Nutrition Bulletin最新文献

Randomised controlled trials (RCTs) are the gold standard of research studies. They aim to recruit participants with similar characteristics and randomly assign them to a treatment or control/placebo arm. Due to randomisation, RCTs provide comprehensive, unbiased evidence about treatment efficacy and safety and examine cause-and-effect relationships between the intervention and outcome. However, RCTs are expensive, recruitment can be time-consuming and high drop-out rates can reduce internal validity. Depending on the target population, findings are not always generalisable at a population level. Of relevance to nutritional sciences, due to the type of research questions, researchers and participants cannot always be blinded to randomisation. Electronic health records (EHRs) provide a possible solution to some of these constraints. Using data from healthcare systems may help to reduce costs and overcome logistical challenges as (1) pragmatic trials integrated into routine care enable real-time data analysis and faster translation of findings and (2) once dynamic longitudinal cohorts have been generated, they can be analysed using quasi-experimental designs. These have the potential to provide population level data with higher generalisability, lower attrition and greater statistical power. EHRs do come with their own challenges, including the lack of a uniform information infrastructure, missing data and data quality. There are also ethical considerations, as patients may not wish for their data to be used in a research capacity, which in turn can affect the generalisability of findings. When it comes to nutritional sciences and generating evidence, there is no one-size fits all approach. EHRs offer great potential for advancing certain research questions, such as when there is a population level intervention, for example, the soft drinks industry levy or the inclusion of folic acid in non-wholemeal wheat flour. EHRs offer the opportunity to integrate multiple datasets which will enable a comprehensive understanding of a nutrition intervention impact on health and disease in diverse populations and real-world settings. However, RCTs remain imperative for understanding causality. The scope of this review is to examine how RCTs and EHRs can be used to generate evidence in nutritional sciences, highlighting their respective opportunities and challenges.

Cardiovascular disease (CVD) remains a leading cause of mortality worldwide, necessitating effective preventive and therapeutic strategies. Flavonoids and polyphenols, which are abundant in colourful fruits and vegetables, have emerged as promising bioactive compounds for mitigating CVD. This study elucidates the mechanisms by which flavonoids exert cardioprotective effects through their antioxidant, prebiotic, and mitochondrial restorative properties. Flavonoids function as hydrogen donors, scavenging free radicals such as nitric oxide (NO^•), superoxide anions (O^•), and hydroxyl radicals (OH^•), thereby reducing oxidative stress by decreasing inducible nitric oxide synthase (iNOS) and reactive oxygen species (ROS) activity while enhancing endothelial nitric oxide synthase (eNOS) functionality to promote vasodilation and prevent hypertension. Additionally, flavonoids act as prebiotics, fostering the symbiotic gut microbiota (GM), including Bifidobacteria and Lactobacillus, which produce short-chain fatty acids (SCFAs) and suppress pathogenic trimethylamine-N-oxide (TMAO)-producing bacteria. This enhances gut epithelial barrier integrity, reduces inflammation mediated by lipopolysaccharide (LPS), and protects against heart failure, ischaemia, and atherosclerosis. Under ischemic and heart failure conditions, flavonoids inhibit apoptosis, necrosis, ferroptosis, and fibrosis by restoring hypoxia-damaged mitochondrial function and cardiac energy metabolism. Furthermore, flavonoids prevent arteriosclerosis by inhibiting low-density lipoprotein (LDL) oxidation, reducing cholesterol absorption, promoting bile salt-hydrolysing bacteria, and decreasing vascular cell adhesion molecule (VCAM)-1 expression on coronary vessels. Here, we aim to advance the understanding of flavonoid-mediated cardioprotection by considering their antioxidant, anti-inflammatory, and gut microbiome-modulating effects, offering novel insights into dietary interventions for CVD prevention and management. The findings underscore the potential of flavonoids as accessible, natural agents to address global health disparities in CVD burden.

Low and no-sugar sweeteners (LCNS) are used in the food supply, notably within the beverage industry in many countries, where sugar reduction is a key public health concern. In the UK, following the announcement and implementation of the Soft Drinks Industry Levy (SDIL), nearly 9 out of 10 soft drinks contain < 5 g sugar per 100 mL, most of which now contain LNCS. In 2023, the World Health Organisation (WHO) issued a guideline with a conditional recommendation advising that LNCS should not be used as 'a means of achieving weight control or reducing the risk of non-communicable disease' (NCDs). This recommendation potentially conflicted with existing recommendations from several authoritative sources at the time, including the Diabetes UK position statement published in 2018 (developed in collaboration with the British Dietetic Association, BDA and the British Nutrition Foundation, BNF), as well as information on the NHS website, which suggests that LCNS can be helpful in reducing sugar intake. More recently, a working group comprising the BDA, BNF and Diabetes UK produced an updated insight document. This review included a re-evaluation of the WHO's systematic review and meta-analysis, alongside the Scientific Advisory Committee on Nutrition (SACN) statement on the guideline. The narrative review outlines the relationship between LNCS and a range of public health outcomes, including weight management, dental health, cardiovascular disease, type 2 diabetes (T2D), cancer and related risk markers such as appetite and gut microbiome composition. The insights document also considered the safety of LNCS and their impact on overall dietary quality. The insight document informed a subsequent joint position statement from the three organisations, highlighting research gaps and providing practical guidance for healthcare professionals to support individuals living with obesity and diabetes in reducing sugar intake. It also includes recommendations for policymakers and identifies actions for the food industry. The Position Statement emphasises that, while LNCS may not directly promote weight loss or reduce disease risk, they can serve as a useful tool for reducing sugar intake at both individual and population levels, at least acting as a 'stepping stone' from sugar-sweetened foods and unsweetened food and beverages.

Rising interest in the links between processed food consumption and poor health outcomes often overlooks the perspectives of those working in food technology and innovation. To address this, a virtual roundtable was held in October 2024 to provide a setting for a technical discussion among those working in food processing, technology and engineering and related fields. The aims were to explore whether (a) the concept of ultra-processed foods (UPF) as a whole (or any elements thereof) may be useful to consider in the development of healthier and more sustainable foods, including its strengths, opportunities, weaknesses and barriers; and (b) where there might be opportunities for food technologists to improve current approaches to food processing for human health in the future. Presentations focussed on reformulation and included a critique of the evidence and proposed mechanisms linking UPF consumption to food intake and health. Areas of discussion included use and replacement of ingredients deemed to be 'UPF'; material properties of foods; advances in food production; consumer communication; practicalities of consuming a healthy, sustainable diet; food systems considerations; environmental sustainability in food processing and the role of meat alternatives. Looking ahead, participants identified opportunities for improvements centred around four themes: target areas and considerations for innovation and reformulation that can be suggested based on current or future capability; potential definitions/targets that industry can work towards to improve the healthiness of products and related evidence needs; greater transdisciplinary working (cross-sector, food systems approaches); consumer-related issues and potential policy/regulatory changes. Caution was expressed around both 'overprocessing' and misplaced reformulation efforts to the detriment of health. However, a potential role for consumer education around food processing techniques and ingredients was identified and the importance of continued advancements in food processing and technology in the production of healthier, sustainable food was highlighted.

Brain development is an ongoing process that occurs throughout the first 1000 days of life (conception until 2 years) and proceeds throughout childhood, adolescence and up until early adulthood. Adequate nutrient intakes are crucial for both neurodevelopment inside the womb and critical life-stages thereafter when the brain continues to grow and develop. This review critically summarises the current evidence for eggs and nutrients found in eggs in relation to their potential to support brain development and function. Twenty-one key publications, including a mixture of meta-analyses, systematic reviews, randomised controlled trials (RCTs), clinical trials and observational studies, were identified, focusing on eggs or nutrients found in eggs that could influence brain development and function. Findings suggest that the consumption of eggs or nutrients found in eggs could have potential benefits for aspects of neurodevelopment, certain markers of motor development and academic performance. Eggs are high in protein, monounsaturated fatty acids, riboflavin, vitamin B12, vitamin D, biotin, iodine, selenium and a source of vitamin A, folate, pantothenic acid and phosphorus. They also provide an array of nutrients and bioactive components, including docosahexaenoic acid, choline, lutein and zeaxanthin that have potential to reinforce brain growth and development. Given the nutrient-dense profile of eggs, consumption could be encouraged across life-stages that are physiologically demanding from a brain development, growth and function stance. This includes amongst women of childbearing age, infancy, childhood and adolescence. However, the extent to which egg intake can influence specific markers of brain/cognitive function requires further investigation.

Pulses offer significant nutritional and environmental benefits and are useful components of healthier, more sustainable diets and global food security. However, their consumption in France remains low and below the world average. Farmers face economic and technical challenges in diversifying crops, and current domestic production is insufficient to meet this low demand, resulting in continued reliance on imports. Production and consumption are closely linked: low consumer demands limit incentives for farmers to expand cultivation, while limited availability can also constrain uptake. One of the major barriers to consumption relates to preparation and processing. While consumers generally view raw or minimally processed pulses positively, they often avoid using them because they perceive them as time-consuming to prepare or associate them with undesirable sensory attributes (e.g., bitterness and astringency). It also might be difficult for consumers to categorize pulses according to their level of processing. Although pulse processing makes them more convenient for users, former studies suggest that consumers are suspicious about the processing of pulses, and that they may even confuse processing with ultra-processing. This suspicion could sometimes lead to rejection by consumers. The process should thus remain moderate. Encouraging the use of minimally processed pulses, which balance convenience and acceptance, is crucial for wider adoption. The aim of the PULSE FICTION project is to develop minimally processed pulse products with pulses as the main ingredient that align with consumer preferences, farmer constraints and sustainability goals. A key innovation will be the selection of intermediate food products (IFPs) on the basis of consumer and farmer input and chef-developed easy-to-make recipes. These products will be evaluated for their nutritional and sensory qualities, satiety, consumer acceptance and environmental impact. Beyond product development, PULSE FICTION explores the cognitive and sensory factors influencing consumer acceptability and designs effective communication strategies for all stakeholders to facilitate consumer adoption of pulse-based foods.

This study investigates the relationship between climate change awareness, sustainable nutrition behaviours, and the acceptability of alternative protein sources among Generation Z university students. This cross-sectional study employed a mixed-methods approach, combining structured quantitative measures and open-ended qualitative questions in a digital survey. A total of 785 university students aged 18-29 from Türkiye participated in the study. The survey included the Behavioural Scale for Sustainable Nutrition, the Global Climate Change Awareness Scale, and the Attitudes Toward Alternative Protein Sources Questionnaire. Descriptive statistics, independent t-tests, one-way ANOVA, post hoc Tukey HSD tests, and correlation analyses (Pearson/Spearman) were conducted to examine the associations between climate change awareness, sustainable nutrition behaviours, and the acceptability of alternative protein sources, including edible mushrooms, algae, flowers, grasshoppers, crickets, and cultured meat. A statistically significant but moderate positive relationship was observed between climate change awareness and sustainable nutrition behaviours, particularly in food purchasing habits. A weaker but positive association was found for food preference, food waste reduction, and seasonal and local dietary practices. Participants reported low familiarity with alternative protein sources, with the highest acceptability for edible mushrooms (74.5%), followed by edible flowers (37.8%) and cultured meat (14.4%). While greater climate change awareness was linked to a higher willingness to consume certain alternative protein sources, this did not consistently translate into broader acceptance. These findings highlight the need for targeted awareness campaigns and educational initiatives to overcome cultural barriers and food neophobia, fostering a greater acceptance of sustainable protein sources.

The double burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same population or individual, is a growing concern in low- and middle-income countries (LMICs) such as Nepal. Identifying malnutrition in schools supports targeted interventions. This study estimates the prevalence of stunting, underweight, overweight and obesity among Nepalese schoolchildren and examines the coexistence of stunting and overweight. We conducted a cross-sectional study of 11 782 students aged 6-18 years from 111 randomly selected schools in Kaski, Nepal. Sociodemographic data were collected via questionnaire, and trained researchers measured height and weight. Malnutrition was classified using the World Health Organization (WHO) growth standards, and chi-square tests were used for statistical comparisons. The prevalence of stunting, underweight, overweight and obesity was 15.8%, 6.1%, 10.7% and 3.3%, respectively, while 1.0% of students were both stunted and overweight/obese. Stunting was more common in rural schools (20.5% vs. 15.1%, p < 0.001), whereas overweight (11.2% vs. 7.1%, p < 0.001) and obesity (3.6% vs. 1.5%, p < 0.001) were more common in urban schools. Public school students were more often stunted (18.2% vs. 13.2%, p < 0.004) and underweight (6.7% vs. 5.4%, p < 0.001), whereas private school students were more often overweight (13.3% vs. 8.2%, p < 0.001) and obese (5.0% vs. 1.7%, p < 0.001). The DBM occurs at both school and individual levels, including within the same school, with undernutrition more common in rural and public schools and overnutrition in urban and private schools. Tailored school-based nutrition programmes are urgently needed.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Women with GDM have an increased risk of adverse outcomes during pregnancy and delivery. Although diet and physical activity play a crucial role for pregnant women in the management of GDM, studies on dietary quality and physical activity in these individuals prior to diagnosis remain limited. Therefore, the purpose of our study is to evaluate the association between the women dietary diversity score (WDDS) and the level of physical activity assessed by the International Physical Activity Questionnaire (IPAQ) during pregnancy with the incidence of GDM. A total of 390 pregnant women were recruited, including 209 with GDM and 181 without GDM. Anthropometric and medical data were collected and WDDS was assessed using a 24-h recall method. Our results showed that high pre-pregnancy BMI, physical inactivity, a personal history of GDM, polycystic ovary syndrome and previous spontaneous abortion were positively associated with GDM. Additionally, our results showed that diets rich in total carbohydrate (excluding fibre), fat, starchy staples, dairy products or eggs as well as diets poor in legumes, nuts and seeds were positively associated with GDM. Interestingly, a significantly higher WDDS, a low IPAQ score and energy intake were positively associated with GDM. A more diversified diet and physical inactivity may be risk factors for GDM. These findings highlight the importance of women's dietary diversity and physical activity as potential modifiable factors for the prevention of GDM.