Navigating the complexity of applying nutrition evidence to individualised care: Summary of an Academy of Nutrition Sciences position paper

Diet is key to the maintenance of health and crucial in the prevention and management of many diseases. Modified nutrient intake may become essential to prevent deficiency, optimise development and health or manage symptoms and disease progression. Adding to the complexity, disease and its treatment can also affect taste, appetite and ability to access and prepare foods. Coupled with this, individual requirements for energy, macronutrients and micronutrients are influenced by factors such as life stage (age, growth, pregnancy, etc.) and health status, which can affect the processes of consuming, digesting, absorbing, metabolising or excreting nutrients. First and foremost, dietary advice must be based on sound evidence if it is to achieve and maintain human health. Furthermore, the practice of nutrition and dietetics must integrate and apply the sciences of food, nutrition, biology, physiology, behaviour management, communication and must also recognise the context that society presents, including the plethora of often conflicting information on diet and health available via the internet and other media sources

UK Nutrition Research Partnership (NRP) workshop:Forum on advancing dietary intake assessment

The development of better and more robust measures of dietary intake in free living situations was identified as a priority for advancing nutrition research by the Office of Strategic Coordination for Health Research (OSCHR) Review of Nutrition and Human Health Research in 2017. The UK Nutrition Research Partnership (NRP) sponsored a workshop on Dietary Intake Assessment methodology alongside its series of ‘Hot Topic’ workshops designed to accelerate progress in nutrition research by bringing together people from a range of different disciplines. The workshop on Dietary Intake Assessment methodology took place via Zoom over two half‐days in January 2021 and included 50 scientists from a wide range of disciplines. The problems with current methods of dietary assessment and how emerging technologies might address them were set out in pre‐recorded presentations and explored in panel discussions. Participants then worked in breakout groups to discuss and prioritise the research questions that should be addressed to best further the field and lead to improvements in dietary assessment methodology. Five priority research questions were selected. Participants were asked to brainstorm potential approaches for addressing them and were then asked to focus on one approach and develop it further. At the end of these sessions, participants presented their project ideas to the rest of the workshop and these will be reported back to the Medical Research Council. It is hoped that potential collaborative projects arising from these discussions will be taken forward in response to future funding calls

The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package

The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms "processing" and "ultra-processing," which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable, or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) are unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration

Expert consensus on low-calorie sweeteners:facts, research gaps and suggested actions

A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation

Diet modelling: How it can inform the development of dietary recommendations and public health policy

With the global population expected to increase to 9 billion by 2050 coupled with concerns about food security in relation to climate change and increasing prosperity in many parts of the world causing desire for a less monotonous diet, efficient use of resources such as food becomes ever more important. While the prevalence of obesity is a cause for concern in many parts of the world, many people still go to bed hungry, and in many communities, obesity co-exists with poor diet quality. The result is a series of complex and challenging nutrition problems, such as the access to nutritionally adequate and affordable diets and the development of dietary recommendations. Diet modelling is a useful tool to help identify solutions to such complex questions and this paper summarises a session on this topic at the International Congress of Nutrition that took place in September 2013