevity-promoting compound. This review synthesizes growing evidence from observational, interventional and mechanistic studies. Observational data consistently associate low blood ergothioneine levels with cognitive impairment, neurodegenerative diseases, cardiovascular disorders, frailty and mortality. Interventional trials in older adults suggest that ergothioneine supplementation may improve cognition, memory, sleep quality and stabilize neurodegeneration biomarkers, with no safety concerns at doses up to 25 mg/day. Mechanistic studies reveal that ergothioneine acts through multiple pathways: mitigating oxidative stress, reducing neuroinflammation, preserving mitochondrial function and potentially modulating neurogenesis and NAD⁺ metabolism, although some mechanisms require further investigation. Beyond cognition, ergothioneine shows promise in supporting other physiological systems relevant to ageing, including cardiovascular, metabolic, gut, eye, auditory, liver, kidney, immune, skin and lung health. Together, current evidence positions ergothioneine as a promising nutritional intervention for promoting cognitive resilience and systemic health in ageing, although larger, long-term interventional trials are needed to confirm causality and optimize use.

This review examines the relationship between diet and functional dyspepsia (FD), a prevalent disorder of gut-brain interaction affecting 8% of the global population and characterised by postprandial fullness, early satiety and epigastric pain or burning. Despite 40-70% of FD patients reporting symptom onset within minutes of eating, standardised dietary recommendations remain limited. The pathophysiological mechanisms underlying food-related symptoms in FD involve complex interactions between altered gastric accommodation and emptying, visceral hypersensitivity, duodenal immune activation and small intestinal microbial dysbiosis. Current evidence most strongly supports dietary lipids as potent triggers of dyspeptic symptoms, likely mediated through cholecystokinin pathways and heightened visceral sensitivity. Additionally, emerging research indicates potential benefits of fermentable carbohydrate restriction, with the low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet showing promise particularly for patients with postprandial distress syndrome. Other dietary factors such as alcohol, coffee, food chemicals, bioactive compounds and meal patterns may also influence FD symptoms though current evidence remains insufficient to inform clinical practice. While existing evidence provides a foundation for understanding diet-symptom relationships in FD, significant gaps remain in translating mechanistic insights into personalised dietary recommendations. Future research should focus on developing evidence-based dietary strategies tailored to FD subtypes, ensuring nutritional adequacy while addressing the complex interplay between nutrient sensing, duodenal immune activation and gut microbiota in symptom generation.

Recent literature has shown that appetite loss during ageing can lead to negative health outcomes in older adults, particularly malnutrition and mortality. However, its association with functional decline and the mechanisms driving this relationship are not well explored. This review summarises the current evidence regarding the potential effects of appetite loss on frailty and functional outcomes. Despite the limitations due to heterogeneous methodologies, including study designs, population characteristics and appetite assessments, most studies indicate that older adults with poor appetite tended to exhibit poor physical performance and increased functional limitations. Furthermore, the simultaneous weight loss in individuals experiencing appetite loss was associated with a higher risk of functional impairments. Finally, emerging evidence connects reduced appetite to biomarkers of ageing, including epigenetic alterations, chronic inflammation and the upregulation of GDF-15. Therefore, loss of appetite is a potential earlier marker of loss of function that deserves further investigation. Adopting a geroscience perspective may enhance our understanding of appetite loss during ageing and foster the development of effective interventions.

The aim of this paper is to review several key aspects of undernutrition in later life, with a major focus on undernutrition in community-dwelling older adults. The prevalence of undernutrition in community-dwelling older adults is about 8.5%, but higher in vulnerable subgroups such as the oldest old (19.3%), those reporting poor appetite (22.4%), and those receiving home care (15.8%). Frequently reported risk factors for undernutrition in the community include poor appetite, functional limitations and previous hospitalisation. The Determinants of Malnutrition in Aged Persons (DoMAP) model provides a clear framework to structure the different direct and indirect potential determinants of undernutrition in old age. Low BMI as well as involuntary weight loss, both important phenotypic criteria of undernutrition, are associated with early mortality in older adults. Furthermore, undernutrition in community-dwelling older adults is associated with a subsequent increased risk of frailty, falls, functional decline and rehospitalisation. Qualitative studies indicate a poor undernutrition awareness among healthcare professionals working in community care as well as among older adults themselves. The Malnutrition Awareness Scale can be used to objectively measure an older persons' undernutrition awareness. In conclusion, the prevalence of undernutrition among older adults living in the community is substantial and has several negative consequences for health and functioning. Strategies towards greater undernutrition awareness by primary care professionals as well as older adults themselves is therefore necessary.

By 2050, 1.31 billion people will be living with type 2 diabetes (T2DM). Those with social disadvantage experience greater diabetes prevalence, morbidity and mortality. Gestational diabetes (GDM) is an established factor for T2DM, with 3-4 times greater risks among women who are Black, Hispanic and South and South East Asians. Lifestyle interventions that include diet and physical activity reduce T2DM in at-risk populations, including women with prior GDM, regardless of ethnicity. However, migrant women from non-Western backgrounds are less likely to engage with the programme despite its efficacy. This review paper aims to describe the social disparities in GDM globally, with a focus on equity issues and interventions in Australia. It outlines a five-part approach to solutions that move us towards equity in reach and uptake for women from non-Western migrant backgrounds in Australia. Culturally inclusive solutions start with evaluating reach in underserved groups through equity audits or stratified analyses and identifying groups where reach is low. Community partnerships can then be formed with key actors across health and social sectors identified through stakeholder mapping. Effective reach strategies, including implementation and evaluation plans, will be co-developed through these partnerships, addressing risk factors, enablers and barriers to a healthy lifestyle. Solutions that integrate medical and social services, such as social prescribing, could facilitate healthy lifestyle choices through restructuring the social environment of the individual. These steps lead to interventions that promote social cohesion and resilience, enabling individuals to attain health and well-being in the face of external challenges.

The food system, particularly animal agriculture, is a major contributor to environmental degradation, impacting critical Earth system processes such as climate change, freshwater use and biodiversity loss. There is a growing consensus that a shift from animal-based to plant-based diets is essential for both human health and environmental sustainability. This review explores the integration of sustainability competences into nutrition education, emphasising how systems thinking, strategic thinking, values thinking, futures thinking and interpersonal competences can contribute to the production of improved dietary guidelines. By applying these competences to the criticisms of the Planetary Health Diet, the Nordic Nutrition Recommendations and the Mediterranean diet as examples, this review highlights the tactics used by specific stakeholders to undermine sustainable healthy dietary guidelines. The review paper concludes by advocating for future dietary guidelines that are free of financial conflicts of interest, decolonised and developed through participatory processes in order to ensure that they are equitable, sustainable and aligned with the needs of diverse populations.

Objective: The transformation of food systems has emerged as a critical component of global climate action, with food-based dietary guidelines (FBDGs) increasingly recognised as a key policy tool to promote both public health and environmental sustainability. However, despite their importance, many national FBDGs fail to integrate sustainability considerations or adequately support diverse plant-based dietary patterns.

Design: This review proposes a socioecological framework for enhancing the inclusivity and adaptability of FBDGs, enabling them to better reflect evolving food systems and consumer behaviours while strengthening their role in promoting sustainable and health-conscious diets.

Results: Five key gaps in current FBDGs worldwide were identified: (1) the need for more inclusive food-group classifications that accommodate plant-based protein sources; (2) clearer recommendations for limiting the consumption of animal-sourced foods (ASF) for health and environmental reasons; (3) guidance on obtaining essential macro- and micronutrients from plant-based sources; (4) the inclusion of plant-based alternatives to ASF within dietary recommendations; and (5) comprehensive advice on well-planned vegetarian and vegan diets.

Conclusion: Addressing these gaps is crucial to ensuring that FBDGs remain relevant to a broad spectrum of dietary preferences, including those motivated by ecological, ethical, religious, and cultural factors.

A national food guide for the UK, providing food based dietary guidelines was first issued in 1995. It was last revised and published as the Eatwell Guide in 2016. The Guide is a pie chart indicating the proportions of foods from different food groups that should make up the ideal diet from a health perspective. The number of segments for the pie chart, the names of the food groups that comprise those segments and the list of individual foods that fit into the wider food groups was in essence decided in around 1995 and have remained essentially unchanged since then. The 2016 edition of the guide - the Eatwell Guide - was the first to employ optimisation modelling to calculate the angles of the segments of the pie chart. This was a significant improvement to the scientific basis to the guide. But still the Eatwell Guide leaves much to be desired and it is time for its revision. This review paper outlines the aims of the guide, provides a brief history of the Eatwell Guide, outlines its strengths and weaknesses and suggests some ways by which the Eatwell Guide might be improved.