The Pacific Islands region is home to a diversity of countries and territories, who are at the forefront of climate change and the triple burden of malnutrition. In recent years there has been increasing interest in schools as a setting for transforming food systems, improving nutrition and health outcomes, increasing educational outcomes, and enhancing livelihoods in the Pacific Islands. This review examines and describes current school food and nutrition initiatives within the literature that aim to promote healthier, sustainable diets within the Pacific Islands region. As there is a paucity of literature in this area of interest in the Pacific Islands, the review focuses on the policy landscape, the provision of food near, and in schools, nutrition education, and future opportunities. The available literature demonstrates that there is broad regional interest and momentum from numerous stakeholders to enhance SFNE in the Pacific Islands, with several opportunities for future activities. While there are frameworks to explore food environments available there is a need for a Pacific Islands school food environment conceptual framework that captures aspects, both within and around schools, that can guide research and assessment for robust comparable data collection. This may in turn support healthier SFNE and ultimately nutritious food choices for children and adolescents.

The current review will examine the field of food intake biomarkers and the potential use of such biomarkers. Biomarkers of food intake have the potential to be objective measures of intake thus addressing some of the limitations associated with self-reported dietary assessment methods. They are typically food-derived biomarkers present in biological samples and distinct from endogenous metabolites. To date, metabolomic profiling has been successful in identifying several putative food intake biomarkers. With respect to food intake biomarkers, there has been a proliferation of publications in this field. However, caution is needed when interpreting these as food intake biomarkers. Many have not been validated thus hampering their use. While much of the focus to date is on discovery of food intake biomarkers there are excellent examples of how to utilise these biomarkers in nutrition research. Applications include but are not limited to: (1) measurement of adherence to diets in intervention studies (2) objectively predicting intake with no reliance on self-reported data and (3) calibrating self-reported data in large epidemiological studies. Examples of these applications will be covered in this review. While significant progress is achieved to date in the food intake biomarkers field there are a number of key challenges that remain. Examples include lack of databases focused on food-derived metabolites thus hindering the discovery of new biomarkers and the need for new statistical approaches to deal with multiple biomarkers for single foods. Addressing these and other key challenges will be key to development of future opportunities.

By involving stakeholders to identify issues, co-design facilitates the creation of solutions aligned with the community’s unique needs and values. However, genuine co-design with consumers across all stages of nutrition intervention research remains uncommon. The aim of this review was to examine notable examples of interventions to improve diets in rural settings that have been co-designed by rural communities. Six studies were identified reporting on community-based and digital interventions to improve diets in rural settings that have been co-designed by rural communities. The level of co-design used varied, with two interventions describing co-design workshops and focus groups over a period of between 6 and 11 months, and others not reporting details on the co-design process. Collectively, most interventions demonstrated positive impacts on dietary markers, including an increase in purchase of fruit and vegetable, an increase in percentage energy from nutrient dense foods and a decrease in intake of high fat meats. While these interventions show promise for improving diets in these under-served communities, it is widely recognised that there is a lack of dietary interventions genuinely co-designed with and for rural communities. Future research should build on these studies to co-design dietary interventions that integrate the benefits of both community-based and digital interventions.

As obesity rates rise globally, addressing modifiable lifestyle factors, such as sleep, presents an opportunity for public health interventions. This review explores the growing evidence linking sleep duration, quality and timing with weight management and dietary behaviours throughout the life course. Observational studies associate short or irregular sleep with increased obesity risk, poor diet quality and metabolic disturbances. Plausible mechanisms include decreased physical activity, heightened hedonic and/or emotional eating, dysregulated appetite signals and circadian misalignment of metabolism, which contribute to a positive energy balance. Unravelling the bidirectional relationship between sleep and weight is challenging; poor sleep exacerbates weight gain, while obesity-related comorbidities such as obstructive sleep apnoea further impair sleep. Despite promising evidence from sleep-restriction studies showing increased energy intake, long-term randomised controlled trials (RCTs) examining interventions designed to improve sleep with weight management as an outcome are lacking. A handful of short-term interventions suggest benefits in reducing energy intake or improving dietary quality, but their effects on weight loss remain inconclusive. This review calls for robust, well-powered RCTs that integrate sleep, diet and physical activity interventions to evaluate the potential of sleep as a core component of obesity prevention and treatment strategies. Currently, there is insufficient evidence to support sleep-focused interventions as a mandatory element in clinical weight-management programmes.

The European Food Safety Authority (EFSA) provides independent scientific advice to EU risk managers on a wide range of food safety issues and communicates on existing and emerging risks in the food chain. This advice helps to protect consumers, animals and the environment. Data are essential to EFSA’s scientific assessments. EFSA collects data from various sources including scientific literature, biological and chemical monitoring programmes, as well as food consumption and composition databases. EFSA also assesses data from authorisation dossiers for regulated products submitted by the industry. To continue delivering the highest value for society, EFSA keeps abreast of new scientific, technological and societal developments. EFSA also engages in partnerships as an essential means to address the growing complexity in science and society and to better connect and integrate knowledge, data and expertise across sectors. This paper provides insights into EFSA’s data-related activities and future perspectives in the following key areas of EFSA’s 2027 strategy: one substance-one assessment, combined exposure to multiple chemicals, environmental risk assessment, new approach methodologies, antimicrobial resistance and risk–benefit assessment. EFSA’s initiatives to integrate societal insights in its risk communication are also described.

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.

This review aims to highlight the relative importance of cardiovascular disease (CVD) lifestyle-associated risk factors among individuals with inflammatory bowel disease (IBD) and examine the effectiveness of lifestyle interventions to improve these CVD risk factors. Adults with IBD are at higher risk of CVD due to systemic and gut inflammation. Besides that, tobacco smoking, dyslipidaemia, hypertension, obesity, physical inactivity and poor diet can also increase CVD risk. Typical IBD behavioural modification including food avoidance and reduced physical activity, as well as frequent corticosteroid use, can further increase CVD risk. We reviewed seven studies and found that there is insufficient evidence to conclude the effects of diet and/or physical activity interventions on CVD risk outcomes among populations with IBD. However, the limited findings suggest that people with IBD can adhere to a healthy diet or Mediterranean diet (for which there is most evidence) and safely participate in moderately intense aerobic and resistance training to potentially improve anthropometric risk factors. This review highlights the need for more robust controlled trials with larger sample sizes to assess and confirm the effects of lifestyle interventions to mitigate modifiable CVD risk factors among the IBD population.

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 WHO 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 revolve 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.

Randomised controlled trials are the ‘gold standard’ approach in nutrition research to show a causal relationship between a dietary intervention and clinically relevant outcomes at the population level. Here we review why different study designs are needed to establish the efficacy of dietary interventions at the individual level and to better account for relevant factors that can also influence the outcomes. Over the past decade, precision nutrition approaches have been developed as a new way to measure the effectiveness of dietary interventions at the individual and population level. Precision nutrition aims to determine the individual factors that are associated with differences in responses to dietary interventions. This is complex, typically needing studies with a large number of participants and using advanced statistical approaches and machine-learning algorithms to identify predictors that can explain why individuals do or do not respond to consuming specific foods, meals or diets, for a given outcome. N-of-1 study designs, which are new to nutrition science, offer a robust alternative approach to assess how an intervention and everyday behaviours affect individual health outcomes. They utilise repeated measures within individuals, rather than baseline and end measures in a larger number of participants, to provide the statistical power required to determine an individual’s responsiveness to an intervention. The adoption of new study designs and modelling approaches, particularly the N-of-1 approach, to examine responses to interventions within individuals, will help to further the understanding of the relationships between diet and health within individuals more effectively and accurately.

Machine learning is increasingly being utilised across various domains of nutrition research due to its ability to analyse complex data, especially as large datasets become more readily available. However, at times, this enthusiasm has led to the adoption of machine learning techniques prior to a proper understanding of how they should be applied, leading to non-robust study designs and results of questionable validity. To ensure that research standards do not suffer, key machine learning concepts must be understood by the research community. The aim of this review is to facilitate a better understanding of machine learning in research by outlining good practices and common pitfalls in each of the steps in the machine learning process. Key themes include the importance of generating high-quality data, employing robust validation techniques, quantifying the stability of results, accurately interpreting machine learning outputs, adequately describing methodologies, and ensuring transparency when reporting findings. Achieving this aim will facilitate the implementation of robust machine learning methodologies, which will reduce false findings and make research more reliable, as well as enable researchers to critically evaluate and better interpret the findings of others using machine learning in their work.

Obesity is a chronic, complex and multi-factorial condition with an increasing prevalence worldwide. Irregular eating schedules might be a contributing factor to these numbers through the dysregulation of the circadian system. Time-restricted eating (TRE), an approach that limits eating windows, has been studied as a strategy to treat obesity, aligning eating occasions with metabolic circadian rhythms. This review aims to provide an overview of the impact of TRE protocols on metabolic, inflammatory, oxidative stress and circadian rhythm biomarkers in people with overweight or obesity. Most studies report significant weight loss following TRE protocols. While glucose levels decreased in nearly all TRE interventions, only a few studies demonstrated statistically significant differences when compared to the control groups. The findings for c-reactive protein and TNF-α were inconsistent, with limited significant differences. Changes in lipid profile changes were variable and generally did not reach statistical significance. Both 4-hour and 6-hour TRE interventions significantly reduced 8-isoprostane levels. Additionally, TRE significantly altered clock gene expression, as well as that of genes associated with metabolic regulation in subcutaneous adipose tissue. While the evidence is still inconsistent, limiting eating to a consistent daily window of 8 to 12 h can improve insulin sensitivity, reduce blood glucose, cholesterol and triglyceride levels and promote weight loss. These effects are likely attributable to both direct metabolic impacts and indirect benefits from weight loss and improved dietary habits. However, data on circadian, inflammatory and specific metabolic biomarkers remain scarce and occasionally contradictory, highlighting the need for further research on these interventions.

The food we eat has a critical impact on human and planetary health. Food systems are responsible for approximately a third of total global greenhouse gas emissions (GHGE). This review summarises studies that have measured dietary GHGE and assessed their associations with various demographic variables. Most studies report dietary emissions at the individual level, but some studies use households as the unit of analysis. Studies investigating individuals estimate dietary intakes using 24-hour dietary recalls, FFQ, diet history interviews, food diaries or other dietary records. Studies investigating households rely on food purchasing data and expenditure surveys. The majority of studies estimate dietary GHGE using process-based life cycle assessments. It is difficult to directly compare emissions estimates between studies at either the individual or household-level due to methodological differences. In general, there are mixed findings with regard to the relationships between various demographic variables and dietary emissions, although older adults generally had higher dietary GHGE than younger adults, and men typically had higher dietary GHGE than women, even when standardising for total energy intake. This review may be useful in informing and targeting policies and interventions to reduce GHGE of dietary intake.

Food systems in Africa are under pressure from climate change, conflicts, health pandemics such as COVID-19 and rising food prices. The COVID-19 pandemic highlighted weaknesses in global food systems and indeed Africa’s was not spared. Although COVID-19 mortality and morbidity in Africa were relatively low in comparison to other regions, the containment measures employed by countries amplified a rather dire situation. Disruptions were seen in livelihoods, food value chains, increases in food prices and loss of income. These changes affected access to nutritious foods. A resilient food system that can withstand and recover from disruption and shocks will be important for ensuring access to healthy diets for all. This review paper assesses the state of food insecurity and malnutrition situation pre-COVID-19 and the impact of COVID-19 on Africa’s food systems and access to healthy diet. To put Africa on a path to accelerated recovery, a resilient and sustainable food system will be crucial. The following recommendations are made: (i) increasing agriculture productivity, with special attention to the foods that contribute to healthy diets – fruits and vegetables, and animal source foods (ii) promoting the production and consumption of nutritious African traditional and indigenous foods (iii) transforming Africa’s food systems to be gender-sensitive (iv) investing in well-targeted social protection programmes (v) supporting food environments that protect healthy diets and (vi) employing data and information to monitor food systems transformation.

A person’s chronotype reflects individual variability in diurnal rhythms for preferred timing of sleep and daily activities such as exercise and food intake. The aim of this review is to provide an overview of the evidence around the influence of chronotype on eating behaviour and appetite control, as well as our perspectives and suggestions for future research. Increasing evidence demonstrates that late chronotype is associated with adverse health outcomes. A late chronotype may exacerbate the influence of greater evening energy intake on overweight/obesity risk and curtail weight management efforts. Furthermore, late chronotypes tend to have worse diet quality, with greater intake of fast foods, caffeine and alcohol and lower intake of fruits and vegetables. Late chronotype is also associated with eating behaviour traits that increase the susceptibility to overconsumption such as disinhibition, food cravings and binge eating. Whether an individual’s chronotype influences appetite in response to food intake and exercise is an area of recent interest that has largely been overlooked. Preliminary evidence suggests additive rather than interactive effects of chronotype and meal timing on appetite and food reward, but that hunger may decrease to a greater extent in response to morning exercise in early chronotypes and in response to evening exercise in late chronotypes. More studies examining the interplay between an individual’s chronotype, food intake/exercise timing and sleep are required as this could be of importance to inform personalised dietary and exercise prescriptions to promote better appetite control and weight management outcomes.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder amongst reproductive-aged women associated with cardiometabolic, reproductive and psychological abnormalities. Lifestyle modification, including a healthy diet, is considered first-line treatment for management of clinical symptoms. However, there is limited high-quality evidence to support one superior therapeutic dietary intervention for PCOS management that is beyond general population-based dietary guidelines. Adherence to a Mediterranean diet (MedDiet) has been shown to decrease cardiometabolic disease risk and attenuate depressive symptoms, particularly in patients with metabolic perturbations. This narrative review summarises the proposed biological mechanisms underpinning the potential therapeutic benefits of a MedDiet for the management of cardiometabolic, reproductive and psychological features related to PCOS. Observational evidence suggests an inverse relationship between MedDiet adherence and PCOS features, particularly insulin resistance and hyperandrogenemia. Although the exact mechanisms are complex and multifaceted, they are likely related to the anti-inflammatory potential of the dietary pattern. These mechanisms are underpinned by anti-inflammatory bioactive constituents present in the MedDiet, including carotenoids, polyphenols and n-3 polyunsaturated fatty acids (PUFAs). Synthesis of the available literature suggests the MedDiet could be a promising therapeutic dietary intervention to attenuate short and long-term symptoms associated with PCOS and may aid in reducing the longer-term risks associated with cardiometabolic diseases and reproductive and psychological dysfunction. Nevertheless, current evidence remains insufficient to inform clinical practice and well-designed clinical trials are needed. As such, we provide recommendations for the design and delivery of future MedDiet interventions in women with PCOS, including exploring the acceptability, and feasibility to enhance adherence.

Endogenous biological rhythms synchronise human physiology with daily cycles of light-dark, wake-sleep and feeding-fasting. Proper circadian alignment is crucial for physiological function, reflected in the rhythmic expression of molecular clock genes in various tissues, especially in skeletal muscle. Circadian disruption, such as misaligned feeding, dysregulates metabolism and increases the risk of metabolic disorders like type 2 diabetes. Such disturbances are common in critically ill patients, especially those who rely on enteral nutrition. Whilst continuous provision of enteral nutrition is currently the most common practice in critical care, this is largely dictated by convenience rather than evidence. Conversely, some findings indicate that intermittent provision of enteral nutrition aligned with daylight may better support physiological functions and improve clinical/metabolic outcomes. However, there is a critical need for studies of skeletal muscle responses to acutely divergent feeding patterns, in addition to complementary translational research to map tissue-level physiology to whole-body and clinical outcomes.

Sleep is vital for the maintenance of physical and mental health, recovery and performance in athletes. Sleep also has a restorative effect on the immune system and the endocrine system. Sleep must be of adequate duration, timing and quality to promote recovery following training and competition. Inadequate sleep adversely impacts carbohydrate metabolism, appetite, energy intake and protein synthesis affecting recovery from the energy demands of daily living and training/competition related fatigue. Sleep’s role in overall health and well-being has been established. Athletes have high sleep needs and are particularly vulnerable to sleep difficulties due to high training and competition demands, as such the implementation of the potential nutritional interventions to improve sleep duration and quality is commonplace. The use of certain nutrition strategies and supplements has an evidence base i.e. carbohydrate, caffeine, creatine, kiwifruit, magnesium, meal make-up and timing, protein and tart cherry. However, further research involving both foods and supplements is necessary to clarify the interactions between nutrition and the circadian system as there is potential to improve sleep and recovery. Additional research is necessary to clarify guidelines and develop products and protocols for foods and supplements to benefit athlete health, performance and/or recovery. The purpose of this review is to highlight the potential interaction between sleep and nutrition for athletes and how these interactions might benefit sleep and/or recovery.

It is estimated that more than one-tenth of adults aged ≥60 years are now classified as having sarcopenic obesity (SO), a clinical condition characterised by the concurrent presence of sarcopenia (low muscle mass and weakness) and obesity (excessive fat mass). Independently, sarcopenia and obesity are associated with a high risk of numerous adverse health outcomes including CVD and neurological conditions (e.g. dementia), but SO may confer a greater risk, exceeding either condition alone. This imposes a substantial burden on individuals, healthcare systems and society. In recent years, an increasing number of observational studies have explored the association between SO and the risk of CVD; however, results are mixed. Moreover, the pathophysiology of SO is governed by a complex interplay of multiple mechanisms including insulin resistance, inflammation, oxidative stress, hormonal shifts and alteration of energy balance, which may also play a role in the occurrence of various CVD. Yet, the exact mechanisms underlying the pathological connection between these two complex conditions remain largely unexplored. The aim of this review is to examine the association between SO and CVD. Specifically, we seek to: (1) discuss the definition, epidemiology and diagnosis of SO; (2) reconcile previously inconsistent findings by synthesising evidence from longitudinal studies on the epidemiological link between SO and CVD and (3) discuss critical mechanisms that may elucidate the complex and potentially bidirectional relationships between SO and CVD.