Previous work suggests low intakes of fruit and vegetables (FV) across the world, poor knowledge of the details of FV recommendations, and associations between the two. This work aimed to develop an interactive mobile phone application (app) to facilitate adherence to the UK 5-a-day FV recommendations, and reports on the findings and feedback from the first test of the prototype.

Requirements for the app were first gained from previous research and potential end-users via four public engagement workshops, and prioritised using the MoSCoW method. A prototype app was then designed and developed using an agile approach. The prototype app was then tested in a randomized controlled pilot trial for impacts on FV knowledge and FV intake. Ninety-four adult volunteers were randomized to either receive (N = 50) or not receive the app (N = 44) for two or four weeks, and FV knowledge, self-report FV intakes, and FV behaviour (complimentary drink choice), were assessed at study start and study end. App use and feedback were also investigated.

Low knowledge of the FV recommendations centred around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving knowledge in a practical manner, that would be available both at time of consumption and outside of these times. Findings revealed improved FV behaviour in volunteers who received the app for two weeks at study end: 16 app users chose a fruit drink, compared to 4 app users who chose a non-fruit drink, where 4 control volunteers also chose a fruit drink and 6 control volunteers chose a non-fruit drink. App users also suggested increased FV intakes, but changes were small, and possibly masked in questionnaire measures. Improvements in FV knowledge (of approx. 10%) were also found, but with no differences between groups. App usage was low and feedback suggested a desire for reminder notifications and a wish to return to the input for a previous day due to forgetting. Increased awareness of low FV intakes was also offered as feedback.

Our prototype app was well received and of potential benefit. A final version of the app was subsequently developed incorporating the findings and feedback from the pilot test. Improvements in the final version of the app include a message to increase awareness of low intakes and an option to add notifications to increase use. Testing of the final app is now needed.

Serious games are a novel and entertaining approach for digital health education in the younger population. Aim of this pilot study was to evaluate the short-term effectiveness of the serious game “Fit, Food, Fun” (FFF) among a subset of children and adolescents in Germany with regard to nutritional knowledge.

Two Bavarian secondary schools were each allocated to one intervention arm. The gameplay intervention (gameplay group; GG) consisted of a 15-minute gameplay session for each of three days (Tuesday to Thursday), while the teaching intervention (teaching group; TG) was performed as a 15-minute classic lecture for the same number of days. Given nutritional information was based on the recommendations of the “German Nutrition Society e.V.” and was identical for both intervention groups. Nutritional knowledge was evaluated through a standardised questionnaire at baseline (Monday) and post-intervention (Friday). Lifestyle behaviour (diet; physical activity) and anthropometrics (height; weight) were assessed once at baseline. Inclusion criteria were sufficient German language skills and parental consent form. Statistical analyses were performed using the statistical software R (R Core Team, 2018).

In total, 47 students (62% male) were assigned to the GG and 47 students (72% male) to the TG. The mean age was 13.5 years in the GG and 12.8 years in the TG. The mean body mass index was in the normal range (GG: 24.4 kg/m2; TG: 22.0 kg/m2). Data at baseline and post-intervention are analysed for 36 participants in the GG and for 40 participants in the TG. Compared to baseline, results revealed significant improvements (p-value < 0.001) in nutritional knowledge in both intervention groups. There was a between-group difference with significantly (p-value = 0.0139) higher increase of nutritional knowledge in the TG.

This pilot study provides evidence for the short-term efficacy of both game-based and traditional education approaches on the improvement of nutritional knowledge; however, further research in warranted to assess the potential effect of a digital gameplay intervention on nutritional behaviour. Finally, the FFF game might be considered as an appropriate educational tool for imparting nutritional knowledge in an entertaining and effective format among children and adolescents.

It is known that significant proportions of the general public do not meet current recommendations. This may be explained by a lack of knowledge or perceived difficulty trying to adhere to the recommendations. In addition, health professionals, such as general physicians, lack solid education in nutrition, which hampers optimal care and prevention in diet-related disorders. In order to help people and health professionals to improve dietary habits, the Eetscore and NutriProfiel tools were developed and implemented.

The Eetscore tool assesses to what extent daily intake adheres to the 2015 Dutch Food Based Dietary Guidelines developed by the Dutch Health Council. The tool consists of a short online food frequency questionnaire (FFQ) which is scored with the Dutch Healthy Diet Index. The total Eetscore (including 16 subscores) ranges from zero to 160, with higher scores implying better adherence to the guidelines. Both FFQ and Index have been validated.

NutriProfiel is a specific application in which the Eetscore monitors micronutrients. Micronutrient deficiencies are common and diagnosed with blood tests. A deficiency may be explained by poor diet or pathophysiology, which requires different follow-up. Therefore, it is important to include information on dietary intake while interpreting micronutrient blood concentrations. For NutriProfiel, the clinical laboratory information system is coupled to the Eetscore questionnaire. Patients who undergo laboratory testing for vitamin B6, folate, B12 and/or D receive a link to the Eetscore questionnaire. Nutriprofiel combines blood values and dietary intake to generate a dietary advice. The advice contains practical hints to increase micronutrient intake and is reported electronically to the doctor.

The Eetscore and NutriProfiel tools have been successfully developed and implemented in 2015, with an increasing number of (clinical) users. The Eetscore has been evaluated and applied for monitoring intake in research, and in medical practices as part of an ehealth platform in health professionals and patients.

The NutriProfiel tool has been positively evaluated by its users and is currently available for all requests for vitamin blood analyses coming from general physicians and selected medical specialists (e.g. gastrointestinal medicine, internal medicine).

Both the Eetscore and NutriProfiel have been successfully developed and implemented for use in both home settings as well as clinical settings. Future perspectives include further implementation of the Eetscore for other clinical disciplines or specific patient populations. For NutriProfiel, future perspectives also include expanding the list of nutrient biomarkers for which a personalized dietary advice can be provided.

A comprehensive literature search was performed on PubMed, Cochrane Library and Web of Science in order to retrieve studies that investigated the impact of exclusively oral administration of β-(1→3,1→6)-D-glucans to healthy individuals and/or patients in any form, at any dosage. Only randomized controlled trials (RCTs) were considered.

Twenty-five RCTs, of the 48 clinical studies retrieved in total, met the eligibility criteria and are included in the present review. The sources of β-(1→3,1→6)-D-glucans were Saccharomyces cerevisiae, Aureobasidium pullulans, Pleurotus ostreatus and Lentinula edodes and the dosage of supplementation ranged from 2.5 to 3000 mg daily for up to 6 months. The main physiological outcome for the majority of the interventions was immunomodulation, which resulted in a) strengthened immune defence that reduces the incidence and symptoms of cold, flu and upper respiratory tract infections in general and b) alleviation of allergic symptoms. However, findings on the induction of immune response alterations were inconsistent at a cellular and molecular level. Another aspect is psychological wellbeing, as the cohorts that received the polysaccharides of interest reported improvement of mood state as well as amelioration of the wellbeing overall, while co-administration with chemotherapeutic drugs enhanced cancer patients’ quality of life and prolonged their survival. Furthermore, supplements containing β-(1→3,1→6)-D-glucan induced beneficial changes in body fat mass and abdominal circumference in overweight adults. Notably, no adverse event causally related to the glucans was recorded in any of the trials.

Supplementation with β-(1→3,1→6)-D-glucans is well-tolerated and health-promoting properties are manifested primarily through the potentiation of the immune system. More studies are required in order to confirm additional beneficial effects, establish the optimal dose and reveal the underlying molecular mechanisms.

The consumption of ultra-processed foods has been increasing during the last decades, and has been previously associated with increased risks of mortality and several chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia. The objective of this study is to assess the prospective associations between consumption of ultra-processed foods and the risk of type 2 diabetes (T2D).

Overall, 104707 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records (5.7/subject in average), designed to register participants' usual consumption for 3300 different food items. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risk of type 2 diabetes were assessed using multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history and nutritional factors).

Ultra-processed sugary products, fruits and vegetables, and beverages were the highest contributors of the ultra-processed category (respectively 27.9, 18.5 and 15.6%). Ultra-processed food intake was associated with a higher risk of T2D (n = 821 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.15 (95% confidence interval 1.06 to 1.25); P = 0.0009, median follow-up: 6.0y, 582252 person-years). These results remained statistically significant after adjustment for other metabolic comorbidities, for several markers of the nutritional quality of the diet (red meat and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.

In this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of type 2 diabetes. These results need to be confirmed in other populations and settings, and causality remains to be established. Various dimensions of processing such as nutritional composition of the final product, food additives, contact materials, and neoformed contaminants might play a role in these associations and further studies are needed to better understand their relative contribution. Meanwhile, public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

Study Registration: Clinicaltrials.gov NCT03335644.

The nutritional supplement market has been growing continuously in the last decades. Dietary supplements has become more and more consumed every day. Epidemiological studies have been shown that supplements users tend to have better health-related behaviors, especially a healthier nutritional intake. The aim of the study was to assess frequency of consumption of selected groups of products depending on the use of dietary supplements by soldiers of the Polish Army.

Six hundred and forty seven male soldiers completed an supplements usage questionnaire and a food-frequency questionnaire assessing information over the previous 12 months. U Mann Whitney test was used to compare food-frequency consumption of 61 groups of products and supplements usage.

From the 647 male soldiers (aged: 31 ± 7; years of service: 9 ± 7), 38% reported supplements usage. Statistically relevant at an accepted level p < 0.05 supplements usage differentiated the frequency of consumption of 36 of the analyzed 61 groups of products. Compared with supplements non-users, soldiers using dietary supplements were more likely to consume daily fruits such as kiwi fruit and citrus (p = 0.003); bananas (p < 0.001); avocado (p = 0.004); olives (p = 0.006); dried fruits (0.004); vegetables – all types (p < 0.001); crucifers (p = 0.020); yellow-orange vegetables (p < 0.001); green leafy vegetables (p = 0.001); tomatoes (p = 0.010);wholegrain bread (p = 0.002); groats (p < 0.001); milk and milk drinks (p = 0.003); eggs (p < 0.001); lean fish (p = 0.002); oily fish (p = 0.004) and nuts (p = 0.003). Sweets such as sugar to sweeten beverages (p = 0.001); chocolate, chocolate candies and candy bars (p = 0.004); non chocolate candies (p = 0.028); biscuits and cakes (p = 0.003); salty snacks (p = 0.005); white bread (p < 0.001); fats such as margarine (p = 0.005); cream, sweet or sour cream (p = 0.037); mayonnaise and dressings (p = 0.002); potatoes (p = 0.008), sausages (p = 0.048), sugar-sweetened beverages (p = 0.001), wine and alcohol drinks (p = 0.035) were less often consumed by supplements users than supplements non-users. Diets of supplement users were more in line with current recommendations on healthy eating. Perhaps, soldiers who were using supplements were probably the ones who would least benefit from it. It is necessary to take educational activities in the field of health promotion of soldiers, with a focus on nutrition and the principles for the safe use of, as well as to motivate soldiers to respect basic principles of proper nutrition.

Four comprehensive medical databases were searched from inception until February 2019: MEDLINE, EMBASE, PsycINFO and Scopus. The literature search was restricted to randomised clinical trials [RCTs], conducted in adult humans [ ≥ 18 years], assessing the effect of nutritional interventions on cognitive performance, and / or incidence of mild cognitive impairment [MCI] or dementia. The outcome of interest for the meta-analysis was: [1] global cognitive performance and [2] domain specific cognitive performance. Data was pooled by random model analysis and estimates of effect size were given for each domain and sub-categorised according to the type of nutritional intervention.

Twenty-two RCTs were included, of which, sixteen studies showed significant beneficial effects in favor of the nutritional intervention based on single neuropsychological test scores and / or scores of global cognitive assessment tools. Sixteen studies had sufficient data reported for meta-analysis, and marginally significant beneficial effects were found on global cognitive performance in elderly for micro-nutrient supplementation [n = 4 studies, n = 451 participants, std mean difference: 0.41 [-0.03; 0.84], p = 0.07], and EPA / DHA supplementation [n = 4 studies, n = 373 participants, std mean difference 0.57 [-0.01; 1.14], p = 0.06].

Several promising strategies, such as B-vitamin supplementation, EPA / DHA supplementation and nutrition and lifestyle counselling interventions, seem to be able to decrease age-related cognitive decline in East Asia. Large, good quality, long term trials are needed to confirm these findings, to further evaluate the role of nutritional interventions on cognitive function and to identify if these interventions are feasible and effective to decrease dementia incidence in developing economies, like East Asia.

Since food banks have a strong influence on recipients’ diets, and seem to have difficulties in supporting healthy diets, improving the dietary quality of food parcels is important. Therefore, we aimed to assess whether improving the dietary quality of food parcels, using different strategies, can positively impact the actual dietary intake of Dutch food bank recipients.

This randomized cross-over controlled trial with four intervention conditions [1) Control (standard food parcel), 2) Snacks– (standard food parcel with replacement of snacks by staple foods), 3) FV + (standard food parcel plus the recommended daily amount of fruit and vegetables), 4) Snacks– + FV (standard food parcel with replacement of snacks by staple foods plus the recommended daily amount of fruit and vegetables)] included food bank recipients from three food banks. In total, 199 recipients were randomly allocated. At baseline, participants filled in a questionnaire and underwent anthropometric measurements. Dietary intake data were collected through 24-hour recalls after both intervention conditions at 4 and 8 weeks follow-up. Primary outcome was fruit and vegetable intake, secondary outcomes were dietary intakes of food groups and nutrients.

Multi-level linear regression analysis, using a two-level model showed a higher mean fruit intake in participants in the FV + condition than in participants in the Control condition (δ: 74 [40.3;107.6] g). Both mean fruit and mean vegetable intake were higher in participants in the Snacks– + FV + condition than in participants in the Control condition (fruit δ: 81.3 [56.5;106.2] g; vegetable: δ: 46.2 [17.5;74.9] g), as well as in the Snacks– condition (fruit: δ: 70.0 [38.8;101.1] g; vegetable δ: 62.2 [26.2; 98.2] g).

This study shows that improving the dietary content of food parcels can positively impact the dietary intake of Dutch food bank recipients. With this we can further develop effective strategies to improve dietary intake of food bank recipients.

Maternal nutrition during pregnancy is a modifiable risk factor for health. Heterogeneity in outcome reporting in studies evaluating nutrition in pregnancy limits their comparability and is a barrier for high quality evidence synthesis. A core outcome set (COS) is set of outcomes, which are agreed by consensus, to be a minimum standard to report within an area of research. The CoRe Outcomes in Women's and Newborn health (CROWN) initiative is an international initiative which supports the development of COSs for Women and Newborn health research. To date, there is no COS which specifically addresses the issues with outcome reporting in research on nutrition in pregnancy. Therefore, we present a study protocol for the development of a COS for maternal nutrition research in pregnancy.

The COS is registered with the Core Outcomes for Measurement of Effectiveness Trials (COMET) registry. A systematic review will be conducted following PRISMA guidelines to identify studies evaluating maternal nutrition during pregnancy. Outcomes will be extracted from eligible studies and cataloged using the taxonomy of the COMET initiative. We will make efforts to supplement our findings with outcomes from other sources, including qualitative interviews with mothers. Secondly, a modified Delphi survey will be conducted with international stakeholders including healthcare professionals, researchers and mothers. Participants will be presented with the list of outcomes from step one and invited to rank the importance of including each outcome in the final COS using a 9-point Likert scale. We will complete descriptive statistics and in a second round of the survey, participants will receive feedback on their individual scores from round one, along with the average score each stakeholder group provided for each outcome. Based on this, participants will have the opportunity to change their scoring and will be encouraged to give a rationale for their final choice. Lastly, a face-face consensus meeting will be held with representatives from all stakeholder groups to finalise the COS.

We will identify the outcomes reported in maternal nutrition research. We will also determine the outcomes which are important to pregnant women and if these are missing from the literature. A final COS for nutrition research in pregnancy will be developed.

This COS will support the harmonisation of outcome selection and reporting in maternal nutrition research which is necessary for high quality evidence synthesis to support clinical practice and the nutritional care of pregnant women.

Breastfeeding is well-established as optimal for both mother and baby, with a number of benefits including a quicker return to pre-pregnancy weight for the mother and the reduced risk of non-communicable diseases, including obesity, for the infant. The current global recommendation is to breastfeed exclusively for 6 months postpartum, yet in Ireland initiation and duration of breastfeeding is extremely low. Low education level is considered a barrier to breastfeeding, however, there is currently a paucity of research on the influence of maternal well-being on breastfeeding habits in Ireland.

To explore the relationship between education levels and well-being in early pregnancy on breastfeeding habits in Irish women.

This was a secondary analysis of the randomised control trial, the ROLO study in the National Maternity Hospital, Dublin, Ireland. 610 healthy, pregnant women on their 2nd pregnancy were included. Well-being was measured using the WHO-5 item well-being index at the end of the 1st trimester. Education level and breastfeeding initiation information were both obtained from hospital records. Women were stratified into two groups of education level; those that had achieved 3rd level education (n = 341), and those with less than 3rd level (n = 269). Within these two groups, the relationship between well-being scores and breastfeeding habits was explored using Pearson correlations, chi-square tests, and multiple regression modelling for confounders.

In Women with high education, those with high well-being (n = 269) were significantly more likely to initiate breastfeeding than those low well-being (n = 72; 69.5% vs 56.9%, p < 0.05). This association remained after controlling for maternal age, BMI, and intervention group (B = 0.57, p < 0.05). Well-being was not associated with breastfeeding duration in women with 3rd level education (26.63 weeks vs 25.64 weeks, p = 0.87). In women with low education levels, there was no association of well-being and breastfeeding initiation (37.4% vs 35.9%, p = 0.84) or well-being and breastfeeding duration (6.75 weeks vs 5.70 weeks, p = 0.65).

While education level is a strong indication of women's likelihood to breastfeed, it is important to recognise other influencing factors. Among highly educated women well-being was also important as a determinant of initiating breastfeeding. This is important for healthcare professionals working in maternity care in Ireland and highlights the potential of improving well-being and there-by increasing Irish breastfeeding rates.

Public and patient involvement (PPI) describes how researchers collaborate and engage with the public in order to make research more relevant to them. The ROLO Family Advisory Committee is a self-selected group of parents who are involved in the longitudinal follow-up of the ROLO Study. It was established in 2017 and the goal is to achieve a partnership between ROLO families and researchers, leading to improved research quality, relevance and outcomes. The aim of engaging with parents from the ROLO study is to understand key outcomes of importance for parents relating to their own health and their children's health and to gain insights into how the research agenda can be more relevant to parent and child needs.

All parents involved with ROLO study were invited to join the ROLO Family Advisory Committee in 2017. Parents who had expressed interest in joining the committee were invited to attend annual ROLO Families Advisory Committee Meetings in 2018 and 2019. Parents were asked to discuss their opinions about current research projects and potential future projects. This was followed by an open discussion about relevant health questions. These meetings were either transcribed on the day or recorded with audio recordings transcribed verbatim and broad themes identified.

Mothers had greater concern for outcomes relating to their children than themselves. Parents were very interested in understanding the relationship between diet in pregnancy and child health and welcomed research regarding blood tests that could be predictors of future health. Parents had great concern for the effect social media has on child mental health and also wanted more studies conducted in the areas of fussy eating and how to ensure children consume a wide range of healthy foods. It was consistently highlighted that children and teenagers should understand healthy eating principles and ways to promote their physical and mental health.

Through the two focus groups, valuable insights were gained regarding what research parents consider relevant and future research questions. The ROLO agenda has certainly been enriched by PPI. We are seeking opportunities to enable research to be carried out in the areas discussed at the meetings.