Multiple sclerosis (MS), known to affect many individuals, can often lead to symptoms such as fatigue, cognitive impairment and depression, thereby adversely affecting quality of life. Therefore, the aim of this planned single-centre, randomised controlled trial is to determine the effects of implementing the MIND diet or a standard diet program on quality of life, fatigue, cognition and brain fog symptoms in patients with relapsing-remitting MS (RRMS). The study will include sixty-two adult RRMS patients living in Muğla, Türkiye. Eligible patients who agree to participate will be randomly assigned, in a 1:1 ratio, to the MIND diet or standard diet group for a 12-week intervention. Participants will be monitored weekly for adherence to the interventions. Primary outcomes will include determining the effects of dietary interventions on Multiple Sclerosis Quality of Life-54, Questionnaire, Modified Fatigue Impact Scale, Brief International Cognitive Assessment for MS battery and Brain Fog Scale. Secondary outcomes will consist of blood parameters including body composition and complete blood count, biochemical parameters (fasting glucose, lipid profile, liver enzymes and albumin), C-reactive protein, thyroid hormones and folate, vitamin B12 and vitamin D levels. The results of this study may help determine the potential beneficial effects of the MIND diet on MS-related fatigue, reduced quality of life, cognitive dysfunction and brain fog, contribute to comparing these findings with existing evidence in the literature and provide up-to-date evidence. In addition, it may contribute to the development of a new nutritional therapy for MS.

Creatine monohydrate (CrM) is a widely used supplement to improve physical performance and strength. Recent studies suggest it may also benefit cognitive function and depression treatment. However, data on its effects in older adults are scarce, highlighting the need for further research in this population. This study is a randomised, double-blind, placebo-controlled trial assessing 5 weeks of CrM supplementation combined with physical training in older adults (≥ 75 years). Participants will be divided into four groups: placebo (PL), placebo with multicomponent training (PL + MT), creatine monohydrate supplementation (CrM) and creatine monohydrate with multicomponent training (CrM + MT). Evaluations will be conducted before, during and after the intervention and again after a 5-week washout period. The training programme includes supervised sessions twice a week over 4 weeks, focusing on resistance, cardiovascular, balance, reaction and agility exercises. Functional capacity and fall risk will be measured, alongside physical tests such as handgrip strength and one-repetition maximum (1RM) tests for leg press, bench press, seated row and leg extension. Cognitive and emotional assessments will also be conducted during the intervention. The results of this study aim to increase our understanding of the effects of CrM supplementation in older adults. This study is expected to generate valuable information on the impact and safety of this nutrition and exercise strategy, and its application can be extended to a variety of health conditions. CLINICAL TRIALS: https://clinicaltrials.gov/study/NCT06677359.

Consuming fruit juice/smoothies could help overcome barriers to fruit and vegetable (F&V) intake. However, their contribution towards F&V intake within a healthy diet is contentious. We investigated how F&V intake is affected by UK 5-a-day advice, with and without one portion/d of fruit juice/smoothies and explored how these interventions impacted markers of health. Healthy individuals (n 42) with low F&V intake (≤ 2 servings/d) completed a 4-week, parallel-group randomised controlled trial (ClinicalTrials.gov ID: NCT06628401). Participants were randomised to (1) control, (2) whole F&V (FV) or (3) whole F&V plus fruit juice/smoothies (FV + FJ). All groups received weekly financial support (to remove financial barriers to F&V purchase in the intervention groups). FV and FV + FJ also received a co-designed educational booklet. We investigated the intervention effects on self-reported F&V intake (primary outcome), biomarkers of intake and metabolism, mood, gut symptoms and acceptability. Post-intervention F&V intake differed between groups (P < 0·001; ηp2 = 0·62). It was significantly higher in FV ((estimated marginal means (se)); 8·9 (0·64) portions/d, P < 0·001) and FV + FJ (6·6 (0·64), P < 0·001) v. control (2·45 (0·64)), but there was no difference between FV and FV + FJ (P = 0·051). Both interventions showed good acceptability. Depression symptoms differed between groups (P = 0·01; ηp2 = 0·21); they were significantly lower in FV + FJ than control. There were no differences in anxiety or gut symptoms, nor in intake or metabolic biomarkers. A financial and educational intervention based on UK 5-a-day recommendations, with or without fruit juice/smoothies, significantly increased short-term F&V intake and benefited mood without adversely impacting health markers in the short-term. Funder: Fruit Juice Science Centre.

Intake of fish and supplementation with n-3 PUFA are associated with reduced incidence of CVD. Cetoleic acid promotes n-3 PUFA generation in salmon and human HepG2 cells, but data in humans are scarce. To explore the effect of cetoleic acid on n-3 PUFA levels, we performed a double-blinded randomised controlled trial in healthy adults (thirty-seven females and twelve males) for 4 weeks. The participants were randomised to consume either capsules with mackerel oil, naturally rich in cetoleic acid, or a control oil, both with a similar concentration of n-3 PUFA. Supplements with mackerel oil resulted in higher plasma levels of the n-3 PUFA 20:4n-3 (eicosatetraenoic acid) and 20:5n-3 (EPA) as compared with those receiving control oil. In addition, those who received the cetoleic-rich capsules had higher levels of 20:4n-3 in the erythrocytes membrane and a decrease in expression of elongation of very long-chain fatty acids protein 5 in peripheral blood mononuclear cells. We found no differences in lipid, glucose or C-reactive protein between the two treatment groups, consisting of healthy subjects. Our data suggest that supplementation with cetoleic-rich mackerel oil may result in increased levels of certain n-3 PUFA. Further studies should include patients with or at risk for metabolic and CVD.

Bioelectrical impedance analysis (BIA)-derived water composition ratios are non-invasive and cost-effective indices that reflect body fluid distribution. This study aimed to investigate the associations between these BIA-derived ratios and overall survival (OS) in patients with gastric cancer. A retrospective multicentre study included 385 gastric cancer patients. Optimal cut-offs were determined via receiver operating characteristic curves. Kaplan–Meier survival analysis, Cox regression analysis and restricted cubic spline (RCS) evaluated associations with OS. The optimal cut-off values were 0.389 for extracellular water (ECW)/total body water (TBW), 0·611 for intracellular water (ICW]/TBW and 0·638 for ECW/ICW. Kaplan–Meier survival analysis revealed that elevated ECW/TBW (72·6% vs. 58·7%; P < 0·001) and ECW/ICW (59·1% vs. 72·4%; P < 0·001) were associated with poorer OS, while a higher ICW/TBW (73·4% vs. 57·3%; P < 0·001) indicated better prognosis. In RCS models, ECW/TBW (hazard ratio (HR) = 1·552, 1·202–2·005, P = 0·001) and ECW/ICW (HR = 1·735, 1·320–2·280, P < 0·001) independently predicted worse OS, whereas ICW/TBW inversely correlated with mortality (HR = 0·620, 0·486–0·790, P < 0·001). Multivariable Cox regression analysis further confirmed that higher ECW/TBW (HR =1·552, 95% CI 1·272–2·688, P < 0·001) and ECW/ICW (HR = 1·735, 1·320–2·280, P < 0·001) ratios independently predicted worse OS. Conversely, a higher ICW/TBW ratio was inversely correlated with mortality (HR = 0·567, 95% CI 0·390–0·824, P = 0·003). The ECW/ICW ratio demonstrated the highest C-index (0·596), outperforming other ratios in predicting survival. These associations were consistent across subgroups, including advanced-stage patients. BIA-derived water composition ratios, particularly ECW/ICW, are robust and independent predictors of survival in gastric cancer patients, reflecting underlying metabolic and inflammatory disturbances. These non-invasive and cost-effective markers could enhance prognostic accuracy and guide personalised treatment strategies.

Low protein intake is prevalent in people with CHD and is inadequately addressed in UK-based cardiac rehabilitation. This pilot feasibility study aimed to identify whether targeted education increases protein intake in patients with CHD and low protein intake, compared with standard cardiac rehabilitation dietary education. People referred to cardiac rehabilitation with CHD (≥ 50 years) underwent anthropometric assessment and completed a food diary, sit-to-stand test and three questionnaires (physical activity, sarcopenia screening and nutrition knowledge). Participants with low protein intake (≤ 1·2 g/kg per d) were randomised to receive either extra protein education (intervention; protein group) or standard education (control; control group), embedded within their usual 6-week cardiac rehabilitation programme. At 6 and 12 weeks, outcome measures were repeated; thirty-four participants provided baseline data. Protein intake was inversely associated with waist circumference (r = −0·348). Twenty-seven participants (79 %) with low protein intake were randomised to the protein group (n 15) or control group (n 12). At week 6, the median (interquartile range) change in protein intake was 0·0 (−0·0–0·3) and 0·4 (0·2–0·5) g/kg per d in the protein group and control group, respectively (effect size 0·5). At week 12, the change in protein intake was 0·0 (−0·0–0·1) and −0·0 (−0·2–0·2) g/kg per d in the protein group and control group, respectively (effect size 0·3). Effect sizes for all other variables were ≤ 0·4. The intervention appeared well-received by those who completed the study; however, changes to primary and secondary outcomes were minimal. Uptake of the study was low, and attrition was high, limiting the interpretation of efficacy and the implementation of a definitive trial.

The purpose of this systematic review and meta-analysis was to investigate the effects of hesperidin supplementation on inflammatory and oxidative stress biomarkers in human adults. A systematic literature search was conducted in PubMed, EMBASE and Cochrane Central Register of Controlled Trials from inception to 4 January 2025 to identify eligible randomised controlled trials. Ten randomised controlled trials with a total of 532 participants were included. The results indicated that hesperidin supplementation significantly reduced the serum levels of C-reactive protein or high-sensitivity C-reactive protein (SMD: –0·43; 95 % CI –0·71, –0·15; P = 0·002) and TNF-α (SMD: –0·51; 95 % CI –0·95, –0·07; P = 0·02) in adults, while no significant beneficial effect of hesperidin on IL-6 was observed (SMD: –0·25; 95 % CI –0·52, 0·01; P = 0·06). In addition, hesperidin intake showed a beneficial impact on the IL-6 level in patients with diseases (type 2 diabetes and myocardial infarction) (SMD: –0·38; 95 % CI –0·72, –0·04; P = 0·03) yet not in healthy adults without diagnosed diseases. Our findings demonstrated that hesperidin supplementation could lower the serum levels of C-reactive protein or high-sensitivity C-reactive protein and TNF-α in adults.

Epidemiological and clinical research has confirmed a link between obesity and depressive symptoms, with inflammation as a potential common mechanism. Given that dietary components modulate inflammation and relate to both conditions, investigating dietary inflammation as a potential underlying pathway is necessary. Herein, we aimed to explore the potential role of the Energy-adjusted Dietary Inflammatory Index (E-DII) in explaining the relationship between obesity and depressive symptoms. We conducted a cross-sectional analysis of the 2007–2018 National Health and Nutrition Examination Survey cohort, enrolling 20 324 participants. Obesity and dietary inflammation were assessed by BMI and E-DII, respectively. Depressive symptoms were evaluated using the nine-item Patient Health Questionnaire-9. We found that obesity and inflammatory diets were positively associated with depressive symptoms (β = 0·50, 95 % CI 0·30, 0·69; β = 0·35, 95 % CI 0·19, 0·50; both P < 0·001), and variations in the association among obesity, pro-inflammatory diets and depressive symptoms were evident across various population subgroups (e.g. sex, age, chronic diseases and smoking status subgroups, Pfor interaction < 0·050). After adjusting for all covariates, E-DII accounted for 4 % of the obesity–depression association. Despite this modest proportion, the finding identifies dietary-induced inflammation as a statistically significant, modifiable pathway. In conclusion, obesity and pro-inflammatory diets are linked to an increased risk of depressive symptoms, with E-DII serving as a modest but significant modifiable pathway. These findings highlight dietary intervention as a potential strategy for mitigating depressive symptoms in individuals with obesity.

Mobility limitations due to chronic musculoskeletal pain are a major contributor to disability in older adults, yet current pharmacological treatments often have limited efficacy and increase the risk of polypharmacy. Omega (ω)-3 PUFA, particularly EPA and DHA, have demonstrated anti-inflammatory and analgesic properties, but are under-consumed among older USA adults. Krill oil, a marine-derived source of EPA and DHA with enhanced bioavailability compared with typical fish oils and additional bioactive compounds such as astaxanthin and choline, may offer a promising nutritional intervention. This pilot study will assess the feasibility and acceptability of a 3-month randomised, double-blind, placebo-controlled trial of krill oil supplementation (4 g/d: 1288 mg EPA + DHA, 0·45 mg astaxanthin, 320 mg choline) v. placebo (mixed vegetable oils) in forty community-dwelling adults aged ≥ 60 years with chronic musculoskeletal pain. Primary outcomes include feasibility (recruitment, retention and adherence) and acceptability (participant satisfaction). Secondary outcomes include changes in the omega-3 index, ω-6/ω-3 ratio and inflammation (high-sensitivity C-reactive protein), as well as exploratory changes in pain intensity and functional interference, and physical function (Short Physical Performance Battery, 6-Minute Walk Test). Findings will inform the design of future fully powered trials that may ultimately contribute to the evidence for omega-3 supplementation as a non-pharmacological strategy to support healthy aging and functional independence in older adults.

This study aimed to explore whether health effects of dietary nitrate depend on its source, by investigating associations between plant and animal-sourced dietary nitrate groups with markers of inflammation and CVD risk factors. Among 100 non-smoking adults (mean age 49 (sd 13) years, 31 % male), dietary nitrate intake was assessed using FFQ (n 100) and 3-d food diary (n 89), combined with nitrate food composition databases. Nitrate intake was classified into plant, naturally occurring animal and additive-permitted meat-sourced groups. Associations between source-dependent nitrate intakes and lipoprotein-associated phospholipase A2 (Lp-PLA2), C-reactive protein (CRP), fasting plasma lipids, anthropometry and blood pressure were examined using multivariable linear regression, adjusted for socio-demographic, lifestyle and dietary confounders. Each 1 sd (∼57 mg/d) increment in plant-sourced nitrate intake was associated with a 0·191 sd lower LDL-cholesterol (β = −0·191, 95 % CI (–0·369, −0·004), P = 0·045; equivalent to −0·21 mmol/l) in primary models, though this association was attenuated in sensitivity analyses. Naturally occurring animal-sourced nitrate intake was not associated with any outcomes. A 1 sd (0·08 mg/d) increment in additive-permitted meat-sourced nitrate intake was associated with a 0·208 sd lower HDL-cholesterol (β = −0·208, (–0·362, −0·054), P = 0·009; equivalent to −0·10 mmol/l) and a 0·192 sd higher waist circumference (β = 0·192, (0·005, 0·380), P = 0·042; equivalent to +1·29 cm) but not with LDL-cholesterol, TAG, blood pressure, Lp-PLA2 or CRP. These preliminary findings suggest potential differential associations between nitrate source and cardiometabolic markers that warrant confirmation in larger studies.

Evidence on the association between the Mediterranean diet and premenstrual syndrome (PMS) remains inconclusive; therefore, this study examined the relationship between adherence to a Mediterranean-style diet and overall PMS severity and specific psychological and physical symptoms. This cross-sectional study included 606 women aged 18–35 years. Premenstrual symptoms and their severity were assessed using the validated Premenstrual Symptoms Screening Tool and the Calendar of Premenstrual Experiences. Adherence to the Mediterranean diet was assessed using a modified Mediterranean diet score (mMDS; range 0–9 points), derived from a validated 138-item semi-quantitative FFQ. Logistic regression was used to estimate OR with 95 % CI to examine the association between adherence to the Mediterranean-style diet and PMS severity. Three overall PMS severity groups were identified: No-PMS (21·8 %), Mild-PMS (50·2 %) and Moderate/Severe-PMS (28·0 %). No association was observed between adherence to the Mediterranean-style diet and overall PMS severity. Compared with women with Low mMDS (0–3 points), women with Moderate mMDS (4–5 points) had an OR of 1·11 (95 % CI 0·63, 1·94) for Moderate/Severe-PMS. Among women with High mMDS (6–9 points), the corresponding OR was 1·37 (95 % CI 0·75, 2·53). Of the thirty-two specific premenstrual symptoms, only headache was inversely associated with Mediterranean-style diet adherence in the Moderate v. Low mMDS group (OR = 0·75, 95 % CI 0·59, 0·95), but not in the High v. Low mMDS group (OR = 0·80, 95 % CI 0·63, 1·03). Given the lack of a significant association, further prospective and intervention studies are needed.

Fasting during pregnancy is a widespread practice in Muslim communities, yet its health implications remain poorly understood. A lack of conceptual frameworks and limited understanding of the characteristics of women who fast during pregnancy have hindered research in this area. This study examines the differences in several nutritional biomarkers between women who fasted and those who did not and identifies factors associated with fasting behaviour. We analysed data from the Kuwait Birth Cohort in which information on fasting, sociodemographic characteristics and health behaviours was collected via structured interviews between 2017 and 2021. Clinical and laboratory data were extracted from medical records. Predictors of fasting were identified using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 5-fold cross-validation, followed by Poisson regression with robust standard errors. Among 1087 women with available data, 581 (53·4 %; 95 % CI 50·4 %, 56·4 %) reported fasting during pregnancy (19·5 % in the first trimester, 25·1 % in the second and 10·1 % in the third). Women who fasted had significantly lower levels of ferritin (P = 0·048), vitamin B12 (P = 0·001), erythrocytes folate (P < 0·001), 25-hydroxyvitamin D (P = 0·002) and vitamin D binding protein (P = 0·011), but higher parathyroid hormone (P = 0·011). Predictive models based on sociodemographic and clinical factors showed limited predictive ability. This study indicates that fasting during pregnancy is a common practice among women in Kuwait and is associated with lower levels of key nutrients such as vitamin D, RBC folate and vitamin B12. Fasting during pregnancy appears to be driven more by personal, religious and cultural influences than by identifiable clinical or sociodemographic characteristics.

Diet plays a critical role in the development and progression of Crohn’s disease (CD). Dietary indices are important tools to evaluate diet quality and inflammatory potential, and we investigated their associations with paediatric CD compared with healthy children. A cross-sectional study including 144 children with CD (122 with clinically active and twenty-two with quiescent disease) and fifty-seven healthy controls aged 6–18 years was conducted. Dietary intake was estimated using three 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI)-2015, alternate Mediterranean diet (aMed) score and dietary inflammatory potential using the modified Children-Dietary Inflammatory Index (mC-DII). Children with active CD had lower total HEI-2015 and aMed scores than healthy controls. A similar pro-inflammatory mC-DII score was found across the three groups. A higher mC-DII score in patients with CD was associated with higher intake of refined sugars, saturated fats and protein, and lower intake of whole grains and dairy, identifying dietary components contributing to dietary nflammatory potential. Similarly, healthy children in the highest mC-DII tertile consumed more added sugars and sodium and fewer whole grains, fruits, vegetables and plant proteins. Fibre intake was significantly lower in children with active CD (median %DRI: 37·0 (22·6–48·3) vs 41·2 (34·1–49·1) vs 45·8 (35·7–62·0), P < 0·001). Overall both children with CD and healthy children in this cohort consume a poor-quality, pro-inflammatory diet low in fibre, but the quality and fibre content are significantly lower in children with active CD. Future randomised controlled trials are needed to evaluate dietary interventions on the risk and progression of paediatric CD.

Mediterranean diet (MedDiet) is central to metabolic dysfunction-associated steatotic liver disease (MASLD) management; however, evidence in non-Mediterranean populations is limited. This study examined the association between MedDiet adherence and MASLD, hospitalisation and mortality in a non-Mediterranean population. This longitudinal study included 119 536 UK Biobank adults with at least one 24-hour dietary recall and available sociodemographic and clinical data. Diet quality was assessed using the Modified-Mediterranean Diet Score (M-MedDietScore). MASLD was determined by fatty liver index (FLI) at baseline and by liver imaging in a subgroup. Hospitalisation and mortality data were obtained from linked records, with MASLD outcomes identified using International Classification of Diseases, 10th Revision codes. Binary logistic regression and Cox proportional hazard models estimated Odds Ratio (OR) for MASLD and hazard ratio (HR) for hospitalisation and mortality. Each five-unit increase in M-MedDietScore was associated with 19 % lower OR of MASLD as identified by FLI and confirmed in the imaging sub-analysis in a multivariate adjusted Model 2. Higher adherence to the MedDiet was associated with lower HR of hospitalisation due to liver-related, CVD, diabetes, respiratory and renal disease (all P < 0·05). During a median follow-up of 9·7 years, 5552 deaths occurred. Higher MedDiet adherence was associated with lower HR of all-cause, CVD and extrahepatic cancer mortality and lower all-cause mortality risk in those with MASLD (HR: 0·94, 95 % CI: 0·90, 0·98). Higher adherence to the MedDiet was associated with lower odds of MASLD and with reduced MASLD-related hospitalisations and mortality and lower all-cause mortality in those with MASLD. These findings support the role of MedDiet in reducing hepatic and cardiovascular burden in non-Mediterranean population.

Given there is no prospective research evidence on the association between ultra-processed food (UPF) intake and human bone health, this study aimed to analyse the associations of UPF intake with bone mineral density (BMD) and risk of fractures using data from 163 855 participants in the UK Biobank. Multiple linear regression assessed BMD, and Cox regression models estimated fracture risk. Restricted cubic splines were used to evaluate non-linearity. Participants’ average age was 56·0 years, with 1097 hip fractures and 7889 all fractures recorded over 12·0 years of follow-up. Complex inverted U-shaped associations between UPF intake and BMD were found at the femur trochanter. Compared with the lowest UPF intake, the highest UPF intake was linked to a reduction in BMD at the femoral neck (β(se) = −0·0061 (0·0024), P < 0·05), femur trochanter (β(se) = −0·0083 (0·0024), P < 0·001), lumbar spine (β(se) = −0·0114 (0·0036), P < 0·01) and total body (β(se) = −0·0095 (0·0021), P < 0·001). The link was more pronounced in participants under 65 years of age and those who were underweight (Pinteraction < 0·01). Per sd increment of UPF intake was linked to 10·5 % and 2·7 % higher risks of incident hip fractures (hazard ratio (HR), 95 % CI 1·105, 1·029, 1·186; P < 0·01) and all fractures (HR, 95 % CI 1·027, 1·000, 1·055; P < 0·05), respectively. Our results suggest that higher UPF intake is associated with lower BMD and increased risk of fractures captured in hospital inpatient records, highlighting the need for dietary interventions to protect bone health.

Depression is a common mental disorder and a leading cause of global disease burden. Emerging evidence supports diet as an adjunct treatment for depression. Previous studies are limited, meaning it is unclear whether improvements are directly due to dietary change. The Optimising Nutritional Psychiatry Treatment: Investigating the Mediterranean Diet to Improve Symptoms of Major Depressive Disorder (OPTIMISM) trial aims to address this gap through a sham-controlled randomised feeding trial design. The OPTIMISM trial is a 4-week double-blind, sham-controlled, randomised feeding trial. A total of forty-four participants with major depressive disorder in a current major depressive episode of moderate to severe severity will be recruited and randomised to a Mediterranean or a sham control diet, designed to reflect typical dietary intake of the general population. All food will be provided for 4 weeks. Participants will complete assessments and have blood and stool collected at baseline and 4 weeks. The primary outcome is the differential change in clinician-rated depressive severity at 4 weeks. Exploratory outcomes include patient-rated depressive and anxiety symptoms and quality of life. Potential mechanisms will be evaluated through analysis of biological samples. An additional group of twenty-two healthy individuals without depression will also be recruited and will receive a Mediterranean diet for 4 weeks; their data will determine whether clinical and biological responses to the intervention are unique to depression and whether the diet treatment modulates depression-related pathology. If the intervention diet leads to a greater reduction in depressive symptoms compared with a sham control diet, this trial will provide preliminary evidence supporting the use of a Mediterranean diet in the treatment of depression.

Understanding trends in height and BMI, along with trajectories of weight status, is crucial to identifying the optimal timing for intervention. The objective of this study was to describe trends in height and BMI among children and adolescents and identify the trajectory of weight status over time. This was a longitudinal study with data collected annually (2013–2020). A total of 41 325 students aged 5–18 years from forty-seven schools participated in the study, and a subsample of 11 535 participants with at least five BMI measurements was used for the analyses. Mixed-effects analysis showed significant increases in height over the years for boys (0·19 cm, standard error 0·01, P < 0·001) and girls (0·15 cm, standard error 0·01, P < 0·001). Regarding BMI, an increasing trend over the years was also found in boys (0·04 kg/m2, se 0·01, P < 0·001) and girls (0·04 kg/m², se 0·01, P < 0·001). Analysing weight status trajectories, three groups were identified: consistently normal weight (males 63·7 %, females 64·5 %), increasingly overweight (males 21·8 %, females 20·7 %) and increasingly obese (males 14·5 %, females 14·8 %). We conclude that in adolescence, height was below expected, indicating that children are not reaching their maximum growth potential. Furthermore, the identification of increasing trajectories of overweight and obesity, starting in childhood, emphasises the progressive nature of excessive weight gain before adulthood. These findings highlight the early onset of nutritional deviations in this population, suggesting the need for interventions to promote healthy weight as children transition into adolescence to mitigate future health risks.