Nutrition plays a pivotal role in cancer survivorship, influencing not only long-term health outcomes but also quality of life and risk of recurrence. As advances in early detection and treatment have led to a growing global population of cancer survivors, attention has increasingly shifted from acute care to the promotion of sustained well-being and prevention of secondary health challenges. Despite growing evidence linking dietary patterns, body composition and metabolic health with survivorship outcomes, there remains significant variability in nutritional guidance, access to evidence-based interventions and integration of nutrition into oncology care. This review explores the current state of knowledge on nutrition in cancer survivorship, highlights key challenges faced by healthcare systems and patients and presents a new proposed model of care to optimise nutrition within survivorship care, bridging the evidence-practice gap.

In the UK, approximately 64,000 individuals are living with an ileostomy. This surgery creates an opening in the abdominal wall (stoma), allowing for diversion of egesta into a disposable pouch. This procedure impacts nutrient absorption meaning people living with an ileostomy may be subject to sub-optimal nutrition, often compounded by the low-fibre diet – which is frequently encouraged post-operatively. This review explores the restrictive dietary patterns of this population and their effects on nutrition and quality of life, alongside current approaches to improve dietary management and health outcomes. Dietary restriction beyond the post-operative period is frequently reported, with avoidance of high-fibre foods (e.g., fruits and vegetables) being most prevalent. These long-term dietary changes are presumed to impact nutritional status, with current evidence suggesting diminished bone mineral density and vitamin B12. High-output stoma (HOS) and dehydration are significant issues for people living with an ileostomy, and dietary management of stoma output and other ileostomy-related symptoms is a major contributor to food avoidance. The efficacy of oral rehydration solutions (ORS) in management of HOS is well-established; however, due to high concentrations of glucose and sodium, the palatability of such treatments is poor, impacting patient adherence. Encouragingly, personalised dietary advice has shown some positive effects on both quality of life and nutritional outcomes for people living with an ileostomy. However, a greater understanding of dietary management is needed, and there remains scope to improve current dietary advice and enable people living with an ileostomy to benefit from a more complete and unrestricted diet.

Biliary atresia is a rare bile duct disease resulting in intestinal bile salt depletion due to poor bile flow. Medium-chain triglyceride (MCT) supplementation is widely recommended and used as the main dietary management in infants, however evidence for its use is limited and there is uncertainty regarding the optimal percentage (proportion of total fat that is MCT) and dose (grams/kilogram/day, g/kg/d). The aim was to review the evidence for the impact of MCT on fat absorption, growth, nutritional status and clinical outcomes in infants with biliary atresia and the optimal nutrition profile of MCT supplementation. A scoping review found that the mostly observational, historic evidence for MCT supplementation pointed to greater fat absorption during MCT supplementation compared to no supplementation, but also some evidence of a risk of essential fatty acid deficiency with very high MCT percentage. Only six studies have investigated MCT percentages and only three reported MCT dose. One analysis of MCT in the largest cohort of biliary atresia patients ever presented (n = 200), found no association between MCT percentage with growth, nutritional status or clinical outcomes. Counterintuitively, there was an unexpected inverse association between MCT dose and growth. A possible interpretation was that increased MCT was a consequence of poor growth rather than a cause, as infants either drank more or dietitians prescribed more MCT as fat malabsorption worsened. In conclusion, MCT is widely recommended, however, the evidence for its use is lacking and there remains uncertainty about the optimum percentage and dose for infants with biliary atresia.

UK food system transformation is urgently needed, but to date, minimal research has investigated ‘blue foods’ probably because they are ethically nuanced. There exists a paradox whereby materially deprived communities should be eating more fish to meet nutritional requirements, yet there is a global ‘red flag’ around global overfishing. New collaborative and creative solutions are, therefore, needed to tackle such food system inequities. By working together, all voices can be equally heard when decisions are being made to improve the system. Similarly, innovation and disruption of established supply chains will enable better access to healthy, affordable and tasty food that will support better nutrition, health and wellbeing. This review paper will present a critique of the ‘The Plymouth Fish Finger’ as a collaborative social innovation case study. Part of the FoodSEqual research project, this exploratory pilot project championed ‘co-production’ approaches to achieve multiple (potential) impacts. This review will critically explore how this social innovation case study has exemplified the complex interplay between factors driving distortions in access to and availability of fish within the local food system. Through collaborative multi-stakeholder (transdisciplinary) processes, using participatory creative methods, new strategies and recommendations for research, practice, action and policy are informed, all of which offer great potential for progressive and transformative systemic (blue) food system change.

Positive food consumption remains one of the most common challenges among older adults in the UK with at least 10% in community settings and up to 45% in care homes affected by malnutrition. It is strongly associated with frailty, functional and health decline. Tracking and understanding the impact of diet is not easy. There are problems with monitoring diet and malnutrition screening such as difficulty remembering, lack of time, or needing a dietician to interpret the results. Computerised tailored education may be a positive solution to these issues. Due to the rise in smartphone ownership the use of technology to monitor diet is becoming more popular. This review paper will aim to look at the issues with current methods of dietary monitoring particularly in older adults, it will present the benefits and barriers of using to monitor food intake. It will discuss how a photo food monitoring app was developed to address the current issues with technology and how it was tested with older adults living in community and care settings. The prototype was co-developed and incorporated automated food classification to monitor dietary intake and food preferences and tested with older adults. The prototype was usable to both older adults and care workers and feedback on how to improve its use was collected. Key design improvements to make it quicker and more accurate were suggested for future testing in this population. With adaptions this prototype could be beneficial to older adults living in both community and care settings.

Undernutrition is common amongst older people and can lead to adverse health outcomes and increased dependence. This review focuses on an aspect of undernutrition that is often overlooked, namely loss of appetite, and will discuss the challenges in this under-researched field from the perspective of geriatric medicine. Appetite decline is common in later life and predicts undernutrition in older populations. As such, timely identification and intervention on poor appetite could delay onset or progression of undernutrition to optimise healthy ageing and maintain independence. In addition, management of undernutrition ultimately requires the individual to meet their nutritional requirements. However, unless attention is paid to mitigating appetite decline, strategies to improve intake are likely to be ineffective. Treatment for appetite decline is challenging due to the multiple and complex underlying mechanisms. Current evidence is limited to a few trials targeting older people including flavour enhancement and fortification or supplementation, lifestyle measures such as increasing physical activity and social interaction, and medications, all with mixed results. Progress on treatments for appetite decline has been hampered by a lack of distinction from undernutrition but also perhaps the approach to it as a concept. Categorising appetite decline in ageing as a geriatric syndrome could aid progress in the unification of approaches to mechanistic research, assessment and management strategies, which are likely to be most effective when in multi-component form and underpinned by the principles of Comprehensive Geriatric Assessment (CGA).

This review aims to (1) provide an overview of research investigating the relationship between body composition, specifically fat-free mass (FFM) and fat mass (FM), appetite and energy intake (EI) and (2) to investigate potential mechanisms underlying these relationships, with a focus on ageing. Appetite and EI are influenced by complex, multifactorial pathways involving physiological, psychological, environmental, social and cultural factors. Early research investigating the association of body composition with appetite and EI focused on FM; however, the role of FFM in appetite control is gaining increasing attention. Studies have shown that FFM is positively associated with EI in younger populations, including infants, adolescents and adults. In contrast, FM appears to have no association or a weak inverse association with appetite/EI. However, research in older adults is limited, and the underlying mechanisms are not fully understood. It has been suggested that one way in which FFM may influence appetite and EI is by impacting resting metabolic rate (RMR). FFM, which includes metabolically active tissues including skeletal muscle and organs, represents the largest determinant of RMR and therefore may influence appetite and EI by ensuring the energetic requirements of crucial tissue-organs and metabolic processes are reached. Given that declines in FFM and RMR are common with ageing, they may be possible targets for interventions aimed at improving appetite and EI. While current evidence in older adults supports a positive association between FFM and appetite, further longitudinal studies are needed to explore this relationship in different contexts, along with the underlying mechanisms.

This review summarises evidence from cohort and intervention studies on the relationships between nutrition in early life, epigenetics and lifelong health. Established links include maternal diet quality with conception rates, micronutrient sufficiency before and during pregnancy with preterm birth prevention, gestational vitamin D intake with offspring bone health, preconception iodine status with child IQ, adiposity with offspring obesity and maternal stress with childhood atopic eczema. Animal studies demonstrate that early-life environmental exposures induce lasting phenotypic changes via epigenetic mechanisms, including DNA methylation, histone modifications and non-coding RNA, with DNA methylation of non-imprinted genes most extensively studied. Human data show that nutrition during pregnancy induces epigenetic changes associated with childhood obesity risk, such as Antisense long Non-coding RNA in the INK4 Locus (ANRIL, a long non-coding RNA) methylation variations linked to obesity and replicated across multiple populations. Emerging insights reveal that paternal nutrition and lifestyle also modify sperm epigenomics and influence offspring development. Although nutritional-randomised trials in pregnancy remain limited, findings from the NiPPeR trial showed widespread preconception micronutrient deficiencies and indicated that maternal preconception and pregnancy nutritional supplementation can reduce preterm birth and early childhood obesity. The randomised trials UPBEAT and MAVIDOS have shown that nutritional intervention can impact offspring epigenetics. Postnatal nutritional exposures further influence offspring epigenetic profiles, exemplified by ALSPAC cohort findings linking rapid infant weight gain to later methylation changes and increased obesity risk. Together, these studies support a persistent impact of maternal and early-life nutrition on child health and development, underpinned by modifiable epigenetic processes.

The global syndemic of obesity, undernutrition and climate change – three interconnected challenges – threatens both human and planetary health. This review focuses on one critical intersection: older populations living with overweight and obesity in the context of sustainable nutrition. Obesity and sarcopenia, particularly the co-occurrence called sarcopenic obesity, are often overlooked until the onset or exacerbation of other diseases necessitates secondary care. Preventing sarcopenic obesity requires reducing excess fat mass while preserving muscle mass and function. This involves lowering total energy intake while ensuring adequate protein intake in terms of quantity, quality and distribution, combined with physical activity, particularly resistance exercise. Short-term studies show that both the source and dose of dietary protein significantly influence muscle protein synthesis rates. Longer-term studies examining the impact of plant-based diets on muscle health in older adults with or without overweight or obesity remain limited. Animal protein have shown a modest advantage over most plant-based protein in supporting muscle mass. Qualitative studies suggest that emphasising both the health benefits and palatability of plant-based protein sources is key to promoting dietary changes in older adults. In older adults with obesity, it is challenging to combine energy restriction with higher protein intake, especially when protein sources are plant-based. To prevent and treat sarcopenic obesity in older adults and support planetary health, a shift toward more plant-based protein sources is required, while ensuring sufficient protein quantity and quality to preserve muscle health during weight loss.

Sarcopenia, the age-related decline in muscle mass and strength, is a contributor to frailty and reduced quality of life. Emerging evidence suggests an emerging role of the gut microbiome in modulating skeletal muscle through microbial species and metabolites, such as short-chain fatty acids (SCFAs), potentially influencing inflammation, nutrient absorption, and glucose and protein metabolism. This review considers the potential of probiotics, prebiotics, and synbiotics as interventions to mitigate sarcopenia based on animal and human studies, while providing a critique of present barriers that need to be addressed. Preclinical models, including germ-free mice and faecal microbiota transplantation, demonstrate that gut microbiota from healthy or young donors may enhance overall muscle health via reductions in inflammatory and muscle atrophy markers. Limited human studies show that probiotics such as Lactobacillus and Bifidobacterium could improve branched-chain amino acid (BCAA) bioavailability and potentially sarcopenia indices, although findings have been inconsistent. Particularly, challenges including inconsistent microbial assessments, lack of dietary control and interindividual variability due to diet, age, genetics, comorbidities and medications may hinder progress in this field. Delivery methods (e.g. capsules, fermented foods or fortified products) could further complicate efficacy through probiotic stability and dietary restrictions in older adults. Standardised protocols [e.g. Strengthening The Organisation and Reporting of Microbiome Studies (STORMS) checklist] and multi-omics approaches may be critical to address these limitations and identify microbial signatures linked to sarcopenia outcomes. While preclinical evidence highlights mechanistic pathways pertinent to amino acid metabolism, translating findings to humans requires rigorous experimental trials.

Individuals with severe mental illness face a significantly reduced life expectancy compared to the general population. Addressing key modifiable risk factors is essential to reduce these alarming rates of mortality in this population. Nutritional psychiatry has emerged as an important field of research, highlighting the important role of nutrition on mental health outcomes. However, individuals with severe mental illness often encounter barriers to healthy eating, including poor diet quality, medication-related side effects such as increased appetite and weight gain, food insecurity and limited autonomy over food choices. While nutrition interventions play a key role in improving health outcomes and should be a standard part of care, their implementation remains challenging. Digital technology presents a promising alternative support model, with the potential to address many of the structural and attitudinal barriers experienced by this population. Nonetheless, issues such as digital exclusion and low digital literacy persist. Integrating public and patient involvement, along with behavioural science frameworks, into the design and delivery of digital nutrition interventions can improve their relevance, acceptability and impact. This review discusses the current and potential role of digital nutrition interventions for individuals with severe mental illness, examining insights, challenges and future directions to inform research and practice.

This review aims to highlight some of the key bioactive functionalities that a range of components in milk can potentially make to reduce risks to health at key life stages. Such functionalities cannot be adequately explained by traditional estimates of nutrient supply. The benefits of gangliosides from the milk fat globule membrane (MFGM) for neonatal neurodevelopment are examined along with milk proteins for growth stimulation of children via the proteins’ ability to stimulate insulin-like growth factor-1 (IGF-1). Exosomes in bovine milk and their miRNA are bioavailable, with an animal study indicating that placenta development and embryo survival were both enhanced. Concerning bone health, the unique characteristics of the casein micelle for supplying Ca, P and Mg to the GI tract were considered. The so-called dairy food matrix and the hypotensive effect of some peptides from milk proteins may be compensatory factors for SFA regarding CVD risk. The recent rise in use of glucagon-like peptide-1 (GLP-1) receptor agonists for adiposity reduction and improving glycaemic control is noted alongside evidence that milk proteins can stimulate GLP-1 synthesis potentially reducing GLP-1 receptor agonist need in high milk protein consumers. Other functionality included the ability of whey proteins to stimulate synthesis of skeletal muscle protein, crucial for bone protection and glycaemic control and the role of milk/Ca for reducing colorectal cancer risk. Perhaps the most exciting functionality is that of polar phospholipids in the MFGM potentially improving cognition and reducing the risk of dementia in the elderly. Clearly more human studies are needed.

Longer life expectancy and growing income inequality have prompted an increasing interest in understanding the impact of ageing on nutritional requirements in order to optimise intakes, increase the number of years lived in good health and reduce morbidity and associated health and social care costs. Food insecurity reduces access to nutritious and healthy food. Understanding the evidence base on the impacts of food insecurity and the maintenance of food security for older people is crucial to informing policy and intervention. The increase in numbers of older people experiencing food insecurity is a public health emergency and is associated with under and malnutrition. Food insecurity can be experienced at any stage of the life course but has been more widely studied with families and children where poverty is a major driver. Food insecurity in later life has been less well explored by academics, but differs from that experienced in earlier years due to additional complexities, as physical and cognitive health amplify the impact of poverty. Additionally, factors which can appear to be relatively small in impact can act in a cumulative way to push people towards food insecurity. This review will draw on research about older people’s food practices, contexts and experiences in relation to food insecurity in later life and offers a model of food insecurity that has the potential to guide focused public health efforts in order to support the older population to be food secure.

Intrinsic capacity, introduced by the WHO, represents a shift in focus from treating disease to maintaining physical and mental capacities individuals as they age. It encompasses five interrelated domains: vitality, sensory, cognition, psychology, and locomotion. Vitality refers to the body’s physiological reserve and is shaped by processes such as energy metabolism, immune function, and neuromuscular integrity. By definition, vitality is closely linked to nutritional status, which plays a central role in maintaining resilience and health in older adults. However, integrating nutritional status into the vitality domain presents several challenges due to inconsistent definitions and varied measurement approaches. This review examines these challenges and explores possibilities for integrating nutritional status in the vitality domain. The absence of standardised nutrition-related indicators limits comparability across studies and constrains the practical application of intrinsic capacity in both research and clinical contexts. To strengthen the role of intrinsic capacity in nutritional monitoring, it is essential to reach consensus on which nutritional indicators to include and how to score them consistently. Addressing these methodological challenges will support the use of intrinsic capacity in identifying early signs of nutritional decline and guiding timely interventions to promote healthy ageing.

The Mediterranean Diet (Med Diet) has long been shown to be associated with lower cardiovascular mortality in epidemiological studies. However, the direct effect of the dietary pattern on cardiovascular risk factors is less clear. Furthermore, the effect of Med Diet interventions in non-Mediterranean populations on cardiovascular and metabolic risk is variable. A Cochrane Review in 2019 concluded there was low to moderate evidence of a modest benefit but noted that there were still ongoing trials. Since 2019, there have been a number of published trials that have not shown a benefit of the Med Diet over other interventions or usual care. It is possible that dietary factors such as quality or quantity of carbohydrate and energy restriction are more important factors, along with the degree of weight loss, than the Med Diet itself. There are also many other factors that influence the uptake and effectiveness of the Med Diet in populations that have a different traditional or habitual diet. This review paper examines a selection of 20 Med Diet intervention trials specifically looking at clinical outcomes of glucose metabolism: fasting plasma glucose, HbA1c, development of type 2 diabetes or need for hypoglycaemic medications, with or without other cardiometabolic risk factors. These trials are a mix of randomised controlled trials, crossover studies and cohort studies of greater than 8 weeks duration with more than 25 participants. There is heterogeneity in study designs and outcomes, making comparison difficult, but there is no clear benefit of the Med Diet presented.

Dietary patterns are prerequisites for health and integral components of ecological systems. For over a century researchers have been building a body of evidence of associations between dietary patterns and health and sustainability outcomes while policymakers have been synthesising and translating this evidence into policies to promote public health. During this period, food systems have dramatically changed and driven the emergence of food supplies and dietary behaviours with no ecological or evolutionary precedent. Now, the relevance of conventional nutrition research and policymaking approaches for understanding food system transitions and protecting against unhealthy and unsustainable diets is being questioned. This review aims to examine how the ecological nutrition paradigm might guide a transformed approach to nutrition research and policymaking to promote healthy and sustainable diets. It shows the ecological nutrition paradigm is transdisciplinary integrating biological, social and environmental dimensions into nutrition research and policymaking. The paradigm operates to a ‘fit-for-purpose’ policymaking orientation. It draws on ecological and evolutionary theories to provide insights to conceptualise the causes of, and solutions to, nutrition problems and help design relevant decision-making processes. These research and policymaking features contrast with the ‘one-size-fits-all’ policymaking orientation and prescriptive decision-making processes of the conventional medical nutrition paradigm. Their attention to a relevance criterion engenders confidence in the likely effectiveness, and ability to avoid unintended consequences, of policies informed within an ecological nutrition paradigm. The review proposes a shift to the ecological nutrition paradigm to transform nutrition research and policymaking for promoting healthy and sustainable diets is overdue.

The 58th Annual Scientific Conference of the Nutrition Society of New Zealand, held in Christchurch in 2024, brought together 187 delegates under the theme ‘Kotahitanga: Bridging Research, Industry and Practice’. This theme reflected the society’s commitment to uniting diverse sectors to address key nutrition challenges across the life course. Kotahitanga refers to unity and collective action. Topics included nutrition in ageing and chronic disease, infant and toddler nutrition, gut health, sustainable food systems and food safety. Presentations on sarcopenia and Parkinson’s disease emphasised the need for greater awareness and tailored nutrition strategies for older adults. The Muriel Bell Lecture celebrated the legacy of New Zealand’s first State Nutritionist and called for continued leadership in evidence-based nutrition and encouraged nutritionists to communicate research to the public. A panel on science communication offered practical strategies for engaging the public and countering misinformation. The conference reinforced the importance of collaboration, advocacy and practical application in advancing nutrition.

Healthy ageing and longevity have emerged as urgent public health priorities amid global population ageing and declining birth rates. This review synthesises empirical evidence highlighting the essential role of diet and nutrition in preventing chronic diseases and supporting functional independence in later life. The review was organised using a problem-solving approach to address three core questions: ‘What’ evidence links food and nutrition with positive health outcomes; ‘Why’ do specific dietary components affect biological ageing – via mechanisms such as nutrient sensing, inflammation modulation and caloric restriction; and ‘How’ culturally tailored, person-centred dietary interventions should be developed for better adoption. Findings from centenarian populations suggest that low-energy (i.e. foods with low energy density, such as fruit and vegetables, whole grains), nutrient-rich and diverse diets may help prevent or delay age-related diseases, supporting the notion that food could be used as medicine. Moreover, addressing barriers such as food insecurity and limited access to culturally appropriate healthy food options, particularly in low-income and rural communities, is crucial for achieving equitable health outcomes. Finally, the review calls for integrating personalised nutrition strategies into clinical care and public health initiatives. These efforts can enhance healthspan, improve quality of life and reduce the broader social and economic burdens associated with ageing populations.

Personalised nutrition aims to deliver targeted advice to promote dietary behaviours that are beneficial to health based on individual characteristics. Given the financial implications (for providers and participants) of characterising, developing, implementing, communicating and supporting individual behaviour change there remains potential for personalised nutrition to widen health inequalities within populations. Some commentators promote a universal approach to achieve wider population-level benefit. Universal approaches attempt to provide a whole systems perspective with individual outcomes, potentially smaller in scale, impacting at the population level. In the UK the national food-based guidance, the Eatwell Guide, is used to communicate advice on diet consistent with UK government dietary recommendations based on robust, independent assessment of the best available evidence by the Scientific Advisory Committee on Nutrition. Effort was taken in ensuring all UK government recommendations in 2016 (when the UK’s national food-based guidance was last reviewed following changes in dietary recommendations on carbohydrates and sugars) could be achieved at a population level based on available and recognised foods. There is evidence that moving towards a diet consistent with national food-based guidelines has positive benefits for health and the environment. There is debate about the cost of a healthy diet and the impact of including elements of sustainability elements. This commentary considers how developments in healthy eating indices may be beneficial as a universal approach could provide opportunities to support individuals move towards healthier diets. It also raises questions about the evidence requirements and timing of any future amendments to the UK’s Eatwell Guide.