Diet may influence circulating sex steroid hormones, but evidence for overall dietary patterns remains limited. We examined associations of dietary patterns reflecting lower inflammatory potential, lower insulinaemic potential and higher overall diet quality, with circulating sex steroids in older men and systematically reviewed the literature in apparently healthy men published through June 2024. We conducted cross-sectional analyses of 1622 men aged ≥65 years from the Osteoporotic Fractures in Men Study. Diet was assessed using FFQ and sex hormone-binding globulin (SHBG), total and free testosterone and total and free estradiol were measured. Dietary patterns included the reversed Empirical Dietary Inflammatory Pattern (rEDIP), reversed Empirical Dietary Index for Hyperinsulinaemia (rEDIH) and Healthy Eating Index-2020 (HEI-2020). Among older men, each 1-standard deviation increase in rEDIP was associated with higher total testosterone (β = 2·15; 95 % CI 0·12, 4·18) and free testosterone (β = 2·02 ng/dL; 95 % CI 0·29, 3·75), whereas rEDIH showed similar but non-significant associations with total testosterone (β = 1·64; 95 % CI –0·28, 3·57) and free testosterone (β = 1·43; 95 % CI –0·21, 3·08). Higher HEI-2020 scores were associated with higher free estradiol (β = 2·46 pg/mL; 95 % CI 0·85, 4·07). Across twenty-one studies, healthier dietary patterns were generally associated with lower estradiol and higher concentrations of SHBG and total testosterone. Taken together, the individual-level analyses and systematic review suggest that anti-inflammatory, low-insulinaemic and overall healthy dietary patterns are associated with more favourable sex steroid hormone profiles in men, although prospective studies are needed to establish temporality.

Iodine is essential for thyroid hormone synthesis and is needed for brain development. In the UK, milk and dairy products are the main dietary sources, but the increasing consumption of plant-based alternatives may affect iodine intake. Few iodine-specific dietary assessment tools have been validated in UK adults, and none reflects recent changes in food availability, food composition and dietary patterns. This study aimed to develop and validate the Iodine Intake Risk Score screening tool, using a rapid digital iodine-specific questionnaire. Healthy UK adults (n 108) aged ≥18 years completed the Iodine Intake Risk Score screening tool and a 6-d food diary, which served as the reference method. Iodine intake from the tool and food diaries was estimated and was classified as insufficient (<140 µg/d) or sufficient (140–600 µg/d). Agreement between methods was assessed using Cohen’s kappa, Wilcoxon signed-rank tests and Spearman’s correlation. There was substantial agreement in iodine classification (κ = 0·68, p < 0·001). The screening tool demonstrated high sensitivity (82%) and specificity (87%) for identifying individuals with insufficient iodine intake. The median iodine intake from the screening tool did not differ significantly from that of the food diaries (145 v 140 µg/d; p = 0·07), and the two methods were strongly correlated (r 0·70, p < 0·001). Median completion time was 4 min. The screening tool provides a valid and efficient method for assessing iodine intake in UK adults, incorporating conventional and plant-based sources. It offers a practical approach for identifying individuals at risk of iodine deficiency and for supporting population monitoring and dietary interventions.

According to expectancy theory, people eat food that they expect will bring positive emotions. The present research aimed to identify food and non-alcoholic beverages UK adults most expected to bring positive emotions; test influences of high fat, salt and/or sugar (HFSS) and branding on expectancies; and investigate associations of expectancies with diet quality and comfort eating (i.e. eating induced by negative emotions). A representative sample of UK adults (n 1203; Mage = 47 years; 52 % women; 87 % white) viewed food and non-alcoholic beverage images and completed the Anticipated Effects of Food Scale-Brief, a food frequency questionnaire, and questions about comfort eating and sociodemographic background. We ranked means of positive expectancies, conducted multilevel modelling to test influences of HFSS and branding on expectancies and examined correlations among expectancies, diet quality and comfort eating. Participants more strongly expected eating branded HFSS (e.g. Cadbury Twirl chocolate) v. generic non-HFSS (e.g. prawn curry) would result in positive emotions [b = 0·10, se = 0·04, p = ·02, 95 % CI (0·02, 0·18)]. Greater positive expectancies for HFSS – branded and generic – were associated with worse diet quality, especially positive expectancies for ice cream sundaes, fizzy drinks and chocolate (rs = –0·14 to −0·19, ps < ·001). Greater positive expectancies for HFSS and negative expectancies for HFSS and non-HFSS were associated with more frequent comfort eating (rs = 0·08 to 0·30, ps < ·05). Targeting positive HFSS expectancies through food environment policy and behavioural programmes may be a promising strategy for improving diet quality and reducing comfort eating in the UK adult population. Adults who comfort eat may also benefit from challenging negative expectancies for all foods.

Protein intake is often suboptimal among older adults, which may lead to protein-energy malnutrition, sarcopenia and frailty. A need exists for a simple, efficient and feasible protein-specific dietary assessment tool. Thus, a novel protein screening test, adapted to the Finnish cultural context, was developed. The aim of this study was to validate a novel protein screening test against a 1-d food record among Finnish older adults. Data were collected as part of the Helsinki Aging Study. The sample (N 140) consisted of Finnish community-dwelling oldest-old individuals (age range 80–100 years) with sufficient cognitive ability for at-home dietary assessment. A 1-d food record and the protein screening test were completed on one habitual eating day. Validity was assessed using the food record as a reference, with suboptimal protein intake defined as <1·2 g/kg BW/d. A Bland–Altman plot and concordance correlation coefficient (0·87, 95 % CI: 0·83–0·91) demonstrated good agreement between the methods. Sensitivity (0·85, 95 % CI: 0·72–0·94), specificity (0·81, 95 % CI: 0·71–0·88), area under receiver operating characteristic curve (0·90, 95 % CI: 0·85–0·95) and positive likelihood ratio (4·40, 95 % CI: 2·86–6·77) indicated strong diagnostic performance of the protein screening test. An optimal cut-off for the screening test to identify suboptimal protein intake was assessed at <1·00 g/kg BW/d. The novel protein screening test has good concurrent validity with the food record in identifying Finnish community-dwelling oldest-olds with suboptimal protein intake. It shows diagnostic potential for identifying individuals with suboptimal intake and to engage in targeted intervention.

Dutch dietary patterns are high in animal-based foods, contributing to non-communicable diseases and environmental pressures, but may vary across generations due to social and cultural factors. Therefore, this cross-sectional analysis examines generational differences in diet quality and environmental impacts among 2348 adults from the Doetinchem Cohort Study (2018–2023). Diet quality was assessed with the Dutch Healthy Diet (DHD15) index and the animal-to-plant protein ratio, and life-cycle analysis linked foods to greenhouse gas emissions (GHGE) and blue water consumption. Analyses were stratified by generation (Generation X, Baby Boomers and the Silent Generation) and sex and adjusted for relevant confounders. Adjusted mean DHD15-index scores were higher in older female generations, ranging from 81 to 84 (P-trend = 0·06). Generation X males obtained a larger share of protein from plant sources than older generations (+4 % in Generation X, P-trend = 0·02). Absolute GHGE were lower in older generations (males: −18 % in the Silent Generation, P < 0·001; females: −11 %, P = 0·005), with differences attenuating per 1000 kcal among males. Older generations also had lower absolute blue water consumption among males (–11 % in the Silent Generation, P = 0·05), with differences attenuating per 4184 kJ (1000 kcal). Generation X had higher impacts from certain meats, processed foods and rice, whereas older generations had relatively higher impacts from dairy products, tea and fruit. These modest generational differences suggest that generation-specific dietary strategies could support healthier and more sustainable diets.

The performance of a prediction equation for total energy expenditure (TEE), derived from a large database of doubly labelled water (DLW) measurements of TEE held at the International Atomic Energy Agency, which has been proposed for estimating population energy requirements (ER) from basic anthropometric data as a replacement for the factorial method, is tested against a dataset of 450 DLW-derived measures of TEE in randomly selected urban US adults aged 40–69 years, and its bias is evaluated. Its performance is also tested by modelling TEE for all ages at the healthy weights identified by the UK Scientific Advisory Committee on Nutrition, (SACN), in its report on dietary reference values (DRV) for energy, and the predicted values for TEE are compared with TEE calculated by the factorial method, as well as with values in a subsequent UK Government report on Dietary Recommendations for Energy, in which values for adolescents and for adults were capped at below their predicted values to help address issues of overweight and obesity. Whilst the prediction equation for TEE is accurate (≤±10 %) for about half of the adults (root mean square of error (RMSE) and %RMSE were 1·67 MJ/d (14·3 %, males) and 1·29 (8·8 %) MJ/d, females), it markedly over-or underpredicts for inactive or active individuals and predicts slightly higher values for males than females than would be expected from their differences in basal energy expenditure. It includes a term for elevation of the subject, which results in additions in TEE which appear unphysiological. These shortcomings raise important questions about its value in improving DRV for energy in the UK.

Variations in diet quality across the lifespan remain insufficiently characterised, particularly in non-Western populations. We aimed to examine age-and sex-specific variation in diet quality and identify associated dietary components and socio-demographic and lifestyle factors in a Japanese population. In this cross-sectional study of 4455 Japanese individuals aged 1–79 years, dietary intake was assessed using 8-day weighed dietary records collected across four seasons. Diet quality was evaluated using the Healthy Eating Index-2020 (HEI-2020) and Nutrient-Rich Food Index 9·3 (NRF9·3). Associations with dietary components and lifestyle and socio-economic factors were examined separately in children and adults, with tests for interaction by age. Both indices showed marked age-and sex-specific variation. HEI-2020 scores reached estimated nadirs at 16·1 years in females and 23·4 years in males, whereas NRF9·3 scores were lowest in early adulthood (approximately 24 years) in both sexes; older adults consistently exhibited the highest scores. Across age-sex strata, the components contributing most to total score variation were dairy, fatty acids, Na and saturated fats for HEI-2020 and Na and added sugars for NRF9·3. Socio-economic disparities emerged early, with higher household income and parental education associated with better diet quality in children. In adults, lower diet quality was associated with lower income and education, smoking and breakfast skipping in both sexes and full-time employment in males. In conclusion, diet quality was lowest in adolescence and early adulthood in this Japanese population, with distinct socio-economic and lifestyle determinants across life stages, thereby highlighting critical periods for targeted, age-appropriate nutritional interventions.

Despite established nutritional benefits of human milk, evidence regarding breastfeeding’s protective effect against childhood adiposity remains equivocal across subpopulations. This study investigates sex- and race-specific heterogeneity in the longitudinal association between duration of breastfeeding and early childhood BMI percentile trajectories. Data were drawn from the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative US prospective cohort (N 8500). The primary outcome was child BMI percentile from anthropometric measurements taken at 9, 24, 36, 48 and 60 months. Breastfeeding duration was categorised as never, less than 6 months and 6 months or longer. Stepwise hierarchical linear modelling, specifying non–linear individual growth curves, was utilised. Models were stratified by sex and adjusted for maternal, obstetric and sociodemographic confounders. A distinct sex-specific effect of breastfeeding was identified, whereby a duration of 6 months or longer significantly lowered BMI percentile trajectories in girls (b = −3·70, 95 % CI: −5·86, −1·54) but yielded no significant association in boys. BMI percentiles by race/ethnicity also varied between sexes. Among boys, only Hispanic infants exhibited significantly higher percentiles than Non-Hispanic (NH) Whites (b = 4·61, 95 % CI: 2·63, 6·60), whereas among girls, both Hispanic (b = 3·26, 95 % CI: 1·24, 5·29) and NH Black infants (b = −3·14, 95 % CI: −5·38, −0·90) showed significant differences relative to NH Whites. No significant interaction emerged between breastfeeding duration and race/ethnicity. These findings suggest that paediatric obesity prevention strategies may benefit from considering sex-specific mechanisms and addressing the structural factors associated with racial disparities.

Switching from regular salt to potassium-enriched salt lowers blood pressure and cardiovascular risk, but this intervention is underutilised by healthcare professionals. We assessed Australian healthcare professionals’ knowledge, attitudes and practices (KAP) regarding regular salt and potassium-enriched salt for hypertension management. We used mixed-methods research including surveys to quantify KAP towards regular salt and potassium-enriched salt and semi-structured interviews to gather in-depth information about knowledge, attitudes and the barriers and opportunities for recommending potassium-enriched salt use in clinical practice. Participants were general practitioners, medical specialists and allied health professionals working in Australia and caring for individuals with hypertension. Ninety-nine participants completed the survey, and thirty-six participants completed interviews. Survey participants generally had high knowledge related to regular salt; most were aware of potassium-enriched salt (94 %), but only 49 % reported familiarity with it. Of those aware, 73 % considered it safe to use and 66 % knew of the blood pressure-lowering benefits. Only 14 % had recommended it in the previous 12 months, though most interview participants were willing to recommend it in the future. Key barriers to recommendation were limited knowledge about potassium-enriched salt, insufficient time to discuss use with patients and concerns about taste, availability and affordability. The key opportunity identified was incorporating recommendations and information about potassium-enriched salt into existing resources supporting hypertension management by clinicians. Healthcare professionals are mostly aware and supportive of recommending potassium-enriched salt but lack in-depth knowledge. Advice about using potassium-enriched salt needs incorporation into clinical education programmes and hypertension management systems.

Healthy dietary patterns (DP) in early life constitute an internationally recommended platform for preventing childhood obesity. New Zealand (NZ) ranks high globally for the prevalence of child obesity. Yet, national data on overall diet quality and its relationship with healthy weight remain limited. Data from 54-month-olds (n 6048) in the Growing Up in New Zealand cohort were used to examine associations between indicators of adiposity and scores on two previously identified DP. Excess adiposity was defined by body-mass ondex/age (BMI/A) >+2 z-score (WHO Growth Standards) and a waist-to-height ratio (WtHR) >90th percentile within the cohort. Adjusted associations were examined using multiple Poisson regressions with robust variance. Prevalence ratios (PR) and 95 % confidence intervals (CI) were reported. Compared with females in the lowest tertile of adherence to a DP characterised by high intake of refined foods and those high in sugar, salt and unhealthy fats, those in the middle (PR: 1·56; 95 % CI 1·07–2·28; p = 0·021) and third tertile (PR: 2·14; 95 % CI 1·48–3·10; p < 0·001) had a higher prevalence of overweight/obesity (BMI/A). Scores in this DP were not associated with BMI/A > +2z in males nor with WtHR > 90th percentile in either sex. There were no associations between the tertiles of a DP characterised by high intake of fruit, vegetables and protein foods, and the two adiposity indicators examined for both sexes. Overall, poorer diet quality was linked to obesity at 54 months, with sex-specific effects, supporting national early childhood obesity prevention strategies targeting foods high in sugar, salt and unhealthy fats.

Acute consumption of cocoa flavanols (CF) has been reported to enhance cognitive functions, primarily through nitric oxide synthesis within blood vessels. These effects include improved performance in sustained attention, spatial attention and attentional control. However, its effect on covert attention remains unclear. The current study aimed to explore the acute effects of CF on overt and covert attention, using visual attention tasks. In a randomised, double-blind, placebo-controlled crossover study with a counterbalanced design, forty-eight undergraduate students completed the visual search task (VST) and the spatial cueing task across three conditions. A flavanol-rich cocoa beverage (710 mg), a flavanol-free cocoa beverage (placebo) and sugar water (control) were administered in separate testing sessions with a 1-week washout interval. Three-way repeated measures ANOVA revealed that the acute CF intake did not improve accuracy (F2,94 = .33, p = .72, ηp2 = .01) or reaction time (F2,94 = .67, p = .51, ηp2 = .01) in the VST. Similarly, the main effect of acute CF intake was not significant for accuracy (F1·83,85·85 = 1, p = .37, ηp2 = .02) or reaction time (F2,94 = .57, p = .57, ηp2 = .01) in the spatial cueing task. Overall, the findings provide no evidence that a single 710 mg dose of CF improves overt or covert attention in healthy young adults. A single acute dose of CF may not be sufficient to improve visual attention performance in the current sample.

Hyperemesis Gravidarum (HG) is characterised by severe nausea and vomiting in pregnancy. Despite the critical role of nutrition during pregnancy and risk of malnutrition in this cohort, few studies have reported dietary intakes of women with HG. The aim was to assess the nutritional intakes of women with HG compared with dietary recommendations and to explore the association between nutritional intakes and symptom severity. In this cross-sectional study, women with a diagnosis of HG attending a day assessment unit in a large maternity hospital in Dublin, Ireland, were invited (March 2021–January 2022) to participate. Nutritional intake was assessed using 24-h food and fluid diaries. Median intakes were compared with requirements using Wilcoxon signed-rank tests. The median (interquartile range) energy and fluid intake of the thirty-six women included was 1050 (481–1461) kcal and 1196 (778–2081) mL compared with estimated requirements of 2057 (1978–2332) kcal and 2300 mL (p < 0·001 for both). The median intakes of studied nutrients and fluid were significantly below estimated requirements. Spearman’s correlations between nutritional intakes and symptom severity (24-h Pregnancy-Unique Quantification of Emesis and Nausea score) were calculated for twenty-nine participants. Several nutrient intakes, including energy, macronutrients, Na, potassium, Ca, Fe, iodine, vitamin D, thiamine and vitamin B12, were significantly negatively correlated with nausea and/or vomiting scores. In conclusion, women with HG consume inadequate energy, fluid and essential nutrients, with poorer intake associated with more severe nausea and vomiting. These findings highlight the need for routine nutrition assessments and tailored interventions to improve nutritional status in women with HG.

Although consuming a diverse diet is generally considered beneficial for chronic disease prevention, its relationship with type 2 diabetes (T2D) remains unclear. This study investigated the associations of overall and within-group dietary diversity scores (DDS) with T2D incidence in the Korean Genome and Epidemiology Study–CVD Association Study. A total of 16 666 participants aged 40 years and older without T2D at baseline were followed for 96 609 person-years, during which 953 incident T2D cases were identified. Cumulative average overall DDS and within-group DDS were derived from repeated FFQ administered at each visit. Modified Poisson regression with a robust error variance estimator was used to estimate incidence rate ratios (IRR) and 95 % CI. A significant inverse linear trend was observed between overall DDS and T2D risk (IRR = 0·56, 95 % CI = 0·40–0·79 for men; IRR = 0·73, 95 % CI = 0·54–0·98 for women). Among the five within-group DDS, those for ‘Milk and Dairy products’ in both sexes, ‘Fruits’ in men and ‘Vegetables/Seaweeds/Mushrooms’ in women were inversely associated with T2D (Q4 v. Q1). No significant sex-related interactions were observed (all p for interaction > 0·05). Higher overall DDS and greater within-group diversity in ‘Milk and Dairy products,’ ‘Fruits’ and ‘Vegetables/Seaweeds/Mushrooms’ were associated with lower T2D risk. These findings suggest that maintaining overall dietary diversity – particularly emphasising non-energy-dense food groups such as fruits, vegetables, and dairy – may help prevent T2D.