Self-reported dietary assessments have long been a limiting factor in advancing the field of precision nutrition. This is due to challenges such as unrecorded eating episodes, recall bias and portion-size estimation errors (1) . We developed a system using customised wearable cameras and reasoning-enabled large vision–language models (LVLMs) to create a fully automated pipeline facilitating scalable and objective dietary assessment. Beyond reducing user burden, passive capture can record brief or opportunistic eating episodes that are typically missed, while the use of LVLMs improves identification across heterogeneous contexts. However, the feasibility, privacy safeguards, and quantitative performance of such systems remain underexplored. This study aims to evaluate the LVLM-enabled passive system’s performance in real-world deployments, focusing on its ability to accurately capture and analyze dietary intake. A feasibility study was conducted at two centres, Hammersmith Hospital and the University of Reading (2) , where thirty UK participants wore customised cameras side-mounted on glasses (STM32 microcontroller; 128-GB SD card; rechargeable) throughout waking hours whilst consuming two highly-controlled, standardised diets; one of which was compliant with UK healthy eating guidelines and the other was not. Each diet was consumed over four study days, during which participants remained in the facility and consumed meals provided by the study team. The model outputs were benchmarked against a dietitian-verified reference menu and the weights of food portions consumed. The preprocessing pipeline was first applied to blur faces and screens in captured images for privacy protection. The LVLM-based pipeline then performed three tasks: (i) extracting eating episodes; (ii) recognising food items across heterogeneous settings; and (iii) context-aware portion-size estimation, using cues from containers, utensils, and hands to mitigate monocular visual scale ambiguity (3) . Any eating sessions lacking captured images were excluded from subsequent analyses. Data passively captured with wearable cameras from 30 participants (Hammersmith, n=15; Reading, n=15) over eight study days yielded 2.08 million raw images at Hammersmith and 2.15 million at Reading. After privacy filtering and removal of redundant frames, 0.49% and 0.46% of images were retained from each site, respectively. Overall, food-item recall from passively captured imagery was 82% (95% CI 81–84%). Portion-size estimation showed a mean absolute error of 44.7 g (95% CI 42.2–47.3 g) for food items and 70.4 mL (95% CI 67.4–73.4 mL) for beverages against weighed consumed portions. This feasibility study provides foundational evidence for LVLM-enabled, passive, camera-based dietary monitoring and supports progression to real-world deployment. These feasibility results support further multi-site validation, inclusion of metrics beyond recall (e.g., energy and macronutrient assessment), and assessment of performance across settings (home vs out-of-home) and subgroups to capture nutrient intake at population-level and enhance precision nutrition approaches.

Cardiovascular disease (CVD) is a leading cause of death in the UK, and cardiac rehabilitation (CR) is recommended post-myocardial infarction to improve outcomes. However, uptake remains low due to referral barriers, logistical challenges, and limited resources. Poor diet is a modifiable risk factor for CVD, yet access to tailored nutrition support within CR is limited. NICE guidance recommends personalised dietary advice as part of CR (1) , and remote delivery of personalised nutrition may offer a scalable solution to improve diet quality and support equitable CR access. eNutriCardio is a novel web-based personalised nutrition advice (PNA) tool adapted from the validated eNutri web-app (2) , originally developed for the general population (3) . This study investigated the effectiveness of eNutriCardio in improving diet quality in UK NHS patients offered CR. Patients eligible for CR completed a validated food frequency questionnaire (FFQ) via eNutriCardio shortly after their cardiac event or procedure. Participants were randomised to receive either usual care (including CR programme) (control) or usual care plus eNutriCardio PNA (intervention). The PNA was tailored to individual FFQ responses and an 11-component diet quality score (DQS), providing food-based recommendations to improve their three lowest scoring DQS components, where a higher score reflects greater adherence to UK dietary guidance. Intervention participants received coaching emails at weeks 2, 4 and 8, prompting participants to set and reflect on healthy eating intentions. After 12 weeks, both groups repeated the FFQ and provided feedback. An independent samples t-test compared change in overall DQS between groups (primary outcome). Targeted analysis (paired samples t-tests) explored whether change in DQS differed between PNA components that intervention participants intended to change versus components they either did not intend to change nor received advice about. The study was registered with ClinicalTrials.gov (ID: NCT05449769) and conducted according to the principles outlined in the Declaration of Helsinki. Twenty-seven participants were included in the present analysis (intervention: n=13; control: n=14). Baseline characteristics were not significantly different between groups: mean age 61 years (SD 8), 82% male, and mean BMI 27.9 kg/m 2 (SD 5.4). Intervention participants showed a 54% greater increase in total DQS (+21.2 points, out of 100) compared with control participants (+9.8 points) after 12 weeks (p=0.036). Within the intervention group, changes in DQS component scores were 80% higher for components participants intended to change versus those without intentions or advice (p≤0.001). No significant difference in BMI change was observed. All intervention participants agreed that eNutriCardio PNA helped them eat healthier and should be offered to all CR-eligible patients. Adding eNutriCardio PNA to usual care improved diet quality significantly more than usual care alone in NHS patients offered CR. This digital tool may enhance CR by offering a remote, personalised nutrition solution for patients unable to attend in-person programmes.

BACKGROUND:Digital dietary assessment tools are highly beneficial for nutrition research and personalized interventions. OBJECTIVE:This paper describes the development and evaluation of eNutriFFQv2.0, an updated online food frequency questionnaire designed to reflect current diets in the United Kingdom (UK). Updates included modernized food lists based on recent UK population surveys, food composition tables, and food portion photos to improve accuracy and user experience. METHODS:To assess reproducibility, UK adults completed the FFQ twice, 14 days apart; validity was evaluated against a 3-d weighed food record in a sub-sample. Multiple statistical methods were used. After excluding participants with unfeasible energy intakes, 87 participants completed the reproducibility and 53 the evaluation. RESULTS:The final eNutriFFQv2.0 captured 164 items and estimated intake for 56 nutrients and 6 food groups. Agreement with the WFR was acceptable to good for 25 out of the 29 nutrients analyzed (weighted kappa 0.21-0.77), with ≤10% misclassification into opposite quartiles for most nutrients. Bland-Altman plots showed good agreement for energy (176 kcal/d higher in FFQ1) and macronutrient estimates. Reproducibility was good for 24 out of the 29 nutrients analyzed (weighted kappa 0.58-0.85) with <5% misclassification. Mean bias for estimates of carbohydrate, fat, and protein was small (0.0-0.7). Energy estimates were 209 kcal/d (10.7%) higher in the first compared with the second completion of the FFQ. CONCLUSIONS:These findings demonstrate that eNutriFFQv2.0 is a valid and reliable tool for assessing nutrient intake in UK adults, offering a practical, scalable solution for research and public health in the context of digital health and personalized dietary interventions.

Research exploring the influence of diet on the skin microbiome and its role in skin aging is limited (1,2) . This study aimed to investigate age-related changes in skin microbiome and physiological parameters across adulthood, and to examine associations with habitual diet, anthropometry, demographics, and use of skin care products or medications. Institutional ethical approval was obtained (0617-2025-Apr-HSET). Adults were recruited across 5 age groups through word of mouth, flyers and social media. Exclusion criteria included ongoing intensive medical treatment (e.g., chemotherapy), current or recent smoking (stopped <1 year ago), and allergies to tape strips and/or swabs. Anthropometric measures included weight (kg), body mass index (BMI) (kg/m2), waist circumference (cm) and body fat (%). Habitual dietary intake over the proceeding 4 weeks was assessed using the validated eNutri web app (3) capturing fluid, food, nutrient and supplement intake. Skin physiological measures were conducted on the non-dominant forearm using validated instruments to measure barrier function (indicated by lower trans-epidermal water loss [TEWL]), stratum corneum cohesion (indicated by protein removed from stratum corneum), skin hydration and skin surface pH. Skin swabs from the inner elbow were used for DNA extraction and 16S metagenomic sequencing. Bacterial diversity (observed species, Shannon index), abundance, and phylum level composition were determined. Statistical analysis included Pearson’s or Spearman’s correlation coefficients, Mann–Whitney U and Kruskal–Wallis tests for non-parametric comparisons, and general linear models to identify predictors of skin physiological parameters and skin microbiome. Forty-one adults, aged 20-92 years, 30 female, 11 male (median BMI 24.9kgm2, IQR 6.5) completed the study. There was a significant negative correlation between TEWL and age (r=-0.431, p=0.012), and alcohol intake (% total energy) (r=-0.325, p=0.002) whereas iron intake (mg/d) was positively associated with TEWL (r=0.311, p=0.028). Skin barrier function was significantly higher in females (p=0.008). This indicates that older age, higher alcohol consumption, lower iron intake, and female sex may be associated with improved skin barrier function. There were also significant negative correlations between protein removal from the stratum corneum and both age (r=-0.371, p=0.007) and fruit intake (g/day) (r=-0.480, p=0.013), indicating stronger cohesion in younger individuals and those with higher fruit intake. Skin hydration was negatively associated with body weight (r=-0.343, p=0.020) and positively associated with dietary fibre intake (AOAC g/d) (r=0.468, p=0.001). Additionally, body weight (kg) was positively associated with skin microbiome abundance (r=0.536, p=0.002) and negatively associated with microbial diversity (observed species) (r=-.513, p<0.001). This study shows it is feasible to explore how age, anthropometry, and diet relate to skin physiology and microbiome in healthy adults. Our findings suggest that these factors influence different aspects of skin health in distinct ways. A larger powered cross-sectional study is warranted to validate these findings.

Diet quality scores (DQSs) are widely used in research to quantify diet quality based on adherence to population-based dietary recommendations and favourable dietary patterns. Many DQSs exist (e.g. Healthy Eating Index and Mediterranean Diet Score), but there are no recognised DQSs developed for a UK population (1) . The evidence-based DQS-UK-2022 was developed to quantify diet quality in UK adults (2) . This research aims to explore its relationship with CVD risk in UK adults. Cross-sectional data from the UK’s National Diet and Nutrition Survey (NDNS) rolling programme (2008-2014) (3,4) were used (n=4738 adults). Markers of CVD risk included blood pressure, anthropometric measurements, fasting serum lipids, C-reactive protein (CRP), haemoglobin A1C, fasting glucose, and homocysteine (n=2387 for blood biomarkers). The DQS-UK-2022 was calculated for dietary intake data (nutrients and food groups) from estimated diet diaries collected as part of NDNS. The DQS includes 6 adequacy components (fruits, vegetables, wholegrains, dairy, nuts/pulses and oily fish, where greater intakes scored higher), 4 moderation components (sodium, alcohol, red/processed meats and free sugars, where lower intakes scored higher) and a mixed component (saturated fatty acids (SFA) and ratio of unsaturated to SFA) 2. Each component had absolute cut-offs broadly based on current UK dietary recommendations. Intakes above/below the maximum/minimum cut-offs scored 10 or 0 points, respectively, with intermediate intakes scored proportionately using linear interpolation. Component scores were summed and scaled to a total score out of 100, with higher DQS-UK-2022 scores indicating greater adherence to UK dietary recommendations. Participants with unfeasible energy intakes (<600 and >4500 kcal/d) were excluded (n=34). DQS scores were divided into quintiles (Q1: ≤35 points; Q5: ≥57 points). All continuous variables were log transformed to normalise data. Associations between DQS quintiles and CVD risk markers were assessed using analysis of covariance (ANCOVA) adjusted for age, sex and ethnicity. Where significant (p<0.05), a comparison between Q1 and Q5 was conducted, with Bonferroni correction for all potential pairwise comparisons. Results are presented as estimated marginal means ±SD. Those in Q5 vs Q1 had significantly lower body mass index (26.9 ±0.2 vs 28.0 ±0.2 kg/m2), waist circumference (90.7 ±0.5 vs 95.1 ±0.5 cm), waist-to-hip ratio (0.86 ±0.03 vs 0.89 ±0.03), serum triacylglycerol (1.15 ±0.04 vs 1.50 ±0.04 mmol/l), total cholesterol to high density lipoprotein cholesterol (HDL-C) ratio (3.52 ±0.06 vs 3.91 ±0.06), CRP (2.67 ±0.32 vs 4.52 ±0.34 mg/l), homocysteine (9.0 ±0.2 vs 11.5 ±0.2 μmol/l), systolic blood pressure (125 ±1 vs 128 ±1 mmHg) and diastolic blood pressure (72.5 ±0.4 vs 75.0 ±0.5 mmHg) and higher HDL-C (1.54 ±0.02 vs 1.44 ±0.02 mmol/l) (ANCOVA: p≤0.007 for all). Higher scores from the novel DQS-UK-2022 were associated with lower CVD risk factors. To strengthen these findings, prospective associations between the DQS-UK-2022 and CVD incidence/mortality will be investigated.

Diet is a major determinant of life course outcomes, yet the accurate measurement of an individual’s dietary intake remains a persistent challenge (1) . Intake biomarkers measured in urine and blood using advanced analytical tools, have proven to be a robust and objective method of measuring the intake of particular dietary components(2-3). The “Standardised and Objective Dietary Intake Assessment Tool” (SODIAT)-1 study aimed to determine the effectiveness of using a combination of dietary assessment technologies, to accurately measure an individual’s dietary intake (4) . A randomised controlled crossover trial recruited 33 UK adults (Male; 14, Female;19) with a median age of 43 years (IQR; 29, 56), across two sites; University of Reading and Hammersmith Hospital, Imperial College London. Participants consumed two 4-day controlled diets, one designed to be compliant and one non-compliant with recommended UK dietary guidance. For each 4-day period participants consumed two separate menu plans, on alternating days. Participants collected nine spot urine samples; First Morning Voids on days 1-5 and Bed Time on days 1-4. Fasted capillary blood samples were self-collected by the participants on days 1, 2 and 4 using the OneDraw blood collection system. Urine samples were analysed by Ultra High Performance Liquid Chromatography UHPLC Triple Quadrupole Mass Spectrometry using a panel of previously validated intake biomarkers (2) . Dried blood samples were analysed using UHPLC High Resolution Mass Spectrometry for lipid biomarkers of dietary intake. All biomarkers were measured as absolute concentrations. Supervised machine learning (Random Forest) was used to determine the extent of discrimination between study diets. Classification accuracies were calculated as mean values from 1000 randomised resamples. Supervised models consisting of 83 urinary biomarkers yielded classification accuracies of 0.975 [95% CI; 0.973 - 0.978], the addition of 154 lipid biomarkers from dried blood samples enabled perfect classification; 1.000 [95% CI; 0.999 - 1.000]. Following recursive feature elimination, the model was reduced to a total of 47 biomarkers, with no loss in classification performance. Top ranked features in the optimal model consisted of triacylglycerols (TAG:53_2, TAG:50_2, TAG:49_1) which sufficiently discriminated between dairy and sugar containing components, and urinary markers of the intake of meat (3-Methyl-histidine, L-Anserine), wholegrains (DHPPA-3-Sulfate) and high anti-oxidant containing components (Protocatechuic acid, Hippuric acid). Biomarkers from spot urine samples and capillary blood samples can provide objective measurements of the intake of dietary components commonly consumed in the UK. Combining urinary and lipid biomarkers into single models, improves performance while extending the coverage of detectable dietary components. These models can serve as a foundation for scalable and objective reporting of dietary intake in free living populations.

INTRODUCTION:Behaviour change techniques (BCTs) are key components of interventions designed to improve health behaviours including eating and drinking. The Behaviour Change Technique Taxonomy v1 (BCTTv1) identifies 93 distinct BCTs. To effectively support practitioners and researchers in nutrition and dietetics, practical examples of these are essential. The aims of this study were to develop examples that illustrate the 93 BCTs in the BCTTv1, focusing on clinical nutrition (CN) and public health nutrition (PHN), and use a Delphi technique to achieve a consensus on their applicability and usefulness. METHODS:Examples of BCTs, described in the BCTTv1, were drafted for CN and PHN. Experts were invited to evaluate them using a 0-5 score and provide comments. Following an initial assessment round, the examples were revised in response to feedback, and a second round of evaluations was conducted. BCTs achieving a mean score of ≥ 4.0 were considered to have reached consensus. RESULTS:Fourteen experts from eight countries participated, including researchers, teachers, and practitioners. After round 1 (R1), consensus was reached in 77 CN examples and 60 PHN examples. After round 2 (R2), average scores significantly increased (CN median [range] R1 4.42 [3.33-4.92], R2 4.73 [3.72-5.00], p < 0.0001; PHN: mean [SD] 4.09 [0.34], 4.46 [0.29], p < 0.0001) and consensus was reached in 85 CN and 84 PHN examples. CONCLUSION:Consensus on the applicability and usefulness of 85 and 84 BCT examples was reached for CN and PHN, respectively. These examples provide a foundation for practitioners and researchers to use when designing and implementing behaviour change interventions.

The diversification of Nutrition Sciences (NS) in recent decades has highlighted the need to review current practices in relation to funding, communication and interaction with stakeholders. The Federation of European Nutrition Societies (FENS) Presidential Activity “Improving standards in the science of nutrition” established three working groups to develop consensus documents. This paper is part of Working Group 2 (WG2) “Organisation, Capabilities and Funding” and aims at describing the European Nutrition Research Landscape, addressing its diversity, challenges and future perspectives. WG2 developed two rounds of questionnaires designed to map the current funding architecture in FENS member countries. Questionnaires were administered to representatives of national NS member societies in 2022 and desk research was carried out to describe the main European Union (EU) sources of funding. Qualitative data analysis was performed on questionnaire data collected and agreed and approved by WG2. 42

BACKGROUND:Evidence suggests that women should eat a healthy diet during pre-conception and pregnancy as this benefits their own health as well as reducing the risk of non-communicable diseases in offspring (such as obesity, diabetes, hypertension, cardiovascular and mental health problems); however, previous work indicates that the recommendations are not being followed. This study aimed to understand: the facilitators and barriers to healthy food and diet practices during pre-conception and pregnancy; how these barriers could be addressed, and the changes required to facilitate good food practices. METHODS:The research used a qualitative approach; five online focus groups were undertaken with 19 women living across the UK who were trying to conceive, pregnant or had babies under 6-months old. Data were thematically analysed. RESULTS:The findings revealed three main themes (Challenges of trying to eat healthily; Facilitators to eating healthily; Changes required) and six subthemes (Mothers' load; Body sabotage; Food environment; Information not individualised; Planning skills; Family support; Co-creation and investment for the future; Access to professional advice). Participants spoke of internal factors (such as tiredness and nausea) and external influences (e.g., their financial situation) that impacted on their ability to eat healthily. They identified the need to access more effective professional advice. CONCLUSIONS:This unique study demonstrated a need for clear, consistent, engaging and culturally appropriate dietary information, as well as access to professionals (such as nutritionists and dietitians) who can give both generic and tailored advice to those trying to conceive and those who are already pregnant.

BACKGROUND:Psoriasis is a chronic immune-mediated skin condition. Evidence supporting dietary management of psoriasis is limited. However, People Living with Psoriasis (PLwP) trial dietary interventions as a management strategy, often taken from popular literature. Social media is a popular source of nutrition information. However, little is known about the dietary information suggested for psoriasis on these platforms. The aim of this study was to explore the dietary approaches suggested for psoriasis on Instagram and evaluate their quality. METHODOLOGY:Cross-sectional content analysis of Instagram posts providing dietary information for plaque psoriasis management, posted under the 12 most popular psoriasis hashtags. Posts were evaluated for quality using the DISCERN instrument. RESULTS:Overall, 138 Instagram posts were analysed. The most common type of dietary recommendation was 'exclusion', most frequently of alcohol and dairy. Detox and 'clean eating' were also frequently mentioned, as well as the inclusion of protein, and adherence to a gluten-free diet. The most common content creators were those with those with lived experience of psoriasis (29.7%). None of the posts were created by qualified nutrition professionals and only 6.5% were by healthcare professionals (HCPs). The majority (99%) of posts identified were of 'poor' quality. CONCLUSION:Most dietary information on Instagram for managing psoriasis is poor quality, restrictive, unsubstantiated and shared by non-HCPs. Therefore, PLwP may be subject to dietary misinformation when using Instagram. HCPs should be equipped to counter diet and psoriasis misinformation. Further research is needed to investigate appropriate ways to provide dietary support for PLwP.

Objective This study aimed to explore the use, experiences and perceptions of diet in psoriasis management among adults with lived experience in the UK.Design Qualitative. Data were analysed thematically using a reflexive thematic approach.Setting Online discussions with adults living with psoriasis in the UK.Participants Nine adults (two men, seven women) ≥18 years of age, living in the UK, English speaking, with a diagnosis of psoriasis of any severity.Results Four key themes were generated: (1) impact of diet, (2) dietary modification, (3) dietary information and (4) dietary support. Overall, the majority (n=8) perceived that diet had an impact on their psoriasis. Most participants (n=7) reported trying restrictive diets including dairy free, gluten free and ‘cleanses’ to help manage their psoriasis with limited success. A perceived lack of dietary support resulted in participants relying on social media and online forums for dietary information. Participants reported a high cognitive burden due to the lack of reliable nutrition guidance and insufficient dietary support from healthcare professionals (HCPs).Conclusions Participants rely on social media and online forums for dietary information, which suggest unsubstantiated restrictive diets that could negatively impact health. Participants felt overwhelmed by dietary recommendations and wanted more relevant dietary support. In the absence of evidence-based dietary information for psoriasis, HCPs need to be able to provide basic dietary support and combat misinformation. Larger studies aimed at understanding how best to support people with psoriasis are needed.

Background: Plant-based milk alternatives (PBMA) are increasingly popular, driven by medical, environmental, or moralistic reasons or perceived health benefit. Objectives: This study aimed to compare the nutritional profile, cost, and environmental impact of all PBMA and dairy milk (DM) in the United Kingdom. Methods: Nutritional information, ingredients, and cost of PBMA (n = 191) and DM (n = 195) were systematically collected from the top 10 supermarkets. Published data on the environmental impact of foods were assessed. Milk was classified per 100 mL by energy (kcal), macronutrients (g), and micronutrients (mg, μg) and mean/median were compared between PBMA and DM. Further analysis stratified milks by DM fat profile. PBMA were categorized according to NOVA criteria. Cost per 1 L and environmental impact were compared for PBMA and DM. Results: PBMA with a similar fat profile to “semi-skimmed” milk had a significantly lower energy content (P < 0.001) and most (except coconut) had a significantly lower saturated fat content than DM. DM provided more protein, carbohydrate, total sugar, and salt and PBMA provided more fiber and total vitamin D. In total, 92% of nonorganic PBMA were fortified with ≥1 micronutrient; 87% with calcium, 34% iodine, 79% vitamin B12, and 56% vitamin B2. PBMA contained between 2% and 16.5% of the “main ingredient,” e.g. “oats.” Of nonorganic PBMA, 97% were classified as “ultraprocessed.” On mean, PBMA (£1.95/L) cost 64% more than DM (£1.19/L). Environmental analysis was conducted but not considered sufficiently robust to draw meaningful results (Appendix A). Conclusions: PBMA cannot be recommended as a nutritional replacement for DM, due to varying nutritional profiles. However, some PBMA will be more beneficial than others depending on an individual's health needs. Cow milk is cheaper than PBMA. Further understanding of the potential health impacts of consuming PBMA is warranted. There is a need for robust, primary research on the environmental impacts of foods.

Introduction Current dietary assessment methods struggle to accurately capture individuals’ dietary habits. The ‘Standardised and Objective Dietary Intake Assessment Tool’ (SODIAT)-1 study aims to assess the effectiveness of three emerging technologies (urine and capillary blood biomarkers, wearable camera technology) and two online self-reporting dietary assessment tools to monitor dietary intake. Methods This randomised controlled crossover trial was conducted at two sites (Hammersmith Hospital and the University of Reading) and aimed to recruit 30 UK participants (aged 18-70 years, BMI 20-30 kg/m2). Exclusion criteria included recent weight change, food allergies/intolerances, restrictive diets, certain health conditions and medication use. Volunteers completed an online screening questionnaire via REDCap and eligible participants attended a pre-study visit. Participants consumed, in a random order, two highly-controlled diets (compliant/non-compliant with UK guidelines) for four consecutive days, separated by at least one-week. Dietary intake was monitored daily using wearable cameras and self-recorded using Intake24 (24HR). Two versions of the online eNutri FFQ were completed: at baseline to assess habitual diet and on day 4 of each test period to record food intake. Urine and capillary blood samples were collected for biomarker analysis. Data analysis will assess dietary reporting accuracy across these methods using Lin’s concordance correlation coefficient. Discussion and ethical considerations The SODIAT project introduced a novel approach to dietary assessment, aiming to address the limitations like misreporting and inclusivity. However, challenges persist, such as variability in biomarker data due to failure to follow sample storage requirements and the practicalities of wearing cameras throughout the day. To protect privacy, participants removed cameras at inappropriate times, and AI removed non-food related images and blurred faces/device screens captured on the images. The accuracy of the tools in a highly-controlled setting will be evaluated in this study. Future studies are planned to validate these tools further in free-living and minority populations.

Students' diets often change when leaving home and starting university due to increased responsibility for their diet and finances. However, there is limited qualitative research with students at UK universities about how their diets change during the transition to, and whilst at university and the reasons for these changes. The aim of this study was to qualitatively explore three topics: 1) specific dietary changes reported by students at UK universities, 2) reasons for these dietary changes and 3) how students can be supported to eat more healthily. Fifteen students (100% female, 54% white) across different academic years (60% undergraduate and 40% postgraduate) from the Universities of Reading and Hertfordshire were recruited. Four online focus groups were conducted, ranging from groups of 2 to 6 participants, using a semi-structured topic guide. Discussions were recorded and professionally transcribed. Transcripts were coded and themes derived for each research topic using qualitative analysis software. After joining university, dietary changes commonly reported by the students included either increased or decreased fruit and vegetable intake, increased snacking behaviour, and increased alcohol and convenience food consumption. Common reasons for changes included limited budget, time management struggles, a lack of cooking skills, and peer influence. Students suggested that reduced cost of healthy foods on campus and cooking classes to learn new skills could help them to adopt a healthier diet. These suggestions could be used to guide future healthy eating interventions for university students.

Dietary assessment methods play a crucial role in evaluating individuals’ and communities’ dietary intake (1). Among these methods, Food Frequency Questionnaires (FFQs) are common in epidemiological dietary surveys. However, with the rapid advancement of technology and increased internet usage globally, innovative digital tools to assess dietary intake have emerged (2). Collaborative efforts between tool developers and dietitians are vital for leveraging technology effectively and advancing evidence-based nutrition practice. Thus, the aim of this study was to explore the: 1) perceived advantages and disadvantages of FFQs, 2) challenges and benefits associated with transitioning from traditional paper-based to web-based FFQs, and 3) opportunities and challenges of integrating a range of new technologies, from established digital tools such as web-based or smartphone applications to more futuristic options such as artificial intelligence and biosensors, into dietary assessment practices and research among researchfocused dietitians with PhD.Seven dietitians from Turkey with extensive experience in using dietary assessment methods were selected using purposive sampling. One-to-one semi-structured interviews were conducted using a topic guide via Microsoft Teams and transcribed verbatim into text-based records. They examined advantages and challenges of paper-based and web-based FFQs, ranked a list of predefined features for FFQ development, and provided insights into technology integration, addressing both the benefits and challenges of incorporating new tools. Preliminary thematic analysis was conducted using NVivo12 software to identify common themes.Participants had an average of 18 years (6-49 years) of experience in nutritional research. Common challenges identified by the group included the absence of validated FFQs in Turkish (n = 5), necessitating the use of FFQs alongside other methods like 24-hour recall (n = 4). General diet representation was commonly appreciated, while all participants deemed paper-based semiquantitative FFQs time-consuming. The top priorities for FFQ enhancement included a semiquantitative feature for nutrient intake calculation, inclusion of portion size photos, and evidencebased development using national diet survey data. None of the participants had employed any digital dietary assessment tools in their research endeavors. However, there was a consensus recognizing the potential benefits and drawbacks of using technology in dietary assessment. Participants highlighted the efficiency (n = 7), increased flexibility in data collection (n = 6), and heightened accuracy (n = 5) associated with technology-based assessment methods as significant advantages. Common concerns included users’ lack of proficiency with technology (n = 6), potential challenges related to the cost of research and development (n = 4), and considerations surrounding data privacy and ethical breaches (n = 3), particularly the unauthorized recording of sensitive information by artificial intelligence in camera-based technology.The insights from Turkish dietitians highlight the necessity for validated Turkish web-based FFQs. While technology-based dietary assessment tools offer research benefits, addressing integration barriers is crucial. These findings will contribute to the development of web-based FFQs and more futuristic dietary assessment tools, advancing evidence-based nutrition practice.

The foundations for child health begin in pregnancy and pre-conception; however, little is known about how health professionals advise prospective parents regarding nutritional needs. The aim of this study was to understand the facilitators and barriers to healthy food and diet practices during pre-conception and pregnancy; how the barrier(s) to healthy diets can be addressed; and the changes required to facilitate good food practices. Three focus groups and four interviews were conducted with 12 UK professional representatives working in health or dietary/nutrition contexts. Participants reported that expectant parents need to understand what healthy eating means and that health and allied health professionals require more nutrition-related education to maximise health promotion opportunities. There is a need for consistent, engaging and culturally appropriate dietary information, as well as access to professionals who can give generic and tailored advice.

In the absence of specific dietary guidelines and perceived inadequate dietary support from healthcare professionals (HCPs), people living with psoriasis (PLwP) often make restrictive or misinformed dietary changes(1) Following self-prescribed dietary modifications without the guidance of HCPs could negatively impact health and well-being (2). There is high demand for dietary advice among both HCPs involved in psoriasis care and PLwP(3). Research suggests that online content about psoriasis treatment is frequently inaccurate and typically not produced by HCPs(4). Therefore, PLwP need easily accessible support to help them navigate the nutritional information they may encounter, to enable them to make evidence-based informed decisions. This study aimed to develop a user-friendly and evidence-based guide to help PLwP in the UK navigate nutritional information.A 4-phase User-Centered Design (UCD) approach was employed, utilising the UCD-11(5) framework, to co-design a guide that provides evidence-based information for nutritional navigation support for PLwP. Phase 1 involved the establishment of an expert panel which included experts in dermatology, nutrition and individuals with lived experience of psoriasis. The expert panel defined the scope and focus of the guide and from this the initial version of the guide was developed. The subsequent phases involved iterative design and content refinement, incorporating feedback from potential users through think-aloud methodology. Subsequently, the expert panel reviewed and provided input to complete the formation of the final guide.The UCD-11 framework effectively engaged prospective users in the design and development of the guide and ensured a user-centered focus. The expert panel provided insights that enhanced the accuracy and relevance of the guide. Iterative design phases incorporated continuous user feedback, improving the quality, usability and visual design of the guide. The think-aloud methodology provided real-time insights into the guide’s clarity and functionality. Participants found the format clear and wording easy to read but made suggestions to improve usefulness. This included: “It would be useful to have more information on what dairy alternatives are and further sign-posting” and “explain what nightshades actually are”. Furthermore, participants highlighted other dietary recommendations they commonly see, and the need for clearer information on these. This feedback facilitated further refinements based on user insights.Developing evidence-based dietary support materials using a co-design approach and UCD framework, resulted in a tailored guide that met the needs of service users. This approach facilitated the creation of user-friendly, evidence-based advice with input from experts and key stakeholders in psoriasis care. Future research should focus on exploring the value of the guide to healthcare professionals involved in psoriasis care. Additionally, monitoring effectiveness and use of the guide, by PLwP and HCPs, will help improve implementation, identify barriers to effective use and inform any necessary updates to the guide.

Healthy diet during preconception and pregnancy is evidenced to benefit maternal health and reduce risk of non-communicable diseases in offspring (such as obesity, diabetes, hypertension, cardiovascular and mental health problems)(1). In the UK, population-based initiatives (e.g., Healthy Start Schemes, drop-in sessions at Family Hubs), and antenatal appointments (7-10) with midwives have the potential to influence dietary behaviours during pregnancy. However, despite policy, guidance and initiatives, nutritional recommendations in the prenatal period are not being met and healthcare professionals can struggle to support the delivery of nutritional advice(1-3). This study aimed to understand: the facilitators and barriers to healthy food and diet practices during preconception and pregnancy; how these barrier(s) could be addressed, and the changes required to facilitate good food practices. The research used a qualitative exploratory approach. Women (aged > 18 years) living across the UK, who were trying to conceive, pregnant or had babies under 6-months old, were recruited to attend a virtual focus group. Focus groups were led using a topic guide including 'prompt' questions; they were audio recorded and transcribed verbatim by a professional agency, and thematically analysed according to the stages offered by Braun and Clarke(4). Ethical approval was granted by the University of Hertfordshire Health, Science, Engineering & Technology Ethics Committee with Delegated Authority [protocol number: HSK/SF/UH/04840]. Five focus groups were conducted with 19 participants (aged 18-44 years). Participants were trying to conceive (n = 3, 15.7%), pregnant (n = 3, 15.7%) or had babies under 6 months old (n = 15, 78.9%). Participants resided in England (n = 6, 31.6%), Wales (n = 4, 21.1%), Scotland (n = 4, 21.1%) and Northern Ireland (n = 5, 26.3%). The findings revealed three main themes (Challenges of trying to eat healthily; Facilitators to eating healthily; Changes required) and eight subthemes (Mothers' load; Body sabotage; Food environment; Information not individualised; Planning skills; Family support; Co-creation and investment for the future; Access to professional advice). Participants spoke of internal factors (such as tiredness and nausea) and external influences (for example, their financial situation and local food environment) that impacted their ability to eat healthily. There was a view that the one dimensional 'do not eat & mldr;' (P16) instruction was 'disempowering' (P1) and in prepregnancy and pregnancy women needed to be empowered to eat healthily. Participants identified online apps, group sessions (as part of antenatal courses) and/or one-to-one advice in GP practices from nutritionists or dietitians, as potential mechanisms for facilitating healthy diets. There is a need for clear, consistent, engaging and culturally appropriate dietary information that is co-created with pregnant women and those trying to conceive, as well as access to professionals (such as nutritionists and dietitians) who can give both generic and tailored advice.

Poor dietary habits are associated with the development of non-communicable diseases(1). Most strategies implemented to enhance population diet quality follow a “one-size-fits-all” standardised approach, often neglecting individual preferences and requirements. Evidence suggests that personalised nutrition (PN) advice, tailored to an individual, can improve dietary intakes(2). This research investigates participants’ subjective feedback from the EatWellUK-2 randomised control trial that compared PN advice versus general dietary guidance, both delivered via eNutri, a web app, developed at the University of Reading. eNutri delivers automated food-based nutrition advice tailored to the user based on their dietary intake recorded by a food frequency questionnaire (FFQ)(3).Participants were disease-free UK adults (>18y) who were randomised to the PN or control group. Participants completed the eNutri FFQ, then automatically received via the app either advice tailored to their dietary intake (PN group) or general population advice based on the UK’s Eatwell Guide (control). Following a 12-week intervention, the FFQ was repeated and participants completed a feedback questionnaire containing open-text and Likert questions assessing agreement with statements (strongly disagree, disagree, neutral, agree and strongly agree). MannWhitney U tests compared the mean ranks between the PN and control groups for each question. Data are presented as percentages of participants who felt positively about each statement based on “agreed” plus “strongly agreed” responses. The study received ethical approval from the University of Reading Research Ethics Committee (08/19) and was registered at ClinicalTrials.gov (NCT03897972).Participants (90% female) had a mean (SD) age of 46 (15) y and BMI of 25.8 (6.1) kg/m2. When asked about the advice received, the responses of the PN group (n = 54) were more positive that “it encouraged me to eat healthily, even if only for short time” (p = 0.045, PN 55.6% vs control 41.8%) and “it was clear what changes I needed to make to improve my diet” (p = 0.011, PN 73.6% vs C 51.8%). When asked to provide an “app review” of eNutri, the control group (n = 55) described their advice as “too general” and “readily available elsewhere”, while the PN group said it contained “varied and realistic examples”, and the advice was “very clear”, “helpful” in relation to choosing “better foods to eat” and allowed people to “assess your own goals”.Participant feedback favoured PN over general population advice as it provided encouragement and clarity about which dietary changes would benefit each individual. Together with the quantitative results from the EatWellUK-2 study, which are still being analysed, these findings will help to assess eNutri’s potential as a useful tool to encourage UK adults to adopt healthier dietary behaviours.