Vitamin D deficiency has previously been linked to higher rates of exacerbation and reduced lung function in asthmatics. Previous randomised controlled trials investigating the effect of vitamin D supplementation have mainly focused on children with asthma. Trials involving adults have typically used bolus dosing regimens, and the main outcomes have been patient-focused without investigating underlying inflammation. The present study aimed to conduct a 12-week placebo-controlled randomised controlled trials administering a daily 125 µg vitamin D3 supplement to adults with mild to moderate asthma. A total of 32 participants were randomised to receive either the 125 μg vitamin D3 supplement or an identical matching placebo. The primary outcome of the study was lung function measured by the ratio of FEV1:FVC (effect size 2·5) with secondary outcomes including asthma symptoms and inflammatory biomarkers. There was a small but statistically significant higher increase in the mean (±sd) ratio of FEV1:FVC from baseline to post-intervention in the vitamin D group (+0·05 ± 0·06) compared with the placebo group (+0·006 ± 0·04, P = 0·04). There was no effect of the intervention on asthma control test scores, or the inflammatory biomarkers measured. There was a moderate, significant association between baseline plasma 25(OH)D concentration and baseline plasma IL-10 (r = 0·527, P = 0·005) and TNF-α (r = −0·498. P = 0·008) concentrations. A daily vitamin D3 supplement led to slightly improved lung function in adult asthmatics and may be a useful adjunct to existing asthma control strategies, particularly for individuals with suboptimal vitamin D status.

Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein’s high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult’s appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.

The present paper provides an overview of the approach to developing food-based dietary recommendations in the UK. UK dietary recommendations are based on independent advice from the Scientific Advisory Committee on Nutrition (SACN). SACN's remit includes specific reference to the nutrient content of individual foods and advice on diet as a whole, including the definition of a balanced diet. SACN's approach is set out in its Framework for Evaluating Evidence and its assessments are supported by the data provided by the National Diet and Nutrition Survey. SACN's risk assessments have primarily focused on energy requirements, macro and micronutrients and/or the needs of specific population groups. However, dietary patterns or individual foods and health outcomes have been considered where sufficient evidence is available. An example of this is SACN's risk assessment on carbohydrates and health, which included consideration of evidence on sugar-sweetened beverages and the resulting dietary recommendations on free sugars and sugar-sweetened beverages led to a range of policies to reduce sugar intake in the UK, including the soft drinks industry levy. SACN has also recently published a position statement on processed foods and health. Government dietary advice is encapsulated in the UK's national food model, the Eatwell Guide. The Eatwell Guide shows the proportions in which different food groups should be consumed to have a well-balanced, healthier, more sustainable diet, to help meet nutrient requirements and reduce the risk of chronic disease. Any substantive change to government dietary advice is likely to lead to a review of the national food model.

Diets deficient in fibre are reported globally. The associated health risks of insufficient dietary fibre are sufficiently grave to necessitate large-scale interventions to increase population intake levels. The Danish Whole Grain Partnership (DWP) is a public–private enterprise model that successfully augmented whole-grain intake in the Danish population. The potential transferability of the DWP model to Slovenia, Romania and Bosnia-Herzegovina has recently been explored. Here, we outline the feasibility of adopting the approach in the UK. Drawing on the collaborative experience of DWP partners, academics from the Healthy Soil, Healthy Food, Healthy People (H3) project and food industry representatives (Food and Drink Federation), this article examines the transferability of the DWP approach to increase whole grain and/or fibre intake in the UK. Specific consideration is given to the UK’s political, regulatory and socio-economic context. We note key political, regulatory, social and cultural challenges to transferring the success of DWP to the UK, highlighting the particular challenge of increasing fibre consumption among low socio-economic status groups – which were also most resistant to interventions in Denmark. Wholesale transfer of the DWP model to the UK is considered unlikely given the absence of the key ‘success factors’ present in Denmark. However, the DWP provides a template against which a UK-centric approach can be developed. In the absence of a clear regulatory context for whole grain in the UK, fibre should be prioritised and public–private partnerships supported to increase the availability and acceptability of fibre-rich foods.

Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.

For 20 years the UK Government has recognised that food advertising plays a part in food choices and hence diets of the population, particularly for children. In 2007 the UK brought in regulations to stop the advertising of less healthy foods on television (TV) during child-specific programming. Less healthy foods were defined using the 2004/2005 nutrient profiling model (NPM) as products high in saturated fat, salt and sugar (HFSS). Evaluations showed that children were still seeing and being affected by the adverts for less healthy foods. To try to mitigate childhood obesity, in 2018, the UK Government announced its intention to consult on further restrictions on the advertising of HFSS products on TV and online. Two years later, the intention to implement a 9pm advertising ban on TV and a further consultation on restricting online advertising of HFSS products was announced. New legislative controls on the advertising of HFSS foods are expected to be brought into legislation in the UK in January 2024. In the present paper, the history of advertising restrictions in the UK and the evidence informing them is reviewed. There will also be a reflection on where further actions might be needed in due course.

In May 2021, the Scientific Advisory Committee on Nutrition (SACN) published a risk assessment on lower carbohydrate diets for adults with type 2 diabetes (T2D)(1). The purpose of the report was to review the evidence on ‘low’-carbohydrate diets compared with the current UK government advice on carbohydrate intake for adults with T2D. However, since there is no agreed and widely utilised definition of a ‘low’-carbohydrate diet, comparisons in the report were between lower and higher carbohydrate diets. SACN’s remit is to assess the risks and benefits of nutrients, dietary patterns, food or food components for health by evaluating scientific evidence and to make dietary recommendations for the UK based on its assessment(2). SACN has a public health focus and only considers evidence in healthy populations unless specifically requested to do otherwise. Since the Committee does not usually make recommendations relating to clinical conditions, a joint working group (WG) was established in 2017 to consider this issue. The WG comprised members of SACN and members nominated by Diabetes UK, the British Dietetic Association, Royal College of Physicians and Royal College of General Practitioners. Representatives from NHS England and NHS Health Improvement, the National Institute for Health and Care Excellence and devolved health departments were also invited to observe the WG. The WG was jointly chaired by SACN and Diabetes UK.

A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.

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.

This Position Paper from the Academy of Nutrition Sciences is the first in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This first paper focuses on evidence which underpins dietary recommendations for prevention of non-communicable diseases. It considers methodological advances made in nutritional epidemiology and frameworks used by expert groups to support objective, rigorous and transparent translation of the evidence into dietary recommendations. The flexibility of these processes allows updating of recommendations as new evidence becomes available. For CVD and some cancers, the paper has highlighted the long-term consistency of a number of recommendations. The innate challenges in this complex area of science include those relating to dietary assessment, misreporting and the confounding of dietary associations due to changes in exposures over time. A large body of experimental data is available that has the potential to support epidemiological findings, but many of the studies have not been designed to allow their extrapolation to dietary recommendations for humans. Systematic criteria that would allow objective selection of these data based on rigour and relevance to human nutrition would significantly add to the translational value of this area of nutrition science. The Academy makes three recommendations: (i) the development of methodologies and criteria for selection of relevant experimental data, (ii) further development of innovative approaches for measuring human dietary intake and reducing confounding in long-term cohort studies and (iii) retention of national nutrition surveillance programmes needed for extrapolating global research findings to UK populations.

The role of meat in the diet has come under scrutiny recently due to an increased public emphasis on providing healthy diets from sustainable food systems and due to health concerns relating to the consumption of red and processed meat. The present review aimed to summarise dietary guidelines relating to meat, actual meat intakes and the contribution of meat to energy and nutrient intakes of children, teenagers and adults in Europe. The available literature has shown that food-based dietary guidelines for most countries recommend consuming lean meat in moderation and many recommend limiting red and processed meat consumption. Mean intakes of total meat in Europe range from 40 to 160 g/d in children and teenagers and from 75 to 233 g/d in adults. Meat contributes to important nutrients such as protein, PUFA, B vitamins, vitamin D and essential minerals such as Fe and Zn; however, processed meat contributes to significant proportions of saturated fat and Na across population groups. While few data are available on diaggregated intakes of red and processed meat, where data are available, mean intakes in adults are higher than the upper limits recommended by the UK Scientific Advisory Committee on Nutrition (70 g/d) and the World Cancer Research Fund (500 g/week). While there are no recommendations for red and processed meat consumption in children and teenagers, intakes currently range from 30 to 76 g/d. The present review provides a comprehensive overview of the role of meat in the European diet which may be of use to stakeholders including researchers, policy makers and the agri-food sector.

It is clear that the sugars component of the diet has potentially deleterious effects on health. In the past, the dietary sugars were collectively referred to as non-milk extrinsic sugars (UK) or added sugars. The WHO first proposed a new term, free sugars, which is rather broader than added sugars, and also includes the sugars in fruit juices and purees, as well as honey and syrups. This review considers the potential problems that free sugars represent in relation to health risks, and the recent proposals that free sugars are a more appropriate focus than added or total as far as public health initiatives are concerned. This will require major activities in relation to measurement, labelling and communication to the consumer if attempts to reduce dietary free sugars content are to be successful.

CVD is a major burden on the health system in the UK. On average, diets are not aligned with current dietary recommendations, including those for salt, saturated fat, fibre, fruit and vegetables. Obesity prevalence is high and the majority of the population is consuming more energy than required. Addressing these issues would reduce the burden of CVD and help reduce inequalities in health. There is currently a range of policy interventions in place in England designed to help improve diets and reduce obesity, which in turn should help reduce the risk of CVD. Further actions may be needed in the long term to deliver sustained improvements to diet and health.

Vitamin D is a unique nutrient. First, it acts as a pro-hormone and secondly, the requirement for vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This complicates the determination of dietary requirements for vitamin D, which along with the definition of optimal vitamin D status, have been highly controversial and much debated over recent years. Adolescents are a population group at high risk of low vitamin D status, which is concerning given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations are important from a public health perspective in helping to avoid deficiency and optimise vitamin D status for health. However limited experimental data from winter-based dose–response randomised trials in adolescents has hindered the development of evidence-based dietary requirements for vitamin D in this population group. This review will highlight how specifically designed randomised trials and the approach adopted for estimating such requirements can lead to improved recommendations. Such data indicate that vitamin D intakes of between 10 and about 30 µg/d may be required to avoid deficiency and ensure adequacy in adolescents, considerably greater than the current recommendations of 10–15 µg/d. Finally this review will consider the implications of this on public health policy, in terms of future refinements of vitamin D requirement recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency.

Research into the analysis, physical properties and health effects of dietary fibre has continued steadily over the last 40–50 years. From the knowledge gained, countries have developed guidelines for their populations on the optimal amount of fibre to be consumed each day. Food composition tables from many countries now contain values for the dietary fibre content of foods, and, from these, combined with dietary surveys, population intakes have been determined. The present review assessed the uniformity of the analytical methods used, health claims permitted, recommendations and intakes, particularly from national surveys across Europe and around the world. It also assessed current knowledge on health effects of dietary fibre and related the impact of different fibre types on health. The overall intent was to be able to provide more detailed guidance on the types of fibre which should be consumed for good health, rather than simply a total intake figure, the current situation. Analysis of data indicated a fair degree of uniformity in the definition of dietary fibre, the method used for analysis, the recommended amount to be consumed and a growing literature on effects on digestive health and disease risk. However, national dietary survey data showed that intakes do not reach recommendations and very few countries provide guidance on the types of fibre that are preferable to achieve recommended intakes. Research gaps were identified and ideas suggested to provide information for more detailed advice to the public about specific food sources that should be consumed to achieve health benefits.

Recent re-evaluations of dietary reference values (DRV) for vitamin D have established intake requirements between 10 and 20 µg/d. National nutrition surveys indicate that habitual mean intakes of vitamin D in the population are typically in the range 3–7 µg/d. As vitamin D supplementation will not be effective at a population level because the uptake is generally low, creative food-based solutions are needed to bridge the gap between current intakes and these new requirement values. The overarching aim of this review is to highlight how food-based solutions can have an important role in bridging this gap and counteracting vitamin D inadequacy in Europe and elsewhere. The present review initially briefly overviews very recent new European DRV for vitamin D and, while not in agreement on requirement estimates, how they point very clearly to the need for food-based solutions. The review discusses the need for traditional fortification of foods in the dairy and other sectors, and finally overviews recent advances in the area of biofortification of food with vitamin D. In conclusion, increasing vitamin D intakes across the population distribution is important from a public health perspective to reduce the high degree of inadequacy of vitamin D intake in Europe. Fortification, including biofortification, of a wider range of foods, which accommodate diversity, is likely to have the potential to increase vitamin D intakes across the population distribution. Research has had, and will continue to have, a key role in terms of developing food-based solutions and tackling vitamin D deficiency.

Data on the diets of young children in the UK are limited, despite growing evidence of the importance of early diet for long-term health. We used the largest contemporary dietary data set to describe the intake of 21-month-old children in the UK. Parents of 2336 children aged 21 months from the UK Gemini twin cohort completed 3-d diet diaries in 2008/2009. Family background information was obtained from questionnaires completed 8 months after birth. Mean total daily intakes of energy, macronutrients (g and %E) and micronutrients from food and beverages, including and excluding supplements, were derived. Comparisons with UK dietary reference values (DRV) were made using t tests and general linear regression models, respectively. Daily energy intake (kJ), protein (g) and most micronutrients exceeded DRV, except for vitamin D and Fe, where 96 or 84 % and 70 or 6 % of children did not achieve the reference nutrient intake or lower reference nutrient intake (LRNI), respectively, even with supplementation. These findings reflect similar observations in the smaller sample of children aged 18–36 months in the National Diet and Nutrition Survey. At a population level, young children in the UK are exceeding recommended daily intakes of energy and protein, potentially increasing their risk of obesity. The majority of children are not meeting the LRNI for vitamin D, largely reflecting inadequate use of the supplements recommended at this age. Parents may need more guidance on how to achieve healthy energy and nutrient intakes for young children.

Both the intake of fat, especially saturated trans fatty acids, and refined carbohydrates, particularly sugar, have been linked to increased risk of obesity, diabetes and CVD. Dietary guidelines are generally similar throughout the world, restrict both intake of SFA and added sugar to no more than 10 and 35 % energy for total fat and recommend 50 % energy from carbohydrates being derived from unrefined cereals, tubers, fruit and vegetables. Current evidence favours partial replacement of SFA with PUFA with regard to risk of CVD. The translation of these macronutrient targets into food-based dietary guidelines is more complex because some high-fat foods play an important part in meeting nutrient requirements as well as influencing the risk of chronic disease. Some of the recent controversies surrounding the significance of sugar and the type of fat in the diet are discussed. Finally, data from a recently published randomised controlled trial are presented to show the impact of following current dietary guidelines on cardiovascular risk and nutrient intake compared with a traditional UK diet.

Carbohydrates provide the major source of energy in the diet and hence the type and amount of carbohydrate consumed is an important consideration for weight control. Recent risk assessments have shown that there is no consistent association between the proportions of energy consumed as carbohydrate and body weight and reinforce the dominance of total energy intake as the primary determinant of body weight. However, they have highlighted evidence that different types of carbohydrate have specific effects on the risk of obesity. Short-term experimental studies suggest that some types of dietary fibre may be linked to increased satiation and cohort studies are supportive of an association between low intakes of fibre-rich, whole-grain foods and weight gain. But these observations are not supported by evidence of effects on body weight in randomised controlled trials, suggesting that high-fibre or whole-grain intake may simply be a marker of a broader dietary pattern. Recent attention has focused on the growing evidence of a positive association between the intake of free sugars and weight gain and particularly the risks linked to consumption of sugar-sweetened beverages (SSB). Given the high population-level intake of free sugars the challenge is to identify actions that will successfully reduce consumption to contribute to reductions in the prevalence of obesity. The present paper considers the range of policy options available, using the Nuffield ladder of intervention to provide a framework for risk management, with a focus on the consumption of SSB. Current policy interventions are largely based around consumer education and encouragement to industry to renovate products to reduce the sugar content of food and drinks and/or reduce portion size, but dietary change has been slow. Further measures, including the use of specific incentives/disincentives may be needed to change consumption patterns, some of which may infringe personal or commercial freedom. For these policies to be implemented will require sustained efforts to create a climate in which such interventions are acceptable or even welcomed by society as an appropriate protection against obesity and other diet-related ill-health.