Proceedings of the Nutrition Society最新文献

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.

Healthy diets are unaffordable for billions of people worldwide, with food prices rising in high-, middle- and low-income nations in recent times. Despite widespread attention to this issue, recent actions taken to inform policy prioritisation and government responses to high food inflation have not been comprehensively synthesised. Our review summarises (i) innovative efforts to monitor national food and healthy diet price, ii) new policy responses adopted by governments to address food inflation and (iii) future research directions to inform new evidence. Evidence synthesis. Global. None. We describe how timely food and beverage pricing data can provide transparency in the food industry and identify key areas for intervention. However, government policies that improve food affordability are often short-lived and lack sustained commitment. Achieving meaningful impact will require long-term, cross-sectoral actions that are led by governments to support food security, healthy diets and resilient sustainable food systems. This will necessitate a better understanding of how the political economy enables (or hinders) policy implementation, including through coherent problem framing, mitigating conflicts of interest in policymaking, working together as coalitions and developing and utilising evidence on the food security and related impacts of food pricing and affordability policies. Diverse actors must be better equipped with robust data platforms and actionable policy solutions that improve the affordability of healthy and sustainable diets, including by lowering food prices and addressing the broader socio-political determinants of food insecurity.

Unhealthy diets are a leading cause of preventable ill health. Healthy diets tend to be more expensive than less healthy diets and as such are more likely to be consumed by individuals with a higher income. This review paper discusses the development of the Eatwell Guide, evaluates the affordability of a diet consistent with the Eatwell Guide ('the Eatwell Guide diet') and explores how food pricing can be leveraged to encourage and support healthier dietary choices. The Eatwell Guide is the UK's food-based dietary guidelines. It provides healthy eating advice that is intended to facilitate policy cohesion but is also used as a public-facing health promotion tool. The cost of food has increased and recent estimates suggest that the Eatwell Guide diet is now more expensive than the current average diet. There is strong evidence that subsidies would be effective at increasing the uptake of healthy diets. Monitoring the cost of a healthy diet is important for policy development; however, we should exercise caution when considering how to incorporate costs into food-based dietary guidelines and be mindful of the limitations of the data that could support this.

(Poly)phenols are plant secondary metabolites widely abundant in plant foods and beverages comprising a very large number of compounds with diverse structure and biological activities. Accumulating evidence indicates that these compounds exert beneficial effects against cardiometabolic diseases, and this review will provide a summary of current knowledge in this area. Epidemiological and clinical data collectively suggest that intake of flavonoids reduces the risk of cardiovascular disease (CVD), with the evidence being particularly strong for the flavan-3-ol subclass. However, to provide adequate dietary recommendations, a better understanding of their estimated content in foods and intake among the general public is needed. Regarding mechanisms of action, we now know that it is unlikely that (poly)phenols act as direct antioxidants in vivo, as it was hypothesised for decades with the popularity of in vitro antioxidant capacity assays. One of the reasons is that upon ingestion, (poly)phenols are extensively metabolised into a wide array of circulating metabolites with different bioactivities than their precursors. Well-conducted in vitro and in vivo studies and human nutrigenomic analysis have revealed new molecular targets that may be underlying the health benefits of (poly)phenols, such as the nitric oxide pathway. Recently, a bi-directional relationship was established between (poly)phenols and the gut microbiota, suggesting that individual gut microbial metabolising capacity may be a key factor explaining the variability in the cardiometabolic response to (poly)phenols. Future research is needed to elucidate which are the key factors affecting such capacity, and whether it can be modulated, along with the mechanisms of action.

School food has a major influence on children's diet quality and has the potential to reduce diet inequalities and non-communicable disease risk. Funded by the UK Prevention Research Partnership, we have established a UK school food system network. The overarching aim was to build a community to work towards a more health-promoting food and nutrition system in UK schools. The network has brought together a team from a range of disciplines, while the inclusion of non-academic users and other stakeholders, such as pupils and parents, has allowed the co-development of research priorities and questions. This network has used a combination of workshops, working groups and pump-priming projects to explore the school food system, as well as creating a systems map of the UK school food system and conducting network analysis of the newly established network. Through understanding the current food system and building network expertise, we hope to advance research and policy around food in schools. Further funding has been achieved based on these findings, working in partnership with policymakers and schools, while a Nutrition Society Special Interest Group has been established to ensure maximum engagement and future sustainability of the network. This review will describe the key findings and progress to date based on the work of the network, as well as a summary of the current literature, identification of knowledge gaps and areas of debate, according to key elements of the school food system.