Introduction: With the rising popularity of plant-based diets, assessing the nutritional status of individuals following these diets has become increasingly important, especially for vulnerable groups such as women of childbearing age (WCBA)(1). Vitamin B12, an essential nutrient primarily found in animal products, is of particular concern, as its deficiency can lead to serious health problems. Evaluating vitamin B12 status through multiple biomarkers provides a more comprehensive analysis, ensuring a thorough understanding of nutritional health in these populations.

Aims: To assess vitamin B12 status using a full battery of B12 biomarkers, including serum B12, Holotranscobalamin (Holo-TC) and total homocysteine (tHcy), among women of childbearing age adhering to vegan and vegetarian, compared to omnivorous diets, and to examine the association between vitamin B12 status and vitamin B12 dietary and supplement intake.

Methods: Repeated cross-sectional study based on data from four publicly available NDNS (2008-2012, 2012-2014, 2014-2015, 2016-2019) datasets (2,3). These were population-based surveys of randomly selected samples of adults which were conducted in their households.

Results

A total of 2,299 WCBA (6 vegans, 89 vegetarians & 2,204 omnivorous) across all the NDNS year groups, of which 521 had complete data for biochemical and dietary intake (participant number varies for each variable), were included in the study. Among WCBA group, the median dietary intake of B12 was 0.9mcg (IQR = 0.5) in the vegan group, 1.7mcg (IQR =2.0) in the vegetarian group, and 2.0mcg (IQR =2.4) in the omnivore group. Median B12 intake from both diet and supplements was 1.2mcg (IQR = 1.7) in vegans, 3.6mcg (IAR = 2.6) in vegetarians and 5.2mcg (IQR =2.6) among omnivores. No significant differences in B12 intake were observed between WCBA and older women (5 vegans and 48 vegetarians, age: 46-64) among vegan or vegetarian groups. We did observe significant differences in serum B12 (p = 0.02) and Holo-TC concentrations (p<0.001) but not for tHcy (p = 0.760) between these two age groups among vegetarians. Vitamin B12 biomarker data was available for only four vegans of which none were deficient, but half had insufficient B12 status based on serum B12 (<258 pmol/L) and Holo-TC (<70 pmol/L) levels. The proportion of B12 supplement users among vegans and vegetarians was 50% and 27%, respectively. Among all WCBA, of those with intake levels below 2.5mcg (current WHO/FAO recommended EAR for B12) (4) 41% had serum B12 levels below 200pmol/L compared with 23% when intake is above 2.5mcg. There were not enough data for vegans but 54% of vegetarians had serum B12 levels below 200pmol/L when not meeting the EU EAR.

Conclusion

There has been a considerable rise in the number of individuals taking up plant-based diets in Western society but data pertaining to this demographic remains notably scarce. Results presented here based on four combined releases of the NDNS program underscores a significant risk of B12 deficiency and insufficiency among individuals adhering to plant-based diets significantly exacerbated in WCBA and not adhering to an appropriate regimen of B12 supplement use.

There is a considerable body of evidence supporting the effects of increasing quantity of plantbased food consumption on health. Recently, there has been interest in the importance of diversity of plant-based food consumption, however, this remains less well understood(1). This study aims to (1) characterize the quantity and diversity of plant-based foods consumed, and (2) determine the association between plant-based food diversity, nutrient intake and demographic characteristics, in a nationally representative UK adult population.

This is a cross-sectional study using the National Diet and Nutrition Survey Year 9 (2016/2017) adult cohort. Participants completed estimated food and drink diaries over four days, which were then analysed to determine the intake of 258 distinct plant-based items within 2,202 discrete and composite foods. Items in all plant food categories (fruits, vegetables, grains, herbs, spices, nuts, seeds, fats, oils and beverages) were included. The mean daily diversity count was calculated by dividing total diversity counts by the number of food-diary days completed. Diversity was categorised into terciles to estimate low, moderate and high plant-based food diversity.

Multivariate regression analyses were conducted to identify predictors of diversity of plant-based food consumption.

Overall, 677 adults were included (58% female, 91% white, 29% with a degree). The median diversity of plant-based food intake was 8 counts/d (IQR 4). Diversity of plant-based food intake was categorised into the following terciles: low (median 5.5, IQR 1.8 counts/d), moderate (median 8.1, IQR 1.3 counts/d), and high diversity (median 11.0, IQR 2.3 counts/d). Vegetables were the largest contributors (22%) to diversity, followed by fats and oils (19%), and fruit (18%). The high diversity tercile had a higher fibre intake, compared to low diversity (median 11.5, IQR 4.9 g/d vs median 9.5 vs 4.0 g/d; p<0.001), and a lower trans fat intake (median 0.5, IQR 0.3 g/d vs median 0.6, IQR 0.4 g/d; p = 0.031). Higher annual income (+0.2 diversity counts/d per £5,000 increments, 95% CI 0.1−0.3; p<0.001), higher qualification levels (p<0.001), and following a vegetarian dietary pattern (p = 0.008) were significantly associated with higher daily diversity.

This is the first study to characterise plant-food diversity intake in the UK, showing the UK population consumes on average eight different plant foods a day. Higher plant-food diversity is linked to improved nutritional intake, and may offer an alternative strategy to optimise healthy diets. However, this remains to be confirmed in high quality randomised controlled trials, and the potential socio-economic disparities in relation to such a nutritional public health intervention need to be explored.

Dietary guidelines, such as the Eatwell Guide, play a crucial role in shaping public perceptions and behaviours regarding nutrition. In recent years, there has been a growing interest in diversifying protein sources, particularly towards more sustainable options such as plant-based and fungibased proteins.(1,2) However, the effectiveness of current dietary guidance in promoting these alternatives remains uncertain.(3) This study aims to seek views from healthcare and food professionals on whether an evolution of the Eatwell Guide to represent more protein-rich foods, and incorporate icons to denote origin of protein sources, could raise awareness of and support protein diversification.

Between 8th and 31st March 2024, an incentivised survey was distributed to members of the MyNutriWeb community, consisting primarily of healthcare and food professionals. The survey aimed to gauge respondents’ perceptions of whether an evolution of the visual representation of the Eatwell Guide, to represent more protein sources pictorially or within the description, and the use of icons within the plate image, would support them when talking through the protein section and support protein diversification, particularly in the form of plant-based and fungi-based proteins.

Of the 865 respondents, the majority (65%) were dietitians and nutritionists, with 12% being students and the remaining respondents representing various other food and health professions. While 83% (of 719 respondents) reported finding plant-based and fungi-based foods and drinks easy to identify within the Eatwell Guide plate image and description, only 12% were confident that those they support can easily identify them. However, a significant proportion (92% of 712 respondents) believed that updating the proteins description and images within the Eatwell Guide to showcase a more diverse range of proteins, will support people to consider more plant-based and fungi-based proteins within their diet. Furthermore, 68% (of 688 respondents) think adding plant-based and fungi-based icons to help themselves and other people to more easily identify plant-based and fungi-based foods and drinks would be ‘helpful’ or ‘very helpful’.

These findings underscore the potential for visual and descriptive enhancements of the Eatwell Guide, such as the inclusion of a more diverse range of protein foods and the use of icons, to improve the effectiveness of dietary guidelines in promoting protein diversification. By better representing plant-based and fungi-based options, the Eatwell Guide could facilitate informed decision-making and encourage the adoption of more sustainable dietary practices. Moreover, the high level of support expressed by respondents, including nutrition professionals, highlights the relevance and importance of incorporating visual aids to support the in-practice promotion of healthier and more sustainable dietary habits.

Climate change is strongly linked to production of livestock(1,2) and national recommendations are to reduce meat consumption, especially ruminant meat(2), as part of a more sustainable diet. However, this recommendation in isolation is no guarantee that diets would be healthy or have lower greenhouse gas emissions because foods are eaten within the context of meals and a wider diet. In this study the role of meat within the context of UK meals was examined to understand the potential knock-on consequences for meal structures.

Cross-sectional dietary intake data from UK National Diet and Nutrition Surveys(3) (2008- 2019) were analysed to compare the composition of 287,719 eating occasions. Mixed-effects logistic and gamma regressions models were used to determine the likelihood of consumption and, when eaten, the quantity consumed of selected food groups based on the coincidence of other foods in the meal. Models adjusted for age (1.5 ≤ years ≤ 96), gender, and time of day in addition to a random intercept for participants.

Of the eating occasions examined, 30% contained meat, rising to 42% for evening meals (5pm to 8pm). Meats were a significant determinant of the type of starchy foods within a meal, for example the likelihood of pasta was higher with beef (OR 1.06 (95% CI 1.04, 1.07) per z-score change in beef in the meal) than poultry (OR 0.87 (0.85, 0.87)) whereas rice was more likely to be eaten with chicken (OR 1.44 (1.42, 1.46)) than beef (OR 1.06 (1.04, 1.08)). The likelihood of potatoes in a meal increased with all meats, but the likelihood of bread was lower in meals containing meat, except for bacon and ham (OR 1.30 (1.30, 1.33)). The presence of meat, of almost any type, in a meal was predictive of vegetables in the meal. On average the quantity of meat increased the quantity of vegetables in the meal by approximately 11.2% (95% CI 9.5, 12.8), 8.7% (6.0, 11.4), 8.1% (5.5, 10.8), and 3.9% (2.7, 5.2)% per 100g increase of beef, lamb, pork, and poultry respectively.

Recommendations to reduce meat consumption must consider the wider impact on the whole diet

as meals are restructured. Observed meals indicate the combinations of foods currently consumed, and how people may change eating patterns if they reduce meat consumption. The consequence of reducing meat in meals may change the choice of starchy elements. Switching from beef to poultry would likely increase rice consumption and reduce use of potatoes and pasta, attenuating the net reduction in emissions. However, since meat was positively predictive of the presence and quantity of vegetable in meals, reducing meat content may, in the short term, have negative implications for public health as people restructure meals.

Fruits and vegetables are rich in dietary fibre, vitamins and minerals making them beneficial for health. The UK’s Eatwell Guide (EWG)(1) recommends fruits and vegetables make up 40% of the diet (by weight), but on average they contribute less than 29% to the UK diet(2). Prominent product placement can boost sales. We explored the effect of placing salads next to ready meals in a retail setting, on salad and total fruit and vegetable sales.

In a 12-week intervention (July – October 2021), four bagged salad products were shelved above Italian ready meals in 23 stores. Salads displayed a ‘healthy’ on-pack symbol and shelf signposting encouraging customers to ‘add salad to their baskets for a balanced meal’.

Two matched control store groups were identified, based on store area demographics (n = 23 stores) and store-level pre-intervention bagged salad and Italian ready meal sales (n = 21 stores), accounting for external sales influences, e.g. weather, supply chain shocks and Covid-19 lockdown behaviours. Transactions were shared by the retailer for 2 years before, 3 months during, and 9 months post-intervention.

Two years of pre-trial transactions (units and weight) were aggregated to the store level to produce an interrupted time series model quantifying changes in store-level daily sales of promoted salads, versus a predicted counterfactual. Analysis was repeated in control stores.

Within-group change in mean basket proportion (by weight) by EWG segment was examined via the Wilcoxon signed-rank test for difference, comparing the intervention period with two timematched baseline (BL) periods (BL1=July – October 2019, and BL2=July – October 2020).

In the first three weeks of the intervention, unit sales of promoted salads increased by 35.74% (CI 25.91 - 45.72, p<0.001) vs counterfactual in the intervention stores. However, over the whole 12weeks, unit sales were down 18.34% (CI -26.17%, -10.35%, p<0.001) vs counterfactual. A similar trend was observed across control groups, indicating changes were independent of the intervention.

In intervention stores, fruits and vegetables made up 38.75% of baskets at BL1, but declined significantly over time, down 4.12 (p<0.001) percentage points in the intervention period vs BL1 and 1.43 (p<0.001) vs BL2. The proportion of composite (multi-ingredient) dishes rose; up 0.74

(p<0.001) percentage points vs BL1 and 1.35 (p<0.001) vs BL2, as did discretionary items; up 0.91 (p<0.001) percentage points vs BL1 and 0.45 (p<0.001) vs BL2. Similar patterns were observed in control stores.

Salad sales increased at the start of the intervention relative to predicted sales, but the same change was observed in control stores meaning it cannot be attributed to the trial. Pre-intervention fruit and vegetable purchases with the retailer aligned with the EWG, indicating shoppers already had healthy purchase patterns which may have limited intervention effectiveness.

Regulations restricting promotion of some High Fat, Sugar, Salt (HFSS) products within “restricted areas” (RAs) (e.g. end of aisles) of eligible supermarket stores came into force in October 2022 in England.

To evaluate the prevalence of HFSS products, Front-of-Pack Nutrition Labelling (FOPNL) characteristics and categories of foods sold within RAs in a sample of supermarket stores, with respect to the Food (Promotion and Placement) Regulations 2021.

A cross-sectional survey of products in RAs in three supermarkets.

Following the manual identification of each supermarket’s RAs, from November 2022-January 2023, these were photographed and the display of products and their Front-of-Pack Nutrition Labelling (FOPNL) recorded. Products were identified using corresponding online supermarket webpages, from which data collected included product name, nutrition, and ingredients. This information was used to allocate each product to a category (e.g. ready meals) that was either in or out of scope of the Regulations. Evaluation of each product’s healthfulness was performed using the UK Nutrient Profiling Model (to determine HFSS status) and UK Multiple Traffic Light criteria to calculate number of inherent (i.e. possessed regardless of their display) Red Traffic Lights (iRTL). Prevalence of HFSS, FOPNL and iRTL were calculated as a proportion (%) of total products displayed in the included RAs. Associations between the prevalence of these characteristics were performed using chi-squared tests.

Across the three stores, 86 RAs were identified, with data collected from 32 RAs displaying 679 food products, most of which fell into product categories considered out-of-scope of the Regulations (64%, n = 435). Across included RAs, the prevalence of HFSS products within all in and out-of-scope categories, was 42 % (n = 282). Half of all products (53%, n = 357) displayed FOPNL, and 16% possessed 1, 2 or 3 iRTL, including both HFSS and non-HFSS items. Across those product categories in-scope of the Regulations (n = 245), prevalence of HFSS was 17% (n = 42). These HFSS products were less likely to display FOPNL compared to non-HFSS products (2= 25.01, p < 0.001).

Following the implementation of The Food (Promotion and Placement) Regulations, intended to create healthier food retail environments, products sold across Restricted Areas of three eligible supermarkets included those in categories in and out of scope of Regulations with varied prevalence of less-healthy (HFSS) products, display of FOPNL, and possession of iRTL across both. This study is a first researcher-led evaluation of the recently regulated consumer-facing instore environment, with implications for future policy impact evaluation.

Poor dietary habits are associated with the development of non-communicable diseases(1). Most strategies implemented to enhance population diet quality follow a “one-size-fits-all” standardised approach, often neglecting individual preferences and requirements. Evidence suggests that personalised nutrition (PN) advice, tailored to an individual, can improve dietary intakes(2). This research investigates participants’ subjective feedback from the EatWellUK-2 randomised control trial that compared PN advice versus general dietary guidance, both delivered via eNutri, a web app, developed at the University of Reading. eNutri delivers automated food-based nutrition advice tailored to the user based on their dietary intake recorded by a food frequency questionnaire (FFQ)(3).

Participants were disease-free UK adults (>18y) who were randomised to the PN or control group. Participants completed the eNutri FFQ, then automatically received via the app either advice tailored to their dietary intake (PN group) or general population advice based on the UK’s Eatwell Guide (control). Following a 12-week intervention, the FFQ was repeated and participants completed a feedback questionnaire containing open-text and Likert questions assessing agreement with statements (strongly disagree, disagree, neutral, agree and strongly agree). MannWhitney U tests compared the mean ranks between the PN and control groups for each question. Data are presented as percentages of participants who felt positively about each statement based on “agreed” plus “strongly agreed” responses. The study received ethical approval from the University of Reading Research Ethics Committee (08/19) and was registered at ClinicalTrials.gov (NCT03897972).

Participants (90% female) had a mean (SD) age of 46 (15) y and BMI of 25.8 (6.1) kg/m2. When asked about the advice received, the responses of the PN group (n = 54) were more positive that “it encouraged me to eat healthily, even if only for short time” (p = 0.045, PN 55.6% vs control 41.8%) and “it was clear what changes I needed to make to improve my diet” (p = 0.011, PN 73.6% vs C 51.8%). When asked to provide an “app review” of eNutri, the control group (n =55) described their advice as “too general” and “readily available elsewhere”, while the PN group said it contained “varied and realistic examples”, and the advice was “very clear”, “helpful” in relation to choosing “better foods to eat” and allowed people to “assess your own goals”.

Participant feedback favoured PN over general population advice as it provided encouragement and clarity about which dietary changes would benefit each individual. Together with the quantitative results from the EatWellUK-2 study, which are still being analysed, these findings will help to assess eNutri’s potential as a useful tool to encourage UK adults to adopt healthier dietary behaviours.

Previous research has shown personalised nutrition feedback is more effective than generic onesize-fits-all nutrition advice(1). Using fruit and vegetable intakes from the MyPlanetDiet randomized controlled trial, this analysis will determine if different severity of personalised nutrition feedback delivers greater dietary change.

Participants were recruited from the general public and randomised to receive personalised feedback based on a more sustainable diet (intervention) or Healthy Eating Guidelines (control). Intervention participants received feedback on total fruit, total vegetables, dark green vegetables, and/or red/orange vegetables. Control participants received feedback on total fruit and vegetables, total vegetables, citrus fruits, and/or fruit juice. Participants completed dietary assessments (3x 24-hour recalls) at baseline (Week 0) and endpoint (Week 12) using Foodbook24, a validated online dietary assessment tool(2). Mean food group intakes and Healthy Eating Index scores were calculated. Personalised feedback messaging was assessed to measure the severity of fruit and vegetable feedback, ranging from zero messages (least severe) to four messages (most severe). Data are presented as mean±standard error. Data were analysed via two-way mixed analysis of covariance and univariate general linear models using IMB SPSS Statistics (Version 29).

Participants (n = 292) were 56% female and 42.3 ± 0.7 years old. Mean fruit and vegetable intake at baseline was 325.4 ± 183.3g. Almost all participants (97%) received feedback for at least one component of fruit and vegetable intake. Control participants were more likely to receive feedback on fruit (p<0.001) while intervention participants were more likely to receive vegetable feedback (p<0.001). There was a significant time*group interaction for fruit intake (p = 0.005) with larger increases in the control (+102.3g) than the intervention group (+38.6g). The intervention group had higher vegetable intakes (200.6 ± 7.9g) compared to control (164.2 ± 7.5g) at endpoint (p<0.001). Those receiving more severe fruit and vegetable feedback had significantly lower intakes of fruit and vegetables at baseline (p<0.001) but not endpoint (p = 0.80). There was a significant time*group interaction for fruit and vegetable intake (p<0.001) between severity groups. Those with least severe feedback decreased fruit and vegetable intake (-57.4g) while those in the most severe group increased intakes by 162.2g. However, mean fruit and vegetable intake in the least severe group was still higher (472.9 ± 31.8g) at endpoint than in the most severe group (397.2 ± 23.6g). There was a significant time (p<0.001) and time*group interaction (p = 0.039) in HEI scores with the smallest increase in the least severe group (+3.7) and the largest increase in the most severe feedback group (+9.6).

More personalised nutrition feedback was associated with greater behaviour change when using fruit and vegetable intake as an example. Differences in messaging between control and intervention groups led to corresponding differences in dietary change. Different severity of personalised nutrition feedback resulted in participants having comparable fruit and vegetable intakes at endpoint.

Adhering to traditional diets could significantly contribute to enhancing health and promoting environmental sustainability (1). China reports the highest incidence of non-communicable disease related fatalities globally (1). There has been no consistent definition of the traditional Chinese diet (TCD). Findings on the association between TCD and health outcomes are also inconsistent (2). Therefore, it is critical to establish a consensus on the definition of the TCD, including food groups that are characteristic of this diet and their quantities. The Delphi method is widely accepted as an effective tool for consensus-building among experts (3). Hence, this study aimed to 1) establish an index for assessing adherence to the overall TCD, involving inviting nutrition experts to achieve a consensus on which food groups, food quantities, and food-related habits define the TCD; and 2) develop five indices that characterise regional TCDs (for the eastern, western, southern, northern, and central Chinese regions).

From October 2023 to February 2024, a three-round modified Delphi study was conducted via an online platform. The eligible participants were nutrition experts, working in various fields, including academic professors, registered dietitians, and clinical nutrition physicians. Participants were invited to complete online questionnaires, to establish the food groups and food-related habits that characterise TCD by using a mix of Likert scales, a list of responses, and yes/no questions. Openended and free-text questions were also used to collect detailed comments/suggestions. Consensus was assessed by using percentages of agreement; median values and interquartile ranges were used to illustrate the recommended consumption ranges for each food group to be included in the index. Statistical analyses were performed using SPSS and NVivo 12.

Fifty-eight nutrition experts (a minimum of ten experts from each region) were involved in the first Delphi round. Response rates for the second and third rounds were 87.9% and 93.1%, respectively. The resulting overall TCD index comprises 15 food groups plus one dietary habit, with scores ranging from 0 to 23 (minimum to maximum), where higher scores reflect higher adherence to TCD. Rice, various vegetables, fruits, eggs/egg products, wheat/wheat products (excluding wheat with filling), and starchy roots and tubers scored two points when meeting the consumption range. Wheat with filling, pork/pork products, fermented foods, deep-fried wheat, corn/coarse grains, legume products, beef/beef products, poultry and cooking by steaming and/or boiling were scored one point each when meeting the consumption criteria. Five regional TCD indices, including food groups and the range of quantities for each food group, were also developed.

This modified Delphi study achieved consensus for developing TCD index and five regional TCD indices for the first time. These indices can be utilised as essential instruments for future research on exploring adherence to TCD and its impacts on health outcomes and environmental sustainability.

Food poverty is an acknowledged social determinant of health and is associated with significant adverse health outcomes(1,2). It is a growing issue on the Island of Ireland, due to a number of factors, including, the COVID-19 pandemic, chain supply issues, inflation and external geo-political events. As news media play a key role in shaping policy discourse(3)and public attitudes(4) towards health and social issues, understanding how the issue of food poverty is framed on the island of Ireland may help health promoters develop alternate framings to better advocate for effective policy measures. The overall aim of this research was to investigate the discursive construction of food poverty in the news media, and to explore public, policy and key stakeholder perceptions of food poverty.

A series of interlinked studies were conducted, including analysis of policy documents, analysis of print and broadcast news media reporting on food poverty, and qualitative interviews with news media professionals, members of the public, third sector community organisations and policymakers. In analysing how the topic is framed, the research drew on Entman’s Framing Theory. An integrated knowledge translation approach was adopted throughout the research process.

Findings from analysis of policy documents (n = 48), print (n = 81) and broadcast (n = 91) news media, and qualitative interviews with key stakeholders (n = 44) across the island of Ireland revealed four core inter-linked and over-lapping discursive frames, including: political dysfunction, economic dysfunction, social dysfunction, and individual dysfunction. A key finding included differing opinions between participants in the North and the Republic on whether lifestyle (individual dysfunction) or structural (political dysfunction) factors were salient drivers of food poverty. Those who leaned more towards understandings of food poverty that included individual dysfunction showed greater endorsement of individual and community level interventions, while those who leaned more towards understandings that included political dysfunction showed greater endorsement of policy-led interventions. This coherence was not evident in news media reporting, where media discourse more prominently highlighted community-led responses (e.g. charitable food aid), despite acknowledgement of its upstream drivers. Another key finding was the absence of the voices of those experiencing food poverty from news media reporting on the issue. While news media professionals expressed a need for case studies, third sector service providers raised questions about the ethical engagement with vulnerable populations.

The research findings highlight that the problem of food poverty is largely depicted through the lens of charity, which precludes obligations for state actors and says nothing of the right to food. Re-framing discussions of food poverty as a health and human rights issue may be a fruitful strategy in addressing the problem. Health promotors, researchers and other stakeholders interested in food poverty should move towards adopting rights-based messaging when translating knowledge, including to policymakers and the media.

Dysphagia is more common in older age and is present in up to 70% in long-term care facilities (LTCFs)(1). Thus, the demand for texture-modified diets (TMDs), required to ensure safe nutrition for residents, is high. Individuals with dysphagia are at greater risk of malnutrition, poorer health outcomes and quality of life(2). Moreover, TMDs are less energy- and nutrient-dense due to necessary processing(3). Consequently, TMDs require additional planning and fortification to meet nutrient requirements for this cohort. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework describes drink thickness (level 0-4) and food textures (level 3-7; liquidisedregular), to ensure standard textural characteristics of foods and drinks, however, there is little guidance for food providers in Ireland on how to prepare TMDs to meet nutritional requirements. Whether TMDs in LTCFs meet nutrition standards for food provision in Ireland is unknown. Our aim was to conduct a clinical audit, evaluating adherence of TMDs in a LTCF in Cork, Ireland, to the BDA Nutrition and Hydration Digest(4).

Samples of the daily menu, i.e. all meals, snacks and drinks for IDDSI level 3,4,5 and 6 were weighed over a 2-day period, representing the maximum food and beverages available to residents. Recipes were confirmed with the catering department. Nutritional analysis was conducted using Nutritics©. Nutritional composition was compared to the nutrition standards of the BDA for food providers for nutritionally vulnerable individuals (total daily targets:1840-2772kcal, 79-92g protein; main courses: 800kcal, 27g protein).

The daily TMDs of the LTCF provided [mean (SD)] 1928 (334) kcal, 73 (0.0) g protein (level 3); 1646 (62) kcal, 52 (2.0) g protein (level 4); 1323 (91) kcal, 45 (3.0) g protein (level 5); 1506 (75) kcal, 53 (5.0) g protein (level 6). On analysis of main courses, lunch meals provided 534 (99) kcal, 20 (3.0) g protein (level 3); 436 (0.3) kcal, 16 (0.8) g protein (level 4); 399 (16) kcal, 12 (1.0) g protein (level 5); 353 (13) kcal, 14 (0.3) g protein (level 6), while evening meals provided 770 (58) kcal, 33 (7.0) g protein (level 3); 561 (33) kcal, 19 (0.4) g protein (level 4); 305 (39) kcal, 9 (0.4) g protein (level 5); 379 (52) kcal, 18 (6.0) g protein (level 6).

Across levels, there was poor adherence to energy and protein standards. Only level 3 provided sufficient daily energy and met protein targets for evening meal, potentially explained by the use of full fat milk as a dilutant to create the correct consistency. Guidance is needed for food providers of all LTCFs in Ireland on how to prepare TMDs for nutritionally vulnerable individuals. Future research should investigate actual food consumption, malnutrition risk, oral nutritional supplementation use and training of food providers in LTCFs.

Culinary nutrition (encompassing culinary medicine) is an emerging field that is gaining traction as potential means to mitigate the global disease burden linked to unhealthy dietary patterns, by fostering practical culinary and nutrition literacy among health professionals. Culinary nutrition programmes have shown promise in improving dietary behaviour, cooking confidence, and nutrition counselling skills among students and professionals(1). There is a recognised need for the development and evaluation of standardised culinary nutrition training for nutrition and dietetics (N&D) professionals and there is limited understanding regarding the preparedness of the next generation of nutritionists and dietitians in delivering effective culinary nutrition programmes(2). This study aimed to investigate the cooking and food practices of students of N&D in UK to assess their capabilities and to inform the requirements of future educational curricula.

Between May and June 2023, an online survey was circulated to all UK universities delivering AfN- or BDA-approved nutrition or dietetics programmes, for subsequent circulation to students. It contained validated questionnaires on cooking and food skills confidence, meal preparation frequency, food engagement, and completion of curriculum-based cooking sessions. King’s College London provided ethical approval. Kruskal-Wallis H tests and hierarchical multiple regression modelling with adjustment of relevant covariates were conducted using SPSS Statistics v29.0.2, with a significance threshold of p<0.05.

There were complete responses from 213 students of N&D from 27 UK universities. Respondents mean age was 28.1± 9.4 years, 194 (91.1%) were female, and 132 (62.1%) were white ethnicity. The cohort comprised 57 undergraduate and 95 postgraduate nutrition and 32 undergraduate and 29 postgraduate dietetic students. Students’ average confidence scores were 84.3± 14.7 (out of 98) for cooking skills and 112.0± 20.7 (out of 133) for food skills, with an average food engagement score of 40.2± 4.7 (out of 50). 95 (44.6%) students reported cooking a main meal daily, and 141 (66.2%) had completed an average of 14.2± 16.4 practical cooking session hours as part of their degree program. Undergraduate dietitians completed the least time of cooking sessions at 3.00h, versus undergraduate nutritionists at 9.00h (p = 0.044) and postgraduate nutritionists at 10.00h (p = 0.025). Hierarchical regression models accounted for 18.8% of the variance in cooking skills confidence and 27.7% in food skills confidence. Notably, meal preparation frequency and food engagement significantly contributed to the explained variance in the respective models (p<0.001), even after adjusting for demographic factors such as gender and ethnicity.

Students of N&D in the UK exhibit higher cooking and food skills confidence compared to the general population(3). Coupled with their inherent knowledge of nutritional science, they are wellpositioned to implement future culinary nutrition interventions that could enhance public dietary behaviour and health outcomes. However, to ensure the future workforce is ready, there is a need for curriculum consensus.

Dietary assessment methods play a crucial role in evaluating individuals’ and communities’ dietary intake (1). Among these methods, Food Frequency Questionnaires (FFQs) are common in epidemiological dietary surveys. However, with the rapid advancement of technology and increased internet usage globally, innovative digital tools to assess dietary intake have emerged (2). Collaborative efforts between tool developers and dietitians are vital for leveraging technology effectively and advancing evidence-based nutrition practice. Thus, the aim of this study was to explore the: 1) perceived advantages and disadvantages of FFQs, 2) challenges and benefits associated with transitioning from traditional paper-based to web-based FFQs, and 3) opportunities and challenges of integrating a range of new technologies, from established digital tools such as web-based or smartphone applications to more futuristic options such as artificial intelligence and biosensors, into dietary assessment practices and research among researchfocused dietitians with PhD.

Seven dietitians from Turkey with extensive experience in using dietary assessment methods were selected using purposive sampling. One-to-one semi-structured interviews were conducted using a topic guide via Microsoft Teams and transcribed verbatim into text-based records. They examined advantages and challenges of paper-based and web-based FFQs, ranked a list of predefined features for FFQ development, and provided insights into technology integration, addressing both the benefits and challenges of incorporating new tools. Preliminary thematic analysis was conducted using NVivo12 software to identify common themes.

Participants had an average of 18 years (6-49 years) of experience in nutritional research. Common challenges identified by the group included the absence of validated FFQs in Turkish (n = 5), necessitating the use of FFQs alongside other methods like 24-hour recall (n = 4). General diet representation was commonly appreciated, while all participants deemed paper-based semiquantitative FFQs time-consuming. The top priorities for FFQ enhancement included a semiquantitative feature for nutrient intake calculation, inclusion of portion size photos, and evidencebased development using national diet survey data. None of the participants had employed any digital dietary assessment tools in their research endeavors. However, there was a consensus recognizing the potential benefits and drawbacks of using technology in dietary assessment. Participants highlighted the efficiency (n = 7), increased flexibility in data collection (n = 6), and heightened accuracy (n = 5) associated with technology-based assessment methods as significant advantages. Common concerns included users’ lack of proficiency with technology (n = 6), potential challenges related to the cost of research and development (n = 4), and considerations surrounding data privacy and ethical breaches (n = 3), particularly the unauthorized recording of sensitive information by artificial intelligence in camera-based technology.

The insights from Turkish dietitians highlight the necessity for validated Turkish web-based FFQs. While technology-based dietary assessment tools offer research benefits, addressing integration barriers is crucial. These findings will contribute to the development of web-based FFQs and more futuristic dietary assessment tools, advancing evidence-based nutrition practice.

The recent ONS survey reported that 92% of students had been affected by the cost-of-living crisis with 46% revealing their overall mental health and well-being had worsened(1). London Metropolitan University has a unique diverse student population: in 2020-21, 82% of students were mature, 64% of students identified as female, 55% of students were from a minoritised background and 13% had a known disability(2). Furthermore, at least 50% of our students, many of whom have caring responsibilities, reside in the most deprived wards of Islington or other impoverished London boroughs. It has been documented that those students with families, who come from a low income and a minority background are more vulnerable(3) and are more likely to be disproportionately affected by the cost-of-living crisis and at risk of food insecurity. We sought to ease the burden of the cost-of-living crisis with a recipe box scheme, BRITE Box (4) and evaluate its acceptance.

BRITE Box provides a complete set of pre-weighed ingredients for a healthy nutritious meal with an easy-to-follow recipe guide. Each box typically contains two servings of vegetables, meat, bread and dairy, as well as spices, dried and tinned goods to feed a family of five people. We distributed 300 boxes over a period of five months to students primarily with families who had accessed the university hardship fund. Student volunteers and the academic staff pre-weighed the ingredients, prepared and distributed the boxes. The scheme was advertised through Student Services who administer the hardship fund, the Student Union and the intranet. The recipients of the boxes were provided with a QR code linking to a 20-item online survey on demographic characteristics, number of children, acceptability of the box and perceived advantages and disadvantages of the scheme. Ethics was approved by London Metropolitan University.

Thirty-three participants completed the survey, 42% of the recipients identified as female, 55% were from a minority background and 30% had children. The responses showed that students agreed and strongly agreed that the recipe box introduced them to new flavours (52%), and new foods (42%). The majority followed the recipe and will use again (67%). Most importantly, 73% students agreed and or strongly agreed that it helped with the food budget and helped foster a sense of belonging to the university (85%).

The scheme has proved to be popular among the students: “a really cool concept”, “it helped me cook”, “the box provided food for 3 days” and created a buzz around campus on distribution days. It has enhanced the feeling of community and belonging within the university, whilst also alleviating food insecurity and tackling the cost-of-living crisis.

Community cafés are non-profit setups seeking to address food insecurity (FI) locally and equitably usually using a pay-as-you-feel model and surplus foods(1). Concerns about rising levels of FI(2) and food waste(3) frequently drive this model. Started in 2023, the Kitchen Roots Café (KRC) aims to provide healthy, sustainable, affordable meals without proof of need or referral. Open once a week during lunch it offers hot meals, primarily using surplus foods. Clients can pay as much or little as they wish and can pay a meal forward. A mixed methods evaluation of KRC was carried out which aimed to identify who KRC clients were and their reasons for attending, in addition to its social and nutritional impact.

Qualitative and quantitative data were gathered using bespoke questionnaires and optional interviews. In all, 32 individuals completed questionnaires, the majority in-person at KRC (91%), the remainder online. Four client telephone interviews were also held. Thematic analysis of qualitative data was carried out to identify recurring themes, while descriptive statistics were generated for quantitative data.

KRC clients were largely vulnerable. The majority were at least middle-aged (28.1% aged ≥60; 25.0% aged 50-59 years) and out of full-time employment (62.5% worked <1 day a week while 9.3% worked part-time). Self-reported disability was common (43.8% overall; 50.0% of all men). Several lived in supported housing (e.g. YMCA, accommodation for women victims of domestic violence). One reported homelessness due to their immigration status. High levels of FI were evident: over half (54.8%) used other, often multiple, food support services, including food banks, community fridges and church lunches.

The majority made use of the KRC primarily in response to FI, indicating as their main reason for visiting support with food cost and/or the cost of living (46.9%). For this group using the service was tightly linked with their ability to access a healthy hot meal and to save money; 85.7% agreed or strongly agreed with this.

Many added the social aspect of the KRC experience as a second main reason for visiting (50.0% of those who gave multiple reason). Additionally, support the local community and enjoy delicious food were highlighted. Ninety-six % of participants agreed or strongly agreed that coming to the KRC had improved their wellbeing, while 65.6% agreed or strongly agreed that it had made them feel more valued, like they ‘belonged’ to the community.

While concern about food waste was not their primary reason for coming, 90.6% of participants thought that eating surplus food offered at KRC benefitted the environment.

For this vulnerable group, local community café provision offered a safe space with affordable healthy food. This, plus feeling welcomed and included, benefitted their feelings of wellbeing and belonging.

Morbidity and mortality from preventable diseases among ethnic minority groups are higher when compared with white population group in the UK(1). Diet is a major modifiable disease risk factor and depends on several factors, including the affordability and availability of foods commonly consumed by these communities. With families now bearing the burden of inflation with an increase in the price of food, and with people adapting to this by adjusting their spending, the widening of health inequality is reported(2).

Understanding of the impact of the cost-of-living crisis (COLC) on the dietary practice and health of ethnic minority populations is limited(2). This study explored the impact of dietary choices in the immigrant Nigerian community living in the UK, within the context of a COLC.

Using hermeneutic phenomenological design and with the aid of purposive sampling, community networks, and snowballing were leveraged to assist in recruiting participants from the Nigerian population in Manchester and London based on age, gender, and socio-economic factors. Utilising an informed consent process, fifteen one-to-one telephone semi-structured interviews were undertaken, and detailed information about culture, dietary choices, and the cost-of-living crisis was collected.

The six-step guide Braun & Clark’s Reflexive thematic analysis of verbatim transcribed data from the audio-recorded interviews revealed adaptive and coping strategies have been adopted(3). Participants report what they now eat, and activities adopted to support eating. This includes purchasing cheap, low-quality, and reduced quantities of food, reducing wastage of food through preservation of any excess, bulk cooking, or preparation to minimise energy usage. Other cost savings are being made through, cutting down on social engagements (e.g. eating out and nightlife), A focus on food ‘’needs’’ and not ‘’wants’’, a reliance on social networks for support and assistance, the use of food banks, and skipping meals is also reported. One participant: ‘’This has affected our diet. So, it’s been very challenging. I mean generally, everywhere the cost of things is high’’. (GregM61). Another said, “I just cook enough for two days so that I can save some energy and reduce my energy bills”. (KhadijatF45). Illustrating the impact on health one participant suggested: ‘’When you have a cheap cost of meat and a cheap cost of carbohydrates, then you are eating badly’’. (EkongM51).

These findings cause concern since cheap and low-quality diets eaten by ethnic minority communities are known to be unhealthy and are high-risk factors for chronic diseases(4). The need for long-term support for individuals or groups most at risk of the COLC, and an ongoing need to develop culturally appropriate strategies to support healthy eating on a budget for this ethnic group are paramount to prevent poor health outcomes in this group.

In the 12-month period leading up to March 2023, inflation in the UK increased by 8.9%(1). Notably, the annual inflation rate for food and non-alcoholic beverages reached a peak of 19.2% in March 2023, marking a 45-year high(1). Concurrently, research conducted between October 2022 and January 2023, revealed that 25% of adult respondents were classified as food insecure(2). Food insecurity disproportionately affects young families, ethnic minorities, and individuals with disabilities, and correlates with poorer mental health, higher rates of obesity, and lower dietary quality. However, improving skills in cooking, meal planning, and budget shopping may alleviate some of the adverse health consequences associated with food insecurity. This primary research aimed to investigate the relationships between food insecurity, mental wellbeing, dietary quality, and food behaviours among a nationally representative sample of UK adults and was pre-registered (https://doi.org/10.17605/OSF.IO/ZFMHD).

A nationally representative cross-sectional survey was conducted in April 2023. Participants were recruited using a market research company (Dynata, UK) and quota-controlled sampling ( ± 5%) for age, gender, region and socioeconomic status. Data on food insecurity, mental wellbeing, diet quality and food behaviours, were collected, using validated measures where available. Ethical approval was received from King’s College London (Ref: LRS/DP-22/23-35412). Data analysis consisted of chi-square tests of homogeneity, Kruskal-Wallis H tests and hierarchical multiple regression modelling with adjustment of relevant covariates, using SPSS Statistics v29.0.2. The significance threshold was set at p<0.05.

1493 UK adults participated. Within the sample, 49.9% were male, mean age was 44.7 years (SD 16.3), 35.9% were classified into groups of either low (22.2%) or very low (13.7%) food security(3). Analyses revealed significantly higher proportions of females, individuals with lower income, and those of non-white ethnicity in the low or very low food security groups compared to groups with higher levels of food security (p<0.05). Participants in the low or very low food security groups exhibited lower mental wellbeing scores and consumed fewer fruits and vegetables per day compared to those with higher food security (p<0.05). Hierarchical regression models explained 28.5% of the variance in mental wellbeing scores and 16.4% in daily fruit and vegetable intake. Notably, variables related to food behaviour, such as food engagement and cooking skills confidence, significantly added to the variance explained by the models (p<0.001), even after controlling for factors such as food insecurity score and income, respectively.

This study reveals the substantial prevalence of food insecurity among UK adults, whilst also highlighting its associations with mental wellbeing and dietary quality, particularly among higher risk groups. The findings emphasise the urgent need for targeted interventions. Implementing programs focused on enhancing cooking skills and wider food behaviours could serve to mitigate some of the adverse health consequences associated with food insecurity, leading to improvements in overall wellbeing.

University students have high risk of food insecurity (FI)(1). Largely comprising young adults, they often have poor diets(2), important given the potential for this life stage to embed healthful eating behaviours(3). Having established high levels of concern about their food security among students at a post-92 university(4), the KingsGate Student Pantry was established in November 2023 as a partnership between university staff and student volunteers, a local food charity and a local church. It includes a weekly social space with free refreshments to encourage belonging, signposting to support, cookery demonstrations and access to a range of food, household and personal hygiene items, including bread, fresh fruit and vegetables. For a weekly payment of £5, customers receive £20-35 of items (estimated). An evaluation of the Pantry to understand its impact on customers and volunteers was carried out.

Bespoke questionnaires for each group collected qualitative & quantitative data about experiences of FI, reasons for coming (or volunteering) and impact of the Pantry on nutrition and belonging. These were administered at the Pantry using QR codes. Optional telephone interviews were held. Qualitative data were analysed using thematic analysis to identify key themes, while quantitative data were used to generate descriptive statistics. The impact of demographics on responses was explored using Kruskal Wallis tests.

This ongoing evaluation currently includes 112 customer and 14 volunteer questionnaires, as well as 3 customer and 5 volunteer interviews. Preliminary results suggest that finances and social reasons are major drivers for customer attendance. Key food items required at the Pantry are vegetables and fruit; cereals, pasta and rice; and milk and dairy products – basic staple foods now expensive largely due to cost-of-living pressures. High levels of satisfaction among both customers and volunteers are apparent, not limited to the goods on offer although levels of satisfaction with these are high. Goods are largely surplus, supplemented with additional items specifically purchased using the £5 weekly customer fee. This ensures a high quality offer in addition to contributing to sustainability of the Pantry. Satisfaction also extends to opportunities to build relationships, including between community and university volunteers and customers, groups otherwise unlikely to meet. The social space and welcome received are highly valued:

‘Doesn’t feel like support, feels like going out shopping with friends’ [customer interview]

‘Happy place to be’ [volunteer interview]

The Pantry therefore represents a pathway to developing a shared understanding of the meaning of community between diverse groups, to their shared benefit. Built using existing relationships and partnerships, it exemplifies how universities can utilise the skills and expertise of their community stakeholders to mutual benefit.

Four main NCDs identified in India (cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes) are closely related to behavioural risk factors - unhealthy diet, lack of physical activity, and use of tobacco and alcohol(1). South India (Tamil Nadu state) where the research was conducted faces challenges like the rich-poor gap in access to health, the persistence of high levels of malnutrition, anaemia, and the ever-increasing expectation and demands for public health services from the public(2). Variation and inequality in nutrient intake showed a declining trend(3) due to factors such as expenditure on food, household size, and literacy and poverty especially in rural area(4). There is need to determine the food insecurity situation comprehensively in India and plan appropriate policy actions to address it effectively, to attain the key Sustainable Development Goals (SDGs)(5). This pilot study investigated food insecurity and related health behaviours in a rural village in Tamil Nadu. Additionally, collaborative learning (peer learning) was implemented, as both UK and local Indian students conducted this research - UK students travelled to India using the Turing Funding Scheme.

This is qualitative research, whereby researchers from two universities (UK and India) obtained perspectives of the rural communities. Data was collected in two stages: observation of health behaviours (for each family on three different days in a week), where pictures were taken with permission, and followed by face-to-face interviews (with 6 heads of households). A total of three male and three female adults (aged between 28–68 years old, all married and living in an intergenerational family setting) were interviewed for approximately 30-40 minutes and analysed thematically using the Braun & Clarke approach(6). Consensus coding was used to determine invariant constituents, while reliability and validity were achieved through intercoder agreement, audio recording, triangulation, and member checking.

A total of five themes were identified: Accessibility to food, Influences of culture, Health behaviour and barriers, and Vision for a healthier community. It was apparent that their food consumption was affected by their economic background, but it was thought-provoking to discover that they were focusing on more sustainable and traditional ways to address food insecurity, such as consuming different millets rather than rice (which were cheaper, sustainable, and nutrient-rich), vegetables and fruits sourced locally, milk, and eggs. Limited consumption of meat and fish, processed food, and snacking was rare. Deficiencies and malnutrition were self-reported during the interview (such as iron and calcium). Limited motorized vehicles were used, and they walked a lot, there was no exercise routine practiced. Social media plays a significant role in influencing their health behaviour.

There is a need for more awareness of nutrition and health through the right channels- social and digital media.

The Covid-19 pandemic exposed the fragility of the UK food system(1). Currently, 46% of fruit and vegetables are imported(1), making the UK vulnerable. Recent events such as war in Ukraine, volatile fuel prices and crop failures attributed to climate change have exacerbated this(1), with global food prices reflected in the cost-of-living crisis(2). Food is not just a source of nutrition, but of personal and cultural identity(3), with potential to impact on the extent to which people feel that they belong to a place or community. Community food growing schemes such as allotments remain popular in the UK(4). They could increase food resilience and security through growing produce, otherwise imported. The impact of a community growing scheme based in south London was explored. The scheme, a small farm allotment, was established by a Hong Kong farmer to grow produce including traditional Asian vegetables. It also aims to encourage collective efforts e.g. co-farming, through use of shared and private spaces. Focusing on traditional Asian vegetables, it offers bespoke advice, support and education via workshops, online mentoring and traineeships.

Evaluation of this scheme was undertaken with ethics approval from Kingston University London. Using participatory non-extractive methods, qualitative and quantitative data were obtained using questionnaires and optional interviews with attendees of workshops (n = 52), online mentees (n = 2), and trainees (n = 3).

All participants described themselves as Asian, Chinese or Hongkongers. More than two thirds (69.1%) had been in the UK for a relatively short time (up to 24 months). Both experience of, and knowledge about, growing food were low amongst participants, although this varied by group. While none of the trainees had previous food growing experience, half of online mentees and more than quarter (26.9%) of workshop attendees had some. All of the online mentees and over half (53.8%) of workshop attendees described themselves as having some knowledge about growing food. The most common reasons given for their involvement were an interest in urban growing/agriculture and practical (rather than theoretical) skills acquisition. Asian vegetables had multiple meanings for participants. Most commonly, they related to aspects of home, demonstrating the importance of culturally specific foods in evoking memories of people, place and time. Asked whether taking part in growing could help them build a sense of belonging within the UK Hong Kong community, responses were almost entirely affirmative for a variety of reasons.

This highlights the multiple roles of food in people’s lives, and the potential for food to be used as a bridge between different groups, and as a bridge between their original and current homes. It also emphasises the role that growing food could play in cultural identity and pride, potentially building belonging as well as food resilience.