BMJ Nutrition, Prevention & Health

Vitamin D is essential for bone and metabolic health. Deficiency remains a global health issue, particularly among older adults and ethnic minorities with darker skin pigmentation. Data on circannual variation these groups remain sparse. This study reports vitamin D status in older adults ([&ge;]65 years) and ethnic adults ([&ge;]18 years, Fitzpatrick classes IV-VI) in northern Britain during the screening phase of a supplementation trial. Participants were screened for inclusion between December 2024 and August 2025. Serum 25-hydroxyvitamin D (25(OH)D) was assessed in dried blood spots followed by LC-MS/MS analysis. 299 participants were screened. Vitamin D insufficiency or deficiency (<50 nmol/L) was noted in 54.8% of older adults and 72.1% of ethnic individuals. These rates did not decline during summer months. These findings highlight persistently high rates of vitamin D insufficiency across high-risk groups in northern Britain and underscore the inadequacy of sunlight exposure as a corrective measure.

ObjectivesTo construct a diet-score measuring the level of adherence to the Healthy Reference Diet (HRD), to explore whether adherence to the HRD is associated with coronary heart disease (CHD), all-cause mortality risk, and to calculate its environmental impact. DesignProspective cohort study. SettingThe Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL). Participants37,349 adults (20-70y) without CHD at baseline. Main outcome measuresPrimary outcomes were incident CHD and all-cause mortality. Secondary outcomes were greenhouse gas emission (GHGE), land use, blue water use, freshwater eutrophication, marine eutrophication, and terrestrial acidification. ResultsDuring a median 15.3-year follow-up, 2,543 cases of CHD occurred, and 5,648 individuals died from all causes. The average HRD-score was 73 (SD=10). High adherence to the HRD was associated with a 15% lower risk of CHD (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96), as well as a 17% lower risk of all-cause mortality (hazard ratio 0.83, 95% confidence interval 0.77 to 0.90) in multivariable-adjusted models. Better adherence to the HRD was associated with lower environmental impact from GHGE ({beta}= -0.10 kg CO2-eq, 95% confidence interval -0.13 to -0.07), land use ({beta}= -0.11 m2 per year, 95% confidence interval -0.12 to -0.09), freshwater eutrophication ({beta}= -0.000002 kg P-eq, 95% confidence interval -0.000004 to -0.000001), marine eutrophication ({beta}= -0.00035 kg N-eq, 95% confidence interval -0.00042 to -0.00029), and terrestrial acidification ({beta} = -0.004 kg SO2-eq, 95% confidence interval -0.004 to -0.003), but with higher environmental impact from blue water use ({beta}=0.044 m3, 95% confidence interval 0.043 to 0.045). ConclusionHigh adherence to the HRD was associated with lower risk of CHD and all-cause mortality. Additionally, increasing adherence to the HRD could lower some aspects of the environmental impact of diets, but attention is needed for the associated increase in blue water use.

ObjectiveMonitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-hour salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-08 to 2017-19, and to describe variations by sex, age, and educational level. DesignRepeated cross-sectional studies. SettingThe population-based HUNT Study. ParticipantsIn each of two consecutive waves (HUNT3: 2006-08 and HUNT4: 2017-19), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of sodium, potassium and creatinine, age, sex, and body mass index, we estimated 24-hour sodium intake using the INTERSALT equation for the Northern European region. ResultsMean (95% confidence interval (CI)) estimated 24-hour salt intakes in men were 11.1 (95% CI 10.8, 11.3) g in HUNT3 and 10.9 (95% CI 10.6, 11.1) g in HUNT4, p=0.25. Corresponding values in women were 7.7 (95% CI 7.5, 7.9) g and 7.7 (95% CI 7.5, 7.9) g, p=0.88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. ConclusionsEstimated 24-hour salt intake in adult men and women in mid-Norway did not change from 2006-08 to 2017-19.

BackgroundOlder adults and those with underlying health conditions were advised to stay at home to help reduce the spread of COVID-19 however little advice on regular physical activity was given to those at risk. We modelled the effects of enforced inactivity on diabetes burden using published evidence. MethodsUsing Health Survey for England data, we estimated the prevalence of pre-diabetes and physical activity in adults aged 70 and older. The number of new diabetes cases directly attributed to lockdown were calculated using population attributable risk. Unit cost estimates of the additional burden on primary care and the cost of complications to secondary care were taken from the literature. ResultsFrom 9 million older ([&ge;]70yrs) people living in England, 2.1 million could be defined as pre-diabetic (glycated haemoglobin 42<48 mmol/mol). The estimated population attributable fraction (0.281) (assuming relative risk of diabetes from inactivity=3.3, 40% physically active) would give rise to 392,948 new cases of diabetes which we argue are directly attributed to a prolonged period of lockdown. We estimate that the cost of screening and testing these patients in primary care ({pound}35m), their subsequent treatment and management ({pound}229m), and complications ({pound}909m) would equate to an additional {pound}1.17bn to the health care system. ConclusionsInactivity related to lockdown in previously active older adults may contribute up to {pound}1.17b in additional healthcare costs through a potential increase in diabetes. Clear advice about the importance of physical activity may reduce this potential economic burden during global pandemics.

ObjectivesTo investigate how the relationship between vitamin D and COVID-19 has been presented in traditional media sources (UK newspapers) and assess the level of misinformation associated with this issue by comparing newspaper article content to the evidence-based guidelines. DesignQualitative study SettingData were collected over the first year of the pandemic (February 2019-20), from the five most widely read UK based newspapers by searching the Nexis database using keywords "vitamin D" and "COVID". An inductive thematic analysis was carried out on the data to identify themes and subthemes. Quality control of the coding was conducted on a sample of the dataset (20%). Data were also compared to the "ground truth" identified as the NICE report titled "COVID-19 rapid guideline: vitamin D" to explore the accuracy of media outputs. ResultsThe four main themes identified were association of vitamin D with COVID-19, politically informed views, vitamin D deficiency and vitamin D sources. When compared to the ground truth, most of the information from newspaper articles relating to the key findings was correct for each of the findings, except for COVID-19 infection. ConclusionsAlthough most of the information included in newspaper articles concerning the relationship of vitamin D with COVID-19 was correct, this study highlighted that there was still a notable amount of incorrect information published. In the context of COVID-19, it is imperative that media outputs are accurate and inform the public and front-line health professionals as correct information is a key factor in disease prevention. Future research should focus on the accuracy of media outputs to further investigate health misinformation as an issue in traditional media and how that may affect public health. Attempts should be made to improve journalistic integrity through more rigorous and standardised regulations enforced across all media outlets so that public knowledge on current events is based on evidence rather than conjecture. Summary boxes O_TBL View this table: org.highwire.dtl.DTLVardef@1b38ed1org.highwire.dtl.DTLVardef@16576aforg.highwire.dtl.DTLVardef@52e415org.highwire.dtl.DTLVardef@1fc2d3aorg.highwire.dtl.DTLVardef@fd3de7_HPS_FORMAT_FIGEXP M_TBL C_TBL Data sharing statementWe are happy to share any data if/when asked.

Background: Sugar sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and fruit and vegetable juices are consumed worldwide, yet their associations with cancer remain unclear. Methods: Within World Cancer Research Fund International's Global Cancer Update Programme (CUP Global), we conducted a systematic review by searching PubMed and Embase until September 2024 for cohort studies of SSBs, ASBs, and juices and cancer risk. Meta-analyses were conducted to calculate the relative risks (RRs) and 95% CIs per 1 serving/day (355 mL for SSBs/ASBs; 177 mL for juices). Evidence was graded by the CUP Global Expert Panel. The CUP Global standard protocol was registered at: https://osf.io/7utbm/. Findings: We identified 158 publications from 51 cohorts. Evidence supported a judgment of a probable causal association of SSBs, including carbonated SSBs, with pancreatic cancer incidence (RR 1.09 [95% CI 1.01-1.16]; I2=8%, n=18 studies), and of SSBs with colorectal cancer incidence (RR 1.07 [95% CI 1.00-1.14]; I2=41%, n=13). Limited suggestive evidence supported positive associations of SSBs with ovarian (RR 1.61 [95%CI 1.03-2.53]; I2=0%, n=2), endometrial (RR 1.21 [95%CI 1.03-1.42]; I2=0%, n=3), and postmenopausal breast cancer (RR 1.05 [95%CI 1.00-1.10] ; I2=0%, n=6), and of carbonated ASBs with leukaemia (RR 1.29 [95%CI 1.01-1.64]; I2=0%, n=2). Evidence supported a judgment of a probable causal association of orange juice with melanoma (RR 1.21 [95%CI 1.08-1.34]; I2=0%, n=4), and skin basal (RR 1.12 [95%CI 1.06-1.17]; I2=46%, n=2) and squamous cell carcinoma (RR 1.13 [95%CI 1.04-1.24]; I2=0%, n=2). An interactive evidence platform is available at: Soft Drinks and Cancer Risk - CUP Global Evidence Platform. Interpretation: This review provides evidence supporting probable causal associations of SSBs with pancreatic and colorectal cancers, and of orange juice with skin cancers, with additional suggestive evidence for SSBs with other obesity-related cancers, extending concerns about sugary drink consumption beyond cardiometabolic health to cancer risk. Funding: World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).

BackgroundThe role of nutritional status and risk for contracting and/or suffering adverse outcomes from SARS-CoV-2 infection is unclear. Preliminary studies suggest that higher n-3 PUFA intakes may be protective. ObjectivesThe purpose of this study was to compare risk for three COVID-19 outcomes (testing positive for SARS-CoV-2, hospitalization, and death) as a function of baseline plasma DHA levels. MethodsDHA levels (% of total fatty acids) were measured by nuclear magnetic resonance. The three outcomes and relevant covariates were available for 110,584 subjects (hospitalization and death) and for 26,595 ever-tested subjects (positive for SARS-CoV-2) in the UK Biobank prospective cohort study. Outcome data between January 1, 2020 and March 23, 2021 were included. Omega-3 Index (red blood cell EPA+DHA%) values across DHA% quintiles were estimated. Multi-variable Cox-proportional hazards models were constructed and linear (per 1-SD) relations with risk for each outcome were computed as hazard ratios (HRs). ResultsIn the fully adjusted models, comparing the fifth to the first DHA% quintiles, the HR for testing positive (95% CI) was 0.79 (0.71, 0.89; p<0.001), for being hospitalized was 0.74 (0.58, 0.94; P<0.05), and for dying with COVID-19 was 1.04 (0.69, 1.57; NS). On a per 1-SD increase in DHA% basis, the HRs were: for testing positive, 0.92 (0.89,0.96; p<0.001); for hospitalization, 0.89 (0.83, 0.97; p<0.01); and for death, 0.95 (0.83,1.09). Estimated Omega-3 Index values across DHA quintiles ranged from 3.5% (quintile 1) to 8% (quintile 5). ConclusionsThese findings suggest that nutritional strategies to increase circulating n-3 PUFA levels, such as increased consumption of oily fish and/or use of n-3 fatty acid supplements, may reduce risk for adverse COVID-19 outcomes.

Background & AimsCirculating proteins are integral to many biological processes and could be influenced by diet. We aimed to assess differences in the plasma proteome between people of different dietary groups, defined by degree of animal food consumption. MethodsThe UK Biobank recruited middle-aged adults (mostly 40 to 69 years) throughout the UK between 2006-2010. Relative concentrations of 2920 plasma proteins were quantified using the Olink Proximity Extension Assay on blood samples from 49,615 participants, who were also asked to report their ethnicity and consumption of red and processed meat, poultry, fish, dairy and eggs. We defined six diet groups among the white British participants (23,243 regular meat eaters, 23,472 low meat eaters, 486 poultry eaters, 1081 fish eaters, 721 vegetarians, and 54 vegans), and two diet groups among the British Indians (391 meat eaters and 167 vegetarians). We used multivariable-adjusted linear regressions to assess the cross-sectional differences in protein concentrations between diet groups, with correction for multiple testing. ResultsWe observed significant differences in many plasma proteins by diet group (920 proteins in white British participants, 2 in British Indians). Of the biggest differences, compared with regular meat eaters, the non-meat eaters had significantly higher FGF21 (e.g. +0.40 SD in vegetarians), CKB (+0.34), GUCA2A (+0.33), FOLR1 (+0.32), IGFBP2 (+0.31) and DSG2 (+0.30); all groups except the vegans had lower HAVCR1 (-0.38 in vegetarians). Vegetarians also had significantly lower SELENOP (-0.46), while the vegans had lower FGFBP2 (-0.68). The observed differences were generally similar in direction in both ethnicities. ConclusionsIn this first comprehensive assessment of plasma proteins by diet group, we identified many differences in proteins between vegetarians, vegans and meat eaters; this variation in protein levels suggests differences in various biological activities, including gastrointestinal tract and kidney function, which may relate to differences in future disease risk.

ObjectiveWe assessed dietary patterns (DPs) using the pre-defined Dietary Approaches to Stop Hypertension (DASH) score and reduced rank regression (RRR) to evaluate their association with estimated glomerular filtration rate (eGFR) in a general population sample. MethodsWe analysed cross-sectional data from 6,133 healthy adult participants of the Cooperative Health Research In South Tyrol (CHRIS) study. Using self-reported food frequency questionnaire data, we derived the DASH-score and two RRR-based sex-specific DP-scores based on nine cardio-renal-metabolic parameters. We fitted sex-stratified linear and non-linear models to assess associations with creatininebased eGFR. ResultsMales with higher intake of cereals, whole grains, sugar, fruits, and legumes, and lower intake of beer, and red and processed meat (MDP1), exhibited higher eGFR levels. Coherently, high adherence to the DASH-style diet was associated with higher eGFR. In females, the associations varied by menstrual status. Among those with ceased menstruation, a low intake of meat, spirits, refined grains, beer, and fish, and a high intake of whole grains and dairy products was associated with higher eGFR. In females still experiencing regular menstruation, a high intake of beef, nuts, beer, legumes, fish, and coffee, and low intake of refined grains, (FDP2) was associated with lower eGFR. No association was observed with the DASH score in females. ConclusionOur findings confirm the DASH-style diet is associated with better kidney function in males, but not in females. By identifying sex-specific kidney function-oriented DPs, the RRR approach provides new insights into the diet-eGFR relation, highlighting in addition potential effect modification by menstrual status.

PurposeAdequate hydration is vital for health, yet many people do not meet fluid recommendations. This study aimed to characterise the role of water and sugar-sweetened beverages in hydration across different levels of socioeconomic status (SES) in the UK. MethodsIn a pre-registered cross-sectional study, participants (N = 1,112) recalled beverages consumed on the previous day and reported urine colour as an indicator of their hydration status. We analysed water intake (H1), sugar-sweetened beverage (SSB) intake (H2), and SES (education; H3) as predictors of hydration status using stepwise binomial logistic regression adjusted for health, demographic, and lifestyle covariates. ResultsForty percent of participants were classified as underhydrated. Higher water intake was associated with a greater likelihood of adequate hydration: Drinking one extra glass of water per day (250 ml) increased the odds of being adequately hydrated by about 16%. However, SSB intake was not associated with hydration unless intake from other drink sources was held constant. Having a higher versus lower level of education was not significantly associated with hydration status, although finer-grained and income-based analyses suggested modest socioeconomic differences. ConclusionWater intake--rather than SSB intake--is the primary correlate of adequate hydration in this UK sample. Public health initiatives should emphasise the importance of water for hydration, invest in ways to make water more appealing, and promote the use of urine colour as a marker of hydration status.

1.Traditional nutrition science often proceeds under the assumption of a universal metabolic return to healthy eating, yet social environments may fundamentally modify these biological associations. This investigation utilized survey-weighted data from the National Health and Nutrition Examination Survey (NHANES 2017-2023) representing a weighted population of 286 million adults aged 20 years and older to test for association heterogeneity in the dietglycemia relationship. Dietary exposure was operationalized as energy-adjusted nutrient density scores derived via the residual method to measure the healthfulness of intake independent of total caloric volume. The primary outcome was HPLC-measured glycated hemoglobin (HbA1c) modeled as a continuous variable. Multivariable interaction models evaluated the Income-to-Poverty Ratio (PIR) as a formal effect modifier, adjusting for age, sex, race/ethnicity, body mass index, and smoking status. Analysis demonstrated that while quality-weighted nutrient intake levels remained statistically uniform across income tiers (p=0.207), multivariable interaction models identified significant modification of the diet-HbA1c association by socioeconomic position (p=0.028 for interaction). In the low-income reference group, higher quality nutrient intake was associated with a significant protective decline in HbA1c ({beta}=-6.11x10-5 percentage points per kilocalorie, p=0.017). Conversely, this protective association was attenuated to non-significance for the middle-income stratum ({beta}=3.31x10-6, p=0.849). Sensitivity analysis restricted to participants without clinical diabetes showed the interaction was non-significant (p=0.859), identifying an observed boundary condition where differential associations are most evident in pathological states. These findings suggest association heterogeneity where identical dietary behaviors relate to divergent glycemic patterning across socioeconomic groups. Socioeconomic position appears to function as an effect modifier of the diet-HbA1c relationship rather than a mere confounder. Such patterns suggest that the metabolic correlates of healthy eating are socially patterned, potentially due to structural factors that constrain the associations expected from improved nutrition.

Introduction People with severe mental illness (SMI) and learning disabilities (LD) experience significant health inequalities, with diet-related conditions contributing substantially to early and preventable death. Despite high levels of nutritional risk, the presence and effectiveness of nutritional screening in mental health (MH) and LD settings remains under-researched. This study aimed to investigate nutritional screening practices in UK inpatient MH and LD services from the perspectives of dietitians. Methods A cross-sectional mixed-methods study was conducted using a novel 22-question online survey. Data was collected via the British Dietetic Association Mental Health Specialist Group (April-June 2025). Quantitative data was analysed descriptively and qualitative data by reflexive thematic analysis. Findings were integrated and presented thematically. Ethical approval was granted by Teesside University (2025Mar26544). Results Forty-seven dietitians participated, most with substantial dietetic experience, from a range of MH settings. Screening practices were widely established and supported by policy and audit. However, participants reported low confidence in screening translating into meaningful patient care. Barriers to screening included appropriateness of available tools, time constraints, difficulty engaging distressed patients and poor prioritisation of physical health. Digital integration and wider infrastructure were also important. Dietitians rarely undertook screening directly, instead holding secondary or leadership roles, while screening was most often completed by nursing staff who were often perceived to place limited importance on the process. Existing tools, particularly the Malnutrition Universal Screening Tool (MUST), were viewed as insufficiently capturing the broader nutritional risks relevant to MH/LD populations, leading some services to adopt bespoke, unvalidated tools. Conclusion Concerns regarding the suitability of existing nutritional screening tools in MH/LD settings are consistent with previous literature. However, we suggest cautious use of unvalidated bespoke tools. Whilst there was no clear front runner, MH specific tools such as the St Andrews Nutrition Screening Instrument (SANSI) and the NutriMental Screener warrant further evaluation. Importantly, findings indicate that optimising tool choice alone is unlikely to improve screening effectiveness. Nutritional screening must be embedded within clear care pathways, supported by organisational leadership, digital infrastructure, and multiprofessional engagement to move beyond procedural completion and support meaningful clinical action to improve patient care.

In the UK, black African-Caribbeans (ACs) and South Asians (SAs) have 3-6 times greater risks of developing diabetes than white Caucasians do. East London is among the areas with the highest prevalence of type 2 diabetes and the highest proportion of minority groups. This ethnic health inequality is ascribed to socioeconomic standing, dietary habits, culture, and attitudes, while biological diversity has rarely been investigated. The evidence shows that the postprandial glucose peak values in SAs are 2-3 times greater than those in white Caucasians after the same carbohydrate loads; however, the mechanism is poorly understood. In the UK, 50% of SAs and 33% of ACs have vitamin D (vitD) deficiency, whereas 18% of white Caucasians have vitamin D deficiency. There is evidence that vitD status is inversely associated with insulin resistance in healthy adults and diabetic patients and that vitD supplementation may help improve glycaemic control and insulin resistance in type 2 diabetes patients. However, little evidence is available on minority groups or East London. This study will investigate the postprandial glycaemic response (PGR) in three ethnic groups (white Caucasians, SAs and ACs) in East London and link PGR to plasma 25(OH)D (an indicator of vitD status). Ninety-six healthy adults (n=32 per group) will be recruited. Two test drinks will be provided to the participants (300 ml of glucose drink containing 75 g glucose, and 300 ml of pure orange juice) on different occasions. PGR is monitored before and after drinking every 30 min for up to 2 hours via finger prick. A fasting blood sample obtained via phlebotomy will be used for 25(OH)D and relevant tests. A knowledge/perception questionnaire about vitD and a 4-day food diary (analysing vitD dietary intake) will also be collected. The findings of the study will be shared with participants, published in journals, disseminated via social media, and used to inform a randomized controlled trial of the effects of vitD supplementation on PGR in minority groups. The study complies with the Helsinki Declaration II and was approved by the Senate Research Ethics Committee at City, University of London (ETH2223-2000). The study findings will be published in open access peer-reviewed journals and disseminated at national and international conferences. ClinicalTrials.gov Identifier: NCT06241976

BackgroundOne of the key assumptions underlying causal inference is the assumption of consistency; that is, the absence of relevant multiple versions of the same treatment. Although ultra-processed food (UPF) as a dietary construct has been associated with a greater risk of type 2 diabetes (T2D), subtypes of UPFs may exert different strengths and directions of associations on T2D. The main objective of this study was to systematically evaluate the current literature on subtypes of UPFs and their associations with T2D and to contextualize these findings within the framework of counterfactual theory, with particular emphasis on the consistency assumption. MethodsWe searched PubMed and Embase for relevant articles. Cohort studies of adult men and women without T2D and with the exposure (subtypes of UPFs) and outcome (incident T2D) of interest were included. Two independent researchers screened the articles and evaluated risk of bias using the ROBINS-E tool. UPFs were categorized into eight subtypes. No meta-analyses were conducted. A post-hoc analysis of n=52,201 in the Danish Diet, Cancer and Health (DCH) cohort was performed to illustrate the implications of causal inconsistency. We formed a fictive food group (the terrible five) combining sugar sweetened beverages, processed meat, red meat, refined grains and vegetables and investigated the associations with T2D. ResultsOut of n=222 articles screened for eligibility, n=6 cohort studies with n=635,332 participants (average follow-up of 6-26.1 years) were finally included. Most studies on UPF breads and cereals; packaged snacks; and sauces, spreads and condiments showed no associations with T2D. Most studies on UPF ready-to-eat-dishes; meat-based products; and artificially and sugar-sweetened beverages were positively associated with T2D. UPF dairy products; and sweets, snacks and confectionaries were generally inversely associated with T2D, although with some variation. Overall risk of bias was considered moderate to high in all included studies. In the DCH cohort, a positive association between the "terrible five" and T2D was observed (HR: 1.14, 95% CI: 1.05, 1.23). Intake of vegetables was inversely associated with T2D (HR: 0.96, 95% CI: 0.95, 0.98). ConclusionThe systematic review showed different strengths and directions of associations on the risk of T2D across the different subtypes of UPFs. Aggregating these sources into a coarse food category such as UPF therefore violates the assumption of causal consistency and, as illustrated in our post hoc analysis, can mask individual associations. This study illustrates potential unintended consequences of broad implementation of UPF-related policies without further improvement of the definition or mechanistic understanding. RegistrationThe protocol was registered in PROSPERO (ID: CRD420251058458).

Plant-based diets have grown in popularity in recent years, in part because of the perceived health benefits; higher consumption of vegetables and other healthy foods is associated with better nutrition and reduced risk of disease. In this study, we estimate the potential impact of higher uptake of a 100% plant-based (vegan) diet in England from the perspective of the National Health Service (NHS). We estimate the impact in terms of quality-adjusted life years (QALYs), health care expenditure, and total net benefit compared to the current level of uptake. This model-based analysis combines estimates for disease prevalence, the relative risk of disease associated with a vegan diet, and disease-specific health state utility values (HSUVs) and health care costs. We conducted a literature review to identify the most suitable inputs to the model, which included estimates for cancer, coronary heart disease, cataracts, diverticular disease, bone fractures, stroke, and type 2 diabetes. The model is open-source and implemented in an interactive online dashboard, allowing for further extension and exploration of the findings. In our base case analysis with 100% adoption of a plant-based diet in England, the total health care cost savings across all considered diseases is around {pound}6.7 billion per year, with 172,735 additional QALYs, and a total net benefit to the NHS of around {pound}18.8 billion when QALYs are valued at {pound}70,000. The majority of potential savings are realised through the avoidance of almost 1.3 million cases of type 2 diabetes. Numerous challenges are associated with estimating the impact of widespread dietary changes in society. However, strong evidence shows that plant-based diets are associated with better health outcomes for some of Englands most significant causes of disease burden. Higher rates of plant-based diet adoption may bring considerable cost savings for the NHS and generate substantial health benefits for the population. Policymakers should consider the relevance of these estimates to their settings and the potential for interventions that support healthy dietary changes that contribute to population health. Future research should seek to identify the causal effects of plant-based diet adoption on health outcomes, and health care resource use across different populations. FundingThis study was funded by a grant from The Vegan Society. Author DeclarationsThe authors are employees of the Office of Health Economics, a registered charity and independent research organisation that receives funding from a variety of sources. Both authors identify as vegan. CS is a member of The Vegan Society.

BackgroundUltra-processed food (UPF) intake has been associated with multiple negative health outcomes. Research investigating UPF intake and cognitive health outcomes has begun. The aim of this review is to summarise the existing evidence of associations between exposure to UPFs, as defined by the NOVA food classification system, and cognitive health outcomes. MethodsWe conducted a systematic search across MEDLINE, PsycINFO, Embase, and APA Psych Articles through OVID, and PubMed for relevant studies up-until October 2024. The Newcastle-Ottawa Scale was used to assess the quality of included studies. A narrative approach was used to summarise and integrate results across studies. ResultsThree hundred and eighty-three articles were screened and five met the inclusion criteria. All studies were published between 2022 and 2024. The association between UPF intake and four different cognitive outcomes (dementia risk, cognitive impairment risk, cognitive performance and cognitive change trajectories) were explored across the studies. Three out of the five included studies found a significant negative main effect of consuming UPF on the cognitive outcome of interest. All studies identified adverse consequences of consumption in either a sub-group of the population or a sub-group of UPF type. ConclusionsDeleterious effects of UPF consumption on multiple cognitive health outcomes were identified across all studies. However, the results suggest the relationship may be specific to sub-groups of the population or sub-groups of UPF type. Conclusions should be drawn with caution due to the limited number of studies available examining UPF intake according to NOVA and its association with cognitive outcomes, as well as the variability in cognitive measures assessed and other methodological differences across studies.

BackgroundRandomized trials have shown that a healthy Nordic diet (HND) improves liver steatosis, but there is limited evidence on the effects of Nordic dietary patterns on the risk of major adverse liver outcomes (MALO). We specified a hypothetical target trial protocol to estimate the effects of adhering to a HND or the Nordic Nutrition Recommendations 2023 (NNR23) on the 24-year risk of MALO in a middle-aged to elderly Swedish population. MethodsTwo pooled population-based cohorts including n=64,406 men and women (Cohort of Swedish Men (COSM) and the Swedish Mammography Cohort (SMC)) with repeated measurements on diet and confounders in 1997, 2008/2009 and 2019 were used to emulate population-adapted versions of the diets. Under the assumptions of no unmeasured confounding, selection bias or measurement error, the parametric g-formula was used to estimate 24-year risks of MALO from each hypothetical intervention. Secondary analyses included comparing the HND and NNR23 with a low-adherence group; reducing alcohol as an additional hypothetical intervention; and assessing risk of all-cause mortality. ResultsThe estimated 24-year risk of MALO in the HND was 0.53% (95% CI: 0.38, 0.73), in the NNR23 diet 0.70% (95% CI: 0.57, 0.90) and in no intervention 0.64% (95% CI: 0.56, 0.77). Estimated risk differences (RDs) of MALO for HND versus no intervention and NNR23 versus no intervention were -0.11% (95% CI: -0.27, 0.07) and 0.06% (95% CI: -0.04, 0.15), respectively. Compared to NNR23, the estimated RD for the HND was -0.17% (95% CI: -0.38, 0.05). Meaningful risk reductions following the HND were estimated when compared to a low-adherence diet group (-1.50% (95% CI: -9.53, -0.05)), when including reducing alcohol, and for all-cause mortality (-2.67% (95% CI: -3.51, -1.85) versus no intervention; -1.68% (95% CI: - 2.75, -0.62) versus NNR23)). ConclusionWe estimated no clear risk reductions from a population-adapted HND or a NNR23 diet on the 24-year risk of MALO when compared to each other or no intervention. However, when either compared to a low-adherence group or when including reducing alcohol as a hypothetical intervention or when specifying all-cause mortality as the outcome, we estimated meaningful risk differences following the HND.

BackgroundPrediabetes affects 34.1% U.S. adults and is primarily linked to added sugars consumed from sugar-sweetened beverages. It is unclear if total dietary intake of added sugar also increases the risk for prediabetes. ObjectiveThis study examined if total (g/day) and percent intakes of <10%, 10-15%, or >15% added sugar increase the odds for prediabetes in U.S. adults. DesignA cross-sectional, secondary analysis using 2013-2018 NHANES data was conducted. Participants/settingThis study included data from U.S. adults [&ge;] 20 years with normoglycemia (N= 2,154) and prediabetes (N= 3,152) with 1-2 days of dietary recall information. Main outcome measuresPrediabetes, defined as a Hemoglobin A1c of 5.7%-6.4% or a fasting plasma glucose of 100-125 mg/dL. Statistical analysisSurvey-weighted logistic regression was used to estimate odds ratios of prediabetes based on usual intakes of added sugar (total and percent intakes) using the National Cancer Institute Method. Differences in prediabetes risk and total and percent intakes of added sugar were compared by race/ethnicity. ResultsThe samples total energy intake from added sugar was 13.9%. Total (unadjusted: OR: 1.01, 95% CI: .99 - 1.00, p = .26; adjusted: OR: 1.00, 95% CI: .99 - 1.00, p = .91) and percent intakes of added sugar (unadjusted [<10%: (ref); 10-15%: OR: .93, 95% CI: .77 - 1.12, p = .44; >15%: OR: 1.03, 95% CI: .82 - 1.28, p = .82] and adjusted [<10%: (ref); 10 - 15%: OR: .82, 95% CI: .65 - 1.04, p = .09; >15%: OR: .96, 95% CI: .74 - 1.24, p = .73]) were not significantly associated with an increased odds of prediabetes. Prediabetes risk did not differ by race/ethnicity for total (unadjusted model [p = .65]; adjusted model [p = .51]) or percent (unadjusted model [p = .21]; adjusted model [p = .11]) added sugar intakes. ConclusionsIn adults [&ge;]20 years with normoglycemia and prediabetes, total added sugar consumption did not significantly increase ones risk for prediabetes and risk estimates did not differ by race/ethnicity. Experimental studies should expand upon this work to confirm these findings.

BackgroundThe surgical stress response is a predictable, physician-managed metabolic state triggered by anesthesia and tissue injury, marked by insulin resistance and hypercatabolism that create unique nutritional needs unmet by standard, pre-surgical fasting diets. We developed a multi-nutrient medical food to support perioperative metabolic homeostasis and piloted its safety/tolerability and exploratory outcomes. MethodsIn a single-center pilot trial (n=67) of adults undergoing elective abdominal, cardiac/thoracic, gynecological, or orthopedic surgery, participants were allocated to medical food or no-treatment control. The product was taken twice preoperatively (evening before and 4 h pre-op) with standard care. Primary safety outcomes were adverse events, postoperative nausea/vomiting (PONV), 30-day readmission, and infections. Exploratory outcomes were fasting glucose, HbA1c, electrolytes, cortisol, pre-operative emotional state, and post-operative pain. ResultsAll participants completed the intervention. No product-attributed adverse events occurred. Gastric clearance was achieved within 2 h in all, and there were no 30-day readmissions or infections. PONV occurred in 30.3% vs 35.3% (risk ratio 0.86, 95% CI 0.43-1.71, p=0.796). Post-operative glycemia favored the intervention; at 48 hr the intervention group showed lower glucose (HL -9 mg/dL, g=0.35, p=0.030), while earlier timepoints were nonsignificant. Post-operative magnesium was numerically lower with intervention (4.76 vs 5.10) without statistical significance; other electrolytes and cortisol showed minimal differences. Post-operative pain was 5.33 vs 5.62 (g=0.19, p=0.43). Positive pre-operative emotion was more frequent with intervention (17/33 vs 9/34; risk ratio 1.95, p=0.046). ConclusionThe medical food was safe and well tolerated without increased PONV or readmissions. Preliminary metabolic and emotional signals justify a larger, adequately powered efficacy trial. Clinical Relevancy StatementThis pilot trial demonstrates that a preoperative multi-nutrient medical food was well tolerated and feasible to administer in a routine clinical setting: all participants achieved gastric clearance within 2 hours of the pre-operative dose, with no increase in PONV and no readmissions. Exploratory findings indicate potential benefits that could nutritionally support recovery if confirmed. These results support the feasibility of administering a targeted nutrition intervention shortly before surgery and justify evaluation in a larger efficacy trial. Clinical Trial RegistrationNCT07359222

ObjectiveRegional Australians have a poorer quality of diet compared to people living in metropolitan areas. Food-related cultural capital is one potential mechanism linking social determinants and nutrition. Relationships between food-related cultural capital and diet were investigated as an explanation for nutritional inequalities in regional New South Wales (NSW). DesignA cross-sectional survey of rural NSW adults was conducted from 12th October 2019 to 31st March 2020 focusing on diet, socio-economic factors and cultural capital. Three dietary outcomes were assessed: fruit consumption, vegetable consumption, and a healthy diet score. Food-related cultural capital was analysed as objectivised and total incorporated cultural capital separately. The survey was distributed online with social media promotion. SettingRegional south-eastern and western NSW Participants448 adults (median age 57 years) of whom 93% were female. ResultsIn unadjusted analysis, both total incorporated and objectivised cultural capital had strong correlations with all three diet outcomes, with low cultural capital associated with poorer nutrition. After adjusting for sociodemographic confounders, low total incorporated cultural capital showed modest associations with low fruit consumption (OR = 1.69, 95%CI = 1.00 - 2.87), low vegetable consumption (OR = 2.94, 95%CI = 1.69 - 5.11) and low diet score (OR = 3.35, 95% CI = 1.59 - 4.71). ConclusionsFood-related cultural capital, particularly incorporated cultural capital, was independently associated with healthy food consumption in regional NSW. This new finding presents potential avenues to improve the diet of rural Australians through diet-related education, promoting food participation and reducing barriers to healthy food access.