Free sugar intakes are currently higher than recommended for health, yet effective strategies for reducing consumption are yet to be elucidated. This work investigated the effects of different dietary recommendations for reducing free sugar intakes, on relevant outcomes, in UK adults consuming >5% total energy intake (TEI) from free sugars. Using a randomized controlled parallel-group design, 242 adults received nutrient-based (N=61), nutrient- and food-based (N=60), nutrient-, food- and food-substitution-based (N=63) or no (N=58) recommendations for reducing free sugars at a single timepoint, with effects assessed for the following 12 weeks. Primary outcomes were free sugar intakes as a percentage of TEI (%FS) and adherence to the recommendations at week 12. Secondary outcomes included TEI, diet composition, sugar-sweetened and low-calorie-sweetened food consumption and anthropometry. In Intention-to-Treat analyses adjusted for baseline measures, %FS reduced in intervention groups (%FSchange=-2.5 to -3.3%) compared to control (%FSchange=-1.2%) (smallest B=-0.573, p=0.03), with effects from week 1 until week 12, and no differences between interventions (largest B=0.352, p=0.42). No effects of intervention were found in dietary profiles, but change in %FS was associated with change in %TEI from non-sugar carbohydrate (B=0.141, p<0.01) and from protein (B=-0.171, p=0.02). Body weight was also lower at week 12 in intervention groups compared to control (B=-0.377, p<0.05), but associations with %FS were weak. Our findings demonstrate benefit from dietary recommendations for reducing free sugar intakes in UK adults. Limited advantages were found for the different dietary recommendations, but variety may offer individual choice.

Trial Registration: Clinicaltrials.gov: NCT04816955, registration date: 24.03.21.

Prior observational studies have reported the potential protective effect of n-3 fatty acids on the prognosis of acute pancreatitis (AP). However, the causal impact of n-3 fatty acids on AP is unclear. We aimed to investigate further the association of n-3 fatty acids with AP. We performed a meta-analysis and Mendelian randomisation (MR) to explore the association between n-3 fatty acids and the prognosis of AP from clinical observation and genetics perspectives, respectively. Nine randomised controlled trials were included in this study. The result meta-analysis showed that complementary therapy of n-3 fatty acids significantly decreased mortality (Relative Risk (RR): 0·30; 95 % CI 0·14, 0·65, P < 0·05) and infectious complications in AP (RR: 0·45; 95 % CI 0·27, 0·77, P < 0·05). Compared with the control groups, the hospital stays (MD: −1·02; 95 % CI −1·85, −0·20, P < 0·05) in AP patients with n-3 fatty acids treatment were statistically reduced. However, the ICU stay (MD: −0·49; 95 % CI −1·29, −0·31, P > 0·05) between control groups and AP patients with n-3 fatty acids treatment was insignificant. Utilising genetic susceptibility analysis in the MR approach, the MR showed n-3 fatty acids have a significant causal effect on the AP risk (OR, 0·887; 95 % CI 0·797, 0·986, P = 0·027, fixed-effect; OR, 0·887; 95 % CI 0·792, 0·993, P = 0·037, random-effect). n-3 fatty acids complementary therapy may improve the prognosis of AP. Furthermore, genetically predicted serum levels of n-3 fatty acids can significantly lower AP risk.

Numerous public initiatives aim to influence individual food choices by informing about what is considered ‘healthy’, ‘climate-friendly’, and generally ‘sustainable’ food. However, research suggests that rather than public authorities, social influence is more likely to affect people’s behaviour. Using a randomised controlled trial, this study investigated if and how the two kinds of influences (factual versus social) could affect the real-life, self-reported intake of plant- and animal-based foods. In a four-month randomised controlled trial, a self-selected sample of adults living in Sweden (N = 237) tracked their daily food consumption several times per week using a tailored mobile phone app. Participants were randomised into one of three groups: two treatment groups receiving factual or social information about plant- and animal-based food consumption, or a control group receiving no information. Pre- and post-questionnaires provided additional background information about the participants. Participants’ food habits varied from week to week, and an explorative analysis pointed to a slight decrease in the consumption of animal-based food in the group that received social information. However, the longer-term patterns remained relatively constant in all groups, showing no substantial shift regardless of the kind of cues that the participants received. By investigating the roles of two common types of information about food and dietary change, the results contribute to discussions about how and by whom effective and efficient measures can be implemented to transform food habits. The results suggest there is limited potential for sustained and substantial behavioural changes through both social and factual information campaigns.

The scientific literature indicates that chokeberry is widely used as a supplement to support the maintenance of the body’s homeostasis by reducing inflammation and oxidative stress. In recent years, positive effects of chokeberry on intestinal parameters have also been observed. Oxidative stress, inflammation and, according to recent reports, also the gut microbiome are closely related to the overall well-being and health of the population. This study, therefore, attempts to summarise all the health benefits of black chokeberry supplementation. This study was registered in PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD42023395969. Additionally, the systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Electronic databases were searched in Web of Science, PubMed, Scopus and EBSCO using the following combination of the words ‘chokeberry or aronia’ and ‘inflammation or oxidative stress or microbiota or microbiome or permeability or gut’. Ultimately, fifty-seven studies were summarised in the review. Data analysis showed that black chokeberry has a positive effect on the reduction of inflammation, oxidative stress and intestinal microflora, but the size of the changes varies and depends on many variables. Therefore, the researchers concluded that the compounds found in black chokeberry play a pivotal role in maintaining the overall balance within the system. This is a crucial consideration given the tendency for disturbances in organismal homeostasis to accompany disease processes and various disorders. However, further research is necessary to elucidate the mechanisms and optimise its use fully.

The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration and dose needed to elicit gut microbial changes and whether these changes also influence microbial metabolites remain unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)) on the stool microbiota and microbial metabolite concentrations in plasma, stool and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study. The DISC study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma and urine by high-performance liquid chromatography. A total of fifty-eight participants with paired samples available were included. After 50 d, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance or on metabolite concentrations. However, Drichlet’s multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention. The gut microbiota and fecal, plasma and urinary microbial metabolites were stable in response to a 50-d fibre intervention in middle-aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome and host health.

Dietary n-3 PUFA may have potential benefits in preventing peptic ulcer disease (PUD). However, data from observational epidemiological studies are limited. Thus, we conducted a Mendelian randomisation analysis to reveal the causal impact of n-3 PUFA on PUD. Genetic variants strongly associated with plasma levels of total or individual n-3 PUFA including plant-derived α-linolenic acid and marine-derived EPA, DPA and DHA were enrolled as instrumental variables. Effect size estimates of the n-3 PUFA-associated genetic variants with PUD were evaluated using data from the UK biobank. Per one sd increase in the level of total n-3 PUFA in plasma was significantly associated with a lower risk of PUD (OR = 0·91; 95 % CI 0·85, 0·99; P = 0·020). The OR were 0·81 (95 % CI 0·67, 0·97) for EPA, 0·72 (95 % CI 0·58, 0·91) for DPA and 0·87 (95 % CI 0·80, 0·94) for DHA. Genetically predicted α-linolenic acid levels in plasma had no significant association with the risk of PUD (OR = 5·41; 95 % CI 0·70, 41·7). Genetically predicted plasma levels of n-3 PUFA were inversely associated with the risk of PUD, especially marine-based n-3 PUFA. Such findings may have offered an effective and feasible strategy for the primary prevention of PUD.

Epidemiological and clinical trial evidence indicates that n-6 polyunsaturated fatty acid (PUFA) intake is cardioprotective. Nevertheless, claims that n-6 PUFA intake promotes inflammation and oxidative stress prevail. This narrative review aims to provide health professionals with an up-to-date evidence overview to provide the requisite background to address patient/client concerns about oils containing predominantly unsaturated fatty acids (UFA), including MUFA and PUFA. Edible plant oils, commonly termed vegetable oils, are derived from vegetables, nuts, seeds, fruits and cereal grains. Substantial variation exists in the fatty acid composition of these oils; however, all are high in UFA, while being relatively low in saturated fatty acids (SFA), except for tropical oils. Epidemiological evidence indicates that higher PUFA intake is associated with lower risk of incident CVD and type 2 diabetes mellitus (T2DM). Additionally, replacement of SFA with PUFA is associated with reduced risk of CVD and T2DM. Clinical trials show higher intake of UFA from plant sources improves major CVD risk factors, including reducing levels of atherogenic lipids and lipoproteins. Importantly, clinical trials show that increased n-6 PUFA (linoleic acid) intake does not increase markers of inflammation or oxidative stress. Evidence-based guidelines from authoritative health and scientific organisations recommend intake of non-tropical vegetable oils, which contain MUFA and n-6 PUFA, as part of healthful dietary patterns. Specifically, vegetable oils rich in UFA should be consumed instead of rich sources of SFA, including butter, tallow, lard, palm and coconut oils.

Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.

Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023).

Clinical guidelines recommend avoiding the use of medications to manage personality disorder. In clinical practice, however, substantial amounts of medication are used. In this article, we summarise the recommendations of guidelines published in various countries in the past 15 years. We review the evidence from randomised controlled trials and recent reviews, discuss the discordance between guidance and clinical practice and give recommendations on what a clinician should consider if they choose to prescribe in cases of severe disturbances in mood or behaviour despite the lack of evidence.

Diabetes and depression have a bidirectional relationship, but some antidepressants (such as the tricyclics) may have detrimental effects in diabetes that are exacerbated by behavioural changes associated with depression. This month's Cochrane Review evaluated the efficacy of psychological and pharmacological treatments of comorbid depression in diabetes and found that such interventions have a moderate and clinically significant effect on depression outcomes in people with diabetes. However, conclusions were limited by significant heterogeneity within examined populations and interventions, and significant risk of bias within trials. This commentary critically appraises the review and aims to contextualise its findings.

Carotenoids, a group of phytochemicals found in plant-based foods with yellow, red, or orange pigments, have been shown to be stored in the skin upon consumption of carotenoid-rich foods(1). Skin carotenoid levels can be measured using skin reflectance spectroscopy, which assesses skin lightness (L*), redness (a*), and yellowness (b*)(2). Previous research has demonstrated significant increases in skin yellowness (b*) after a 4-week high-carotenoid diet(2). The aim was to examine shorter-term changes (two weeks) in skin yellowness following the consumption of a Healthy Australian Diet rich in carotenoids compared to a Typical Australian Diet with low carotenoid content. The study analysed data from an eight-week randomised, cross-over feeding trial involving 34 adults (53% female, aged 38.44 ± 18.05 years). Participants were randomly assigned to each diet for two weeks, separated by a two-week washout period. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(3), emphasising the consumption of carotenoid-rich fruits and vegetables such as carrots, pumpkin, tomatoes, red capsicum, and sweet potatoes. In contrast, the Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4) and emphasised the intake of fruits and vegetables low in beta-carotene, such as white potatoes, onions, cauliflower, and pears. Skin carotenoids were measured using skin reflectance spectroscopy at three sites (palm, inner and outer arm), and each measurement was taken thrice. Overall skin yellowness (b*) was calculated as the average of all three measurements at all three sites. Measurements were conducted at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout; baseline 2), and week 8 (post-feeding phase 2). Differential changes in skin carotenoid levels between intervention groups were assessed using linear mixed-effect models, adjusting for diet sequence, feeding phase, body fat percentage, total fat intake, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to evaluate the relative effects of each diet. Although there was a trend towards higher skin yellowness (0.215 ± 0.517; p = 0.41) following consumption of the Healthy Australian diet relative to baseline, and an inverse trend following the Typical Australian Diet (−0.118 ± 0.539, p = 0.56), the difference in change between the two diets was not statistically significant (p = 0.32). Notably, baseline values within this participant cohort were higher than previously reported at b* = 16.7(1) (baseline 1 b*: 17.57 ± 2.23, baseline 2 b*: 17.71 ± 2.26), which may influence the magnitude of observable change. The findings suggest that the two-week intervention duration may be insufficient to achieve statistically significant changes in skin carotenoid levels. Future investigations into whether plasma carotenoids increase first, with skin changes occurring later, could offer valuable insights into the potential utility of this as a biomarker validation of change in fruit and vegetable intake.

Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305 Australia.Cardiovascular disease (CVD) remains a major cause of global mortality. Poor diet quality, characterised by excessive consumption of energy-dense, nutrient-poor foods and insufficient intake of fruits, vegetables, and whole grains, is associated with an increased risk of CVD(1). This study compares the impact of two short-term dietary interventions, a Healthy Australian Diet adhering to national guidelines and a Typical Australian Diet representing current national consumption patterns, on several cardiometabolic outcomes. These outcomes include body weight, waist circumference (WC), body fat percentage (BFP), blood pressure (BP), fasting blood lipids and glucose concentrations. Data from an eight-week randomised, cross-over feeding study involving 34 adults (53% female, age 38.4 ± 18.1 years) were analysed, with participants randomly assigned to consume each diet for two weeks, separated by a two-week washout period. During each feeding phase, all food items were provided to ensure compliance. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3), with saturated fat limited to ≤10% of energy. The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4), setting total fat intake at 40% of energy and total saturated fat at 15% of energy. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Trained personnel measured WC using a tensible tape, while body weight and BFP measurements were obtained using bioimpedance analysis (Inbody 270; Biospace Co, Seoul, Korea). Blood pressure was recorded using the Uscom BP+ supra-systolic oscillometric central blood pressure device. Blood glucose and lipid (triglycerides, total-, low-density lipoprotein- [LDL] and high-density lipoprotein- [HDL] cholesterol) concentrations were measured after a 12-hour fast by an accredited pathology service. Differential changes in cardiometabolic variables between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. There were no significant differences between the Healthy Australian Diet and the Typical Australian Diet with respect to weight, BFP, WC, blood triglycerides, systolic and diastolic BP. However, the Healthy Australian Diet led to a significantly greater decrease in total-, LDL-, HDL- and non-HDL cholesterol, and fasting blood glucose relative to the Typical Australian Diet (p<0.001). The results underscore the importance of promoting dietary intakes that align with Australian Dietary Guidelines for optimising the risk of CVD and impaired glucose tolerance. Conversely, the Typical Australian Dietary pattern demonstrated detrimental cardiometabolic effects over a short period of just two weeks.

Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.

Prebiotic fibre represents a promising and efficacious treatment to manage pre-diabetes, acting via complementary pathways involving the gut microbiome and viscosity-related properties. In this study, we evaluated the effect of using a diverse prebiotic fibre supplement on glycaemic, lipid and inflammatory biomarkers in patients with pre-diabetes. Sixty-six patients diagnosed with pre-diabetes (yet not receiving glucose-lowering medications) were randomised into treatment (thirty-three) and placebo (thirty-three) interventions. Participants in the treatment arm consumed 20 g/d of a diverse prebiotic fibre supplement, and participants in the placebo arm consumed 2 g/d of cellulose for 24 weeks. A total of fifty-one and forty-eight participants completed the week 16 and week 24 visits, respectively. The intervention was well tolerated, with a high average adherence rate across groups. Our results extend upon previous work, showing a significant change in glycated haemoglobin (HbA1c) in the treatment group but only in participants with lower baseline HbA1c levels (< 6 % HbA1c) (P = 0·05; treatment –0·17 ± 0·27 v. placebo 0·07 ± 0·29, mean ± sd). Within the whole cohort, we showed significant improvements in insulin sensitivity (P = 0·03; treatment 1·62 ± 5·79 v. placebo –0·77 ± 2·11) and C-reactive protein (PFWE = 0·03; treatment –2·02 ± 6·42 v. placebo 0·94 ± 2·28) in the treatment group compared with the placebo. Together, our results support the use of a diverse prebiotic fibre supplement for physiologically relevant biomarkers in pre-diabetes.