Low and no-sugar sweeteners (LCNS) are used in the food supply, notably within the beverage industry in many countries, where sugar reduction is a key public health concern. In the UK, following the announcement and implementation of the Soft Drinks Industry Levy (SDIL), nearly 9 out of 10 soft drinks contain < 5 g sugar per 100 mL, most of which now contain LNCS. In 2023, the World Health Organisation (WHO) issued a guideline with a conditional recommendation advising that LNCS should not be used as ‘a means of achieving weight control or reducing the risk of non-communicable disease’ (NCDs). This recommendation potentially conflicted with existing recommendations from several authoritative sources at the time, including the Diabetes UK position statement published in 2018 (developed in collaboration with the British Dietetic Association, BDA and the British Nutrition Foundation, BNF), as well as information on the NHS website, which suggests that LCNS can be helpful in reducing sugar intake. More recently, a working group comprising the BDA, BNF and Diabetes UK produced an updated insight document. This review included a re-evaluation of the WHO's systematic review and meta-analysis, alongside the Scientific Advisory Committee on Nutrition (SACN) statement on the guideline. The narrative review outlines the relationship between LNCS and a range of public health outcomes, including weight management, dental health, cardiovascular disease, type 2 diabetes (T2D), cancer and related risk markers such as appetite and gut microbiome composition. The insights document also considered the safety of LNCS and their impact on overall dietary quality. The insight document informed a subsequent joint position statement from the three organisations, highlighting research gaps and providing practical guidance for healthcare professionals to support individuals living with obesity and diabetes in reducing sugar intake. It also includes recommendations for policymakers and identifies actions for the food industry. The Position Statement emphasises that, while LNCS may not directly promote weight loss or reduce disease risk, they can serve as a useful tool for reducing sugar intake at both individual and population levels, at least acting as a ‘stepping stone’ from sugar-sweetened foods and unsweetened food and beverages.

The British Nutrition Foundation convened a roundtable event in January 2024 entitled ‘Meat and the Future of Sustainable Diets: Turning Challenges into Opportunities’, bringing together multi-sector stakeholders to discuss the social, nutritional, public health and environmental aspects of meat consumption within a sustainable food system. Participants explored the challenge of the complexity of balancing nutrition and planetary goals, emphasising the need to navigate trade-offs between various dimensions of sustainability. Whilst recognising the global nature of the issue, the roundtable primarily focussed on a UK perspective. The discussion highlighted the urgency of transforming the food system to achieve net zero, whilst ensuring broader environmental benefits, nutritional adequacy and dietary and health equity across all life stages. Concerns about poor dietary patterns, particularly among vulnerable groups were raised, with participants stressing the need for policies that promote healthy, sustainable and equitable diets without worsening inequalities. These policies should also enhance livelihoods and community wellbeing, foster resilience and support local economies. On the supply side, participants called for better data within the agri-food system, particularly at the farm level. They advocated for a multidimensional, holistic approach that goes beyond greenhouse gas emissions to encompass wider environmental impacts and whole-farm benefits, such as enhancing soil health, promoting biodiversity, improving water management, supporting nutrient cycling and boosting farm-level resilience through diversified cropping systems. Roundtable participants acknowledged existing recommendations to reduce meat consumption for both environmental reasons, such as land use and greenhouse gas emissions, and health concerns, as evidence links red, particularly processed, meat consumption with increased colorectal cancer risk. Given the variation in meat consumption globally and even locally between individuals, the discussion explored the potential of targeted campaigns to reduce high meat intake, along with the role of public food procurement and the food industry in decreasing processed meat consumption. The consensus was that dietary changes must be framed within the context of a balanced diet and broader sustainability concerns. Despite some differing viewpoints on implementation, participants agreed that transitioning to healthier, more sustainable diets is a priority. Collaboration across the entire food chain, from farm to fork, with investment in innovation, robust data collection and research, alongside policy support, was emphasised as essential to achieving this goal.

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term.

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

The foods and beverages that people consume have a profound impact on their health. Unhealthy diets are a major contributor to the global burden of disease (GBD, 2017). Worldwide, 39% of adults are underweight or obese, 31% are affected by hypertension and 69% of women of reproductive age are affected by one or more micronutrient deficiencies (GBD, 2017). At the same time, undernutrition continues to cause nearly half of deaths in children aged under 5 years and impacts the ability of many more to achieve their full economic, social, educational and occupational potential (WHO, 2021). Our food systems cause substantial environmental destruction, accounting for 34% of greenhouse gas emissions and 70% of freshwater withdrawals (Mbow et al., 2019). To support optimal health and wellbeing, we need to produce nourishing, sustainable food for nearly 8 billion people across the world and this will increase to 9.7 billion by 2064 (UN, 2019). The United Kingdom with its recognised strength in nutrition research, nutrition data and nutrition policy should be an important contributor to the global response to this challenge. But to maximise its impact, research needs to be translatable to public health benefits. To achieve this, partnerships between funders, researchers and industry are needed and such partnerships will unlock greater investment in innovation. New funding from the Biotechnology and Biological Sciences Research Council (BBSRC), with support from the Department for Environment, Food and Rural Affairs (Defra), Innovate UK and the Medical Research Council (MRC) into the Diet and Health Open Innovation Research Club (OIRC) provides such a platform for businesses, researchers, UK Government and wider stakeholders to develop collaborations to address shared barriers to innovation across the food and drink sector. The investment of almost £15 million has created six new OIRC innovation hubs (see below), bringing together leading academics and experts from nutrition, food and behaviour science, tackling key strategic themes to address some of the most pressing topics associated with improving the diets of our nation. This will build on the legacy of the DRINC programme, which brought together the diet and health research community and industry to learn from one another (Buttriss, 2022). Nutrition research has provided invaluable evidence that has shaped our current national dietary guidelines and holds the key to better understanding of how diet may influence the major causes of ill health such as obesity, cardiovascular disease, diabetes and cancers (Williams et al., 2021). Effective partnerships between academia and the industry sector, including agriculture, retail and food production, are key to ensuring the translation of research advances into healthier and more sustainable products and improved nutrition. The food environment is commonly cited as a major driver of obesity, by providing a large supply of relatively inexpensive, highly palatable, energy-dense foods that are easily accessible, convenient to consume and heavily marketed (Dimbleby, 2021). Although recent policies have driven the reformulation of core products, which is an important part of meeting the challenge, this can only take us so far on the journey to healthier and more sustainable dietary patterns. Concerns have also been expressed about the health effects of ultra-processed foods and there is a need for a better understanding of the role of processing on the physiological response to foods (Berry et al., 2023). Innovation and new product development are crucial contributors to the solution. However, there are challenges in the costs associated with innovation and developing healthier products that respond to consumer demands for palatability, affordability, safety and convenience but are more sustainable and with cleaner labels. Sharing of high-quality research can help ensure that investment in innovation is driven by the best evidence-based nutrition and science, rather than being led by consumer trends. Encouraging wider and more accessible public dissemination and improving nutrition literacy can encourage consumers to make better-informed choices. Knowledge emerging from nutrition science also plays a central role in informing public health programmes, policies and clinical management of health service delivery but stronger cross-sector and cross-disciplinary partnerships are crucial to ensure the research base is better placed to tackle the major global nutrition research challenges. It is also critical to frame future research priorities against the backdrop of rising food insecurity, the cost-of-living crisis and the urgent need to change the way our food is produced to mitigate the worst environmental consequences. Addressing these issues requires a better understanding of the multi-level, interrelated biological, individual, social and environmental determinants of food choice and the corresponding translational solutions. However, the current pace of advances in nutritional knowledge and innovation has been insufficient to address the burgeoning rates of diet-related illness and the associated societal and economic consequences. In 2017, the Office for Strategic Coordination of Health Research (OSCHR) Review of Nutrition and Human Health Research (Buttriss et al., 2018; MRC & NIHR, 2017) set out a future vision for nutrition research and developed a series of recommendations to capitalise on UK strengths and tackle weaknesses to revitalise the UK nutrition research base. However, nutrition research was described as fragmented and lacking in critical mass, and the need for a high-level, national strategy requiring greater leadership was identified (Mathers, 2022). The Review recognised that high-quality, multidisciplinary nutrition research and effective collaborations are key to improving global health and concluded that transformative thinking and action would be needed to ensure that this nutrition research remains innovative and forward-looking. To achieve those goals, several recommendations were made aiming to re-invigorate and strengthen the field, whilst capitalising on existing strengths. One of these was a partnership with industry: outlining that industry should be considered a part of the solution, not least because the sector is key to ensuring the translation of research advances into healthier products or improved nutrition support. OIRC is a continuation of the BBSRC's long-standing support for a scientific area, diet and health, that is vital to the wellbeing of the UK population, and, like previous initiatives, it is structured to engage industry in recognition of their role in progressing shared challenges. Research is a cumulative process, and the interconnected flow of information is key to the uptake of evidence into policy and practice. The British Nutrition Foundation is delighted to have been appointed by the BBSRC to act as a coordinator across the six OIRC hubs, to help facilitate conversations between the research community, industry and policymakers, identify areas where innovation and transformative thinking are needed and support the development of open, transparent collaborative partnerships. It is also hoped to widen the reach to educators (including schools, teachers and health professionals) and investors. The Foundation will extend the engagement of the hubs with the global research community (e.g. via its international working and advisory groups and its peer-reviewed academic journal, Nutrition Bulletin) to ensure that learnings influence health and wellbeing across the world. With its long history of convening, and bringing together academics, government, industry and other stakeholders, it is well placed to support the OIRC hubs to share findings across the food system and help researchers to develop clear policy recommendations. Together the six innovation hubs will provide thought leadership for the United Kingdom through advancing research and innovation and, by building cross-sector collaborative networks, and will help build capacity across the United Kingdom to focus on the most pressing topics associated with improving the diets of our nation. The six hubs cover the breadth of the identified five key strategic research priorities and identify and establish specific challenges within the focus of each theme. Each will offer annual awards including Business Interaction Vouchers (up to £50 000) to strengthen collaborations between academia and industry; Feasibility Awards (up to £100 000 with expected matched cash or in-kind contributions from industrial collaborators) for projects at a more advanced stage to enable translation and commercialisation activities leading to innovation; and Flexible Mobility Awards to support early career researchers, technicians, industry workers and others that wish to expand their skill base. RIPEN Hub: https://www.ripenhub.co.uk. TRanslational Innovation Hub for Population HEalth using Food and Nutrition approaches to enhance Positive Physiology. Lead investigators: Professor Gary Frost, Imperial College London, Professor Susan Lanham-New, University of Surrey, Dr Sue Gatenby, PepsiCo. Hub manager: Dr Katerina Petropoulou, Imperial College London. To join: https://www.imperial.ac.uk/metabolism-digestion-reproduction/research/digestive-diseases/nutrition-research/ripen-hub/. The RIPEN Hub will support research and translation activity that bridges the gap between biosciences research and development to better understand the interplay between food components and human physiology, and to ultimately improve health. It will provide thought leadership, develop partnerships and build critical mass in the areas that affect food and its consumption in relation to human physiology. A specific aim is to develop talent and a vibrant environment for this field, supporting the next generation of young scientists in this area. Biofortification Hub: https://biofortificationhub.org/. Innovation Hub for improving health and nutrition through biofortification. Lead investigators: Professor Martin Warren, Quadram Institute Bioscience and Professor Cathie Martin, John Innes Centre. Hub manager: Dr Philippe Vain. To join: https://biofortificationhub.org/apply-for-membership/. The Biofortification Hub aims to leverage expertise in soil, crop genetics, food innovation and human health to strengthen the United Kingdom's position as a world leader in the research and commercialisation of biofortification (the development of crops and foods with higher levels of nutrients). It will work with a community of food producers across the supply chain, industry, policymakers and researchers who can collectively address challenges to the biofortification of food and feed crops, seeking to deliver new, real-world applications. Consumer Lab Hub: https://consumer-lab.bristol.ac.uk/. Building academic-industry partnerships to ensure sustained acceptance of healthy foods. Lead investigators: Professor Jeffrey Brunstrom, University of Bristol, Professor Louise Dye, University of Leeds, Dr Danielle Ferriday, University of Bristol, Lisa Kehoe, University of Bristol and Dr David Mela, industry consultant. To join: https://consumer-lab.bristol.ac.uk/hub-membership/. This hub aims to develop a distributed UK-wide ‘consumer lab’ comprising a network of industry and academic members with a portfolio of interdisciplinary methods to investigate food product appeal and consumer choice and dietary behaviours in everyday places (e.g. home, cafés and school canteens). There is a clear need for better tools to understand food choice and how better food products can be accepted in real-world settings. We also need to understand more about how changes to food packaging, labelling and processing can influence people's preferences. The Hub will prioritise research aimed at studying food choices in groups at risk of food insecurity to help the food industry address their specific needs. INFORM Hub: https://research.reading.ac.uk/inform-innovation-hub/. Investigating the role of Functional foOds and beveRages to iMprove health and recovery. Lead Investigators: Dr Gemma Walton, University of Reading, Professor Kieran Tuohy, University of Leeds. Hub Management Committee: Prof Glenn Gibson, University of Reading, Dr Kirsty Hunter, Nottingham Trent University, Lorraine Bailey, University of Reading, Dr Sue Gatenby, PepsiCo UK. Hub Manager: Fiona Lee, University of Reading. To join: https://research.reading.ac.uk/inform-innovation-hub/become_a_member/. The INFORM Hub aims to foster a relationship between academics and industries to initiate and grow new collaborations seeking to understand more about functional foods and support translational research activities. The focus will be on prebiotics, probiotics and plant stanols that can all impact positively on gut microbiota. The Hub will seek to identify research needs underpinning the development of functional foods that target health and recovery through alteration of the gut microbiome and drive forward research in these areas. It will look to provide expert advice to policymakers based on strong scientific evidence and support research development with industry focusing on functional products for bespoke use targeting recovery from exercise fatigue, inflammation, mental stress and post-illness to promote improved health. i-NutriLife Hub: https://www.i-nutrilife.org/. Innovative Nutrition solutions for Lifecourse Health. Lead investigators: Professor Philip Calder, Professor Jonathan Swann, Professor Keith Godfrey and Associate Professor Caroline Childs, University of Southampton; Professor Louise Dye, University of Leeds; Dr Miriam Clegg, University of Reading; Professor Simon Carding, Quadram Institute Biosciences; Dr Albert Koulman, University of Cambridge, Hub Manager: Julie Hickman, University of Southampton. To join: https://www.i-nutrilife.org/apply-for-membership/. The Hub focuses on research across the life course emphasising the role of good nutrition in promoting early life development, in sustaining function and resilience through adolescence and adulthood, and in promoting healthy ageing. The Hub seeks to work with academic researchers and industry to develop and test novel strategies for enhancing the quality of food and beverages to improve nutrition across the life course. This Hub aims to catalyse novel collaborative research to understand how factors such as age, sex and ethnicity modify the diet-physiological function axis and the mechanisms behind this, providing the basis for translation to more healthful foods and beverages that can change biological and physiological processes to better meet consumer needs. STAR Hub: https://www.surrey.ac.uk/start-healthy-stay-healthy-star-hub. Start healthy – Stay Healthy: Aligning Public and Planetary Health Through Precision Plant-Based Dietary Solutions across the Life course. Lead investigators: Director Dr Kourosh Ahmadi, University of Surrey. Co-Directors Professor Claire Williams, University of Surrey, Professor Helene McNulty, Ulster University, Professor Thomas Hill, Newcastle University, Professor Louise Dye, University of Leeds. Hub Manager: Brita Terpe, University of Surrey. Join at: https://www.surrey.ac.uk/join-star-hub. The STAR Hub aims to consolidate the activities of communities working on novel plant-based products and to highlight opportunities for industry to exploit this evidence through further research and development. This will involve academia to produce innovative plant-based products, services and systems that are targeted and tailored to specific life stages to improve and maintain cognitive and mental health across the life course. The Hub's focus is on polyphenols, fibre and resistant starch, alternative plant protein sources and the improvement of existing or novel plant-based foods. Together the Hubs provide a cross-cutting, innovative opportunity to advance nutrition research across a wide range of areas and to create a collective voice which is translatable, implementable, and maximises the impact of research. The British Nutrition Foundation urges all interested parties from academia (including Early Career Researchers), the food industry (especially Small to Medium-size Enterprises), government, civil societies and charities to sign up for relevant Hubs to keep informed about workshops, meetings, events and funding calls. Membership is free so do not miss this timely opportunity to work collaboratively to help provide solutions for UK diet, health and nutrition challenges. Data sharing not applicable – no new data generated.

Oxygen metabolism produces a series of oxygen free radicals (ROS), which are highly unstable and can lead to functional impairment or damage of lipids, proteins and DNA. This process is known as oxidative damage. Antioxidants have the ability to scavenge and neutralize free radicals, or are necessary to enable other molecules to perform such a function. The body's antioxidant system is complex and prevent formation of ROS and terminate chains of ROS-initiated peroxidation of biological substrates. Antioxidants present in the diet include vitamin C, vitamin E, carotenoids and polyphenols. Metals and minerals that are key components of antioxidant enzymes, such as zinc or selenium, are also referred to as antioxidants. Many antioxidants can also act as pro-oxidants in certain conditions, such as the presence of transition metals or at high concentrations. Intervention studies demonstrating higher risk of cancer in smokers with β-carotene supplementation have, for example, attributed this finding to its pro-oxidant effect.

Claims about the nutritional and health benefits of foods and drinks crop up all over the place. But are all claims authorised, thereby based on robust scientific evidence, and compliant with legislation? For example, such claims cannot be associated with alcoholic drinks (Advertising Standards Authority, 2022). And what regulatory processes exist to protect the public? The regulation of nutrition claims and health claims is the subject of a new Position Paper from the Academy of Nutrition Sciences (Ashwell et al., 2022). This article is protected by copyright. All rights reserved.

Context Considering the accumulation of recent studies investigating the health effects of walnut consumption, both including and beyond cardiovascular health effects, a systematic review of this literature to investigate the strength of the evidence is warranted. Objective To investigate associations between walnut consumption and outcomes with public health relevance (specifically all-cause mortality, type 2 diabetes, CVD, metabolic syndrome, obesity, cancer, neurological and mental health, musculoskeletal, gastrointestinal, and maternal disorders) and the effect on associated disease risk markers, reported in studies published from 2017 to present. Data Sources MEDLINE, FSTA, CENTRAL, and Scopus were searched from 1 January 2017 to 5 May 2021. Data Extraction Human studies (cohort studies and RCTs) >= 3 weeks in duration comparing consumption of walnuts (whole, pieces, or 100% butter) to a control and measuring associations with relevant public health outcomes and disease risk markers were assessed. Key study characteristics were extracted independently by 2 investigators using a standardized table. The quality of the studies was assessed using the Cochrane Risk-of-Bias tool 2.0 and the Newcastle-Ottawa Scale. Data Analysis Only 1 RCT was considered to be at low risk of bias for any of its outcomes. The cohort studies were considered to be of moderate or high quality. The results were synthesized using vote counting, based on the direction of effect. Thirty-three articles, 23 describing RCTs (walnut dose similar to 10-99 g/day, 1,948 subjects) and 10 describing cohort studies (similar to 675,928 subjects), were included. Vote counting could be performed for the blood lipids, cardiovascular function, inflammation- and hemostatic-related factors, markers of glucose metabolism, and body weight and composition outcome groupings. The results are presented in effect direction plots. With respect to blood lipids, results from 8/8 RCTs favoured walnuts, in accordance with associations with a reduced risk of CVD suggested by cohort studies; results from 6/6 RCTs favoured control with respect to body weight and composition, although most of these effects were small. This was contrary to cohort study results suggesting small benefits of walnut consumption on body weight. There was no overall consistent direction of effect for cardiovascular function, markers of glucose metabolism, or inflammation- and hemostatic-related factors. Conclusions Evidence published since 2017 is consistent with previous research suggesting that walnut consumption improves lipid profiles and is associated with reduced CVD risk. Evidence is accumulating in other areas, such as cognitive health, although more research is needed to draw firm conclusions. Systematic Review Registration PROSPERO registration no. CRD4202122.

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

Dr Gail Goldberg sadly passed away unexpectedly after a short illness on 10 November 2019 at home in Cambridge. By many she will be remembered for her work on developing the ‘Goldberg cut-offs’, a method still widely used to assess the credibility of dietary assessments based on reported energy intakes and predicted energy requirements and to identify biologically implausible reporters. The use of the ‘Goldberg cut-offs’ has enabled the extent of bias in energy reporting to be assessed and, to a degree, adjusted for in many different areas of nutrition research. However, she went on to become an acknowledged expert in many other areas of nutrition, including pregnancy and lactation, energy requirements and calcium metabolism and bone health. Gail was born on 15 December 1960 as the eldest child of Leonard and Barbara Goldberg. The family, including her younger brother, Trevor, initially lived in a flat in Wood Green and, in 1966, moved to a house in the leafy suburban London Borough of Enfield. Gail attended the local primary school and at the age of 11 years started at Tetherdown School in Muswell Hill. It was a grammar school at the time, later made famous, whilst Gail was in sixth form, by Hunter Davis with his book ‘The Creighton Report: A Year in the Life of a Comprehensive School’. Gail's headmistress was Molly Hattersley, wife of Roy Hattersley, who was Shadow Secretary of State for Education at the time, under Harold Wilson. The school was therefore frequently in the public eye! In 1978, the family moved to Melbourn in Cambridgeshire and Gail commuted to school in London to complete her A Levels in Physics, Chemistry and Biology. Her interest in science was encouraged by her father, an engineer, and they always enjoyed talking about science and frequently read the New Scientist together. In 1979, Gail began a degree in Biological Sciences at The University of East Anglia in Norwich. On completion of her degree, she joined the Medical Research Council's Dunn Nutrition Unit in Cambridge in 1983, working in a group that focussed on vitamins and minerals. Her long association with research projects in The Gambia began around this time when she analysed the calcium content of a range of Gambian foods. However, Gail was soon snapped up by another group at the Dunn, who were carrying out ground-breaking studies into energy metabolism, and was closely involved with all aspects of their research, now the stuff of textbooks. The Energy Group was interested in measuring energy balance more accurately, and conducted detailed experiments where they used a calorimeter, in which volunteers stayed for prolonged periods, to measure energy expenditure, whilst they were put on specific diets or exercise regimes and a BOD POD to measure changes in body composition. They also pioneered the doubly labelled water technique to measure the energy expenditure of volunteers during day-to-day activities. The huge improvements in the ability to measure energy balance more accurately led to an increased awareness of the problem of misreporting in dietary assessments and prompted Gail to publish a method for identifying potential misreporters, now known as the ‘Goldberg cut-offs'. These cut-offs have proved very useful and have been cited by nearly 2000 subsequent publications. Gail quickly became an acknowledged expert and her published papers culminated in a PhD from the Ulster University in 1999. The Energy Group also conducted studies at the Dunn's research site in Keneba, The Gambia, and Gail was involved in these too. Sometimes this took her to Keneba to run and oversee projects. One such memorable study was designed to measure energy expenditure during hard physical work in the tropics. This involved volunteer men from Keneba village collecting laterite soil in wheelbarrows from a pit some distance from the village and, after multiple trips over several days, creating a roadway from one end of the village to the other. Although this study took place many years ago, ‘Gail's Road’ can still be seen in Keneba, and in recent visits to the village Gail would be greeted by one of the men involved with gleeful shouts of ‘push-pusho’ (Mandinka for wheelbarrow) followed proudly by the number he and his wheelbarrow had been given in the study. In 1999, Gail joined the British Nutrition Foundation in London and started a career in nutrition communication, being involved in media work, writing and editing. She became an editor of Nutrition Bulletin, helping the journal to move to a new publisher and grow in terms of its readership and circulation. She also edited a Task Force report on Plants: Diet and Health, chaired by Professor Malcolm Jackson. This reviewed the evidence for protective effects on health of the wide range of substances in plant foods – a subject still so topical today. In 2001, Gail became a UK National Network Leader for Flair-Flow Europe 4 (a 5th Framework Concerted Action project), producing tailored information about EU-funded food and nutrition projects disseminated to health professionals, food producers and consumer groups in 24 countries. During her 4 years at the Foundation, she was pivotal in helping the Science Director at that time, Professor Judy Buttriss, to shape the direction that the science programme has followed for the past 20 years. But just as importantly, as Senior Nutrition Scientist, she mentored and supported members of the science team, always providing useful critique in a sensitive and caring manner. She was highly valued by all for her measured, considered and calming approach to any issue – attributes that were particularly helpful when dealing with journalists! During this period, she also served on the Publications and Programmes Committee of the Nutrition Society, to which she contributed for many years. Gail returned to the MRC Human Nutrition Research (later renamed the Elsie Widdowson Laboratory) in 2003 and worked alongside Professor Ann Prentice, the Director of the Laboratory, who was still leading active research teams in Cambridge and The Gambia, with collaborations all over the world. Gail helped to run and manage the group, supervising students, mentoring PhD and post-doctoral scholars and taking forward a wide range of projects. Gail led the theme of Nutrition and Population Health in the group, continuing her interests in pregnancy and lactation and dietary assessment. She was also an active member of several societies and committees, and taught on the MSc courses at the University of Surrey, as well as London School of Hygiene and Tropical Medicine (LSHTM) where she became an honorary professor. Gail was a consummate ‘team scientist’, who enjoyed working with the whole group to ensure their studies were conducted to the highest possible standards and tirelessly chased down missing data or sorted out an inconsistency until she had a satisfactory explanation. In recent years, Gail's research projects in places such as China, Bangladesh, Uganda and South Africa or when she presented results from their studies at international conferences, most recently in Japan, enabled her to pursue an interest in meeting new people, finding out about local customs and foods, catching up with old friends and just being part of the wider community. Outside her professional career, Gail had a passion for music, the theatre and all things related to arts, culture and history. Her many friends and colleagues would agree that she was a gentle, warm, generous soul, who was always interested in you, quietly supportive and never intrusive and she will be missed by them all.

The continuing global increase in the prevalence of overweight and obesity, particularly amongst children, attracts widespread public and political attention. Obesity is a complex condition, with multi-faceted determinants, and prevention strategies require consideration of dietary and lifestyle patterns alongside a range of environmental factors. Reduction in intake of sugar-sweetened beverages and foods is advised around the world as part of healthier dietary patterns to help reduce energy intakes, obesity risk and obesity-related disorders. Current intakes indicate that this is challenging and will likely require a concerted approach with a broad range of interventions including fiscal measures. In recent years, after some notable success with salt andtransfats, there has been considerable focus on food reformulation to support the reduction in population intakes of free sugars from manufactured foods, often without need for consumer behaviour change. In some products, particularly sugar-sweetened beverages, reformulation is relatively easy and has been widely achieved, as the sweetness of sugars can be replaced with low-calorie sweeteners. However, other products, in which sugar delivers a variety of functional properties, are more challenging to reformulate to maintain consumer acceptance and achieve a reduction in energy, alongside sugar, content. This paper will look at current definitions and recommendations for free (or added) sugars, as well as key dietary sources and trends in intakes, and explore various strategies to promote population reductions in intake of sugars for public health, including the opportunities and challenges presented by reformulation using low-calorie sweeteners. Ultimately strategies to promote sugar reduction, including reformulation, should adopt a holistic approach that considers wider dietary recommendations.

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.

This chapter contains section titled: Definitions Pathogenesis Epidemiology of Cardiovascular Disease Risk Factors for Cardiovascular Disease Role of Diet Structure of the Report Key Points Key References

Weight management programmes have been shown to be effective interventions that encourage clinically relevant weight loss. The aim of a weight management programme is not only to achieve weight loss, but also to support long-term weight maintenance and for that reason their suitability in helping people to meet the key dietary recommendations for health must be considered. The British Nutrition Foundation was asked to investigate whether the Slimming World weight management programme is consistent with current nutrient and food-based recommendations, and whether Slimming World members following the programme are typically eating diets meeting these recommendations in the 'real world'. This was to help inform any potential refinements to their dietary approach. A three-stage approach included a review of Slimming World's dietary approach resources, nutritional analysis of Slimming World's example menu plans and dietary analysis of 40 7-day weighed food diaries completed by adult female Slimming World members. The Slimming World dietary approach reflects many of the main messages in the UK's Eatwell Guide and generally accepted healthy eating advice. Several observations were made with indications for potential changes in relation to key food groups. Nutritional analysis of the 7-day menu plans suggests that a Slimming World member following a provided example menu plan could meet many of the UK dietary recommendations that were analysed in this review. Food diary analysis suggests the Slimming World study sample on average met dietary recommendations for total fat, saturated fat, calcium, salt and 5 A DAY. In comparison, national dietary surveys report that the average UK adult female population meets the total fat and calcium recommendations, but is not meeting the recommendations for saturated fat, salt and 5 A DAY. The study sample did not meet the recommendations for intakes of fibre and free sugars and oil-rich fish, but these were still closer to recommendations than the average UK adult female population. High intakes of red and processed meat and alcohol were observed amongst some of the study sample. Overall, the findings suggest that despite a reduction in energy intake, adult females following this weight management programme may be consuming a diet that more closely meets UK dietary guidelines when compared with the average UK adult female population.

Globally, more people die from cardiovascular disease (CVD) each year than from any other cause. The recently published Global Burden of Disease Study reported CVD to be responsible for 10 million deaths in 2017, and 207 million disability-adjusted life years (DALYs) (Afshin et al. 2019). In the UK, the condition accounts for a quarter of all deaths – that's over 150 000 each year (British Heart Foundation 2019). CVD mortality rates have been declining in the UK and many other western European countries, as well as in the US, since the 1960s. This is thought to be due to improved prevention strategies and advances in treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, the personal and national burden of CVD comes not only from deaths, but also from living with the disease. As survival rates after experiencing a heart attack or stroke have improved, the number of people living with the condition remains high; it is estimated that around seven million people in the UK are currently living with cardiovascular conditions (BHF 2019). Healthcare costs relating to heart and circulatory diseases are estimated at £9 billion per year (BHF 2019). The underlying cause of most CVD is atherosclerosis, a slow, progressive process associated with ageing that is heavily influenced by lifestyle factors, such as smoking, physical inactivity and poor diet. Thus, many cases of CVD are preventable by changing diet and lifestyle behaviours; estimates suggest this could be around half of all CVD deaths. Seminal studies since the mid-20th century have improved our understanding of CVD risk factors in both populations and individuals. The Framingham Heart Study, launched in 1948, provided evidence for multiple CVD risk factors, leading to the conception of the Framingham Risk Score algorithm to determine an individual's future cardiovascular risk. Researcher Ancel Keys established the Seven Countries Study in the 1950s, which studied populations in countries including Japan, Greece, the US and Finland and found large variations in diet and blood cholesterol levels in relation to coronary heart disease risk. The average level of blood cholesterol correlated positively with both the incidence of heart disease and with the saturates:polyunsaturates ratio of the diet, leading to raised blood cholesterol becoming the first well-documented risk factor for developing heart disease. Subsequent large epidemiological studies have improved our knowledge of the major modifiable risk factors for CVD development, or the so-called ‘classical risk factors’ which include raised blood pressure, obesity, smoking, type 2 diabetes and physical inactivity, and further developed risk-prediction algorithms and cardiovascular risk models for men and women (Ridker et al. 2007; Assmann et al. 2002; Menotti et al. 2003). However, whilst these factors undoubtedly remain influential, they cannot explain all risk or the regional, gender, socioeconomic and ethnic differences in the disease that we see, prompting the search for other novel risk factors that may play an important role in the development of CVD. Investigation of such factors helps to improve knowledge of the mechanisms of vascular disease and identify new targets for potential therapies. The first edition of the British Nutrition Foundation's (BNF) Task Force Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors brought together leading academics to review the suggested novel, or emerging, risk factors which were being widely researched at that time for their links with CVD (Stanner 2005). However, as the field has moved on vastly over the past 15 years, an update of this popular report seemed timely and the Task Force was reconvened to consider how research has altered our thinking in the intervening years. We were delighted that Professor Keith Frayn, Emeritus Professor of Human Metabolism, University of Oxford, agreed to chair this once again and that many of the original members of the Task Force were able to be involved. When writing the chapters, authors were asked to consider how recent research has changed our thinking about the importance of each risk factor in relation to CVD risk, and its associations with diet and lifestyle (Stanner & Coe 2019). Understanding of the mechanisms by which the classical risk factors may influence CVD risk has improved considerably since the last edition was published. Indeed, clearer links between CVD and metabolic derangements, especially type 2 diabetes, have led to the use of the term ‘cardiometabolic risk’ to cover the combined risk of both CVD and metabolic disease. Research has also strengthened the available evidence for some of the ‘emerging’ factors identified by the Task Force in the first edition, both in terms of their role in CVD risk and links with specific dietary components (Stanner & Coe 2019). For example, it is now widely accepted that the early life environment influences adult disease, possibly via tissue re-modelling (permanent changes in the structure of key metabolic tissues during critical periods of development, from which they cannot later recover) and epigenetic changes. Unhealthy adult lifestyles (e.g. smoking) add to the vulnerability resulting from intrauterine programming and have been shown to have a greater effect on risk in people born at a lower birth weight. This supports the need to improve the nutrition of women of childbearing age, as well as to instigate primary prevention measures in early life and focus on diet and lifestyle choices across the life course to retard atherogenic processes. Conversely, evidence of a causal direct association between some of the risk factors that were ‘emerging’ at the time of the first edition has waned (e.g. homocysteine). New risk factors have also emerged; the notable new chapter in this second edition being on the role of the gut microbiome. There is increasing evidence that compositional bacterial changes of the gut microbiome have a role in reducing cardiovascular risk with postulated mechanisms including the action of bacterial fermentation metabolites (primarily short-chain fatty acids) on lipid and glucose metabolism and satiety hormones, and via the putative effects of bacterial energy harvesting on adiposity. Knowledge of the effects of individual nutrients and foods on different risk factors and the mechanisms involved has progressed considerably over the last 15 years, and many of the dietary messages have been clarified, particularly in relation to carbohydrate and fat quality. We now know that when reducing the saturated fat content of the diet, what is used as a replacement is key: substitution with unsaturated fatty acids can lower blood cholesterol and reduce risk, whilst replacement with refined carbohydrate has no benefit (Griffin 2017; Antoni & Griffin 2018; Minihane 2018). Replacing saturates with unsaturates may also do more than just improve blood cholesterol; it could have benefits on other risk factors including inflammation, endothelial function and platelet activity. Similarly, evidence has accumulated for the link between high-sugar consumption and its role in excess energy intake and obesity risk, and also for a beneficial role for dietary fibre in cardiometabolic health, leading to the government's revised dietary recommendation for adults of 30 g of fibre per day (SACN 2015). The potential mechanisms for this association have broadened – for example, specific fibres have been shown to be modulators of the gut microbiome, which is thought now to impact broadly on human health and disease. Research into the role of diet in CVD has historically assessed the role of single nutrients, but this strategy does not consider that meals are consumed as a combination of nutrients and foods that have the potential to interact with each other. As discussed in the paper by Professor Judy Buttriss, the importance of dietary patterns over individual nutrients is increasingly recognised, with remarkable consistency in associations between healthy dietary patterns and decreased disease risk (Buttriss 2019). This is important in the context of an ageing global population and the need to reduce risk of other conditions such as cancer and dementia. Healthy dietary patterns are typically characterised by higher consumption of vegetables, fruit, wholegrains, lower fat dairy products, seafood, nuts, seeds and legumes, and lower intakes of fatty or processed meat, refined grains, sugars-sweetened foods and beverages, salt and saturated fat. Dr Hyang-Min Byun from the University of Newcastle describes her interesting finding in this issue of Nutrition Bulletin of the association between mitochondrial DNA methylation with both CVD risk and the Mediterranean diet in overweight and obese subjects, work supported by a BNF Drummond Pump Priming Award (Byun 2019). The new Task Force report also emphasises the importance of a healthy diet over supplementation. Despite the widespread interest in a number of micronutrients including B vitamins, antioxidants, and vitamin D, as well as omega-3 fatty acids, in relation to several risk factors, no supplement has yet been shown to be effective in CVD prevention. This again highlights the effects on health of diet as a whole, rather than isolated nutrients having the greatest beneficial impact on health. As well as diet, other lifestyle factors should be considered by all those involved in advising on CVD prevention. The benefits of physical activity, as well as physical fitness, have been well documented, with both offering reduced CVD risk of similar magnitude (15–35% across studies). The greatest population benefit appears to be from moving from low to moderate levels of activity and fitness, suggesting that small changes at a population level could offer significant public health benefit. Sedentary behaviour is now widely believed to increase the risk of heart disease, with physical activity being suggested to attenuate, but not eliminate, the increased risk associated with high sitting time. Therefore, minimising time spent in sedentary activities, such as watching TV, using the computer and travelling by car, bus or train, should be encouraged as well as promoting the benefits of regular exercise. Sleep duration and quality have also been linked to an increased risk of CVD, type 2 diabetes, hypertension and obesity. The link between sleep and bodyweight is explored in more detail in this issue (Gibson-Moore & Chambers 2019). Key messages from the second edition of the report have been translated into a consumer resource providing practical tips on diet, bodyweight, quality of sleep, stress management and alcohol consumption, for example, to protect against heart disease and stroke (https://bit.ly/2BYRc7z). Sleep is also the focus of a new challenge for BNF Healthy Eating Week 2019, taking place on 10–14 June. BNF Healthy Eating Week is a dedicated week in the year to encourage organisations across the UK (including workplaces, universities, and schools) to focus on healthy eating and drinking, and physical activity, and celebrate healthy living. To register your organisation for free, visit https://bit.ly/2HDO3PE. The new Task Force report Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors, 2nd Edition was published in February 2019 and is available at https://bit.ly/2A3UQLt. A summary of the key messages in a Q&A format is available free to download at https://bit.ly/2D2MbLA.

Interesterification rearranges the position of fatty acids within triacylglycerols, the main component of dietary fat, altering physical properties such as the melting point and providing suitable functionality for use in a range of food applications. Interesterified (IE) fats are one of a number of alternatives which have been adopted to reformulate products to remove fats containing trans fatty acids generated during partial hydrogenation, which are known to be detrimental to cardiovascular health. The use of IE fats can also reduce the saturated fatty acid (SFA) content of the final product (e.g. up to 20% in spreads), while maintaining suitable physical properties (e.g. melt profile). A novel analysis was presented during the roundtable which combined data from the UK National Diet and Nutrition Survey (2012/2013-2013/2014) with expert industry knowledge of the IE fats typically used in food products, to provide the first known estimate of population intakes of IE fats among UK children and adults. IE fats were found to contribute approximately 1% of daily energy across all ages. The major contributors to overall IE fat intakes were fat spreads (54%) and bakery products (22%), as well as biscuits (8%), dairy cream alternatives (6%) and confectionery (6%). Increasing use of IE fats could contribute towards reducing total SFA intakes in the population, but would depend on which food products were reformulated and their frequency of consumption among sub-groups of the population. Studies comparing the effect of IE and non-IE fats on markers of lipid metabolism have not shown any consistent differences, either in the fasted or in the postprandial state, suggesting a neutral effect of IE fats on cardiovascular disease risk. However, these studies did not use the type of IE fats present in the food supply. This issue has been addressed in two studies by King's College London, which measured the postprandial response to a commercially relevant palm stearin/palm kernel (80:20) IE 'hard stock', although again no consistent effects of the IE fat on markers of lipid metabolism were found. Another study is currently investigating the same IE hard stock, consumed as a fat spread (blended with vegetable oil), and will measure a broader range of postprandial cardiometabolic risk factors. However, further long-term trials using commercially relevant IE fats are needed. Subsequent to the roundtable, a consumer survey of UK adults (n = 2062; aged 18+ years) suggested that there is confusion about the health effects of dietary fats/fatty acids, including trans fats and partially hydrogenated fats. This may indicate that providing evidence-based information to the public on dietary fats and health could be helpful, including the reformulation efforts of food producers and retailers to improve the fatty acid profile of some commonly consumed foods.

Prebiotics are food components that are selectively used by gut bacteria, conferring a health benefit, most notably stimulating the growth of bifidobacteria. Accepted prebiotics at present are the fibre types galacto-oligosaccharides, fructo-oligosaccharides and inulin, some forms of which occur naturally in foods such as pulses, grains, fruit and vegetables. Prebiotics can also be isolated and produced commercially for use as functional ingredients and supplements. The aim of this paper is to provide an overview of the place of prebiotics in a healthy, balanced diet, to explore potential health effects, particularly in relation to gut health, and to consider whether there are implications of consuming a diet low in prebiotics. Dietary fibre is important for health, with high-fibre diets reducing risk of several chronic diseases, via its effects on bowel function, gut microbiota, and cholesterol and glycaemic levels. The prebiotic effects of some fibre types may contribute to these effects. Evidence from supplementation studies carried out in humans suggests that consumption of prebiotics may confer an array of health benefits such as cholesterol lowering, relief of symptoms of gastrointestinal disorders, increased satiety and immunomodulatory effects, though more studies are needed. Findings from observational and intervention studies indicate that exclusion diets, such as low-carbohydrate, gluten-free and the low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols diet, result in changes to the gut microbiota such as reduced abundance of Bifidobacterium and Lactobacillus species, though whether or not there are any long-term health implications remains unknown. Studies investigating whether prebiotic supplements may be useful in conjunction with such diets (when these are required for medical reasons) to help restore levels of bacteria that are considered to be beneficial, are warranted. Overall, there is a need to promote high-fibre foods across the UK population as intakes currently fall well below recommendations.

Scientific and clinical evidence on the health effects of probiotics has expanded rapidly in recent years and points towards benefits for a number of specific health conditions, particularly those related to the gut. Healthcare professionals are important conduits in the transfer of evidence-based messages on probiotics, but research indicates many do not consider themselves to have good knowledge in this area. To identify potential solutions to support healthcare professionals, the British Nutrition Foundation held a one-day roundtable event on 7 February 2019 to gather expert views on the content of, and best delivery mode for, evidence-based resources to guide healthcare professional advice about the use of probiotics. This report describes the main themes emerging from the discussions and the group's recommendation for the development of a UK-focused online toolkit for healthcare professionals, which assimilates, appraises and translates current scientific knowledge of probiotics to promote evidence-based practice for the benefit of patients.

Portion size of foods and drinks is likely to be an important factor in helping people to control their weight. The British Nutrition Foundation (BNF) undertook work, with input from an Expert Panel of academics, to develop portion size guidance for healthy adults to complement the UK Eatwell Guide. A Working Group from the food industry provided funding and input on issues related to their sector. To inform the development of the portion size guide, information on portion sizes provided in food-based dietary guidance from selected countries was reviewed as well as the methods used to develop the guidance. Portion sizes for a range of foods from the main food groups of the Eatwell Guide (excluding fruit and vegetables) were developed with reference to consumption data from the UK National Diet and Nutrition Survey and portion sizes available in major supermarkets. These were tested within different dietary patterns (e.g. omnivorous vs. vegetarian) for their ability to meet current UK food and nutrient-based recommendations. Views on portion size and design concepts for the guidance were then explored in consumer focus groups. The final Find your balance resources were published in January 2019, with a large amount of associated media coverage and over 58 000 downloads from the BNF website in the 6 months following publication.