The common C677T polymorphism in the MTHFR gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase is implicated in hypertension and hypertension in pregnancy. Hypertension affects up to 15% of all pregnancies and has been identified as a leading cause of maternal and neonatal morbidity and mortality worldwide. We previously reported higher systolic and diastolic blood pressure (BP) in non-pregnant women with the variant MTHFR 677TT genotype compared to CT/CC genotypes. In addition, randomised controlled trials (RCTs) in non-pregnant hypertensive adults from our Centre demonstrated that supplemental riboflavin (co-factor for MTHFR) lowers BP specifically in those with the TT genotype. However, the role of this common folate polymorphism and its interaction with riboflavin during pregnancy remains unclear. The aim of this study was to investigate the impact of MTHFR genotype and riboflavin status on BP in pregnancy. Data were generated from the ongoing Optimal Nutrition for the Prevention of Hypertension (OptiPREG) project. Pregnant women were recruited at the end of the first trimester from antenatal clinics in Northern Ireland and in the Republic of Ireland. Participants were screened for MTHFR genotype and BP was measured according to current clinical guidelines. Biomarker status of riboflavin was determined using the erythrocyte glutathione reductase activation coefficient (EGRac), a functional assay with higher EGRac values representing a lower status. Overall, 117 (11.6%) participants were identified with the variant MTHFR 677TT genotype. Both systolic and diastolic BP decreased from 8th to 16th gestational week (GW), however, this typical BP pattern was not observed in the TT genotype group. After adjusting for maternal age, GW and body mass index, women with the TT genotype at 12th GW had higher mean systolic (P 0.035) and diastolic (P 0.034) BP. When the results at the 12th GW were stratified by riboflavin status, the BP phenotype owing to this polymorphism was evident only among women with lower status (i.e. EGRac > 1.30), with mean (SEM) systolic BP of 120.4 (3.1) mmHg compared to 112.6 (2.5) mmHg in those with higher status (EGRac ≤ 1.30) within the TT genotype group; in contrast, low versus high riboflavin status had no impact on BP in CT/CC genotype groups. These results suggest that MTHFR genotype influences BP during pregnancy and that riboflavin can exert an important modulating effect on BP in women with TT genotype. An RCT is required to fully investigate the role of MTHFR genotype and its interactive effect with riboflavin in BP during pregnancy.

Maternal BMI has been shown to be inversely correlated with vitamin D status (25-hydroxyvitamin D (25(OH)D) concentrations) during pregnancy. Pregnant women with obesity and with vitamin D deficiency are at risk of many adverse health outcomes in pregnancy.

The aim of this study was to examine differences in maternal vitamin D status across normal weight, overweight and obese pregnant women in early pregnancy.

Data collected at baseline from a double-blind randomised vitamin D intervention study (MO-VITD) were used. Pregnant women without pregnancy complications, aged > 18 years and having a singleton pregnancy were recruited between January 2016 and August 2017 at antenatal clinics in the Western Health and Social Care Trust, Northern Ireland. Non-fasting blood samples were collected at 12 weeks gestation and analysed for total serum 25(OH)D, using liquid chromatography tandem mass spectrometry. Data from 239 pregnant women (80 normal weight, 79 overweight, 80 obese) were included in the current analysis.

The mean ± SD 25(OH)D concentration of all pregnant women at 12 weeks gestation was 52.0 ± 21.6 nmol/L. Women classed as obese or overweight had significantly lower 25(OH)D concentrations compared to women of normal weight (48.8 ± 20.3 vs 49.8 ± 20.4 vs. 57.5 ± 23.1 nmol/L, P = 0.019; obese, overweight, normal weight respectively). A total of 45% of all pregnant women were found to be either vitamin D deficient (25(OH)D < 25nmol/L; 13%) or insufficient (25–50 nmol/L; 32%) in early pregnancy. BMI was significantly negatively correlated with 25(OH)D concentrations (r = -0.168; P = 0.009). Regression analyses showed that BMI (β = -0.165; P = 0.006), season (β = 0.220; P = < 0.0001), supplement use (β = -0.268; P < 0.0001) and a sun holiday within the previous 6 months (β = -0.180; P = 0.010) were significant predictors of 25(OH)D concentrations. In early pregnancy, 62% of pregnant women reported using a supplement containing vitamin D and 38% reported no supplement use. Supplement users had a significantly higher vitamin D status than non-supplement users in all BMI categories but overall, 37% of supplement users were still classified as vitamin D insufficient. Vitamin D status was significantly lower in winter months compared to summer months. In early pregnancy, especially during winter months, pregnant women with obesity, particularly non-supplement users, are at higher risk of low vitamin D status. Based on the lower vitamin D status observed in early pregnancy in obese women, the effect of BMI on vitamin D supplementation throughout pregnancy needs to be examined.

Vitamin B12 deficiency is common among older adults, even with dietary intakes well in excess of current recommendations. Severe clinical B12 deficiency (i.e. pernicious anaemia) leads to irreversible neurological damage, but once diagnosed, can be treated effectively with B12 injections. A much more common cause of low vitamin B12 status in older adults is food-bound malabsorption owing to atrophic gastritis. This in turn leads to reduced gastric acid secretion, thus limiting B12 absorption from food (given the essential role of gastric acid in releasing B12 from food proteins). Proton pump inhibitor (PPI) drugs reduce gastric acid secretion, similar to atrophic gastritis, thus there is a concern that these medications may lead to vitamin B12 malabsorption. Therefore, the aim of this study was to investigate biomarker status of vitamin B12 in relation to atrophic gastritis and PPI usage. Data were accessed from The Trinity Ulster Department of Agriculture (TUDA) Ageing Cohort Study, a cross-sectional study of community-dwelling adults (n 5186, ≥ 60 years) recruited across Northern Ireland and the Republic of Ireland (2008–2012). TUDA participants were classified into 3 groups; ‘healthy’ controls, atrophic gastritis and PPI users. Vitamin B12 status was assessed using a total of four biomarkers: serum total B12; serum holotranscobalamin, holoTC; plasma methylmalonic acid, MMA; plasma homocysteine. Atrophic gastritis was identified using pepsinogen analysis (via ELISA), with a pepsinogen I : II ratio of < 3 considered indicative of atrophic gastritis. Based on results from all four biomarkers, participants with atrophic gastritis were found to have significantly lower B12 status compared to healthy controls: e.g. mean (95% CI) serum total vitamin B12, 188 (156, 218) pmol/L vs. 262 (252, 272) pmol/L P < 0.001; holoTC, 46.0 (38.1, 53.8) pmol/L vs. 60.3 (57.8, 62.8) pmol/L P < 0.001; plasma MMA, 0.65 (0.52, 0.78) μmol/L vs. 0.37 (0.32, 0.42) μmol/L P = 0.001. No differences in B12 biomarker concentrations were observed between PPI users and healthy controls. Regular consumption of fortified foods (i.e. ≥ 5 portions per week) compared to non-regular consumption (i.e. 0–4 portions per week) impacted positively on B12 biomarker status in all participants. This effect however appeared insufficient to restore normal vitamin B12 status in those with atrophic gastritis. These results show that older adults with atrophic gastritis have significantly lower vitamin B12 biomarker status, particularly in those who did not regularly consume fortified foods. Further investigations of the effect of atrophic gastritis and PPI usage on B12 status are warranted.

Age-related bone loss leads to a significant decline in bone formation and an increase in bone resorption resulting in a marked negative effect on bone mineral density (BMD). This bone turnover cycle can be further disrupted by estrogen deficiency during menopause which can lead to a great net loss of bone in post-menopausal women. Evidence suggests that n-3 polyunsaturated fatty acids (PUFA) may have a beneficial effect on the inflammatory regulation of bone remodelling and thus reducing bone loss. This study investigated the relationship between PUFA status, total body bone mineral density (BMD) and bone turnover markers in a cohort of post-menopausal women in Northern Ireland. Total body T-score and BMD were measured using dual energy x-ray absorptiometry (DEXA) in 300 non-osteoporotic post-menopausal women (45–75 years). The bone turnover markers serum osteocalcin, alkaline phosphatase, C-terminal telopeptides of type 1 collagen (CTX) and urinary deoxypyridinoline (DPD) were quantified. Total n6 PUFA (LA + AA) and n3 PUFA (ALA + EPA + DPA + DHA) were measured in serum using gas chromatography mass spectrometry. Total n3:n6 ratio was calculated. Dietary intake and lifestyle factors were determined by 4 day food diary and questionnaire, respectively. Spearman rank correlation analysis were conducted to investigate the relationship between PUFA and total body BMD. Secondary analysis investigated the relationship between PUFA and the bone turnover markers. Median (IQR) age was 61 (10) years, body mass index 27 (6) kg/m2, total body BMD, 1.3 (0.11) g/cm2 and age at menopause was 50 (6) years. Total median (IQR) serum n-3 PUFA status was 0.231 (0.128) mg/mL, total n6 PUFA was 1.248 (0.477) mg/mL and the n6:n3 PUFA ratio was 5.82 (2.63). Median (IQR) daily fish consumption was 25 (46) grams, calcium 702 (364) mg and vitamin D 2.21 (2.3) μg. There was no significant correlation between markers of total n3, n6, n6:n3 ratio and total body T-score, BMD or bone mineral content. PUFA was not significantly associated with total body BMD. There was a significant negative correlation between the urinary bone resorption marker DPD and total n3 PUFA (r = -0.137, P = 0018); EPA (r = -0.150, P = 0.009), and DPA (r = -0.118, P = 0.042). A significant negative correlation was observed between urinary CTX and the n-6 PUFA AA (r = -0.121, P = 0.036), the n3 PUFA ALA (r = -0.123, P = 0.033). PUFA were associated with less bone resorption therefore it is plausible that PUFA have a positive anti-inflammatory effect on bone resorption and warrants further investigation.

Diet is the only source of the essential branched-chain amino acids (BCAA) isoleucine, leucine and valine. High plasma concentrations of these amino acids are discussed as risk factors for the onset of several diseases such as type 2 diabetes mellitus (T2D) or cardiovascular diseases (CVD). Information about the contribution of the overall diet to plasma levels of these amino acids is controversial. Our objective was to investigate which dietary pattern is associated with plasma BCAA concentrations in a healthy population and which other additional nutrients besides isoleucine, leucine and valine, such as other amino acids, may contribute to the diseases risk.

The Karlsruhe Metabolomics and Nutrition (KarMeN) study is a cross-sectional study aiming to determine the impact of a number of factors on the human metabolome in healthy men and women aged 18 and 80 years. In our study, fasting plasma amino acid concentrations as well as current and habitual dietary intake were assessed in 298 apparently healthy individuals, 171 men (57.4%) and 127 women (42.6%) with a mean age of 44.5 and 51.6 years, respectively. All reported foods were summarized into 35 food groups. Dietary patterns were derived that explain as much variation as possible in plasma BCAA concentrations using reduced rank regression. The first derived current dietary pattern covering the diet of the past 24 hours, showed 19.2% of explained variance for BCAA plasma concentrations, whereas the first habitual dietary pattern, covering a period of more than 4 weeks, explained 32.5%. For further analysis, we focused on the first derived habitual dietary pattern. This pattern was high in meat, sausages, sauces, eggs, and ice cream but low in nuts, cereals, mushrooms, and pulses. The age, sex, and energy intake adjusted dietary pattern score was associated with an increase in animal-based protein and at the same a decrease in plant-based protein, dietary fibre and an unfavorable fatty acid composition. Amino acids alanine, lysine and the aromatic amino acids phenylalanine, tyrosine, and tryptophan were positively associated with the dietary pattern score as well. All of these factors were reported to be associated with risk of T2D and CVD.

Our data suggest that rather than the dietary intake of BCAA, the overall dietary pattern contributing to high BCAA plasma concentrations may modulate the chronic diseases risk.

The sustainability of education focused on improving teenagers’ attitudes toward nutrition from a longer-term perspective has not yet been studied extensively. The aim of this study was to determine the sustainability of attitudes toward nutrition after 3 and 9 months among Polish teenagers in a follow-up study. An education-based intervention study was carried out among 464 Polish teenagers aged 11–12 years (educated/control group: 319/145). In the educated group, a multicomponent, school-based education program lasting three weeks and covering five diet-related and lifestyle-related topics was implemented. Attitudes toward nutrition were determined with a shorter version (TFEQ10; 10 statements) of a three-factor eating questionnaire (TFEQ13) dedicated to school-aged adolescents, where three subscales were developed: Emotional Eating (EE: 2 statements, 0–6 points), Uncontrolled Eating (UE: 5 statements, 0–15 points), and Cognitive Restraint of Eating (CRE: 3 statements, 0–9 points). The data was collected 3 times: (i) before education (at baseline), (ii) after 3 months to measure the short-term effect of education, (iii) after 9 months to measure the medium-term effect of education. Differences between groups (educated vs. control or baseline vs. follow-up) were verified with the Mann–Whitney test. At the baseline, the mean values for all three scales were not significantly different between educated and control groups, calculated separately for boys and girls as well as for normal or overweight/obese teenagers, with the exception for Emotional Eating in the total sample and normal weight students. After 3-month follow-up, the mean values decreased in an educated group for all three subscales, for the total sample (EE: 1.3 vs 1.2; UE: 5.2 vs 4.7; CRE: 4.2 vs 4.0), for both sexes, and both body weight subpopulations, while increased or remained on the same level in control group (for total sample EE: 1.5 vs 1.6; UE: 5.6 vs 5.8; CRE: 4.1 vs 4.2). After 9 months, in the educated group, the means slightly increased when compared to the means after 3 months, but were still lower than those at the baseline. This study has shown that nutritional education of teenagers 11–12 years gives a long-lasting effect of attitudes toward nutrition (Emotional Eating and Uncontrolled Eating) visible after 3 months, and to a less extent after 9 months. We suppose, that improvement of the attitudes toward nutrition in teenagers, education programs should be regularly conducted and addressed not only to children but also to the adults responsible for children's nutrition.

It is estimated that 19% of 16–24 year olds suffer from a mental health condition. There has been a fivefold increase in reported mental health problems from first year university students since 2006/07(1). Limited but consistent evidence suggests that nutritional status is linked to mental health. University students may be more vulnerable to the impact of diet on mental health due to increased food insecurity and risk of stress. The aim of this project was to determine the association between nutritional status and stress, anxiety and depression in university students.

After obtaining ethical approval, university students (n = 562) aged 18–24 y were recruited. A cross-sectional design was used to measure body mass index (BMI), percent body fat (%BF), capillary blood measures of glucose and lipids and nutrient intake by validated 3-day food diary. Mental health status was determined by DASS21 questionnaire (2) and participants were grouped into 5 categories: normal, mild, moderate, severe and extremely severe for anxiety, depression or stress. Difference in nutritional status between categories was determined by a Kruskal-Wallis test and Dun-Bonferroni post-hoc tests using SPSS version 25 and significance determined as p < 0.05.

Results showed that depression was associated with %BF (p = 0.025), blood glucose (p < 0.001), dietary protein (p = 0.003) and dietary sugar (p = 0.041). Anxiety was associated with blood glucose (p < 0.001) and dietary protein (p = 0.007).Stress was associated with total cholesterol (p = 0.007), HDL cholesterol (p = 0.007) and blood glucose (p < 0.001).

In light of these findings, further research is required to investigate the effect of student lifestyle habits and university practices on mental health and nutritional status so that strategic interventions can be designed to improve the health of young adults at university.

Historically, Iceland has been an iodine sufficient nation due to notably high fish and dairy consumption. Due to this fact the country does not have a strategy related to iodine status, such as fortification of salt. Iodine status of pregnant women has only been assessed once before in Iceland (in 2009). The median UIC was found to be 180 μg/L, which was in line with the recommended range of 150–249 μg/L defined by the World Health Organization (WHO). Intake of fish and dairy has decreased considerably in the past 10 years. The aim of the present study was to re-evaluate the iodine status of pregnant women in Iceland using data from the PREWICE study (PREgnant Women in ICEland). Subjects were women (n = 983; 73% of the eligible sample) attending their first ultrasound appointment in gestational weeks 11–14 in the period October 2017-March 2018. Spot urine samples were collected for assessment of urinary iodine concentration (UIC) and creatinine. The ratio of iodine to creatinine (I/Cr) was calculated. Diet was assessed using a semi-quantitative food frequency questionnaire (FFQ), which provided information on main dietary sources of iodine in the population studied (dairy and fish). The median UIC (95% CI) and I/Cr of the study population was 89 μg/L (42, 141) and 100 (94, 108) μg/g, respectively. UIC increased with higher frequency of dairy intake, ranging from median UIC of 55 (35, 79) μg/L for women consuming dairy products < 1 time per week to 124 (98, 151) μg/L in the group consuming dairy > 2 times per day (p for trend < 0.001). A small group of women reporting complete avoidance of fish (n = 18) had UIC of 50 (21, 123) μg/L and significantly lower I/Cr compared with those who did not report avoidance of fish (58 (34,134) μg/g vs. 100 (94, 108) μg/g, p = 0.041). Women taking supplements containing iodine (n = 34, 3.5%) had higher UIC compared with those who did not take supplements (141 (77, 263) vs. 87 (82, 94) μg/L, p = 0.037. For the first time, insufficient iodine status is being observed in an Icelandic population. There is an urgent need for a public health action aiming at improving iodine status of women of childbearing age in Iceland.

Maternal adherence to healthy lifestyle behaviours during pregnancy has been associated with reduced risk of obesity in the offspring. Our objective is to examine the association between a composite healthy lifestyle score (HLS) derived from body mass index (BMI), dietary quality, physical activity, smoking and alcohol intake, in expectant mothers and adverse offspring birth outcomes and childhood obesity. The Lifeways Cross-Generation Study comprises 1082 mother-child pairs. We defined five healthy lifestyle factors during pregnancy including: high dietary quality (top 40% of the Healthy Eating Index (HEI)-2015), moderate to vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5–24.9 Kg/m2), never smoker, and no/moderate alcohol intake. A composite HLS was calculated (scored 0–5). Birthweight, length and head circumference were abstracted from hospital records. Waist circumference and BMI was determined when the child was 5 and 9 years. Logistic regression analyses were used to test HLS and individual HLS component associations with offspring birth and childhood outcomes. Offspring birthweight, length and head circumference were positively associated with the number of maternal healthy lifestyle factors (p < 0.001), whereas child BMI and incidence of overweight/obesity at age 5 and 9 were negatively associated with the maternal HLS (p < 0.05). In multivariable models, a lower maternal HLS (0–2 healthy lifestyle factors) was associated with increased risk of low birthweight (LBW) (OR:1.17, 95% CI:1.01–2.69, p = 0.043) and lower likelihood of macrosomia (OR:0.73, 95% CI:0.24–0.99, p = 0.034), relative to those with 5 healthy lifestyle factors. Examination of the individual HLS components revealed that, poor maternal dietary quality, smoking and alcohol intake were associated with higher risk of LBW (OR:1.61, 95%CI:1.01–7.85, p = 0.043, OR: 2.54, 95%CI:1.26–5.12, p = 0.025 and OR:2.30, 95%CI:1.01–5.26, p = 0.031, respectively). Likelihood of macrosomia and combined overweight/obesity at age 5 and 9 years was greater among mothers with a pre-pregnancy BMI in the obese range (OR:2.18, 95%CI:1.23–3.85, p = 0.042, OR:2.19, 95%CI:1.01–5.08, p = 0.03 and OR:3.89, 95%CI:1.00–10.59, p = 0.04, respectively). Smoking during pregnancy was also linked to greater risk of childhood overweight/obesity (OR:1.91, 95%CI:1.01–3.61, p = 0.04 at age 5 and OR:2.14, 95%CI:1.01–4.11, p = 0.03 at age 9). Our findings suggest that maternal adherence to a healthy lifestyle during pregnancy, in particular having a good quality diet, not smoking and no/low alcohol intake in combination with a healthy pre-pregnancy BMI, is associated with reduced risk of adverse offspring birth outcomes and childhood obesity. These findings highlight the potential benefits of implementing maternal based multifactorial interventions to improve offspring birth outcomes and combat childhood adiposity.

Poor diet quality is a major cause of maternal obesity and associated with adverse metabolic effects for mother and offspring. Psychological stress can increase intake of unhealthy dietary choices (e.g. highly palatable, energy dense diet), but no study has investigated the association between stress and diet quality in women of childbearing age.

This systematic review of the association between psychological stress and diet quality used the PEO (Population, Exposure, and Outcome) model.

Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched (October 2018 - January 2019). From 139,552 hits, 471 papers were screened, but only 8 studies met our inclusion criteria: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women (18–49 years of age (population). Data extraction was determined by the PEO. Quality assessment used CASP tool for Cohort studies.

The review included eight studies from USA (n = 6), Egypt (n = 1), and Iran (n = 1). The six cross-sectional and two longitudinal studies were published between 2011 and 2017 and had a total of 3,982 participants. Studies were heterogeneous in methods: three used food frequency questionnaires to assess dietary intake while the others used 24-hour dietary recalls. Diet quality was measured using different indices: Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index- Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Only one study used three diet quality indices. No study explored dietary patterns using factor analysis and other statistical techniques. Most studies used the perceived stress scale to measure stress; however, there were differences regarding the use of this scale to form a continuous or categorical variable (with varying cut-off scores) perceived stress, whereas no study reported biological response to stress. Outcomes also varied in direction of association; no association (n = 4), negative association (n = 3), mixed results (n = 1).

This review is the first to systematically examine association between stress and diet quality in women of childbearing age; there was heterogeneity in measures of diet quality and study designs. Future studies that explore diet quality/patterns should include both diet indices and factor analysis and additionally measure biological markers of both dietary intake and stress.

Pre-pregnancy obesity is associated with a 2-fold increased risk of Neural Tube Defects (NTD), an effect not explained by lower dietary folate intake, or non-use of folic acid supplements (as recommended globally to women before and in early pregnancy for NTD prevention). While the exact mechanism linking NTD and obesity is poorly understood, it is possible that a compromised status or metabolism of folate and/or of the closely related micronutrients (vitamin B12, B6 and riboflavin) may be involved. To date however, this hypothesis has not been adequately explored. This study therefore aimed to investigate the relationship of obesity with folate and related B vitamin biomarkers in a representative cohort of non-pregnant UK women of reproductive age. Data were accessed from the most recent UK National Diet and Nutrition Survey (NDNS; Years 7–8; 2015–16), a rolling cross-sectional survey designed to gather information from a representative sample of the UK population on nutrient intakes, food consumption and nutritional status. Data for women aged 16–45 years (non B vitamin supplement users; n 364), were extracted on: anthropometry (height, weight, body mass index [BMI] and waist circumference [WC]), dietary intakes of B vitamins and biomarkers for serum and red blood cell folate, vitamin B12 (total serum B12 and holotranscobalamin), vitamin B6 (plasma pyridoxal-5-phosphate [PLP]) and riboflavin (erythrocyte glutathione reductase activation coefficient EGRAac]). Prevalence of overweight and obesity (i.e. BMI: 25–30kg/m2 and > 30kg/m2) was 28% and 22% respectively, whilst abdominal obesity (i.e. WC > 88cm) was present in 31% of the women. Total serum B12 (r -0.215, P 0.012) and PLP (r -0.270, P 0.002) were negatively correlated with WC, with similar, albeit weaker, correlations found for BMI. Correspondingly, women with abdominal obesity compared to those without, had a lower status of total serum B12 (Median values of: 212 v 249 v pmol/L; P 0.049), B6 (31.5 v 40.5 nmol/L; P 0.002) and EGRac (1.43 v 1.36; P 0.031). No differences in B vitamin dietary intake were observed by categories of abdominal obesity. Abdominal obesity may be a risk factor for low status of both vitamins B12 and B6, independently of dietary intake. Further investigation to elucidate the potential underlying mechanism is warranted. These findings also highlight the importance of taking abdominal obesity into account, in addition to BMI, when examining possible adverse impacts of obesity on micronutrient status.

Published studies have suggested a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency in western dwelling South Asians, particularly in women. However, sample sizes have been relatively small with few men. Moreover, South Asians are vastly under-represented in national dietary surveys and further research into 25(OH)D status is needed. The UK Biobank is a cohort of 500,000 individuals; n 6433 are of South Asian ethnicity and have baseline serum 25(OH)D data (2006–2010, aged 40–69 years). Blood draws were spread across the year. Of note, the 25(OH)D measurements were produced using the DiaSorin Liaison XL assay which underestimates 25(OH)D by 4% at 25nmol/L, but overestimates 25(OH)D by 5–10% at ≥ 40nmol/\L(1). We used the commonly used cut-points of < 25nmol/L (deficiency), < 50nmol/L (insufficiency). In women (n 2927), median (IQR) was 24.3 (20.5) nmol/L with 50.4% < 25nmol/L, and 88.6% < 50nmol/L. In men (n 3506), median (IQR) was 21.7 (16.2) with 58.4% < 25 nmol/L and 93.8% < 50 nmol/L. Of concern, 17.8% of women and 21.1% of men had 25(OH)D < 15nmol/L. A Mann Whitney test showed that gender differences were statistically significant (P < 0.0001). In terms of ethnic sub-groups, in the Bangladeshi group (n 207), median (IQR) was 26.1 (14.3) nmol/L with 43.5% < 25nmol/L and 91.3% < 50nmol/L. In the Indian group (n 4792), median (IQR) was 23.8 (19.3) with 52.0% < 25nmol/L and 90.4% < 50nmol/L. Finally, in the Pakistani group (n 1434) median (IQR) was 19.3(14.5) with 65.7% < 25nmol/L and 94.9% < 50nmol/L. A Kruskal Wallis test showed that ethnic subgroup differences were statistically significant (P < 0.0001). To the authors’ knowledge, this is the largest analysis to date of 25(OH)D status in European dwelling South Asians. Deficiency of 25(OH)D was almost universal, with 50% or more not even reaching 25nmol/L. Of great concern, 20% of participants had levels < 15nmol/L which, although not a widely used cut-off point, still represents severe deficiency and likely osteomalacia. Moreover, these results are most probably an underestimation of this societal challenge as the UK Biobank is likely to contain participants that are healthier and more educated than the general population. In conclusion, our analyses suggest the need for urgent public health interventions to prevent and treat vitamin D deficiency in UK South Asians. This research was conducted using the UK Biobank Resource under application number 15168.

Nutrients affect bone health status. However, dietary patterns advance insight into which particular foods influence bone and nutritional health status. The aim of this study was to explore the associations between dietary patterns, bone and nutritional health status in postmenopausal women. This cross-sectional study examined 127 postmenopausal women aged between 54–81 years. Body composition and bone health status were determined using dual-energy X-ray absorptiometry (DXA). The dietary composition was assessed by a validated food frequency questionnaire composed of 108 foods, of which 34 food groups were created. Dietary patterns (DP) were identified by principal component analysis. The bone and nutritional measures were regressed onto the dietary pattern. Five DPs were identified, two of which were associated with nutritional status. Fruit and carbohydrate DP was associated with decreased weight (r = -0.192, P = 0.038), body mass index (r = -0.184, P = 0.047) and body fat (r = -0.181, P = 0.050). Coffee and yoghurt/cream DP was associated with weight (r = 0.223, P = 0.015), body mass index (r = 0.245, P = 0.008) and body fat (r = 0.195, P = 0.036). Bone health status; spine T-score (r = 0.283, P = 0.002), hip T-score (r = 0.309, P = 0.001), femoral neck T-score (r = 0.317, P = 0.001) and whole-body bone mineral density (r = 0.261, P = 0.004) were also associated with coffee and yoghurt/cream DP. Milk products DP was associated with spine T-score (r = 0.304, P = 0.001). A dietary pattern characterized by high factor loadings of coffee, milk and yoghurt/cream was associated with higher BMD and T-scores. Although coffee intake has been associated with low bone mass, the impact of milk products appears to override the effects of coffee as an important determinant of bone health status in postmenopausal women.

Nutrition strongly impacts the incidence and progression of chronic kidney disease (CKD). Recently, reduced rank regression (RRR) has emerged as a method that identifies dietary patterns in an exploratory way while using prior knowledge to select a set of response variables. The aim of this study was to identify a specific dietary pattern associated with renal function using RRR, and to evaluate its association with CKD incidence. We included 78,350 participants from the LifeLines population-based cohort in the Northern Netherlands. All participants were free of CKD (defined as eGFRCKD-EPI < 60 mL/min/1.73 m2) at baseline and completed a second visit four years later. Dietary intake was ascertained with a 110-item food frequency questionnaire. The dietary pattern, stratified by sex, was constructed cross-sectionally by RRR, with eGFR as a response variable. Multivariable logistic regression was used to study the association between dietary patterns score and CKD incidence or an eGFR decline of ≥ 20%, adjusted for potential confounders. Among women, the eGFR-associated dietary pattern was characterized by high intake of eggs, low-fat and high-fat cheese, and legumes and low consumption of sweetened dairy drinks, desserts, cake and cookies, sweet sandwich toppings, white meat, and commercially prepared dishes. The male dietary pattern was characterized by high consumption of high-fat and low-fat cheese, bread, full-fat milk, fruits, vegetables, beer, and low consumption of white and red meat. After a mean follow-up of 3.9 years, 7,612 participants experienced a > 20% eGFR decline and 2,072 participants developed CKD. The eGFR-based diet was associated with a lower risk of eGFR decline (OR 4th vs 1st quartile, women: 0.84 [95% CI 0.76–0.92]; men: 0.74 [0.65–0.84] and of incident CKD (women: 0.60 [0.50–0.73] ; men: 0.52 [0.41–0.66]). The results provide support for potential diet interventions to prevent renal function decline and CKD. RRR may be a useful tool to identify dietary patterns that affect renal function loss and CKD development.