Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.

In this study, the heavy metal (Al, Mn, Co, Cu, Zn, As, Se, Cd, Sn, Pb and Hg) concentrations were determined in a total of seventy-two infant formula samples manufactured by sixteen different brands in Türkiye. During the analyses, inductively coupled plasma MS was used in evaluating the nutritional profile and the toxicological risk associated with the consumption of these products. Given the analysis results, the highest Pb content was found in milk-based ‘beginner’ formulas (0–6 months, three samples) packed in metal containers. The highest concentration of Mn was found in powdered infant formula (Brand 3) that is suitable for 9–12-month-olds. Mn level was found to be above the limit values in nine samples (12·5 %). Cd level exceeded the limit values in two infant formula samples of Brand 3 (0·038 µg/g) and Brand 15 (0·023 µg/g). Therefore, the mean Cd concentration found here reaches the maximum limit set by the European Union commission legislation. Cu was detected in all infant formulas. The highest concentration was determined in Brand 1 (9–12 months, seven samples) and found to be 2·637 (sd 1·928) µg/g. This value is much higher than the reference values set in the national and international standards. Based on the results achieved here, the estimated daily intake (EDI) and target hazard quotient values for all the metals in infant formulas were found lower than < 1. These findings suggest that the baby foods examined would not pose any health risk. The daily intakes exceeding the baby nutrition values recommended by the WHO would pose health risk since they would exceed the EDI levels.

The regulation of health claims for foods by the Nutrition and Health Claims Regulation is intended, primarily, to protect consumers from unscrupulous claims by ensuring claims are accurate and substantiated with high quality scientific evidence. In this position paper, the Academy of Nutrition Sciences uniquely recognises the strengths of the transparent, rigorous scientific assessment by independent scientists of the evidence underpinning claims in Europe, an approach now independently adopted in UK. Further strengths are the separation of risk assessment from risk management, and the extensive guidance for those submitting claims. Nevertheless, four main challenges in assessing the scientific evidence and context remain: (i) defining a healthy population, (ii) undertaking efficacy trials for foods, (iii) developing clearly defined biomarkers for some trial outcomes and (iv) ensuring the composition of a food bearing a health claim is consistent with generally accepted nutrition principles. Although the Regulation aims to protect the consumer from harm, we identify some challenges from consumer research: (i) making the wording of some health claims more easily understood and (ii) understanding the implications of the misperceptions around products bearing nutrition or health claims. Recommendations are made to overcome these challenges. Further, the Academy recommends that a dialogue is developed with the relevant national bodies about Article 12(c) in the Regulation. This should further clarify the GB Guidance to avoid the current non-level playing field between health professionals and untrained ‘influencers’ who are not covered by this Article about the communication of authorised claims within commercial communications.

The childhood years represent a period of increased nutrient requirements during which a balanced diet is important to ensure optimal growth and development. The aim of this study was to examine food and nutrient intakes and compliance with recommendations in school-aged children in Ireland and to examine changes over time. Analyses were based on two National Children’s Food Surveys; NCFS (2003–2004) (n 594) and NCFS II (2017–2018) (n 600) which estimated food and nutrient intakes in nationally representative samples of children (5–12 years) using weighed food records (NCFS: 7-d; NCFS II: 4-d). This study found that nutrient intakes among school-aged children in Ireland are generally in compliance with recommendations; however, this population group have higher intakes of saturated fat, free sugars and salt, and lower intakes of dietary fibre than recommended. Furthermore, significant proportions have inadequate intakes of vitamin D, Ca, Fe and folate. Some of the key dietary changes that have occurred since the NCFS (2003–2004) include decreased intakes of sugar-sweetened beverages, fruit juice, milk and potatoes, and increased intakes of wholemeal/brown bread, high-fibre ready-to-eat breakfast cereals, porridge, pasta and whole fruit. Future strategies to address the nutrient gaps identified among this population group could include the continued promotion of healthy food choices (including education around ‘healthy’ lifestyles and food marketing restrictions), improvements of the food supply through reformulation (fat, sugar, salt, dietary fibre), food fortification for micronutrients of concern (voluntary or mandatory) and/or nutritional supplement recommendations (for nutrients unlikely to be sufficient from food intake alone).

Zn deficiency arising from inadequate dietary intake of bioavailable Zn is common in children in developing countries. Because house crickets are a rich source of Zn, their consumption could be an effective public health measure to combat Zn deficiency. This study used Optifood, a tool based on linear programming analysis, to develop food-based dietary recommendations (FBR) and predict whether dietary house crickets can improve both Zn and overall nutrient adequacy of children’s diets. Two quantitative, multi-pass 24-h recalls from forty-seven children aged 2 and 3 years residing in rural Kenya were collected and used to derive model parameters, including a list of commonly consumed foods, median serving sizes and frequency of consumption. Two scenarios were modelled: (i) FBR based on local available foods and (ii) FBR based on local available foods with house crickets. Results revealed that Zn would cease to be a problem nutrient when including house crickets to children’s diets (population reference intake coverage for Zn increased from 89 % to 121 % in the best-case scenario). FBR based on both scenarios could ensure nutrient adequacy for all nutrients except for fat, but energy percentage (E%) for fat was higher when house crickets were included in the diet (23 E% v. 19 E%). This manoeuvre, combined with realistic changes in dietary practices, could therefore improve dietary Zn content and ensure adequacy for twelve nutrients for Kenyan children. Further research is needed to render these theoretical recommendations, practical.

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

Portugal has high fish/seafood consumption, which may have both risks and benefits. This study aims to quantify the net health impact of hypothetical scenarios of fish/seafood consumption in the Portuguese population using a risk–benefit assessment methodology. Consumption data from the National Food, Nutrition and Physical Activity Survey 2015–2016 (n 5811) were used to estimate the mean exposure to methylmercury and EPA + DHA in the current and the alternative scenarios considered. Alternative scenarios (alt) were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (alt1: excluding predatory fishes; alt2: including only methylmercury low-level fishes) or in the frequency of weekly fish/seafood consumption (alt3 to alt6: 1, 3, 5 or 7 times a week, replacing fish/seafood meals with meat or others). The overall health impact of these scenarios was quantified using disability-adjusted life years (DALY). In the Portuguese population, about 11 450 DALY could be prevented each year if the fish/seafood consumption increased to a daily basis. However, such a scenario would result in 1398 extra DALY considering the consumption by pregnant women and the respective risk on fetal neurodevelopment. Our findings support a recommendation to increase fish/seafood consumption up to 7 times/week. However, for pregnant women and children, special considerations must be proposed to avoid potential risks on fetal neurodevelopment due to methylmercury exposure.

Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5–35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children’s water consumption.

Dietary reference values (DRV) are estimates of the daily amounts of nutrients or food energy that meet the needs of healthy people. In the UK, three terms are used to express these estimates, assuming a normal distribution of requirements in a population. These are the estimated average requirement, the lower reference nutrient intake and the reference nutrient intake. DRV are for use in a variety of settings, including the assessment of adequacy and safety of nutrient or energy intake in a population group, in the design of meal provision in care settings, in food labelling and in considering food fortification strategies. DRV, and other expressions of nutrient requirements, assume a relationship between the intake of a nutrient and some criterion of adequacy, the outcome. Estimates of requirements are based on a diverse range of measures of adequacy, according to available evidence. The Scientific Advisory Committee on Nutrition (SACN) is the body responsible for reviewing and setting DRV for the UK population. The work of SACN is guided by a framework of evidence that relates food and nutrients to health. There have been calls for the harmonisation of approaches used in the setting of nutrient requirements, globally, and an increased transparency in the decision-making process. Some progress has been made in this regard, but there is a great deal of work to be done.

Table olives, a product of olive tree (Olea europaea L.), is an important fermented product of the Mediterranean Diet. Agronomical factors, particularly the cultivar, the ripening stage and the processing method employed are the main factors influencing the nutritional and non-nutritional composition of table olives and their organoleptic properties. The important nutritional value of this product is due to its richness in monounsaturated fat (MUFA), mainly oleic acid, fibre and vitamin E together with the presence of several phytochemicals. Among these, hydroxytyrosol (HT) is the major phenolic compound present in all types of table olives. There is a scarcity of in vitro, in vivo and human studies of table olives. This review focused comprehensively on the nutrients and bioactive compound content as well as the health benefits assigned to table olives. The possible health benefits associated with their consumption are thought to be primarily related to effects of MUFA on cardiovascular health, the antioxidant (AO) capacity of vitamin E and its role in protecting the body from oxidative damage and the anti-inflammatory and AO activities of HT. The influence of multiple factors on composition of the end product and the potential innovation in the production of table olives through the reduction of its final salt content was also discussed.

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

The present review aims to give dietary recommendations to reduce the occurrence of the Maillard reaction in foods and in vivo to reduce the body’s advanced glycation/lipoxidation end products (AGE/ALE) pool. A healthy diet, food reformulation and good culinary practices may be feasible for achieving the goal. A varied diet rich in fresh vegetables and fruits, non-added sugar beverages containing inhibitors of the Maillard reaction, and foods prepared by steaming and poaching as culinary techniques is recommended. Intake of supplements and novel foods with low sugars, low fats, enriched in bioactive compounds from food and waste able to modulate carbohydrate metabolism and reduce body’s AGE/ALE pool is also recommended. In conclusion, the recommendations made for healthy eating by the Spanish Society of Community Nutrition (SENC) and Harvard University seem to be adequate to reduce dietary AGE/ALE, the body’s AGE/ALE pool and to achieve sustainable nutrition and health.

Currently, the prevention and treatment of CVD have been a global focus since CVD is the number one cause of mortality and morbidity. In the pathogenesis of CVD, it was generally thought that impaired cholesterol homeostasis might be a risk factor. Cholesterol homeostasis is affected by exogenous factors (i.e. diet) and endogenous factors (i.e. certain receptors, enzymes and transcription factors). In this context, the number of studies investigating the potential mechanisms of dietary fatty acids on cholesterol homeostasis have increased in recent years. As well, the cluster of differentiation 36 (CD36) receptor is a multifunctional membrane receptor involved in fatty acid uptake, lipid metabolism, atherothrombosis and inflammation. CD36 is proposed to be a crucial molecule for cholesterol homeostasis in various mechanisms including absorption/reabsorption, synthesis, and transport of cholesterol and bile acids. Moreover, it has been reported that the amount of fatty acids and fatty acid pattern of the diet influence the CD36 level and CD36-mediated cholesterol metabolism principally in the liver, intestine and macrophages. In these processes, CD36-mediated cholesterol and lipoprotein homeostasis might be impaired by dietary SFA and trans-fatty acids, whereas ameliorated by MUFA in the diet. The effects of PUFA on CD36-mediated cholesterol homeostasis are controversial depending on the amount of n-3 PUFA and n-6 PUFA, and the n-3:n-6 PUFA ratio. Thus, since the CD36 receptor is suggested to be a novel nutrient-sensitive biomarker, the role of CD36 and dietary fatty acids in cholesterol metabolism might be considered in medical nutrition therapy in the near future. Therefore, the novel nutritional target of CD36 and interventions that focus on dietary fatty acids and potential mechanisms underlying cholesterol homeostasis are discussed in this review.

A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.

Type 2 diabetes mellitus (T2DM) is one of the major diseases of our times. Besides being a considerable inconvenience for the patient, the associated healthcare expenses are tremendous. One of the cornerstones of T2DM prevention is a healthy diet, including a variety of fruits and vegetables. Apples are touted to have health benefits, and the apple polyphenol, phloridzin, has gained interest in recent years as it can reduce intestinal sugar uptake by inhibition of the Na/glucose cotransporter 1. By researching the amount of phloridzin in different food sources and linking them to their consumption data, we could estimate the average and high-level phloridzin consumption in Europe. On average, European people consume 0·7–7·5 mg/d phloridzin, the main contributors being apples and apple juice. High-level consumers may get up to 52 mg/d of phloridzin. Older people are more at risk of developing T2DM, yet they consume less phloridzin than adolescents and adults, as determined by our survey. Management of blood glucose levels might be improved by the consumption of phloridzin, as has been shown in recent clinical trials; these trials used phloridzin-enriched apple extract at doses exceeding those from normal food consumption. There are, however, indications that consumption of average to high levels of phloridzin via food might also contribute to reduced sugar load and a reduction in T2DM risk.

The term ‘sweeteners’ encompasses both nutritive and non-nutritive sweeteners, which when added to food/beverages, can enhance the flavour and other functional properties of food/beverage products. This review considers how dietary biomarker approaches may enhance current understanding of nutritive sweetener (namely free sugars) and non-nutritive or low-energy sweetener (LES) intakes and how these may impact health. Recent public health strategies to reduce free sugar consumption will help contribute to challenging sugar intake targets. Robust evaluation is needed to determine the effectiveness of these approaches to reducing free sugar consumption. LES provides a sweet taste without the addition of appreciable energy and can help maintain the palatability of reformulated products. All LES undergo rigorous safety evaluations prior to approval for use. Whilst intervention data suggest LES can be beneficial for health (relating to weight status and glycaemic control), debate persists on their use and findings from population-based research are mixed, in part because of potential contributing factors such as reverse causality. Additionally, assessments often consider only certain sources of LES (e.g. LES-beverages) and/or LES as a homogeneous group despite differing biological fates, thus not adequately capturing intakes of individual LES or allowing for reliable estimation of overall intakes. Urinary biomarker approaches developed/investigated for sweetener consumption have the potential to overcome existing limitations of dietary data by providing more objective intake data, thereby enhancing population-based research. In conclusion, such biomarker approaches to the concomitant study of free sugars and LES intakes are timely and represent interesting developments in an area of significant public health interest.

The WHO reported that high blood pressure (BP) is one of the primary causes of death worldwide. Hypertension (HPT) is a major risk factor for CVD and related diseases as well as for diseases, leading to a considerable increase in cardiovascular risk. Since BP response could also be influenced by caffeine, which is widely consumed with coffee and other items, it is important to define the possible effects associated with caffeine intake. The most recent findings aimed at clarifying the role of caffeine consumption on BP and HPT risk/incidence are conflicting and difficult to interpret. Therefore, in the present narrative review, we aimed to examine various methodological inaccuracies/aspects and factors that make studies difficult to be compared, in order to obtain a single consensus on the effects of caffeine intake on the risk of BP and HPT. We observed that this heterogeneity in results could be due to the presence of: (i) several variables affecting BP (such as age, sex, genetic and lifestyle aspects); (ii) different caffeine content of food and beverages; and (iii) caffeine metabolism. Moreover, different methodological aspects in the evaluation of daily dietary caffeine intake and in the BP measurement could add some other bias in the interpretation of results. Therefore, it is mandatory to consider all methodological aspects and confounding factors to generate a standardised methodology in order to increase cross-study consistency and minimise confounding effects of different variables on the relationship between BP response and HPT risk/incidence after caffeine intake.

Knowing who eats what, understanding the various eating habits of different population groups, according to the geographical area, is critical to develop evidence-based policies for nutrition and food safety. The FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) is a novel open-access online platform, hosted by FAO and supported by WHO, providing access to harmonised individual quantitative food consumption (IQFC) data, especially in low- and middle-income countries (LMIC). FAO/WHO GIFT is a growing repository, which will serve as the global FAO/WHO hub to disseminate IQFC microdata. Currently five datasets from LMIC are available for dissemination, and an additional fifty datasets will be made available by 2022. To facilitate the use of these data by policy makers, ready-to-use food-based indicators are provided for an overview of key data according to population segments and food groups. FAO/WHO GIFT also provides an inventory of existing IQFC data worldwide, which currently contains detailed information on 188 surveys conducted in seventy-two countries. In order for end-users to be able to aggregate the available data, all datasets are harmonised with the European Food Safety Authority's food classification and description system FoodEx2 (modified for global use). This harmonisation is aimed at enhancing the consistency and reliability of nutrient intake and dietary exposure assessments. FAO/WHO GIFT is developed in synergy with other global initiatives aimed at increasing the quality, availability and use of IQFC data in LMIC to enable evidence-based decision-making and policy development for better nutrition and food safety.