British Nutrition Foundation

The health benefits of the long-chain omega-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been known for over 50 years and underpin the UK population recommendation to consume > 450 mg EPA+DHA per day. These recommendations, last revised in 2004, are based mainly on epidemiological evidence. Much research has been conducted in the interim. Most RCTs use doses of EPA+DHA of 840 mg per day or more. For anti-inflammatory, triglyceride lowering and anti-hypertensive effects, > 1.5 g EPA+DHA per day is needed. Cognitive benefits are also likely to require these higher intakes. Farmed salmon now contains considerably less EPA+DHA relative to wild-fish, and relative to farmed fish of 20 years ago, meaning one portion per week will no longer provide the equivalent of 450 mg EPA+DHA per day. Oily fish alone can only provide a fraction of the EPA+DHA required to meet global needs. Furthermore, there is low global oily fish consumption, with typical intakes of < 200 mg EPA+DHA per day, and limited intakes in vegans and vegetarians. Therefore, there is an urgent need for affordable, acceptable, alternative EPA+DHA sources, including vegan/vegetarian friendly options, such as bio-enriched poultry, red meat and milk products; fortified foods; enriched oilseeds e.g. genetically modified Camelina sativa; algae and algal oils; and approaches which enhance endogenous EPA/DHA synthesis. In this narrative review we suggest that current EPA+DHA intake recommendations are too low, consider EPA/DHA from a holistic health-sustainability perspective, and identify research, policy and knowledge mobilisation areas which need attention.

ContextConsidering 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.ObjectiveTo 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 SourcesMEDLINE, FSTA, CENTRAL, and Scopus were searched from 1 January 2017 to 5 May 2021.Data ExtractionHuman 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 AnalysisOnly 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 ∼10–99 g/day, 1,948 subjects) and 10 describing cohort studies (∼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.ConclusionsEvidence 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 RegistrationPROSPERO registration no. CRD4202122.

Vitamin D is truly unique-not a 'vital' amine in the true sense of the word, but rather a prohormone, which is produced in the skin during exposure to sunlight (UVB radiation at 290-315 nm) and which can also be obtained from food and from supplements. A high prevalence of low vitamin D status has been reported across the world in a wide range of population groups, and this includes communities living in low latitude areas despite the abundance of sunlight. It is accepted that vitamin D status is reflected by the level of the circulating metabolite 25-hydroxyvitamin D (25[OH]D), which is produced by hepatic hydroxylation of vitamin D, derived either from the skin from UV exposure or the gut from oral intake. Vitamin D has been associated with a wide range of health outcomes, but controversies remain as to their exact nature and extent and whether associations are in the causal pathway. In order to enable wider discussions on this nutrient, a 'Hot Topic' Vitamin D Workshop achieved funding from the UK Nutrition Research Partnership Medical Research Council call. The objectives of the workshop were (1) to elucidate the role of vitamin D in human health and (2) develop strategies to improve vitamin D status in the UK population. This paper provides a detailed resume of the discussions of the workshop; of the presentations and concomitant Q&As; and of identified areas for future research.

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

Abstract The British Nutrition Foundation held a 1‐day roundtable event to gather views from a wide range of stakeholders on the relevance and importance of the concept of nutrient density in supporting and motivating people to make healthier dietary choices. The opportunities and barriers associated with the use of this concept were also explored. The roundtable involved experts from research, public health nutrition, dietetics, retail and nutrition science communication, and this report describes the main themes emerging from the discussions. High obesity prevalence rates indicate that, on average, we are consuming too many calories relative to energy requirements; yet, the quality of our diets, with respect to certain vitamins and minerals and fibre, seems to be falling somewhat short of recommendations. Addressing this issue may require a more holistic approach than the current focus on restricting single nutrients prevalent in public health messaging internationally. Most members of the roundtable felt that communicating the concept of nutrient density may help in encouraging healthier food choices and dietary patterns that are higher in nutritional quality. However, while nutrient profiling has been used to guide front‐of‐pack labelling and in restricting the advertising of less healthy foods to children, there is a lack of consensus on the precise definition of a ‘nutrient dense’ food or which nutrients should be used as markers of the ‘healthiness’ of foods/drinks, and the term seems to be poorly understood by consumers and health professionals alike. Therefore, further work is required if tools around this concept are to be developed to try and successfully promote behaviour change.

Abstract This paper provides a summary of the British Nutrition Foundation Annual Lecture by Professor Susan Jebb held at the Royal College of Physicians, London, on 14 November 2017. Professor Jebb, recipient of the 2016 British Nutrition Foundation Prize for outstanding achievement in the area of nutrition, spoke of her research on diet, obesity and cardiovascular disease (CVD) risk and her work to translate science into action to help improve the nation's diet. This paper briefly summarises her research, including analyses of the links between dietary patterns and cardiometabolic risk in prospective cohorts, mechanistic studies such as the effect of portion size on energy intake, a series of randomised controlled trials to test the impact of diet composition on markers of CVD risk, and clinical trials of interventions to treat obesity in primary healthcare settings. Professor Jebb emphasised the need to translate the considerable scientific knowledge about the prevention of CVD through modification of risk factors such as obesity, into systems embedded in routine practice and population‐level interventions, in order to improve public health and tackle health inequalities.

Several studies have examined the efficacy of nutrients in enhancing skin health, function and appearance, yet the strength of evidence to support benefit of use is questionable. Stacey Lockyer and Ayela Spiro share the findings of the British Nutrition Foundation's recent review of commonly used ingredients, such as collagen and carotenoids, in skin nutraceuticals