Telehealth, which involves the remote delivery of healthcare services through virtual technologies, has been shown to have benefits such as reducing hospitalisations and length of stay for patients (1,2). The global COVID-19 pandemic has greatly accelerated the adoption of telehealth among clinical nutritionists. For instance, in the USA, telehealth usage for nutritional care has increased from 37% to 78% among clinical nutritionists (3), while in Italy, the adoption of telenutrition services by Registered Dieticians (RDNs) has risen from 16% to 63% (4). These statistics highlight the rapid integration of telehealth into dietetics practices as a response to the global health crisis, reflecting a growing trend towards virtual care delivery as an effective method for providing nutritional care. While telehealth has made progress in Saudi Arabia (5), there is a research gap regarding its prevalence and effectiveness in dietetics practice. This study aims to evaluate the current implementation of telehealth in dietetics practice during the COVID-19 pandemic in Saudi Arabia.

In this cross-sectional, a web-based online survey was used from mid-December 2022 to mid-May 2023. The study was distributed in several Saudi Arabian regions including (central, western, eastern, south, and north) and was completed by 306 clinical Registered Dietitians (RDNs) in public and private healthcare facilities who met the study’s inclusion criteria. The survey consisted of 28 questions divided into four sections, covering sociodemographic information, past or current experiences, obstacles and challenges of telehealth usage, and the future prospects of telehealth. In this study, participants were requested to reflect on their current observations and previous experiences pertaining to the utilisation of telehealth in the field of dietetics. To ensure the validity and relevance of the survey, it was reviewed by a panel of experienced dietitians in Saudi Arabia to obtain their feedback before being used to collect data.

Our research findings reveal that 76% of RDNs in Saudi Arabia utilize telehealth in their practice. The most common obstacles reported by RDNs using telehealth include internet connectivity issues (21.9%), patient disengagement and lack of enthusiasm (21.3%), and difficulties in coordinating with patients (21%). Telehealth interventions used by RDNs primarily involve diet recall (33.7%), weight- related measurements (30.6%), lab findings (26%), and only 8% reported using telehealth for vital signs. A majority of participants (69.4%) believed that telehealth could improve patient accessibility and help reduce no-show rates (68.9%). Additionally, over 70% of participants agreed that telehealth offers them flexibility in inpatient consultations.

In conclusion, telehealth is widely utilised among RDNs in Saudi Arabia, with potential benefits such as decreased no-show rates. Further research is needed to gain a better understanding of telehealth usage among RDNs in Saudi Arabia.

Diet is a large influencer of the gut microbiota composition and function across the lifespan. However, information on whether and how diet can affect the brain via bidirectional communication between the gut and the central nervous system (the microbiota-gut-brain axis) is emerging. Immune, endocrine, humoral, and neural connections between the gastrointestinal tract and the central nervous system are important to this axis. The gut microbiota can produce cytokines, neurotransmitters, neuropeptides, chemokines, endocrine messengers, and microbial metabolites (e.g., short-chain fatty acids, branched chain amino acids, and peptidoglycans), some of which can enter the brain, influencing the function of brain cells. Animal studies investigating the potential of nutritional interventions on this axis have advanced our understanding of the role of diet in this bidirectional communication. This includes insights into microbial metabolites, immune, neuronal, and metabolic pathways amendable to dietary modulation. However, several aspects of the gastrointestinal tract and brain of animal models differ to humans, and it is important to consider these differences and similarities when evaluating the transability of the findings to the human context. Randomised clinical trials using dietary interventions in humans in this field are limited but have high potential application for clinical nutrition. In particular, several microbiota-targeted interventions have been explored as potential approaches for mental health. These approaches include probiotics, prebiotics, etc. as well as dietary approaches(1,2,3). However, there are limited clinical interventions with whole-dietary approaches. Most human studies used faecal samples to infer changes in microbiota parameters occurring in the gastrointestinal tract and do not consider the physiological changes in gastrointestinal physiology (e.g., transit time) that can directly or indirectly affect the diversity and composition of the gut microbiome. Future research considerations should include better characterisation of the participants at baseline (dietary patterns, gastrointestinal phenotype, and gut microbiota composition) to identify potential responders to dietary interventions. In addition to gut microbiota assessment, evaluations of physiological parameters, brain function and behavioural measurements should be considered as part of the study protocol. In this presentation, the current state of the literature triangulating the diet, the gut microbiota, and host behaviour/brain processes will be addressed. Future research considerations will also be discussed.

Dietary acculturation in immigrant groups can impact health and may increase the risk of conditions like diabetes and cardiovascular disease among East Asian immigrants as they adopt host-country eating patterns(1). Pakistani immigration to the UK has resulted in a dynamic cultural exchange, including modifications in culinary preferences and practices among Pakistani ethnic groups. Prior research indicates that second-generation adults exhibit more signs of acculturation in their choice of diets than their first-generation counterparts (2). There is limited understanding of the food habits or the effects of acculturation on this group. The primary purpose of this study was to investigate intergenerational disparities in food preferences among Pakistani immigrants and the impact of dietary acculturation.

This cross-sectional study examined the food habits and acculturation experiences of 51 first (1G) and 51 second-generation (2G) participants of the Pakistani community living in London. Data was collected using survey questionnaires modified from previous studies (3,4). We compared traditional foods like paratha and samosa with Western options like fish and chips through a set of questions, from which a dietary score was calculated (Global scale) (5). We measured food acculturation using a 5-point scale, with higher scores indicating greater Western influence and lower scores indicating less Western acculturation. Scores ranged from 6 to 30 and were categorised as low, moderate, high, or very high. Data was analysed using SPSS (version 28.0). Chi-square and t-tests were applied to identify differences between groups with significance levels set to p<0.05.

Most of the participants were male (67%) with 38.8% aged 36-45 years. Urdu ethnicity predominated in both generations (64.8%). Significant differences in dietary restrictions for health conditions (p =.008), language (p = .001), consumption frequency of traditional Pakistani cuisine (p = .001), desserts/sweets (p = .001), chai/lassi (p = .017), popular UK meals, fizzy drinks, and inclusion of rice/flatbread (p = .003) emerged between first and second generations. Health-related dietary behaviours differed in fruits/vegetables, dairy, and meat consumption (p =.001). ‘Traditional’ and ‘Western’ dietary scores were significantly different between generations (‘Traditional’: 1G: 17.15 ± 3.52 vs 2G: 13.68 ± 4.71, p = .001; ‘Western’: 1G: 16.29± 1.98 vs 2G: 18.21 ± 3.84, p = .001). The results demonstrated a preference for traditional eating patterns by 1G, whereas a nuanced move towards Western food preferences was observed among the 2G participants, falling into the high category of global scale. 1G Participants cited language acquisition, time constraints, and financial issues as factors affecting their dietary changes.

This study found significant differences in dietary habits and preferences between first- and second- generation Pakistani immigrants in the United Kingdom. The second generation displayed a more significant shift towards Western food patterns, possibly because of socio-cultural variables, language fluency, and adaptability to the local environment.

The oral cavity is a vital part of the digestive system. Poor oral health can impact an individual’s ability to eat and has been associated with increased risk of non-communicable diseases and reduced longevity. Conversely, positive oral health has been associated with improved cardiometabolic, cognitive and systemic health and greater longevity. Consumption of dietary nitrate, which is processed in the mouth into nitrite, and is subsequently converted into nitric oxide (NO) in the body (1), has been demonstrated to reduce blood pressure, improve endothelial function, and enhance exercise performance. Interestingly, recent studies suggest that nitrate consumption could also positively modulate markers of oral health (2). To our knowledge, no systematic review has been published examining the effect of inorganic dietary nitrate on oral health. However, this could be valuable to summarise current state of the knowledge, identify effect modifiers and highlight gaps for future research. Therefore, this systematic review aims to investigate the effects of dietary nitrate supplements on markers of oral health in vivo in randomised controlled trials (RCTs).

This study was pre-registered with PROSPERO (CRD42023411159). Five databases (PubMed, The Cochrane Library, CINAHL, MEDLINE, and SPORTDiscus) were searched from inception until March 2023 to identify studies that met the following criteria: adult participants (≥ 18 years) and RCTs investigating the effects of oral dietary nitrate versus placebo on markers of oral health. A narrative synthesis of data was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Nine articles reporting data on 284 participants were included. Nitrate was provided via beetroot juice (six studies), a beetroot-derived supplement dissolved in mineral water (one study), and lettuce juice (two studies). The duration of the interventions ranged from one day to a maximum of six weeks. Dietary nitrate supplementation increased the relative abundance of several individual bacterial genera including Neisseria (increased in three studies) and Rothia (increased in three studies). Dietary nitrate supplementation increased salivary pH (increased in two studies) and decreased salivary acidification resulting from the consumption of a sugar-sweetened beverage (decreased in two studies). Furthermore, dietary nitrate supplementation resulted in a decrease in the gingival inflammation index in one study. Overall, the risk of bias in studies was mixed. One study had a low risk of bias, while the rest were rated as having some concerns. No study was considered to have a high risk of bias.

The results show that dietary nitrate is a potential nutritional strategy that can potentially benefit oral health by modifying the oral microbiome, altering salivary pH, and minimising gingival inflammation.

Uncontrolled hypertension is a primary cause of non-communicable diseases and death globally(1). The gut microbiota plays a role in hypertension and dietary interventions high in fibre have been shown to lower blood pressure (BP)(2). Not all participants respond to dietary fibre interventions, for reasons which are unclear. Here we aimed to identify responders of a high fibre intervention based on their baseline gut microbiome. Twenty treatment-naive participants with hypertension received either placebo or 40g per day of prebiotic acetylated and butyrylated high amylose maize starch (HAMSAB) supplementation for 3 weeks in a phase II randomised cross-over double-blind placebo-controlled trial. Blood pressure was monitored at baseline and each endpoint by 24-hour ambulatory BP monitoring, with those experiencing a reduction between timepoints of ≥ 2 mmHg classified as responders. Baseline stool samples were collected and the V4-V5 region of the 16S gene sequenced. Taxonomy was assigned by reference to the SILVA database. The MaAsLin2 package was used for assessing the relationship between baseline gut microbiota and response to dietary intervention. Overall participants had significant reduction in 24-hour systolic BP (–6.1 mmHg, p = 0.03), with 14 individuals classified as responders and six individuals as non-responders. 13 genera were found to be differentially abundant between responders and non-responders. Genera significantly enriched in responders included Dialister (β = 1.29, q = 1.921x10-134), Coprococcus (β = 1.26, q = 3.282x10-121), Bifidobacterium (β = 1.67, q = 1.11x10-81), Ruminococcus (β = 0.161, q = 1.11x10-8) and Roseburia (β = 0.82, q = 4.275x10-2). Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased level of bacterial genera known to contain species that produce short-chain fatty acids (e.g. Bifidobacterium, Roseburia and Ruminococcus) at baseline. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension.

Research studies suggest that date-palm (Phoenix dactylifera L.) fruits provide a superior nutritional and health benefits, compared to other fruits (1). They are rich source of many essential nutrients including carbohydrates, dietary fibre, vitamins, minerals, phytochemicals, and antioxidants. The date palm fruits are produced in many countries around the world and about 10-15% of the total production is lost or sold extremely at low prices (2, 3). Despite these, date fruits have been rarely used as an ingredient in commercially available energy bars. The aim of this study is to investigate the impact of newly formulated date-based energy bar (DBEB) (4) intake on subjective appetite, postprandial metabolism, energy substrate oxidation and diet-induced thermogenesis (DIT).

Twenty-seven healthy male adults (mean ± SD, aged 20.8 ± 3.5 years with body weight of 66 ± 8 kg) participated in a randomised crossover design study. Each participant conducted two experimental arms and was investigated prior to (baseline) and for three-hours after consumption of either a date- based energy bar (DBEB) or an isocaloric and macronutrient matched mixed fruit-based energy bar (FBEB) as control arm. The DBEB contained significantly less fructose and glucose, but more sucrose and fibre than FBEB. Both experimental arms involved blood sampling, subjective appetite, and indirect calorimetry measurements. At the end of each experiment, an ad libitum buffet meal was provided. Data analysis used descriptive statistics, paired t-test, and two-way ANOVA.

Time-averaged composite appetite and satiety scores were not significantly different between control (FBEB) and DBEB arms. Energy intake during ad libitum buffet was also not different between arms. Metabolic rate measured at baseline and during post-ingestion of the bars were not significantly different between FBEB and DBEB arms (arm effect, P>0.05). Thermic effect of bars calculated as percentage increase in metabolic rate above RMR during whole postprandial duration was (mean ± SE) 9.5 ± 1.6 % in DBEB arm and 8.7 ± 1.3 % in the FBEB arm (arm effect, P>0.05). Rates of carbohydrate and fat oxidation were also not different between the two arms (arm effect, P>0.05) Time-averaged concentrations of blood glucose, insulin and triglycerides were similar between the study arms.

The obtained results suggest that energy bars based on dates or mixed fruits produce similar effects on postprandial appetite, fat and carbohydrate oxidation, thermic effect and cardiometabolic risk factors. Date fruits can be used as rich source for carbohydrate and energy. However, future research should investigate the impact of date-based energy bars on antioxidant capacity and other health related markers.

A majority of Australians consume a limited range of different dietary fibres and insufficient total dietary fibre(1). This contributes to low intestinal microbial diversity and impaired microbial function, such as capability in producing beneficial metabolites like short-chain fatty acids (SCFA). This diet-induced dysbiosis is associated with poor gastrointestinal health and a broad range of non-communicable diseases(2). Our study aimed to determine whether one dietary change, substitution of white bread with a high fibre bread improves faecal microbial diversity and butyrate-producing capability. Twenty-six healthy adults completed a randomised, cross-over, single-blinded intervention. Over the two intervention phases separated with a 4-wk washout, participants consumed either 3 slices of a high fibre bread (Prebiotic Cape Seed Loaf with BARLEYmax®) or control white bread as part of the usual diet, each for 2 weeks. At the beginning and end of each intervention period, participants completed a 24-h diet recall, a gut symptoms rating questionnaire and provided a faecal sample for microbiome analysis. The composition of faecal microbiome was characterised using 16S rRNA amplicon sequencing (V3-V4) and a marker of butyrate synthesis capability, the faecal content of butyryl-CoA:acetate CoA-transferase (BCoAT) gene was assessed using Real-time PCR. The high fibre bread intervention increased the servings of whole grain from 1.5 to 4 per day and increased total dietary fibre intake to 40 g/d which was double the amount of fibre consumed by participants at baseline or during the white bread intervention. Compared to white bread, the high fibre bread increased richness and evenness (Shannon, p = 0.014) of the gut microbiota and increased the relative abundance of SCFA producing taxa Lachnospiracae ND3007 group (p <0.001, FDR = 0.019). In addition, the high-fibre bread tended to increase relative abundance of butyrate-producing genus Roseburia, and microbial BCoAT gene content compared to white bread. In conclusion, the substitution of white bread with high-fibre bread improved the diversity of gut microbiota, specific microbes involved in SCFA production and may enhance the butyrate production capability of gut microbiota in healthy adults.

Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects up to 13% of reproductive-aged women and is associated with reproductive, metabolic and psychological features. Women with PCOS have a higher prevalence of longitudinal weight gain in population-based cohort studies compared to women without PCOS. On meta-analysis, women with PCOS also have an increased prevalence of overweight, obesity and central obesity, compared with controls. PCOS is therefore associated with an elevated prevalence of overweight and obesity which further worsen metabolic, reproductive and psychological dysfunction. Given the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women, weight management is a logical treatment strategy. This can be defined as prevention of excess weight gain, achieving a modest weight loss and sustaining a reduced weight long-term. This is best achieved through lifestyle management which traditionally refers to a complex multidisciplinary approach that combines dietary modification, physical activity and behavioural interventions. Lifestyle interventions and modest weight loss (5-10% of initial body weight) are associated with improvements in outcomes including central adiposity, hyperandrogenism, insulin resistance and cardiovascular risk factors. In PCOS specifically for dietary interventions, the majority of evidence indicates no differences between dietary approaches Lifestyle management advice should therefore follow general population guidance which states that lifestyle intervention can be achieved through a variety of dietary approaches providing these are tailored to dietary preferences and ensure the nutritional and health status of the individual patient with referral to a nutrition professional where possible. These recommendations are summarised in the 2023 International Evidence-based Guidelines on the Assessment and Management of PCOS. 1 These guidelines are now being translated and implemented internationally.

The adoption of plant-based meat analogues is increasing as an alternative to real meat products among consumers because they offer a more ecologically friendly and sustainable source of protein while also alleviating the ethical concerns related to livestock rearing and slaughter (1). However, there are concerns regarding plant-based meat analogues in terms of its nutritional quality, particularly their protein digestibility. This study aims to compared between chicken and plant-based chicken analogues in terms of nutritional composition and degree of protein hydrolysis.

Proximate analyses were performed for raw and cooked samples to assess protein, fat, and energy concentrations in two chicken samples (breast and thigh) and four commercial plant-based chicken (P-C1[Wheat Protein 37%, Pea Protein 10%], P-C2 [ Soya Protein 63%], P-C3 [ Soya and Wheat Protein 83%], and P-C4 [Soya Protein 30%, Pea Protein 2%]). As a first step, the proximate analyses were assessed for the averaged samples, then the product-cooking interactions was assessed using a one-way ANOVA followed by Tukey test (p <0.05). In vitro digestion was performed following the INFOGEST harmonised static in vitro digestion model (2) for cooked samples. After digestion, o- Phthaldialdehyde (OPA) assay was carried out to measure the degree of protein hydrolysis for each sample, and two-way ANOVA test was performed.

Protein content of chicken was higher compared with the plant-based chicken, whereas fat content and energy concentrations were higher in plant-based chicken. The protein content of chicken was higher for raw and cooked samples (raw: 19.8 ± 0.38 g/100 g; cooked: 30.55 ± 4 g/100g), compared with plant-based chicken (raw: 13.8 ± 5.3 g/100 g; cooked: 23.4 ± 4.5 g/100g). Plant-based chicken have a higher fat content and energy concentrations for raw and cooked samples (raw:6.52 ± 1.5 g/100 g; cooked: 9.6 ± 3.17 g/100g) and (raw:189.4 ± 28.1 g/100 g; cooked: 291.3 ± 48.1 g/100g) respectively; compared to chicken fat content (raw:4.6 ± 2.7 g/100 g; cooked: 6.1 ± 4 g/100g) and energy concentration (raw:150.9 ± 25.4 g/100 g; cooked: 228.3 ± 20.7 g/100g). The product-cooking interactions showed a significant increase (P ≤0.0001) in the protein content (raw: 15.6 ± 2.3g/100g to 19.8 ± 0.74 g/100g; cooked: 21.4 ± 0.55 g/100g to 33.06 ± 0.71 g/100g), and fat content P<0.001 (raw: 2.7 ± 0.06 g/100g to 8.3 ± 0.27 g/100g; cooked: 3.29 ± 0.19 g/100g to 13.22 ± 0.33 g/100g) in both chicken and plant-based chicken samples. No significant product-cooking interactions on energy content was found. The results from a two-way ANOVA test of the OPA and the degree of hydrolysis analyses demonstrated a significant increase in the degree of hydrolysis of chicken samples compared with plant-based chicken (P<0.0001).

The degree of hydrolysis and digestibility of chicken and chicken analogues was influenced by protein type, nutrient composition, and processing. These findings would provide substantial information for the improvement of plant-based chicken products with enhanced nutritional profiles. This work will be extended to investigate the availability and digestibility of individual amino acids.

Sales of plant-based meat alternatives (PBMAs) are increasing(1). While these products are becoming more popular, little is known about their impact on health(2). Therefore, the aim of this work was to systematically review the evidence on PBMA consumption and associated health outcomes.

A wider systematic review looking at the environmental impact, ingredient composition, nutritional impact and health outcomes associated with PBMAs was conducted. A search strategy combined terms “meat alternatives” AND “environment” OR “ingredients” OR “nutrition” OR “health.” Five databases were searched, MEDLINE, EMBASE, Web of Science, Scopus and Greenfile, as well as reference lists of relevant articles. All study designs reporting primary data were included, except for animal studies and in vitro studies. Non-English studies and studies published before 2011 were excluded (PROSPERO Registration Number: CRD42021250541).

2184 papers were identified, 1802 papers remained after duplicates were removed, 1536 were excluded at title and abstract screen stage, 266 full texts were assessed for eligibility and 54 papers were included in the analysis for all outcomes investigated. Ten studies examined the impact of PBMA vs. meat consumption on health outcomes. Three studies measured postprandial response to single test meals(3–5), four studies were longer-term RCTs(6–8) with two further separate publications reporting on different outcomes for the same RCT(9,10). One study was a prospective cohort(11) and one a cross-sectional study(12).

Of the single test meal studies, no significant differences were observed for glucose levels in 2/2 studies (100%)(3,5), PYY and GLP-1 levels in 2/2 studies (100%)(3,4) and self-reported hunger/fullness in 3/3 studies (100%)(3–5). Significantly lower insulin concentrations and subsequent energy intakes were both reported in 1/2 studies (50%) following consumption of mycoprotein vs. chicken meals(3).

Longer-term full and partial replacement of meat with PBMAs resulted in significantly lower body weight (kg) in 2/2 studies (100%)(6,10), significantly lower saturated fat intakes in 2/2 studies (100%) (6,10), significantly higher fibre intakes in 2/3 studies (67%)(6,7), improvements in plasma lipid profile in 2/3 studies (67%)(7,10) and positive changes in gut microbiota in 1/2 studies (50%)(8) compared to meat diet phases/control groups with no restrictions on meat intakes. There were no significant differences in protein intakes in 3/3 studies (100%)(6,7,10), energy, total fat and carbohydrate intakes in 2/2 studies (100%) (6,7), blood pressure in 2/2 studies (100%)(6,10), glucose levels in 2/2 studies (100%) (7,10) and insulin levels in 2/2 studies (100%)(7,10).

No definitive conclusions can be made on the impact of PBMAs on health outcomes due to the small number of studies and variation in study designs, outcomes measured and the type of PBMA used. From the limited evidence available, no negative health effects from PBMA consumption were observed, however, further longer-term RCTs are needed to confirm this.

The traditional Mediterranean Diet (MedDiet) is consistent with a dietary pattern and time-honoured eating behaviours by populations living in the olive-tree growing areas of the Mediterranean basin before the mid-1960’s. The MedDiet is described in the literature as a plant-based dietary pattern, consistent with a high intake of vegetables, fruits, nuts, legumes, wholegrains cereals, and daily use of extra-virgin olive oil incorporated into all meals; moderate consumption of fish, shellfish, fermented dairy products (cheese and yogurt), and wine (typically during meals); and a low or infrequent consumption of meat and processed meat products, processed cereals, sweets, vegetable oils, and butter(1). Being predominately plant-based, the MedDiet is naturally low in saturated fat, and rich in several functional components, including vitamins and minerals, carotenoids, unsaturated fatty acids, and phenolic compounds, depicted by antioxidant and anti-inflammatory properties. As a result of its putative beneficial health effects, the MedDiet is one of the most widely evaluated dietary patterns in the scientific literature(2). In both observational and intervention studies, there is a large and consistent body of evidence to support that a MedDiet is protective against chronic and inflammatory conditions, including cardiovascular disease, metabolic syndrome, management and prevention of type 2 diabetes, central adiposity, cancer, neurodegenerative conditions, and frailty(3). The effect of the MedDiet on women’s reproductive health is an emerging area in the literature. There have been a range of studies (observational and interventional) examining outcomes related to menarche, menstrual cycle, pregnancy, infertility, lactation, and menopause. The MedDiet has also been studied for the management of conditions such as polycystic ovary syndrome and endometriosis. These conditions are often associated with hormonal imbalances, inflammation, and oxidative stress, all of which can be influenced by the diet’s key components. The MedDiet may be a promising nutritional strategy for promoting women’s reproductive health. However, more extensive, and rigorous studies, including randomized controlled trials and longitudinal investigations, are necessary to establish a causal relationship between the MedDiet and women’s reproductive health outcomes. While the adoption of a MedDiet in non-Mediterranean populations is appealing, consideration needs to be given about potential barriers and enablers towards adherence(4). Furthermore, while the primary focus has been on nutritional strategies within the framework of the Mediterranean Diet, equal attention must be given to the eating behaviours and lifestyle factors associated with it.

Dehydration during hospital stays is a significant concern, particularly affecting older adults(1). The ageing process associated with pathological changes and conditions such as dementia makes older adults especially vulnerable to both chronic and acute dehydration (1,2). Recent studies indicate that conventional signs and symptoms of low-intake dehydration may not consistently indicate its presence in older inpatients, leading to missed or incorrect assessments. It can result in significant morbidity through falls, constipation, delirium, respiratory and urinary tract disorders, and even death (2,3). Diagnosing low-intake dehydration at the early stage is challenging, leading to treatment delays which further compound the negative consequences of dehydration (1,3). There is a need to determine the scope and practice of detecting and managing low-intake dehydration in ‘Medicine for Older People’ (MOP) wards at University Hospital Southampton (UHS). The primary aim of this study was to explore the current practices and challenges in detecting and managing low-intake dehydration in older inpatients within the MOP wards at UHS.

Using a sequential, explanatory mixed-method design, a prospective chart review study (phase 1) was conducted at all the MOP wards at UHS over one month. The study included 50 adults aged 65 and above admitted to the medical wards for various reasons and now deemed ‘Medically Optimised for Discharge’ (MOFD). The quantitative aspect involved reviewing the completion of a local hydration assessment tool and the proper documentation of hydration and fluid balance charts for at-risk patients. The qualitative component (phase 2) consisted of semi-structured interviews with 10 participants—four doctors and six nurses with years of experience ranging from 4 to 12 years—to understand the perceptions of hospital staff on hydration care, its barriers and facilitators.

The quantitative phase found that all patients were at risk for dehydration and underwent assessment through the hydration risk assessment, with hydration chart reviews during early, late, and night shifts. 20% did not have hydration assessment within 24h of admission and there were some missing reviews during various shifts. Most 24-hour fluid balance sheets were not completed for patients in the red category (start 24-hour fluid balance chart). Qualitative findings revealed that staff had ‘(1) experiential knowledge of hydration understanding the risks of dehydration in older adults’, ‘(2) difficulty in dehydration assessment and diagnosis due to resources’ and ‘(3) challenges related to staff levels and skills’ as well as (4) patient attributes contributing to difficulty in dehydration assessment.

The mixed-methods study underscores the importance of addressing low-intake dehydration in older inpatients on MOP wards and highlights gaps in current practices. The findings emphasise the need for improved training, awareness, and standardised protocols to prioritise hydration care among healthcare professionals and provide optimal hydration care for older inpatients.

Non-communicable diseases (NCDs) have become a major health concern worldwide, with Samoa being no exception(1). This presentation delves into the intricate dynamics of NCDs in Samoa, from the historical perspective before colonization to the contemporary challenges and initiatives taken by the government to address this pressing issue. Samoa, before colonization, maintained traditional diets that were largely plant-based and rich in local fruits and vegetables(2). The evolution of these diets over time has played a significant role in the rise of NCDs. The incorporation of imported processed foods, high in sugars and unhealthy fats, has led to a shift in dietary patterns. Recognizing the urgency of the situation, the Samoan government has initiated a series of policies aimed at addressing NCDs. These include the NCD Policy and Nutrition Policy, which focus on promoting healthier lifestyles through dietary changes and increased physical activity(3). The Samoa Health System Strengthening Program for Results is a crucial component of the government’s approach to combat NCDs. It encompasses several key areas, including the “First 1000 Days” initiative, emphasizing the importance of proper nutrition during pregnancy and early childhood, and breastfeeding promotion, vital for the health and development of infants(4). Furthermore, the School Nutrition program is designed to instill healthy eating habits from a young age(5). Nutrition guidelines, monitored quarterly, are in place to ensure the quality of school meals, with a strong focus on reducing the consumption of instant noodles and sugary drinks among schoolchildren. For adults, the “Healthy eating for Adults” program is pivotal. It introduces Food-Based Dietary Guidelines in Samoa that categorize foods into carbohydrates (energy foods), proteins (body-building foods), and fruits and vegetables (protective foods)(6). These guidelines also recommend reducing the intake of sugary foods, salt, and foods high in fats and oils. An intriguing approach to improving dietary habits is the “Grow the Colors of the Rainbow” initiative, which encourages the consumption of a diverse range of colorful fruits and vegetables(7). By emphasizing the importance of a balanced diet, this initiative aims to address the imbalance that has contributed to the NCD epidemic. Through this presentation, attendees will gain a comprehensive understanding of the historical, dietary, and governmental aspects surrounding NCDs in Samoa. It highlights the urgency of addressing NCDs in the region and underscores the importance of ongoing efforts to promote healthier eating habits and lifestyle choices. By examining government policies and initiatives, as well as the challenges faced, we aim to shed light on the path toward a healthier, NCD-free Samoa.

Brown Buttabean Motivation (BBM) is a Māori and Pacific-driven community-based organisation operating in Tāmaki Makaurau (Auckland) and Tokoroa. It provides free community exercise bootcamps and other social and health support programs. BBM’s foundational mission was to reduce, among Māori and Pacific people, the prevalence of obesity in Auckland through exercise and nutrition programs.1 This study aimed to understand participants’ engagement with BBM, and the meaning it has had in their lives, with a focus on nutrition. Combining Pacific Fonofale and Te Whare Tapa Wha frameworks, this was a process evaluation to understand the impact of BBM’s services on the community using qualitative methods and a systems analysis to identify program sustainability and improvement. Semi-structured interviews explored the benefits and values of engagement with BBM. Followed by cognitive mapping interviews (CMI) and group model building (GMB) to identify the motivations and challenges of sustained engagement. Participants described holistic health benefits and impacts on community wellbeing. BBM responds to inequitable nutrition contexts, through its FoodShare (food bank), community kitchen, and BBM Kai (nutrition literacy). Engagement changed family nutrition patterns, and benefits included healthier spending habits, and addressing food insecurity. Social inclusiveness represented the Fonofale foundation (family) and the roof (culture) was described as ethnic cultural practices and BBM culture. Nutrition was not highlighted by BBM participants in CMI or GMB activities. However, participants suggested BBM increase nutrition initiatives to enable all members to improve their health journeys. BBM was seen as not just an exercise program but their own and their family’s new way of life, that health was a journey, not a destination. Moreover, although participants mentioned nutrition and health benefits, there was an overwhelming understanding that the values of BBM, Pacific culture, and social collectivism were the drivers of engagement, motivating healthier practices. BBM could leverage existing strengths by incorporating nutrition-enabling initiatives that are achieved collectively. Opportunities for systematic intervention will be presented.

Muscle strength and mass decline as we age, typically starting around 35–40 years, and can eventually lead to the development of sarcopenia(1). There are currently no effective drug treatments available for either the prevention or treatment of this condition(2) and whilst resistance exercise has efficacy(3) its effectiveness is limited due to issues with uptake and adherence(4). However, emerging research suggests that nutrition may offer a potentially effective approach to delay the age-related decline in muscle mass and function among older individuals(5), with LCn-3 PUFA emerging as a strong candidate.

The main objective of the current study was to perform a systematic literature review with the purpose of exploring the impact of long-chain n-3 polyunsaturated fatty acid (LCn-3 PUFA) relative to control oil supplementation on muscle strength, with secondary outcomes of muscle mass and physical function in older individuals under conditions of habitual physical activity/exercise.

The review protocol was registered with PROSPERO (CRD42021267011) and followed the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement(6). The search for relevant studies was performed utilizing databases such as PubMed, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2023. Randomized controlled trials (RCTs) in older adults comparing the effects of LCn-3 PUFA with a control oil supplement on muscle strength were included.

Five studies(7,8,9,10,11) involving a total of 488 participants (348 females and 140 males) were identified that met the specified inclusion criteria and were included. Upon analyzing the collective data from these studies, it was observed that supplementation with LCn-3 PUFA did not have a significant impact on grip strength (standardized mean difference (SMD) 0.61, 95% confidence interval [−0.05, 1.27]; p = 0.07) in comparison to the control group. However, there was a considerable level of heterogeneity among the studies (I2 = 90%; p < 0.001). As secondary outcomes were only measured in a few studies, with significant heterogeneity in methods, meta-analyses of muscle mass and functional abilities were not performed. Papers with measures of knee extensor muscle mass as an outcome (n = 3) found increases with LCn-3 PUFA supplementation, but studies measuring whole body lean/muscle mass (n = 2) and functional abilities (n = 4) reported mixed results.

With a limited number of studies, our data indicate that LCn-3 PUFA supplementation has no effect on muscle strength or functional abilities in older adults but may increase muscle mass, although, with only a few studies and considerable heterogeneity, further work is needed to confirm these findings.

Providing access to food in schools can serve as a platform for food system transformation, while simultaneously improving educational outcomes and livelihoods. Locally grown and procured food is a nutritious, healthy, and efficient way to provide schoolchildren with a daily meal while, at the same time, improving opportunities for smallholder farmers(1). While there is significant potential for school food provision activities to support healthy dietary behaviours in the Pacific Islands region, there is limited evidence of these types of activities(2), including scope and links to local food production in the region. Therefore, the aim of this scoping study was to understand the current state of school food activities (school feeding, gardening and other food provision activities) and any current, and potential links to local agriculture in the Pacific Islands. A regional mapping activity was undertaken, initially covering 22 Pacific Island countries. The mapping included two steps: 1) a desk based scoping review including peer-reviewed and grey literature (2007-2022) and 2) One-hour semi-structured online Zoom interviews with key country stakeholders. Twelve sources were identified, predominately grey literature (n = 9). Thirty interviews were completed with at least 1 key stakeholder from 15 countries. A variety of school food provision activities were identified, including school feeding programs (n = 16, of varying scale), programs covering both school feeding and school gardens (n = 2), school garden programs (n = 12), and other school food provision activities (n = 4, including taste/sensory education, food waste reduction, increasing canteen capacity for local foods, supply chain distribution between local agriculture and schools). Existing links to local agriculture varied for the different programs. Of the 16 school feeding programs, 8 had a requirement for the use of local produce (policy requirement n = 6, traditional requirement from leaders n = 2). Of the 12 school garden programs, 6 used local or traditional produce in the garden and 5 involved local farmers in varying capacities. Challenges to linking local agriculture into school food provision programs were reported for 17 activities and were context dependent. Common challenges included limited funding, inflation, Covid-19, inadequate produce supply for the scale of program, limited farmer capacity, limited institutional support for local produce, low produce storage life, climatic conditions and disasters, water security, delayed procurement process, and limited professional development and upskilling opportunities. Modernisation and colonisation of food systems resulting in a preference for hyperpalatable foods and challenges in incorporating local produce in a way that is accepted by students was also identified as a challenge. This evidence can be used to develop a pathway to piloting and implementing models of school food provision programs and promoting opportunities for shared learning and collaboration with key stakeholders across the Pacific Islands region.

During weight loss the loss of body mass is associated not only with body fat reduction but also with a decrease in fat-free mass (FFM), related to the reduction in muscle mass and function(1). Supplementation with long-chain n-3 fatty acids (LCn-3 PUFA), in the absence of caloric restriction, results in a significant decrease in fat mass and an increase in FFM(2) along with improvements in muscle mass and strength(3). However, the impact of supplementation with LCn-3 PUFA during weight loss) remains unknown. Therefore, the aim of this study was to explore the effects of LCn-3 PUFA supplementation, in the form of Krill oil (KO), during alternate day fasting (ADF) on body weight, fat mass loss, FFM and muscle function changes in healthy overweight and obese adults.

A total of 41 men and women (age: 39.35 ± 10.4 years, BMI: 31.05 ± 4.2 kg/m2) completed the study (NCT06001632), in which they were randomised into either a KO or Placebo (PL) groups. Both groups carried out 8-weeks of ADF combined with intake of 4 g/day of the corresponding supplements. ADF involved consuming no more than 500 calories on the 'fast day’ and consuming food ad libitum on each 'feed day’. Data on body weight and body composition (TBF-300, Tanita, Manchester, UK), handgrip strength (Handheld Hydraulic Dynamometer, Vernier Jamar; England, UK), and time to conduct 5 repetition of chair rising test were obtained pre-and post-intervention. Changes from baseline within groups were assessed using paired samples t-test. Mixed analysis of variance (Mixed-ANOVA) was used to measure 2-way interactions between time and group to identify the differences between groups. All statistical analysis were conducted using IBM Statistical Package for the Social Sciences SPSS 28.0.

In both groups, body mass decreased significantly (KO:-4.7 ± 0.4kg, p<0.001; PL:-4.5 ± 0.4kg, p<0.001), along with a significant reduction in fat mass (KO:-2.4 ± 0.5kg p<0.001; PL:-2.3 ± 0.5kg p<0.001), and FFM (KO:-0.6 ± 0.2kg p<0.001; PL:-0.7 ± 0.2kg, p<0.001), with no differences between groups. In the PL group, there was a reduction in handgrip strength (-0.9 ± 0.7 kg, p<0.001), while there was no change in KO group (-0.2 ± 0.5 kg, p=0.1), with a significant difference between groups (p<0.001). In the KO group there was a significant reduction in time to conduct chair rising test (-1.8 ± 0.9s, p<0.05), with no change in the PL group (-0.3 ± 1.3s, p=0.2), with a significant difference between groups (p<0.001).

Supplementation with LCn-3 PUFA (4 g/day) during 8 weeks of ADF, applied to individuals living with overweigh and obesity, does not facilitate body or fat mass loss and does not diminish the reduction in FFM. However, it attenuated the reduction in muscle function in healthy overweight and obese adults.

This abstract was awarded the Student Competition Prize.

Periconception is the period spanning the weeks directly before and after conception and is a crucial window for optimising neurodevelopment in offspring(1-4). Iron and omega-3 fatty acids (n-3 FAs) are two vital nutrients for the development of the nervous system however, little research has been conducted into their importance during the periconceptional window(5-8). This study investigated whether supplementing iron and n-3 FA deficient (ID and n-3 FAD) rat dams before conception compared to after conception results in different neurodevelopmental outcomes in offspring. We hypothesised that initiating iron and n-3 FA supplementation in deficient dams after conception would not be as efficacious in preventing impaired offspring neurodevelopment induced by double- deficiency, compared to initiating supplementation before conception.

Female rats consuming an ID and n-3 FAD diet were randomly allocated to receive iron and DHA/EPA supplementation either 10 days before (Pre-Fe+DHA/EPA) or 10 days after conception (Post-Fe+DHA/EPA). Dams and offspring (Pre-: n = 24; Post-: n = 26) were subsequently maintained on supplemented diets throughout the experiment. Between postnatal days 31–41, cognitive and behavioural tests were conducted on offspring. Offspring were euthanised between postnatal day 42–45 and n-3 FAs, iron and monoamine concentrations were measured in the hippocampus, striatum and frontal cortex. All outcomes were compared to offspring who were either iron and n-3 FA deficient (ID+n-3 FAD: n = 24) or sufficient (Control+Fe+DHA/EPA: n = 22). One-way ANCOVA, with sex as a covariate, was used to determine between-group differences and two-way ANOVA was used to explore diet-sex interactions.

There were no differences in brain iron or n-3 FA levels between Pre- and Post-Fe+DHA/EPA offspring (P > 0.05). Female Post-Fe+DHA/EPA offspring had greater norepinephrine concentrations in the frontal cortex (Pre-: 3.21± 0.57 ng/mg vs Post-: 2.50± 0.55 ng/mg; P = 0.014) and consumed less sucrose in the sucrose preference test (Pre-: 96.16± 1.73%; Post-: 90.15± 1.66%; P = 0.010) compared to Pre-Fe+DHA/EPA offspring. Female Post-Fe+DHA/EPA offspring also had significantly lower liver iron concentrations compared to female Pre-Fe+DHA/EPA offspring (Pre-: 537± 47.13 μg/L vs Post-: 310± 45.28 μg/L; P = 0.034). There were no other significant differences in monoamine concentrations or behavioural tests.

Our results indicate that supplementing ID and n-3 FAD mothers both before and after conception is efficacious in preventing neurodevelopmental deficits associated with deficiency. However, ID and n-3 FAD during the periconceptional period may alter reward-based learning in female offspring(9-11). Additionally, optimising iron provision during periconception may have important implications for the prevention of postnatal ID-anaemia, particular during early infancy(12).

The aim of this study was to explore associations between habitual dietary fibre intake, adiposity, and biomarkers of metabolic health in Pacific and New Zealand European women who are known to have different metabolic disease risks. Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18-45years) were recruited to the PROMISE cross-sectional study(1) based on normal (18-24.9kg/m2) and obese BMI (≥30kg/m2). Body fat percentage (BF%), measured using whole body DXA, was used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute method, involving a 5-day-food-record and a semi-quantitative FFQ. Fasting blood was analysed for glucose, insulin, and lipid profile. NZ European women in the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (median 23.7g/day [25-75-percentile, 20.1, 29.9]; 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; 17.8 [15.0, 20.8]; both p<0.001), respectively. Pacific women consumed a higher proportion of their total fibre intake from discretionary fast foods, in contrast NZ European women consumed more dietary fibre from wholegrains. Regression analysis controlling for ethnicity, age, socioeconomic deprivation, energy intake, protein, total carbohydrate, and fat intake showed significant inverse associations between higher dietary fibre intake and BF% and visceral fat% (β = −0.47, 95% CI = −0.62, −0.31, p<0.001; β = −0.61, [−0.82, −0.40], p<0.001, respectively) among both Pacific and NZ European women. LDL-C (β = −0.04, [−0.06, −0.01]) was inversely associated with fibre intake following further adjustment for BF%-groups in NZ European women. Despite differences in intake, dietary fibre was inversely associated with adiposity and metabolic disease risk in both Pacific and NZ European women. However younger woman living in areas of higher socio-economic deprivation who consumed a higher proportion of total dietary fibre intake from discretionary fast foods were more likely to have low dietary fibre intakes than older, wealthier women. These women were also more likely to be Pacific women. Increasing habitual dietary fibre intake could help to reduce adiposity and metabolic disease risk; so implementing policies that make health-promoting high fibre foods more affordable, ensuring households have sufficient income to purchase nutritious food and limiting the amount of unhealthy food marketing that low income communities are exposed to should be public health priorities.

Monitoring the food supply including composition and what people are eating is an important aspect of maintaining public health and safety. The Food Composition Program at Food Standards Australia New Zealand (FSANZ) is responsible for generating, compiling and publishing data on the nutrient content of Australian foods to support FSANZ standards development work and monitoring activities. This work also supports broader Government public health policies and initiatives such as National Nutrition Surveys, Front of Pack labelling and reformulation. Having robust up to date food composition and dietary intake data that represents the current food supply and consumption patterns provides the strong evidence base needed to support FSANZ activities(1). FSANZ has been working with the Australian Bureau of Statistics since 2019 to support their work on the 2023 National Nutrition and Physical Activity Survey (NNPAS)(2). Our role has been to assist in customising the survey instrument Intake24 used to collect the 24-hour recall data from the NNPAS and to generate the datasets required to allow food, dietary supplement and nutrient intakes to be estimated from the survey and enable reporting against the Australian Dietary Guidelines. This presentation will discuss FSANZ role in monitoring foods and healthy diets in Australia, with a particular focus on the methods and tools for generating and reporting data for the 2023 NNPAS.