Shifting towards predominantly plant-based diets is an important tool in addressing population and planetary health, and diversifying protein intakes is part of this.(1) Whilst updating the Eatwell Guide to include a diverse range of protein sources can encourage individuals to adopt more varied and sustainable dietary patterns, understanding healthcare and food professionals’ perspectives on which protein sources to include in dietary guidelines is essential for effective recommendations, which this research aimed to explore.

Between 8-31 March 2024, an incentivised survey was distributed to members of the MyNutriWeb community, made up primarily of healthcare and food professionals. A part of the survey aimed to gain insights about which protein sources respondents recommend when supporting people with their protein consumption, and which should be included if the visual representation of the Eatwell Guide was to be updated.

Of the 865 respondents, the majority (65%) were dietitians and nutritionists, with 12% being students and the remaining respondents representing various other healthcare and food professions. When supporting people with their protein consumption, 92% (of 748 respondents) regularly recommend legumes and pulses, 87% fish, 85% eggs, 72% poultry, 57% soy/tempeh/tofu, 47% unprocessed red meat (e.g. beef, pork, lamb), 34% mycoprotein (e.g. fungi meat alternatives like Quorn) and 2% processed meat (e.g. sausages, bacon, ham, salami, pies, burgers, pâtés, canned meat). When asked which protein sources should be included if the Eatwell Guide protein description was to be updated, 90% (of 643 respondents) selected soy/tempeh/tofu, 88% legumes and pulses, 79% eggs, 78% mycoprotein, 78% fish, 74% poultry, 63% unprocessed red meat and 6% processed meat. 10% also selected ‘other’ and 25 of the 64 additional comments provided mentioned nuts and seeds. In relation to the brief protein description included on the Eatwell Guide visual, 53% (of 635 respondents) responded yes to an update supporting people to consider more fungi and plant-based proteins within their diet, and only 6% responded no. The remaining 41% responded that it depends or other, and the most prominent additional comment was on the need to keep fish, eggs and meat in the description.

This survey reveals a consensus among healthcare and food professionals regarding the importance of including a variety of protein sources in dietary guidelines. Legumes, pulses, fish, and eggs were among the most recommended protein sources, emphasizing the significance of both non-animal and animal-based proteins in a balanced diet. While there was strong support for including more non-animal protein foods such as soy, legumes, and mycoprotein in the Eatwell Guide, respondents also emphasized the importance of retaining animal protein sources. This suggests that a balanced approach, incorporating non-animal (plant and fungi) and animal-based proteins, is widely supported among professionals for promoting healthier and more sustainable eating habits.

Low-calorie sweeteners (LCS), also known as non-nutritive sweeteners, are suggested to reduce sugar and calorie intake, potentially serving as a useful strategy for weight loss and management of type 2 diabetes (T2D)(1). However, inconsistencies in scientific research and conflicting guidelines regarding the benefits and risks of LCS rendered professionals uncertain about their safety and effectiveness in the management of obesity and T2D(2). Dietitians and nutritionists play a crucial role in preventing and managing obesity and T2D. Understanding their perceptions and knowledge of LCS is essential for developing strategies to keep them updated with the latest evidence. This survey aimed to assess the perceptions and knowledge of LCS among HCPC registered dietitians and nutritionists living and working in the UK.

An online cross-sectional survey was distributed to nutritionists and HCPC registered dietitians in the UK through social media and workplaces such as gyms, hospitals, and universities. Participants rated statements on their perceptions and knowledge of LCS use in obesity and T2D management, their risks, benefits, and government regulations. Ordinal logistic regression was used to investigate the impact of educational level and occupation (dietitians versus nutritionists) on the outcomes.

A total of 200 participants (136 dietitians and 54 nutritionists) responded to the survey. While 99% of respondents were familiar with LCS, only 62.5% were confident about advising clients/patients on their appropriate use. Additionally, 69.9% believed that LCS are helpful for weight loss and 67.8% stated that they can help manage T2D. Some respondents viewed LCS negatively: 15.5% considered it harmful, 39% deemed it unsafe, while 42.5% saw its benefits outweighing risks. Interestingly, 41.5% of respondents were not aware of the regulations surrounding the use of LCS. Open-ended questions revealed that some participants expressed concerns about the negative health effects of aspartame, with many considering stevia to be a healthier alternative due to its natural origin. Further analysis revealed that professionals with a doctorate degree in Nutrition/Dietetics were less likely to believe that LCS are bad for health when compared to those with an undergraduate degree (Wald χ2(1) =4.209, p=0.04). Compared to nutritionists, dietitians were more likely to express concerns regarding the impact of LCS on weight gain (p=0.029), yet the latter outcome is limited by the unequal sample size between the 2 groups.

While the majority of respondents recognize LCS as a valuable tool in managing obesity and T2D, a research and educational knowledge gap remains. Perceptions and knowledge of LCS could be further explored in a larger survey. It is crucial for professional and regulatory bodies to disseminate accessible information, ensuring that healthcare professionals provide the public with evidencebased guidance on the use of LCS in addressing obesity and T2D.

Bolus feeding is the administration of feed to a patient as a series of smaller volumes of enteral nutrition given at regular intervals via an enteral feeding tube.(1) It is currently estimated that approximately 2,000 people are receiving home enteral tube feeding (HETF) in Ireland.(2) However, there is limited evidence surrounding the use of bolus feeding in enterally fed patients.

The aim of this study is to investigate Irish dietitians’ attitudes and usage of bolus feeding in their adult patients.

Survey Monkey was used to create an eighteen-question survey which was distributed by the ‘Irish Nutrition and Dietetic Institute’ in their online newsletter and the ‘Irish Nutrition Jobs’ Facebook page. Descriptive statistics were performed using IBM SPSS® v27 to determine percentages. Dietitians that worked with adult patients and reccommended bolus feeding to patients were eligible to take part in the survey.

Out of 100 respondents, 74 dietitians fit the eligibility criteria for data analysis. Of the 74 participants recommending bolus feeding in adult patients, they primarily worked in hospitals (64%, n = 47) and in the community (35%, n = 26) with 20% (n = 15) specialising in oncology. Just over half (58%, n = 43) of dietitians agreed that the number of patients being bolus fed has increased over the last 5 years with 26% (n = 19) reporting that more than half of their enterally fed patient case load receive bolus tube feeding. The majority of dietitians (99%, n = 73), routinely use the syringing method when administering a bolus feed.

Dietitians commonly recommend bolus feeding in oncology patients (65%, n = 48), those with neurodisability (46%, n = 34) and in adults with gastrointestinal diseases (19%, n = 14). When choosing to administer a bolus feed, 53% (n =39) of dietitians aim for 400kcal per feed, with 200ml ONS being the most popular bolus feed format (62%, n = 46). Almost all dietitians (96%, n = 71), decide to use bolus feeding with their patients as it suits their lifestyles as well as 81% (n = 60) reporting that it is favoured for its convenience.

Many of the dietitians (61%, n = 45) are of the opinion that feeds designed in a format for bolus feeding would improve patient experience. To further improve their training, dietitians reported there is a need for additional practice guidelines (47%, n = 35) and practical workshops (46%, n = 34) on bolus feeding.

This study found that dietitians are recommending bolus feeding for patients more often in the last 5 years (2019-2024). Participants reported that bolus feeding suits patients’ lifestyles as it’s convenient and it suits their social circumstances. There is a need for a specific format for bolus feeding products as well as specific bolus feeds to improve patient experience. Dietitians agree that additional resources such as practical workshops and guidelines are needed to further support them with bolus feeding.

Blended tube feeding for patients requiring enteral nutrition involves the provision of pureed food administered via a gastronomy tube(1). It is relatively new in dietary practice, with several clinical and perceived benefits, which was partly driven by the large prevalence of enteral nutrition intolerance in paediatric patients(2). In response to patient and dietitian preferences, as well as challenges of blended diets, medical nutrition manufacturers have developed commercial tube feed products containing real food ingredients (RFI). There is very limited published literature on these types of tube feeds.

The aim of this study was to understand the attitudes and awareness of dietitians towards recommending tube feeds containing RFI. This was done through investigating the indications behind recommending this type of product, what conditions they are recommended for, and the main barriers and benefits of recommending tube feeds containing RFI to paediatric patients.

A twelve-item online survey was distributed via Irish Nutrition and Dietetic Institute (INDI) and Irish Nutrition Jobs Facebook group to collect data from registered dietitians over six-weeks. Frequencies and Cross-tabulations were performed to analyse categorical variables using IBM SPSS V29.

From the total sample of 23 paediatric dietitians, those who currently recommend tube feeds containing RFI (n = 14) reported that the two main disorders to use this product are, gastrointestinal disorders (n = 13, 93%) or neurological disorders (n = 12, 86%). A primary indication for recommending these products is to improve tolerance (n = 12, 86%), with the main feeding method being bolus pump (n = 13, 93%). Key benefits reported are improvements to GI symptoms (n = 13, 93%) and improved weight gain (n = 5, 36%). Of the total sample, prime barriers found to recommending this type of feed is the low energy dense profile (n = 7, 30%) and insufficient amount of natural ingredients (n = 3, 13%).

This study shows a positive response towards tube feeds containing RFI and gives an insight into the potential benefits that using these innovative tube feeds can have for patients and carers. More case studies using these products are required, for dietitians to fully understand the main benefits and drawbacks of recommending these feeds to their paediatric patients.

Farm advisors provide knowledge and support to farmers, to help them change their on-farm practices or behaviours, with a view to improving the farm’s overall sustainability and competitiveness(1,2). In this way, advisors can be viewed as agents of change(3). In order to fulfil their role as agents of change, advisors must possess sufficient knowledge of human psychology and behavioural science, which is the discipline involved with understanding, predicting and changing behaviour(4,5). Despite this, within advisory education and professional development, it is considered that greater emphasis is given to advisory technical knowledge acquisition, than how to work effectively with others to support learning and change(6). Accordingly, this study aims to implement a behaviour change communication training programme for farm advisors and evaluate its efficacy. As much work within the health and social care field has been undertaken to support health related behaviour change, this study aims to adapt a behaviour change communication training programme originally developed for use within this field to the advisory setting(7,8).

A mixed-methods case study under the pragmatic worldview was conducted. Ethical approval was obtained from the Faculty of Medicine, Health and Life Sciences Research Ethics Committee at Queen’s University Belfast. The programme was adapted from the ‘MAP of Health Behaviour Change Learning Programme’ (MAP) created by NHS Education for Scotland(9). Eight farm advisors completed the programme delivered by health psychologists, which involved the completion of a 40-minute online module and a one-day in-person workshop about the principles of person-centred communication and behaviour change techniques. The Brinkerhoff training evaluation model guided the evaluation(10). Quantitative questionnaire data, including perceived knowledge and confidence, was descriptively analysed. Qualitative data including surveys, logs and focus group/interview data was thematically analysed.

Descriptive analysis found advisors scored highly in perceived knowledge (mean: 5.5) and confidence (mean: 5.5) post-training (measured on 6-point Likert scale). Thematic analysis determined three themes: valuable activities, takeaways, and programme evolution. Advisors valued open discussions and role-playing activities. A key takeaway was how to structure conversations about change; firstly, identifying a person’s stage of change, then delivering behaviour change techniques tailored to that stage. Further training on how to support individuals to explore and build motivation towards change was deemed beneficial.

MAP was shown to be an effective training programme with applications in agriculture. This study offers insights for those involved in advisory education. Incorporating behaviour change communication courses into advisory programmes helps advisors develop knowledge surrounding the psychology behind behaviour change and additional competencies in supporting behaviour change at the farm level.

The current food system is not only unsustainable but also increasingly inequitable, resulting in food insecurity for many people in the United Kingdom and globally(1). The health impacts of the current food system on disadvantaged communities warrants examination to improve ecological public health nutrition strategies(2). Community gardens and kitchens are frequently established by volunteers in the hope that they will serve as alternatives to the current food environment, building healthy food capacity in the community as well as outdoor physical and social activities for urban residents(3). This remains to be explored in deprived communities in Dorset, UK.

This pilot research was conducted in fourteen adults living in disadvantaged areas in Dorset (Hamworthy-Poole). Inclusion criteria were individuals over 18 years old living in low-income households, who were users of community food garden and kitchen initiatives. The individuals usually attend with their family members in the food growing and cooking activities, including young children and older adults in the programmes. Three semi-structured interviews and three focus groups (total n = 14) were undertaken to uncover views on the importance and roles of these community food initiatives in relation to healthy eating and access to locally grown fresh produce. All discussions were digitally recorded, and data were transcribed verbatim. Qualitative data analysis, using Clarke and Braun’s(4)six steps of thematic analysis, was performed via NVivo software.

Four main themes emerged: Tackling food insecurity & sustainability, Utilization of climate friendly & organic Food, Bridging intergenerational gap and Promoting healthy lifestyle. These food initiatives help in addressing food insecurity from the perspective of the participants. The role of community gardens together with cooking sessions can be further recognised as contributors to community development, access to healthy food such as fresh fruits and vegetables and nurturing skills related to nutritious food preparation.

In conclusion, this research provided insights into the perceptions on how we can design a health promotion initiative that is inclusive and sustainable to tackle food insecurity effectively.

Engaging in sedentary activities and consuming energy-dense, nutrient-poor foods increases the risk of developing non-communicable diseases (1). Young adults are one of the largest users of video games in Australia (2). To engage young adults in lifelong healthy behaviours, we need to understand their attitudes and behaviours towards health and healthy eating by examining psychobehavioural characteristics. This cross-sectional study explored the similarities and differences in diet quality of online gamers and non-gamers using a validated psycho-behavioural survey (3).

Online participants (n = 53, 18-30 years) from Australia completed a validated self-administered survey (3) including demographics, self-reported weight and height, searching online, physical activity levels (4), strategic dieting behaviours (5,6), self-identification as gamers or non-gamers (7) and up to three online 24-hour dietary recalls over non-consecutive days using Intake24Australia https://intake24.com/. Diet quality was assessed using the adapted Healthy Eating Index for Australian Adults (HEIFA)-2013 (8). Informed consent was obtained.

Gamers (n = 18, 44%) were more likely to identify as male (14.3% for Non-gamers, p = 0.05) but similar

BMI (Median 23.4kg/m2 (Percentiles = 20.6,29.5) vs 20.76kg/m2 (19.1,24.2), p = 0.10) to NonGamers. Overall differences in Gamers and Non-gamers were not due to gender differences (P>0.05). Gamers were less likely to report significant weight change in the previous 12 months (77.8% vs 42.9% for Non-Gamers, p<0.05) and were more likely to consciously control their weight by dieting than non-gamers (p<0.01). There was no difference in sitting time (Gamers 540min/d (420,601) vs Non-gamers 420min/d (300,600), p = 0.13). Despite being satisfied with the healthiness of their diet (score 9/15, p = 0.99), both groups were somewhat likely to improve the healthiness of their diet (10/15, p = 0.66). Non-gamers had higher intentions to search online for healthy eating and food-related information (p<0.05), healthy recipes, and meal plans (p<0.01). Diet quality was low across both groups (Gamers 50/100 vs Non-gamers 56/100, p = 0.18). Non-gamers reported significantly higher water (398ml (0,981) vs 134ml (0,326) p = 0.031) and beverage (1264ml (761,1558) vs 690ml (505,977) p = 0.010) consumption than gamers.

The findings suggest that online gamers and non-gamers share similar concerns and priorities regarding health. Diet quality was similar, with both groups likely to benefit from targeted interventions to improve dietary intake. Low water consumption is a concern, with campaigns highlighting the benefit of water for cognitive performance more likely to resonate with young adults, particularly gamers. Using a psycho-behavioural survey and co-design methods will provide insights to inform more tailored public health communication strategies for diverse groups such as young adults.

University students often make less healthful dietary choices whilst at university however, do not typically receive advice and support to help them eat more healthily(1,2). A tool which could be provided to students to promote more favourable dietary behaviours is the eNutri web-based app which includes a food frequency questionnaire (FFQ) and delivers automated personalised nutrition advice (PNA) and a diet quality score (DQS) consisting of 11 food/nutrient components(3). The PNA includes scores and general advice for each component and, for the user’s three lowest scoring components, recommends which foods to eat more/less frequently to improve their DQS. As part of a 4-week intervention study, we aimed to explore the perceptions of the eNutri PNA in UK university students.

As part of this intervention, 14 students from the Universities of Reading and Hertfordshire completed the eNutri FFQ and received their PNA. At the end of the study, they rated how much they agreed with statements about the perceived value and benefit (if any) of the eNutri PNA tool, on a 6-point scale ranging from strongly disagree to strongly agree. The percentage of respondents reported is the total number who responded “somewhat agree”, “agree”, or “strongly agree” to each statement.

Of the 14 students, 79% were female with a mean age of 25y (range = 18-37y) and mean BMI of 24.7kg/m2 (range = 19.4-31.9kg/m2). At baseline, the average importance of a healthy diet to the participants (n = 13) was rated at 7.2 out of 10 (with 0 being ‘not important at all’ and 10 being ‘very important’). In total, 57% of respondents indicated that they felt they ‘were eating a healthier diet because of the eNutri advice received’ and only 14% reported that ‘the advice did not motivate them to make changes to their diet’. Furthermore, 64% of respondents indicated that the ‘eNutri PNA gave them confidence in their ability to make changes to their diet’ and that it ‘supported them to do so’. Half of the students agreed that ‘they would want to use eNutri long term to track their progress and receive regular PNA’. In addition, 79% agreed that ‘eNutri should be offered to all university students to help them make healthier food choices’, and that if eNutri was offered to them for free by their university, ‘it would be a valuable student benefit’ and they ‘would want to use it again’.

In general, university students indicated the eNutri PNA tool supported them to eat healthier and providing access to the wider student population would be beneficial to encourage healthy eating at university. These findings along with the quantitative data from the PNA intervention which is currently being analysed will support the development of larger, suitably-powered studies to confirm these findings.

The transition to higher education (HE) constitutes a prime opportunity for intervention to address the sub-optimal dietary behaviours (low intake of fruit and vegetables (F&V), infrequent breakfast consumption [BC]), clinically-relevant gains in body mass, and hazardous alcohol consumption (HAC) patterns that have been reported amongst international HE student cohorts(1,2). To inform such interventions, the current cross-sectional study aimed to explore gender differences in habitual F&V consumption, BC, body mass index (BMI), and HAC among first-year undergraduates at a multi-campus university in Ireland.

A 42-item web-based questionnaire was distributed by e-mail to first-year undergraduate students across the university’s six campuses in semester 1 of 2022/23 (Wave 1) and was repeated in semester 1 of 2023/24 (Wave 2), supplemented by in-class recruitment. Participants met the inclusion criteria if they were a full-time first-year student, and were aged ≥18 years. Participants were asked to quantify their daily servings of F&V (serving defined as 1 piece of fruit, or 3 dessertspoons of vegetables). Habitual BC (days) were reported (weekdays: 0-5, weekend days: 02) and BMI [kg/height(m)2] was calculated from self-reported height and body mass. The AUDIT-C scale (range 0-12) was used to identify HAC on the basis of previously-reported sex-specific threshold scores(3) (females ≥5 and males ≥6). Between-gender differences were examined using Chi-Squared Tests for Independence (categorical data) or Mann-Whitney U Tests (non-parametric continuous data). The level of significance was set at p<0.05.

Overall response rate (W1/W2 combined) was 19.0%, (n = 1910, 54.9% female, mean age 19.7 ± 4.0). Median number of F&V servings per day was 4.0 (IQR±3.0), with 35.7% reporting ≥5 servings. A significantly higher proportion of females reported consuming ≥5 daily servings of F&V, compared to males (38.6% vs. 32.2%, p = 0.007). In total, 36.4% reported consuming breakfast on all weekdays, whilst 54.4% reported consuming breakfast on both weekend days. Males reported significantly more frequent BC than females on all weekdays (43.7% vs. 35.2%) and weekend days (64.4% vs. 53.4%, p<0.01). In terms of BMI, 7.8% of students were classified with underweight (males: 6.6%, females: 8.8%), 61.0% with normal weight (males: 60.7%, females: 61.4%), 22.1% with overweight (males: 24.5%, females: 20.1%) and 9.1% with obesity (males: 8.3%, females 9.8%). The majority (89.9%) of students reported consuming alcohol, and 65.9% exceeded sex-specific HAC thresholds (males: 70.3% vs. females: 62.5%, p<0.01).

The current study has served to highlight sub-optimal dietary behaviours amongst a cohort of firstyear undergraduate students in Ireland. A concerning prevalence of overweight and obesity was also observed, and HAC was prevalent amongst 65.9%. Males appeared to exhibit less favourable behavioural patterns than females in terms of F&V intake and HAC. These findings will inform targeted ‘life-course’ interventions aimed at improving dietary and health related behaviours within the transformative setting of higher education.

Whole grain (WG) consumption has been associated with many health benefits(1–4). However, in the UK, there is a lack of WG intake data with the most recent analysis available spanning the years 2008-2011(5–7). In this study, our aim is to assess the consumption of whole grains among the UK population using data from the National Diet and Nutrition Survey (NDNS) rolling programme covering the years 2008 to 2019.

WG intake trends and sociodemographic patterns from the UK NDNS Rolling Programme, 2008/09 to 2018/19, of 15,655 individuals aged ≥1.5 years who completed a four-day food diary were analysed. WG consumption was assessed by examining the WG content of foods in grams based on product ingredient information. Survey-weighted mean consumption of whole grains overall and by socio-demographic group and health status variables. Survey-weighted Wald tests (for categorical variables such as ethnicity) and trend tests (for ordered variables such as age group) will be used to determine whether intakes of whole grains differ within category.

No statistically significant trend was observed in total WG intake when comparing the intakes from 2008-2012 to 2016-2019, with mean intakes of 29.2g/day (95% CI: 27.8, 30.5) and 28.2g/day(95% CI: 26.8, 29.6), respectively. In 2016-2019 older adults (65y+) had the highest consumption (33.6 g/day [95% CI: 30.5, 36.8]), followed by 19-64y, with an intake of 29.1 g/day (95% CI: 27.1, 31.2). High-fibre cereals, bread, and other cereals including pasta and rice were the primary sources of WG. Between 2008-2012 and 2016-2019, the mean daily intake of high-fibre cereals and bread significantly declined from 11.1g (10.3, 11.9) to 9.3g (8.5, 10.1) and 12.4g (11.6, 13.1) to 10.0g (9.2, 10.8) respectively. Conversely, consumption of other cereals increased from 4.0g (3.3, 4.7) to 6.9g (6.1, 7.6) per day. Individuals with higher incomes, levels of education and healthy weights showed higher mean WG consumption.

Our study showed no statistically significant change in mean whole grain consumption in the UK from 2008/09 and 2018/19. Although, there is absence of dietary WG recommendations in the UK, whole grain intakes are below the recommended levels proposed by many countries.

The importance of dietary fibre consumption for health is widely recognised. However, there is a clear ‘fibre gap’ between actual and recommended fibre consumption(1,2). In the UK, average fibre intake is 18g(1). Fibre intake increases in relation to income, with fibre consumption particularly low in low-income households(3). The absence of a UK reference intake value for dietary fibre means nutrition and health claims are a key route for food manufacturers to promote dietary fibre to consumers(4). The aim of this study was to examine the relationship between perception of valence and understanding of approved fibre related nutrition and health claims, and marketing messages, and the intention to purchase products displaying these claims or messages.

An online survey was used to examine perception of valence and understanding of fibre-related nutrition and health claims, and any effects these claims, and other marketing messages related to fibre have on intention to purchase products, amongst the general population and individuals on a lower income in the UK. Data was collected from 560 respondents, with 84 classified as lowincome, based on an annual household income of below £17,100(5). Chi-squared tests were performed to examine associations, with post-hoc tests applied as appropriate.

Perception of valence was found to be significantly associated with intent to purchase for all the health and nutrition claims that were tested (p<0.001), such that participants who perceived a claim or term to be positive, were more likely to report that they would purchase a product displaying the claim. Three of the eight nutrition claims that were tested demonstrated a significant association between understanding and perception of valence (p<0.01), with only two demonstrating a significant association between understanding and intent to purchase (p<0.05). All four of the health messages that were tested demonstrated a significant association between perception of valence and intent to purchase (p<0.001), three demonstrated a significant association between understanding/interpretation and perception of valence (p<0.01), and two demonstrated a significant association between understanding/interpretation and intent to purchase (p<0.05). Thus, for many of the health claims and some health messages that were tested, there was no evidence to suggest that participants who understood the meaning of the claims would be more likely to perceive them positively or be more inclined to purchase a product displaying the claim or message.

Regardless of consumer understanding, claims must be perceived positively to significantly impact intent to purchase, so effort must be made to promote positive attitudes towards dietary fibre, and its associated health benefits. The wording of some claims may not be conducive to positive perceptions of dietary fibre.

Low- and middle-income countries (LMICs) experience a shifting nutrition landscape marked by rising overweight and obesity alongside persistent undernutrition. This new nutrition reality results in a double burden of malnutrition (DBM) (1). DBM is classified as the coexistence of overweight and obesity alongside undernutrition and micronutrient deficiencies, at all levels of the population. To address DBM, a set of recommended nutrition actions called double duty action (DDA) was publish by the World Health Organization (2) and Hawkes et al., (3). DDAs aims to lift the siloed view of malnutrition. For example, health services such as breastfeeding counselling is a DDA as breastfeeding prevents undernutrition and reduces the risk of overweight and obesity later in life. However, LMICs health programmes often prioritize undernutrition, hindering comprehensive DBM management (1). This scoping review aim to map existing LMICs’ health systems policy on the narrative of DBM and the implementation of DDAs to identify gaps and opportunities to tackle the DBM.

Arksey and O’Malley’s framework (4), with recommendations from Levac, Colquhoun, and O’Brien (5) was used. Countries were selected based on the 2022 World Bank criteria for LMICs (n=102).

Policy documents were extracted from WHO’s Global database on Nutrition Action Implementation (6) between June 16th and September 2nd, 2023. Exclusion criteria included policies predating 2011, lacking English translations, and countries facing significant domestic challenges.

To identify relevant text key search terms were based WHO DBM narrative (7) and DDAs characteristics were based on Hawkes et al., framework (3). When identified a full-text review of the relevant sections captured the narrative and extracted into an excel-sheet using a rubric format divided by country, policy title, and themes based on DBM narrative and DDAs characteristics.

This study included 51 countries (21 Southeast Asia, 19 Sub-Saharan Africa, 7 South Asia, and 4 Latin America and the Caribbean). Ninety-eight policy documents were identified and analysed. The majority focused on non-communicable disease prevention, national nutrition strategies, and health sector plans. Thirteen countries explicitly acknowledged DBM. Miscommunication or mistranslation were found as barriers to DBM narrative in six countries. Majority of the countries (54.9%) had a mismatch on the use of malnutrition definitions mainly focusing on undernutrition issues. If obesity was mentioned, the narrative was separated. Tanzania had incorporated the DDA framework into its policies. Regarding relevant DDA health system characteristics, 42 countries acknowledged breastfeeding, 29 nutrition in antenatal care, 28 complementary feeding, 21 growth monitoring, and 15 supplementation programmes.

Differential global efforts are needed to enhance advocacy, clarify definitions, and improve understanding of DBM and DDA narrative for health workers. Clearer terminology, DDA acknowledgment and consistent communication are crucial. Further research on health workers’ knowledge, attitudes and practice is essential to build capacity for effective DDA implementation.

All four United Kingdom (UK) nations have School Food Standards (SFS) which schools and local authorities must adhere to. Since the Welsh SFS were updated in 2013(1), the UK government has updated its healthy eating guidelines according to advice from the Scientific Advisory Committee on Nutrition (SACN)(2). The Welsh government is committed to revising their SFS to reflect the most up-to-date scientific evidence for nutrients and food. This study aimed to quantitatively and qualitatively content analyse (CA) school food provision (i.e., menus and/or price lists) pan-Wales to determine the extent to which it meets the latest healthy eating government recommendations for school-aged children. Secondly, menu design was thematically analysed (TA) to ascertain the language used and design elements(3).

Menus and/or price lists were collected cross-sectionally for the autumn 2023 term and 79% of the total population was sampled (n = 82/104). Welsh language documentation was translated into English via an online translation website prior to CA. The study protocol received approval from the Cardiff Metropolitan University School of Sport and Health Sciences ethics committee. The researchers developed an assessment tool inclusive of healthiness criteria based on SACN guidelines as well as the Welsh SFS and used this tool to CA and TA all 82 menus.

Local authority organised primary school food provision was most likely to meet the predetermined healthiness criteria. Most secondary schools lacked fruit-based desserts (64%), red meat (95%) and milk (55%). Moreover, occasionally secondaries exceeded the allotted frequency for processed meat (11%), potatoes cooked in oil (22%) and high in fat, salt and sugar mid-morning snacks (18%). Instances were found where the healthiness criteria, identical to the current Welsh SFS, were not fulfilled. Regarding the TA of menu and/or price lists, four key themes were identified: (i) language, (ii) signalling, (iii) imagery and (iv) design. 12% menus featured the Welsh language. Descriptive language was apparent for cooking methods (‘freshly filled,’ ‘oven-baked’) or to popularise dishes (‘veggie-dawgs,’ ‘meatball wrapstar’). An array of keys and icons were employed to signal non-meat items or nutritionally balanced dishes. Logos, photos and illustrations were evident across most menus, yet the imagery could be seemingly unrelated to the school food provision. In particular, primary school menus were bright and colour was utilised to emphasise different weeks of the menu cycle. Issues around clarity were observed on secondary school price lists which could be overly long and include complex pricing structures.

This study has established the current school food and drink provision pan-Wales and provides policymakers with a baseline from which the SFS may be updated and include a formal monitoring process. Improvement in the amount and clarity of information on menus could also be considered at this stage.

Overweight and obesity rates have reached epidemic proportions and are still escalating. In the domain of childhood obesity prevention and management the school plays a vital role, due to its pedagogical position and exposure(1). The aim of this study was to conduct a systematic review examining the effectiveness, barriers and facilitators in school-based prevention and management interventions on childhood overweight and obesity.

The search criteria were, overweight and obese, 2-19 years old, school-based RCTs, no intervention, and change in overweight and obesity parameters (e.g., prevalence, BMI, waist circumference). Additional eligibility criteria were peer-reviewed articles published in the last 10 years, conducted in Europe, Canada, USA, or Oceania. The selection and data collection process were carried out by two reviewers and disagreements settled by a third. The clinical and statistical heterogeneity of studies lead to an analysis based on themes of recurring methods. The heterogeneity also resulted in that only the direction of the result could be analysed, with results reported as having a positive, negative, or inconclusive effect on the population based on the statistical tests performed. If a secondary obesity parameter showed a different effect direction it was noted as a contradicting result.

Of 8725 unique articles identified, 76 fulfilled the selection criteria. Two dimensions (nutrition and physical activity) with three intended mediators (knowledge, behaviour training, and environment) of interventions were identified.

Thirty-eight studies were conducted in Europe, 32 in North America, and 6 in Oceania. The median age of participants was 10.8 years. The median sex distribution of participants was 50.5%. Seventytwo percent of studies were cluster randomised at school level, and the rest on class or region. Only 22% of studies were blinded and the mean retention rate was 83.1%.

In nutrition, the most common interventions included a teaching component (n = 29), or both a teaching and behaviour component (n = 24). In physical activity, the most common intervention included a behavioural component (n = 33), followed by knowledge only (n = 22) and knowledge and behaviour (n = 18). From the summative analyses performed on the main outcome variable of each intervention, 61% of all intervention arms had a positive effect, ranging from 54% to 70%. Five percent had a negative effect, ranging from 0% to 10%. Of the interventions that had a positive effect 50% displayed contradicting results from other obesity markers, ranging from 6% to 44%. Of single components, environment was most effective for nutrition and least effective for physical activity. Too few studies had negative findings to warrant an analysis. Contradicting results were most frequent for the environmental component of the nutrition dimension.

Interventions targeting physical activity and nutrition can be effective in preventing and managing overweight and obesity. Depending on the intended mediator and number of mediators results may vary.

Children are at increased risk of dehydration(1–3), which can adversely impact cognition and mood(4–6). Many children begin their school day dehydrated and fail to replenish fluids adequately throughout the day(7–11), however, these findings have not been confirmed using objective measures of hydration(12,13). This study aimed to confirm hydration status of primary school-aged children across the school day using objective hydration assessments and to examine if changes in hydration are associated with cognition and mood.

Thirty children (mean age 9.4±0.5 years old, stature 1.4±0.5m, body mass 36.5±4.2kg, and body mass index 18.9±1.7 kg/m2) were recruited from a local primary school. Food and fluid intake were tracked via nutritional analysis of photographs. Urine osmolality (Uosm), serum osmolality (Sosm), urine specific gravity (USG) and self-reported urine colour (Ucol) were assessed at first void (Uosm only) or the start (9:00) and end (16:00) of the school day. Children’s self-reported mood were obtained via Visual Analogue Scales(100mm) (9:00, 10:30, 13:30, 16:00). Children completed cognitive assessments using the Computerised Mental Performance Assessment System (15:3016:00).

Mean total water intake was 759.9±240.7 mL. Children consumed more fluid at mealtimes than from water bottle (Mean Difference (MD) 154.3mL, t(29) =-5.763, p<0.001). From the start to the end of the day, significant increases in Sosm (MD 3.3mOsm/kg, t(21)=4.011, p = 0.002), USG (MD 0.0066, t(29)= 8.514, p = 0.005) and Ucol (MD 1.2, t(26) =15.558, p = <0.001), indicated reduced hydration. The prevalence of dehydration (Sosm >290mOsm/kg USG >1.030) increased from the start (17%) to the end of school (40%). A series of ANOVAs from the start to the end of the day showed feelings of boredom, hunger, tiredness, and thirst increased, and focus, and happiness decreased (p’s <0.05). Hydration measures were significantly associated with long term memory (LTM) (changes in Sosm, r =0.437, p = 0.042) and working memory (WM) (changes in Sosm r =0.462, p = 0.031, and USG, r= 0.403, p = 0.033).

Children were less hydrated at the end of the school day suggesting inadequate fluid replacement during the school hours. Changes in hydration status across the school day were associated with subjective mood states. Furthermore, a decrease in hydration resulted in decreased performance in the memory tasks which could potentially hold implications on school performance. Children in this study had access to water throughout the day, however, most fluids were consumed at breakfast and lunch, suggesting interventions promoting sustained drinking throughout the day are required. For example, measures could be taken to educate parents and school staff on the importance of adequate hydration, and the need to remind children to drink throughout the day. For this to be effective, action needs to be taken across lesson time, meals, and break times.

In the UK, ‘The requirements for School Food Regulations, 2014’ specify the ‘type’ and ‘frequency’ of food and drinks that can be provided across the school day.(1) For example, there should be one or more portions of fruit per day. However, there is no monitoring and pupils can choose from a daily selection. Most studies have focused on pupil’s lunch intake(2,3) and there are limited large-scale UK studies. Whilst interventions are needed in schools to improve pupil’s dietary intake, identifying solutions is challenging. This study uses pupil-level purchase data to capture food and drink choices across the school day to identify potential opportunities for intervention development. One aim was to explore the food and drink purchases of UK secondary school pupils across the school day.

Ethics was obtained from Newcastle University (ref: 2482/26614). DPIA agreements were obtained from schools.

Secondary schools in Northeast England participated. Non-identifiable pupil-level purchase data from a four-week menu cycle were used that included: time, date, individual food and drink item, quantity, cost, and FSM status. Data were encrypted and transferred securely. Data were cleaned and manipulated in excel and Stata V18. Food and drink items were coded to 60 preliminary food and drink groups. Excel and Stata V18 were used for analyses; current analyses are descriptive.

Pupil-level purchase data (n = 3466) from five secondary schools were included. FSM pupils accounted for 29% (n = 1015), Year 7 pupils 25% (n = 848) decreasing to Year 11 pupils 17% (n = 580) of the total sample. The two meal types most pupils purchased were ‘Break & Lunch’ combined (58%, n = 2017; FSM 26% n = 524) and ‘Lunch only’ (20%, n = 659; FSM 41%, n = 268).

At break, the top five purchased items were: bacon/sausage bun (n = 7871; 21%) pizza snack (n = 5714; 15%), bagel/crumpet (n = 3697; 10%), fizzy fruit juice (n = 3344; 9%) and water (n = 3459; 9%). At lunch, the top five purchased items were: meal deal (n = 12,527; 16%), fizzy fruit juice (n = 7,895; 10%), hot meal (n = 6,963; 9%), biscuit (n = 5,803; 8%), and water (n = 5001; 6%). Food and drink purchases at break and lunch were similar by FSM status.

Preliminary findings show most pupils purchase at least one food and/or drink item at both break and lunch. Similar pupil purchasing was found regardless of FSM status. Future interventions need to consider the food and drink choices available at break and lunch. One school had a water only policy, therefore, school context and variation in the food and drink offer may impact findings. More detailed analyses will consider the effect of school, school year, meal type (breakfast, break, lunch) and Free School Meal Status (FSM) on pupil’s food and drink purchases using multi-level logistic regressions.

The diets of children in the UK are suboptimal(1), which may influence their immediate and future health and well-being(2). Schools offer convenient and prolonged access to children from diverse backgrounds, thus interventions within this setting have been suggested as a means to promote diet and health outcomes among this population(3). This study explored the effects of Project Daire(4), a school-based food intervention, on children’s diet diversity and diet quality as well as their attitudes towards health behaviours.

A factorial design cluster randomized controlled trial was conducted. Fifteen primary schools in Northern Ireland were randomized into one of four 6-month intervention arms: Nourish, Engage, Nourish and Engage or Control (Delayed). The Nourish intervention modified the school food environment, provided food-related experiences and increased access to local foods. The Engage intervention included educational activities on nutrition, food and agriculture. Data on food consumption at home, school and/or in total over a 24-hour period were collected using ageappropriate food frequency questionnaires at baseline, with follow-up at 6-months. Diet diversity score (DDS) and diet quality score (DQS) were developed based on adherence to the Eatwell Guide. Additionally, a Health Attitudes and Behaviour measure assessed 10-11 year old children’s attitudes towards importance of various health behaviours at both time points. Linear and logistic regression models were used to examine intervention effects and to account for school clustering.

A total of 445 children aged 6-7 and 458 aged 10-11 years old completed the trial. Results indicated that children aged 10-11 year old who received the Nourish intervention demonstrated higher school DDS (adjusted mean difference=2.79, 95% CI 1.40 – 4.19; p = 0.001) and total DDS (adjusted mean difference=1.55, 95% CI 0.66 – 2.43, p = 0.002) compared to their counterparts who did not. Subgroup analyses revealed that the increases in school DDS among 10-11 year old children in the Nourish group were apparent in both boys and girls (Boys: adjusted mean difference=2.4 95% CI 0.1 – 4.7, p = 0.04; Girls: adjusted mean difference=3.1 95% CI 1.6 – 4.6, p = 0.001). However, the increase in total DDS remained statistically significant only among girls, with an adjusted mean difference of 1.9 (95% CI 1.1-2.7, p<0.001). No statistically significant changes in DQS were detected in either age group. High levels of positive attitudes towards health behaviours were observed at baseline, with no clinically significant effects of either the Nourish or Engage interventions detected during the follow-up period.

The multi-component approach of the Nourish intervention, addressing both food provision and environment, showed promise in promoting diet diversity. Further research is warranted to develop sustainable implementation strategies for Daire, to explore additional intervention components to impact other outcomes, including diet quality, and to evaluate long-term effectiveness.

In Saudi Arabia, adolescent health is suboptimal; among those aged 15-29 years, 79% have insufficient levels of physical activity levels, 30% are living with overweight or obesity, and 10% of them have pre-diabetes(1).

The Saudi Guidelines for the Prevention and Management of Obesity recommend implementing school-based interventions to prevent obesity among adolescents(2). Understanding the school setting through a school-based environmental audit can provide insight into the barriers and enablers of obesity prevention strategies in schools (3), which can inform the design of schoolbased interventions. One such tool, the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) tool, assesses the school environment in relation to healthy eating (HE) and physical activity (PA). The reliability and feasibility of this tool has been tested across 256 schools in 12 different countries. Therefore, the ISCOLE tool can be used to conduct reliable environmental audits across international school settings(3). The ISCOLE tool(3) was used along with the Saudi Ministry of Education (MOE) canteen policy checklist to examine the school environment in relation to HE and PA.

The Saudi MOE canteen policy is a checklist of banned and recommended food and drink items sold to students. Three female high schools were selected from differing economic deprivation levels (high, medium, and low deprivation) in Riyadh, Saudi Arabia. The ISCOLE tool covers the domains of HE and PA provisions, school facilities and policies, and was completed by the researcher in conjunction with a senior school staff member. The researcher accessed the school canteens and examined the items present. Checklists were completed and pictures taken for documentation. Ethical approval was granted from the Saudi MOE, Princess Noura University’s Institutional Review Board, and affirmed by Queen’s University Belfast.

There were notable differences between the three high schools sampled. Middle and low deprivation schools had PA and HE policies under development, a specific time allocated for PA, HE promotion and a school shop; the high deprivation school did not have any of these. The results of the MOE canteen checklist illustrated that many ‘banned’ food items were available in the middle and low deprivation schools, including nectar juices, pre-packaged croissants, chocolates, and popcorn. Regarding ‘recommended’ food items, both schools offered sandwiches and bottled water. None of the schools offered healthy food at subsidized prices and only the low deprivation school had access to a small outdoor soccer area.

In Saudi Arabia, female high schools face significant challenges regarding a school environment that supports both HE and PA. These challenges include the absence of HE provision and lack of suitable PA facilities. Understanding the school context will help support the development of a future school-based obesity prevention intervention.

With the rising rates of non-communicable diseases in Nigeria, there is need to understand the links between diet and health using an accurate and efficient dietary assessment method. The new online dietary assessment tool comprising a database of local Nigerian and West African diets, myfood24 West Africa (1), was piloted in a healthy adult population in Nigeria.

Participants were staff of Michael Okpara University of Agriculture Umudike, Abia State in southeast Nigeria, at least 18 years, not pregnant, not had childbirth in the last 3 months, and not diagnosed with diabetes. A pre-recorded video demonstration of food recording with myfood24 was sent to participants. One-day 24-hour recall was self-recorded by either participants or by the researcher on behalf of the participants. Participants who used myfood24 on their own completed the usability questionnaire to rate their agreement with system usability statements and provided feedback on the system.

179 adults were recruited for the study and a total of 1345 food/drink entries were made with a median number of 7 (IQR: 5, 9) food/drink entry per day per participant. Foods from our new West African food database contributed to 60-82% of the energy and nutrient intake. Mean energy intake was 1844 (SD 781) kcal; with energy coming from 28% fat, 63% CHO, and 9% protein. 53 (30%) participants used myfood24 on their own, with a mean age of 38.5±8.7 years. There was no significant difference in the energy intake (p = 0.67) and body mass index (p = 0.82) of participants who used myfood24 on their own and those who did not. 39 out of 53 participants completed the user questionnaire. The mean system usability score was 74 (95% CI 65, 83), indicating a good usability. Participants found the tool easy to use and estimate portion sizes of local foods; it was educative showing levels of macronutrient consumed; and more efficient than manual recording of foods but some participants commented that a few local foods were missing.

myfood24 will support research investigation of relationships between diets and health in Nigeria. There is also now an offline function removing reliance on WiFi. Feedback from participants will inform future updates of the database.

There is no regular, routine measurement of food and nutrient intake undertaken regionally in the UK. This makes evaluation of local public health interventions challenging. Consumers want to be more sustainable in what they are eating. Social media penetration in the UK is 90%(1), with ∼47m people using Facebook, a potential route to study recruitment. Nutritional analysis software with accurate underpinning food composition and sustainability data could enable quick and easy large scale data collection. This study aimed to collect diet and sustainability measures using online tools and to test the feasibility of using social media to obtain a large, regionally focused sample in a short time.

We undertook a rapid, time limited, regional (Yorkshire and Humber) food and nutrient tracking survey ‘One day: Diet in Yorkshire and Humber’ for use with policy makers(2). A Facebook (FB) boost approach was used to recruit a regional sample of adults. Participants completed a brief online demographic survey and used myfood24® to give a detailed measure of their food intake for the previous day. myfood24® generic and branded databases were used(3) which include sustainability metrics.

The FB posts were boosted for 21 days and reached 76.9k individuals. Just under £1,000 was spent on 3 FB boosts and 1,428 participants completed the questionnaire. 673 participants also completed the one-day diet diary. Hull, Barnsley and Doncaster had the highest rates of overweight and obesity in the region. Overall nutrient values recorded were similar to national survey data for older women. Intakes of fibre (mean 18g, SD 11) and iron (mean 9.6mg, SD 5.0) were low. For the first time, measures of sustainability from the diet were calculated from myfood24®.

The mean greenhouse gas emissions (GHGE) were 5.9(kg CO2 eq/day) (95% CI 5.6, 6.1); land use 9.0 (m2year/day) (95% CI 7.6, 10.3) and water use 582 (l/day) (95% CI 551, 611). Regression analysis showed that for each additional 100kcal consumed there was a significant increase in GHGE of 0.9 (kg CO2 eq/day) (95% CI 0.8, 1.1). Land and water use were also significantly increased with increasing energy intake. Adjusting for total energy, protein intake was positively associated with all 3 metrics. Carbohydrate was inversely associated with GHGE and land use. However, fat intake was not associated with any of the sustainability measures. Portions of fruit and vegetables consumed were positively associated with water use only.

Diet is clearly linked to sustainability. The mean GHGE from diet is equivalent to driving an average car ∼22km/day. We successfully recruited a large sample in a short timeframe using FB. Participants were able to use online tools to report food intakes. This data is relevant to local and national policy makers to monitor and evaluate public health programmes.