Globally, diet quality is poor, with populations failing to achieve national dietary guidelines. Such failure has been consistently linked with malnutrition and poorer health outcomes. In addition to the impact of diet on health outcomes, it is now accepted that what we eat, and the resulting food system, has significant environmental or planetary health impacts. Changes are required to our food systems to reduce these impacts and mitigate the impact of climate change on our food supply. Given the complexity of the interactions between climate change, food and health, and the different actors and drivers that influence these, a systems-thinking approach to capture such complexity is essential. Such an approach will help address the challenges set by the UN 2030 Agenda for sustainable development in the form of the sustainable development goals (SDG). Progress against SDG has been challenging, with an ultimate target of 2030. While the scientific uncertainties regarding diet and public and planetary health need to be addressed, equal attention needs to be paid to the structures and systems, as there is a need for multi-level, coherent and sustained structural interventions and policies across the full food system/supply chain to effect behaviour change. Such systems-level change must always keep nutritional status, including impact on micronutrient status, in mind. However, benefits to both population and environmental health could be expected from achieving dietary behaviour change towards more sustainable diets.

An increasing number of food-based recommendations promote a plant-based diet to address health concerns and environmental sustainability in global food systems. As the main sources of iodine in many countries are fish, eggs and dairy products, it is unclear whether plant-based diets, such as the EAT-Lancet reference diet, would provide sufficient iodine. This is important as iodine, through the thyroid hormones, is required for growth and brain development; adequate iodine intake is especially important before, and during, pregnancy. In this narrative review, we evaluated the current literature and estimated iodine provision from the EAT-Lancet reference diet. There is evidence that those following a strict plant-based diet, such as vegans, cannot reach the recommended iodine intake from food alone and are reliant on iodine supplements. Using the EAT-Lancet reference diet intake recommendations in combination with iodine values from UK food tables, we calculated that the diet would provide 128 μg/d (85 % of the adult recommendation of 150 μg/d and 51–64 % of the pregnancy recommendation of 200–250 μg/d). However, if milk is replaced with unfortified plant-based alternatives, total iodine provision would be just 54 μg/d (34 % and 22–27 % of the recommendations for adults and pregnancy, respectively). Plant-based dietary recommendations might place consumers at risk of iodine deficiency in countries without a fortification programme and where animal products provide the majority of iodine intake, such as the UK and Norway. It is essential that those following a predominantly plant-based diet are given appropriate dietary advice to ensure adequate iodine intake.

Selenium (Se) is an essential trace element which has an important role as a constituent of seleno-proteins involved in various physiological processes. Previous research in Irish adults suggests that intakes of this important nutrient are suboptimal. The aim of the present study was to estimate the current intakes and major food sources of Se by Irish adults. Mean daily intakes (MDIs) of Se were calculated using data from the National Adult Nutrition Survey which involved 1500 Irish adults aged 18–90 years. The Se content of foods and drinks consumed over a 4-d period was determined using data from the Irish Total Diet Study (TDS). Adequacy of Se intakes was assessed by calculating the proportion of the population with intakes below the adequate intake (AI) of 70 μg/d and lower reference nutrient intake of 40 μg/d (LRNI). The MDI of Se in the total population was 71⋅7 μg/d, with significantly higher intakes reported in men (80⋅2 μg/d) compared with women (63⋅4 μg/d, P < 0⋅01). Meat and meat products were the major contributing food group to Se intakes for both men (37 %) and women (31 %). Overall, 47 % of the population were not meeting the recommended AI, while 4 % of the total population were not meeting the LRNI. Although the average intake of Se is above the AI, a significant proportion of the population is not meeting this recommendation and continued monitoring of Se intakes is necessary, particularly by at-risk groups and also in the context of sustainability.

Milk, dairy products, and fish are the main sources of iodine in the UK. Plant-based products are increasingly popular, especially with young women, which may affect iodine intake as they are naturally low in iodine; this is concerning as iodine is required for fetal brain development. We, aimed to (i) assess the iodine fortification of products sold as alternatives to milk, yoghurt, cheese and fish through a cross-sectional survey of UK retail outlets in 2020, and (ii) model the impact of substitution with such products on iodine intake, using portion-based scenarios. We identified 300 products, including plant-based alternatives to: (i) milk (n 146); (ii) yoghurt (n 76); (iii) cheese (n 67) and (iv) fish (n 11). After excluding organic products (n 48), which cannot be fortified, only 28 % (n 29) of milk alternatives and 6 % (n 4) of yoghurt alternatives were fortified with iodine, compared with 88 % (n 92) and 73 % (n 51), respectively, with Ca. No cheese alternative was fortified with iodine, but 55 % were fortified with Ca. None of the fish alternatives were iodine fortified. Substitution of three portions of dairy product (milk/yoghurt/cheese) per day with unfortified alternatives would reduce the iodine provided by 97·9 % (124 v. 2·6 µg) and substantially reduce the contribution to the adult intake recommendation (150 µg/d; 83 v. 1·8 %). Our study highlights that the majority of plant-based alternatives are not iodine fortified and that the use of unfortified alternatives put consumers at risk of iodine deficiency.

Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.

Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12–14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.

Cereals and cereal products have a long history of use by humans. Recently, there have been some discussions regarding level of processing as a descriptor to define food products, including cereal-based foods. This has led to a somewhat emotional debate on food processing. Given the widespread inclusion of cereals in the diet, this review highlights the history of cereal processing as well as their consumption by humans. It provides an evidence-based discussion on their production, contribution to human nutrition, benefits and disadvantages. The present review illustrates the impact of processing on nutrients, as well as non-nutrients specifically in bread and ready-to-eat breakfast cereals (RTEC), two cereal-based foods which are widely consumed and integral parts of food-based dietary guidelines globally. As a category, most cereals must be processed in some way to enable consumption by humans as we are not equipped to survive exclusively on raw grains. Even thousands of years ago, the processing of cereals was a common practice by humans, turning raw grains into palatable, safe and nutritious foods. Modern processes for cereal-based products are efficient in providing safe and good-quality products to satisfy population needs, as well as helping to meet consumer expectations by providing a range of foods that allows for a varied and balanced diet. Today, RTEC and bread make significant contributions to dietary energy and nutrient requirements and underpin food-based dietary guidance globally. They have been positively linked with intake of dietary fibre, vitamins and minerals, especially when consumed as whole grain.

Meta-analyses of epidemiological data report that adults who carry a common polymorphism, the MTHFR 677C→T, in the gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase (MTHFR) have a 40% increased risk of CVD and an 87% increased risk of hypertension. Riboflavin (vitamin B2), in its co-enzymatic form flavin adenine nucleotide (FAD), is required as a co-factor by MTHFR and previous trials in hypertensive patients have shown a blood pressure lowering response to riboflavin supplementation that is specific to individuals homozygous for this polymorphism (TT genotype). Low folate status is commonly reported in adults with the TT genotype however the effect of this genetic variant on riboflavin status has not previously been investigated. The aim of this study, therefore, was to investigate dietary intake and biomarker status of riboflavin by MTHFR genotype in Irish adults using data from the National Adult Nutrition Survey (2008–2010) (www.iuna.net).

A 4-day semi-weighed food record was used to collect food and beverage intake data from a representative sample of 1500 Irish adults (18–90 years). Dietary intake data were analysed using WISP© based on UK food composition tables (modified to include recipes of composite dishes, nutritional supplements, fortified foods and generic Irish foods that were commonly consumed). Usual intakes were calculated via the NCI-method using SAS© Enterprise Guide. Blood samples (n = 1126) were collected by venepuncture by a trained professional and were processed and analysed using standard operating procedures. Biomarker status of riboflavin was determined by erthyrocyte gluthathione reductase activation coefficient (EGRac), a functional assay that measures the activity of the enzyme glutathione reductase before and after in vitro activation with its prosthetic group FAD; a lower value indicates better status.

It was found that 12% of the population had the TT genotype. As expected, there was no significant difference in riboflavin intake across the genotype (CC, CT or TT) groups. Similarly, no significant genotype differences in riboflavin status (EGRac) were observed (1.36 vs 1.37 vs 1.38 respectively). Overall, 61% of the total population had EGRac values > 1.3, indicative of low/deficient status with no significant difference observed between the genotype groups (60%,61% and 61%, respectively).

These data suggest that riboflavin status is not influenced by the C677T polymorphism in MTHFR in this cohort of nationally representative Irish adults. Further research is needed to see the impact of riboflavin status on blood pressure across the genotype groups in this nationally representative cohort of Irish adults.

Breakfast is often referred to as ‘the most important meal of the day’ and is consumed after the longest postprandial fast (an overnight fast). Breakfast consumption has been positively linked to many health benefits and has been shown in many studies to be associated with a better diet quality. The aim of this study was to characterise breakfast in Irish adults and to investigate the contribution of breakfast to overall daily nutrient intake.

Analyses were based on the National Adult Nutrition Survey (NANS) (2008–2010) (www.iuna.net). A 4 day semi-weighed food record was used to collect food and beverage intake data from a nationally representative sample of 1500 adults in the Republic of Ireland. Nutrient intakes were estimated using WISP© based on UK and Irish food composition data. Breakfast was subjectively defined by the participant and reported in the food diary. In line with recommendations on breakfast studies, this study confined analyses to nutrients derived from breakfast foods and not nutritional supplements. Usual intakes of energy and selected nutrients (from breakfast foods only and total diet (including nutritional supplements)) were calculated via the NCI-method using SAS© Enterprise Guide.

Breakfast was consumed on at least one recording day by 99% of participants with an uptake of 93% of potential breakfast occasions. The mean (SD) energy intake at breakfast was 365 (162) kcal, contributing on average 19% to overall daily energy intake. Energy intake from breakfast comprised of 56% carbohydrate, 14% fat and 29% protein. The most frequently consumed foods at breakfast included breakfast cereals, white/brown/wholemeal breads and rolls, butters and fat spreads, jams and marmalades, fruits, eggs, yogurts and some meats. The most frequently consumed beverages included teas, coffees, ‘fruit juices & smoothies’, waters and milk (in teas/coffees, with cereals and as a beverage). The contribution of breakfast to total daily nutrient intakes was 25% for carbohydrate, 16% for fat and 16% for protein. Breakfast also contributed to total daily intakes of dietary fibre (22%), total sugars (28%), saturated fat (18%), B-vitamins (20–32%), vitamins C (23%), D (24%), E (19%) calcium (28%), iron (26%) and sodium (18%).

Breakfast was widely consumed among Irish adults and was typically a nutrient dense meal which contributed significantly to total dietary intakes of a number of important macro- and micro- nutrients but also contributed to total sugars and relatively small proportions of total fat, saturated fat, and sodium.

A diet rich in plant-based foods with fewer animal products may offer improved health and environmental benefits. There is little consensus on the definition for a plant-based diet in the literature with some defining it as one rich in vegetables, legumes, fruits, wholegrains, nuts and seeds, excluding animal foods and with heavy restrictions on processed foods. Other definitions make no reference to the inclusion/exclusion of processed foods and refer only to the exclusion of all animal foods from the total diet. This study aimed to examine the nutritional quality of the Irish diet using each of these plant-based diet definitions.

A 4-day semi-weighed food record collected food intake data from 1500 Irish adults (18–90y) in the National Adult Nutrition Survey (NANS). Nutrient intake was analysed using WISP© based on UK and Irish food composition databases. All foods and beverages consumed in the NANS were categorised (included/excluded) into the two definitions; 1.plant-based component of the diet and 2.total diet excluding all animal components. The plant-based component included vegetables, legumes, fruits, wholegrains, nuts and seeds and excluded all animal foods and processed foods. The second categorisation included all non-animal foods regardless of processing. Nutritional quality was assessed by estimating energy-adjusted intakes of macronutrients, saturated fat, free sugars, dietary fibre and sodium. Stastical analysis was conducted using SPSS© v24.

The plant-based component of the diet provided 309 ± 214kcal/d (1.3 ± 0.9MJ/d) comprising of 68% carbohydrate, 20% fat and 12% protein. Mean intakes of saturated fat and free sugars from the plant-based component of the diet were 5% of energy (%E) and 1%E, respectively. Mean intakes of dietary fibre and sodium were 70g/10MJ and 1855mg/10MJ, respectively.

Allowing for inclusion of processed foods, mean energy intake from the total diet excluding all animal foods was 1051 ± 411kcal/d (4.4 ± 1.7MJ/d) comprising of 66% carbohydrate, 23% fat and 10% protein. Mean intakes of saturated fat and free sugars were 7%E and 14%E, respectively. Mean intakes of dietary fibre and sodium were 40g/10MJ and 2642mg/10MJ, respectively.

Overall, the macronutrient profile of the plant-based component of the diet and the total diet excluding animal foods were similar. However, the plant-based component of the diet was of higher nutritional quality; providing lower intakes of saturated fat, free sugar and sodium and higher intakes of dietary fibre compared to the total diet excluding animal foods. This study highlights the variability in nutritional quality between different definitions of plant based-diets.

Dietary iron requirements are higher among women of child-bearing age (WCBA) to replenish blood loss during menses, to prevent iron deficiency anaemia and to support a healthy foetus during pregnancy. Low intakes of iron have previously been reported among WCBA in Ireland and across Europe and data from European countries have shown that there is evidence of anaemia and low iron stores in this population group. The aim of this study was to investigate the dietary patterns influencing iron intakes in WCBA (18–50 years) in Ireland.

Analyses were based on the National Adult Nutrition Survey (NANS) (2008–2010) (www.iuna.net). A 4 day semi-weighed food record was used to collect food and beverage intake data (including nutritional supplement use) from a nationally representative sample of 1500 adults (487 women (18–50y)). Nutrient intakes were estimated using WISP© based on UK and Irish food composition data. On the basis of mean daily intake of iron, WCBA were divided into three intake groups: low, medium and high. The food groups that accounted for the greatest proportion of the difference between the high (top third) and low (bottom third) of iron intakes were identified.

The difference in iron intakes between the high and low intake groups (25 v 6.7mg/d) was 18.3mg/d. Nutritional supplements and ready-to–eat breakfast cereals (RTEBC) (commonly fortified with iron) accounted for 58 and 20% of the difference in intakes between the high and low intake group, respectively. The contribution of nutritional supplements to the difference in iron intakes can be explained by the proportion of users in the high vs low intake group (27% vs < 1%). The contribution of RTEBC to the difference in iron intakes can be explained by both a higher proportion of those in the high vs low intake group consuming RTEBC and those in the high intake group having a higher mean daily intake of RTEBC (78% vs 36%; 32g/d vs 7g/d).

Most of the difference in iron intake between high and low consumers is attributable to nutritional supplement use and the patterns of consumption of fortified RTEBC. These findings will aid in the development of strategies to improve iron intakes in WCBA in Ireland.

Low intakes and suboptimal status of vitamin D, riboflavin, vitamin B12, folate and calcium have been reported in older adults across Europe. Dietary strategies to improve micronutrient intakes and status could include food fortification (mandatory or voluntary) and/or the use of nutritional supplements. This study aims to examine the impact of fortified food consumption and nutritional supplement use on nutrient intakes and nutritional status of vitamin D, riboflavin, vitamin B12, dietary folate equivalents (DFE) and calcium in older Irish adults.

Analyses were based on the National Adult Nutrition Survey (NANS) (2008–2010). A 4 day semi-weighed food record was used to collect food and beverage intake data (including nutritional supplement use) from a nationally representative sample of 1500 adults (226 older adults (≥ 65y)). Blood samples (n 1126 (n 145 ≥ 65y)) were collected, processed and analysed using standard operating procedures. Nutrient intakes were estimated using WISP© based on UK and Irish food composition data. Fortified foods were identified as those that had one or more micronutrients added in the ingredient list and a nutritional supplement was defined as a supplement containing vitamins and/or minerals (i.e. excludes herbal/non-nutritional supplements). A fortified food consumer or nutritional supplement user was defined as a participant who consumed a fortified food or took a nutritional supplement at any time over the 4-day recording period. Usual intakes of micronutrients were calculated via the NCI-method using SAS© Enterprise Guide and analyses of biomarker data were carried out using SPSS©.

The consumption of fortified foods and/or use of nutritional supplements increased mean intakes of vitamin D (3.6 to 6.9μg/d), riboflavin (1.6 to 2.3mg/d), vitamin B12 (4.5 to 6.0μg/d), DFE (228 to 408μg/d) and calcium (784 to 947mg/d) in older Irish adults and reduced the prevalence of inadequate intakes of these micronutrients by up to 40%. Furthermore, consumers of fortified foods and/or nutritional supplements had improved biomarker status and reduced prevalence of low/deficient status for vitamin D (62 vs 16%), riboflavin (65 vs 11%), vitamin B12 (8 vs 0%) and folate (serum folate:18 vs 0%; red blood cell folate: 0% across all groups) when compared to non-consumers.

This study has shown that fortified foods and/or nutritional supplements represent an opportunity to improve intakes and status of key micronutrients in older adults. The data presented in this study will serve to inform the development and implementation of updated dietary recommendations for older adults in Ireland.

Evidence suggests that processed red meat consumption is a risk factor for CVD and type 2 diabetes (T2D). This analysis investigates the association between dietary patterns, their processed red meat contributions, and association with blood biomarkers of CVD and T2D, in 786 Irish adults (18–90 years) using cross-sectional data from a 2011 national food consumption survey. All meat-containing foods consumed were assigned to four food groups (n 502) on the basis of whether they contained red or white meat and whether they were processed or unprocessed. The remaining foods (n 2050) were assigned to twenty-nine food groups. Two-step and k-means cluster analyses were applied to derive dietary patterns. Nutrient intakes, plasma fatty acids and biomarkers of CVD and T2D were assessed. A total of four dietary patterns were derived. In comparison with the pattern with lower contributions from processed red meat, the dietary pattern with greater processed red meat intakes presented a poorer Alternate Healthy Eating Index (21·2 (sd 7·7)), a greater proportion of smokers (29 %) and lower plasma EPA (1·34 (sd 0·72) %) and DHA (2·21 (sd 0·84) %) levels (P<0·001). There were no differences in classical biomarkers of CVD and T2D, including serum cholesterol and insulin, across dietary patterns. This suggests that the consideration of processed red meat consumption as a risk factor for CVD and T2D may need to be re-assessed.

I is an important mineral for health, required for the production of key thyroid hormones, which are essential for cellular metabolism, growth and physical development. Hence, adequate I is crucial at all stages of life, but imperative during pregnancy for fetal brain development and during a child’s early life for neurodevelopment. Within Ireland, limited information exists on population I intakes and status. Therefore, the purposes of the present analysis were to estimate dietary I intakes and to analyse urinary iodine (UI) status using the cross-sectional National Adult Nutrition Survey 2008–2010 and the most recent Irish Total Diet Study. Median I intakes in the total population (n 1106) were adequate with only 26 % of the population being classified as below the estimated average requirement (EAR). Milk consumption was the major source of I in the diet, contributing 45 % to total intake. Likewise, median UI concentrations (107 µg/l) indicated ‘optimal’ I nutrition according to the WHO cut-off points. In our cohort, 77 % of women of childbearing age (18–50 years) did not meet the EAR recommendation set for pregnant women. Although I is deemed to be sufficient in the majority of adult populations resident in Ireland, any changes to the current dairy practices could significantly impact intake and status. Continued monitoring should be of priority to ensure that all subgroups of the population are I sufficient.

Increased whole-grain (WG) consumption reduces the risk of CVD, type 2 diabetes and some cancers, is related to reduced body weight and weight gain and is related to improved intestinal health. Definitions of ‘WG’ and ‘WG food’ are proposed and used in some countries but are not consistent. Many countries promote WG consumption, but the emphasis given and the messages used vary. We surveyed dietary recommendations of fifty-three countries for mentions of WG to assess the extent, rationale and diversity in emphasis and wording of any recommendations. If present, recommendations were classified as either ‘primary’, where the recommendation was specific for WG, or ‘secondary’, where recommendations were made in order to achieve another (primary) target, most often dietary fibre intake. In total, 127 organisations were screened, including government, non-governmental organisations, charities and professional bodies, the WHO and European Food Safety Authority, of which forty-nine including WHO provide a WG intake recommendation. Recommendations ranged from ‘specific’ with specified target amounts (e.g. x g WG/d), ‘semi-quantitative’ where intake was linked to intake of cereal/carbohydrate foods with proportions of WG suggested (e.g. x servings of cereals of which y servings should be WG) to ‘non-specific’ based on ‘eating more’ WG or ‘choosing WG where possible’. This lack of a harmonised message may result in confusion for the consumer, lessen the impact of public health messages and pose barriers to trade in the food industry. A science-based consensus or expert opinion on WG recommendations is needed, with a global reach to guide public health decision making and increase WG consumption globally.

Imbalances in dietary fat intakes are linked to several chronic diseases. This study describes dietary intakes and food sources of fat and fatty acids in 1051 Irish adults (aged 18–90 years), using data from the 2011 national food consumption survey, the National Adult Nutrition Survey. It also compares current intakes for 18–64-year-olds with those reported in the last such survey in 2001, the North/South Ireland Food Consumption Survey. Dietary fat intakes were estimated using data from 4-d semi-weighed (2011) and 7-d estimated (2001) food diaries. In 2011, intakes for 18–64-year-olds were as follows: total fat, 34·1 (sd 6·1) % total energy (%TE); SFA, 13·3 (sd 3·3) %TE; MUFA, 12·5 (sd 2·6) %TE; PUFA, 6·1 (sd 2·2) %TE; and trans-fat, 0·511 (sd 0·282) %TE. Apart from MUFA, intakes decreased (P<0·001) compared with 2001. There was no statistically significant difference in intakes of EPA and DHA by 18–64-year-olds in 2011 (269·0 (sd 515·0) mg/d) and 2001 (279·1 (sd 497·5) mg/d). In 2011, adults aged >65 years had the highest intakes of SFA; however, intakes were typically higher than UK-recommended values for all groups. In contrast, intakes of long-chain n-3 fatty acids were lowest in younger age groups. Intakes of trans-fat were well within UK-recommended levels. Although there have been some improvements in the profile of intakes since 2001, imbalances persist in the quantity and quality of dietary fat consumed by Irish adults, most notably for total and SFA and for younger age groups for long-chain n-3 fatty acids.