Nutrition plays a pivotal role in health and disease prevention and management and through its interactions with social and personal factors, influences an individual's growth, development and life chances, as well as long-term health and longevity. These factors include amongst others, genetic inheritance, ethnicity, socio-cultural context, sex and gender. Although different interpretations exist, in general sex refers to the genetic, biological and physiological attributes that distinguish females, males and intersex whereas gender refers to socio-cultural and politically constructed roles and behaviours associated with a feminine, masculine or non-binary identity, which vary from society to society. Sex has implications for key biological processes involving food and nutrients as well as life-stage differences in nutritional requirements. Sex and gender may have implications in how individuals engage in different dietary behaviours and respond to nutrition interventions. The Irish Section Nutrition Society 2023 Conference sought to enhance understanding of the role of sex and gender in nutrition research; explore the influence of sex and gender on risk of non-communicable diseases and examine sex- and gender-specific considerations across the life course. This short editorial provides an overview and highlights of the conference.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

The FAO states that the term food sovereignty focuses on food for the people by placing people’s need for food at the centre of policies and insists that food is more than just a commodity. Food Sovereignty also promotes knowledge and skills by building on traditional knowledge; using research to support and pass on this knowledge to future generations; and rejecting technologies that undermine local food systems. It is essentially a movement that “recognizes that control over the food system needs to remain in the hands of producers, and is clearly focused primarily on small-scale agriculture of a non-industrial nature, preferably organic”(1). In Māori terms, Kai Sovereignty is drawn first from the relationship of foods to our needs; it is expressed through whakapapa, and has an overarching contribution to food security. Traditional foods abound in Aotearoa. The relationships are longstanding, expressive and contribute to our wellbeing in various ways(2). But the true cultural value of traditional foods is diminishing as new foods, lifestyles and experiences succeed them. Kai sovereignty therefore is at risk of being relegated to historical discourse. The FAO acknowledgement of the intergenerational role of traditional knowledge to support food sovereignty aligns well to the Māori experience. This knowledge covers a myriad of food relationships including foraging, producing, harvesting, processing, cooking and manaakitanga. We are in a renaissance period that seeks to rediscover our relationship with the pātaka, the food store. So much knowledge has been lost, but much also remains. How we draw that together in a way that acknowledges the whakapapa or historical relationship alongside the present and future. The right to achieving kai sovereignty is yet to be properly understood within our communities. The first steps lie in the knowledge space; sharing and acknowledgement of our food traditions before they are lost or misinterpreted.

Pacific Island communities are disproportionally impacted by the effects of climate change, and as teina (younger sibling) to our Pacific tuakana (older sibling), it is our responsibility to ensure these communities have resilience through co-developed solutions to these real-world problems. We focus on marine and freshwater ecosystems, understand their intrinsic links to Pacific communities, while, in partnership with science, empower and enable local knowledge to steer the waka. With more than 20 years’ experience of supporting Pacific communities, we deliver our positive impact through knowledge exchange, capability and capacity development, and problem solving. We strive to learn and grow our own capability, while brokering knowledge between Aotearoa, the Pacific, and our world leading research partners. Our aim is that Pacific Island communities gain a deeper scientific understanding of their aquatic systems, have the tools to rejuvenate and conserve these ecosystems, are empowered to transform their food systems towards more healthy, sustainable, and resilient pathways, and can adapt to the impacts of climate change. We take a systems approach that incorporates adaptive solutions, which are community-led, thereby ensuring a long-lasting positive impact into the future. Our Kete is filled with world-leading expertise from different organizations, which ensures a greater collective impact where it is needed most. This presentation will cover the seven themes within our Pacific Impact area, with a particular focus on food safety and security in relation to ciguatera poisoning (the number one cause of non-bacterial seafood illness affecting Pacific Island communities) (1,2), analytical laboratory development, and transforming food systems.

This review presents evidence related to the postprandial responses after consumption of dairy products focusing on the effect of the dairy matrix and lipid response, which was also presented as part of a speech at the Nutrition Society Winter Conference, January 2023. The key findings are that the dairy product(s) that differentiate from others in the postprandial TAG response are products with a semi-solid structure. There were no differences in lipid responses between cheese and butter. The main factors viscosity, fat globule size and milk fat globule membrane do not seem to explain the effect of the dairy matrix in the acute postprandial response. In summary, it is very difficult to investigate the effects of the dairy matrix per see and with the few studies conducted to date, no clear cause and effect can be established. Future research should focus on the semi-solid dairy matrix, and studies investigating specifically the yoghurt matrix are warranted.

For some 20 years, science funding bodies have been asking for the integration of sex- and gender-related factors into the content of research and innovation. The rationale for those requirements has been the accumulated evidence that sex and gender are important determinants of health and disease. The European Commission (EC) has been the first, since 2002, to seriously ask for the integration of sex and gender into research and innovation in the context of their multi-annual framework programmes. When introduced, this condition was not immediately applauded by the research community, who perhaps lacked training in methods for the integration of sex- and gender-related factors. The EC Expert Group on Gendered Innovations sought to fill this gap. This review describes the work of this international collaborative project which has resulted in the development of general and field-specific methods for sex and gender analysis and 38 case studies for various research domains (science, health and medicine, environment, engineering) to illustrate how, by applying methods of sex and gender analysis, new knowledge could be created. Since 2010, science funding bodies in Canada, the USA and several EU member states have followed the example of the EC issuing similar conditions. Although the effects of nutritional patterns on a range of (physiological and health) outcomes may differ for men and women, sex and gender analyses are rarely conducted in nutrition research. In this review, we provide examples of how gender is connected to dietary intake, and how advancing gender analysis may inform gender-sensitive policies and dietary recommendations.

The purpose of the present article is to describe the current state of sex and gender data collection in nutrition science research, discuss the effects of flawed data collection practices, highlight considerations for transgender and gender non-conforming populations and propose a sex- and gender-informed approach to human subjects research. Sex and gender are separate constructs that are often conflated in nutrition research and practice. Current nutrition surveillance programmes in the United States, United Kingdom and Ireland do not accurately capture sex and gender data, which undermines the accuracy of the analyses and excludes gender minorities. Transgender and gender non-conforming populations have distinct clinical and psychosocial nutrition considerations that require further research to inform nutrition policy and practice, such as anthropometric and biochemical changes with hormone therapy, eating disorders, food insecurity and nutrition as a source of empowerment or expression of gender identity. Researchers can apply a sex- and gender-informed approach to human subjects research by treating sex and gender as separate, relevant demographic data, appreciating gender as a fluid construct, and approaching data collection on gender minorities with sensitivity to privacy and confidentiality.

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the ‘dimensions’). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally.

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.

Malnutrition affects over half the world’s population, manifesting in myriad forms. Nearly 1 in 4 children never reach their full growth potential, while 1 in 2 lack key micronutrients essential for health and development.1 Furthermore, 1 in 3 women suffer from anemia, and 2 in 3 do not get enough vital micronutrients. At the same time, over 2 in 5 adults are overweight or obese, and 1 in 5 live with high blood pressure. These various forms of malnutrition lead to physical and cognitive impairments, increased susceptibility to infections and chronic diseases, and reduced quality and length of life. They also impose immense economic, social, and health burdens. In addition to harming human health, our food system damages the planet, generating greenhouse gas emissions that drive climate change and depleting freshwater reserves. It also causes deforestation and habitat destruction which drive species to extinction. These grave harms to both human and environmental wellbeing demand urgent action. Transforming our food systems is imperative to promote nutritious diets that deliver adequate nutrition and protect against noncommunicable diseases, while simultaneously protecting our planet, its biodiversity, and natural resources. As a response, many call for drastically limiting consumption of animal source foods like meat, eggs, and dairy. They argue that these foods jeopardize both human health and environmental sustainability. However, is it possible to meet the nutritional needs of the global population with few animal source foods? What are the full impacts, both positive and negative, of animal source foods on human health and the environment? In this presentation, I will review the latest scientific evidence surrounding these questions. I will examine whether mindfully produced and consumed animal source foods can be part of the solution. Join me to explore these critical issues concerning sustainable nutrition and the role of animal source foods in our food system transformation.

The aim of the paper is to review the current evidence on the impact of ‘the timing of energy intake’ on the risk of developing obesity and obesity-related metabolic diseases. The prevalence of obesity is currently increasing worldwide thus becoming a severe health burden for most countries. Indeed, obesity represents a risk factor for several non-communicable diseases such as cancer, type 2 diabetes, dyslipidaemia, CVD and overall mortality. In order to treat obesity, several pharmacological approaches have been developed and are indicated for subjects with obesity with a BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 and obesity-related comorbidities. For severe obesity (BMI ≥ 40 kg/m2), bariatric surgery represents a promising approach. The most common bariatric surgical procedures are represented by the Roux-en-Y gastric bypass, laparoscopic adjustable band, laparoscopic gastric sleeve and biliopancreatic diversion with duodenal switch. Both anti-obesity pharmacological and surgical treatments require change in lifestyle. When a nutritional plan is established, attention is usually paid to macronutrient composition and energy intake, while ‘the time of food’ is not taken into account. Chronotype, which is the attitude of a subject to carry out most of their daily activities in the first (morning chronotype) or second half (evening chronotype) of the day, has been reported to have a role in the pathogenesis of obesity and obesity-related cardiometabolic diseases as well as eating speed. Thus, adopting a physiological timing of energy intake could be an additional strategy to potentiate the current anti-obesity approaches.

The high levels of non-communicable diseases such as CVD and type 2 diabetes mellitus are linked to obesity and poor diet. This continuing emphasis on health in relation to food is proving a powerful driver for the development of cheap but palatable and more functional foods. However, the efficacy of such foods is often hard to prove in human subjects. Thus, a suite of tools has been developed including in silico and in vitro simulations and animal models. Although animal models offer physiologically relevant platforms for research, their use for experimentation is problematic for consumers. Thus, in vitro methods such as Infogest protocols have been developed to provide digestion endpoints or even an indication of the kinetics of digestion. These protocols have been validated for a range of food systems but they still miss the final absorption step. This review discusses the use of such in vitro models and what further steps need to be included to make the bioaccessibility determination more relevant to bioavailability and human health.

New Zealand has committed to a 50% reduction in greenhouse gas emissions (GHGEs) from 2005 levels by 2030. Dietary changes within New Zealand could simultaneously improve population health and contribute towards the nation’s emissions reduction target, as agricultural emissions are estimated to account for half of New Zealand’s GHGEs(1). This research aimed to quantify the GHGEs associated with household purchases of major food groups in New Zealand and identify the sociodemographic characteristics that are associated with per capita household dietary emissions. Household dietary emissions were estimated using the NielsenIQ Homescan(R) consumer panel — a large sample of households within New Zealand who report purchasing data of take-home food and beverages. The sample is nationally representative in terms of broad geographical regions and selected key demographic characteristics. Carbon emission estimates were assigned to 1,908,485 total food and beverage purchases from 1,775 households over one year (2019) using a process-based life cycle assessment (LCA) dataset initially constructed in the United Kingdom (UK) and adapted for New Zealand(2). This LCA dataset contains estimates of greenhouse gas emissions generated over the life cycle of the production of food products from the following stages: farming and processing, transit packaging, consumer packaging, transport, warehouse and distribution, refrigeration, and overheads. Greenhouse gas emissions are expressed in kg of carbon dioxide equivalents per kg of food product over a 100-year time horizon. Total emissions from purchases of major food groups were then estimated. Multiple linear regression was used to examine the relationships between household variables and per capita dietary emissions. Overall purchases of red and processed meat (35%) and dairy products (19%) were responsible for the greatest proportion of emissions. The age group of the primary household shopper as well as household size were predictors of per capita dietary emissions — households with primary shoppers > 65 years had, on average, 33% (95% CI: 20% to 49%) higher per capita dietary emissions, compared to households with primary shoppers 34 years; and every additional household member was associated with, on average, 11% (95% CI: 9% to 13%) lower per capita dietary emissions. We have shown in this large representative sample of New Zealand households that purchases of just two food groups — red and processed meat, and dairy — were responsible for approximately half of dietary greenhouse gas emissions. Larger households had lower per capita dietary greenhouse gas emissions, and older shoppers had relatively higher greenhouse gas emissions. Whilst similar associations have been reported elsewhere more research is needed to confirm these latter findings. With enhanced understanding of the observed association between age of a household’s primary shopper and per capita dietary emissions, interventions may be devised that encourage shoppers to purchase lower-emitting foods, particularly less meat and dairy.

Calcium and vitamin D have well-established roles in maintaining calcium balance and bone health. Decades of research in human subjects and animals have revealed that calcium and vitamin D also have effects on many other organs including male reproductive organs. The presence of calcium-sensing receptor, vitamin D receptor, vitamin D activating and inactivating enzymes and calcium channels in the testes, male reproductive tract and human spermatozoa suggests that vitamin D and calcium may modify male reproductive function. Functional animal models have shown that vitamin D deficiency in male rodents leads to a decrease in successful mating and fewer pregnancies, often caused by impaired sperm motility and poor sperm morphology. Human studies have to a lesser extent validated these findings; however, newer studies suggest a positive effect of vitamin D supplementation on semen quality in cases with vitamin D deficiency, which highlights the need for initiatives to prevent vitamin D deficiency. Calcium channels in male reproductive organs and spermatozoa contribute to the regulation of sperm motility and capacitation, both essential for successful fertilisation, which supports a need to avoid calcium deficiency. Studies have demonstrated that vitamin D, as a regulator of calcium homoeostasis, influences calcium influx in the testis and spermatozoa. Emerging evidence suggests a potential link between vitamin D deficiency and male infertility, although further investigation is needed to establish a definitive causal relationship. Understanding the interplay between vitamin D, calcium and male reproductive health may open new avenues for improving fertility outcomes in men.

Diets and dietary constituents that we consume have a considerable impact on disease risk. Intriguingly these effects may be modulated to some extent by sex. Lack of female representation in nutritional studies as well as a lack of stratification by sex has and continues to limit our understanding of these sex × diet interactions. Here we provide an overview of the current and available literature describing how exposure to certain dietary patterns (Western-style diet, Mediterranean diet, vegetarian/vegan, ketogenic diet) and dietary constituents (dietary fibre, PUFA and plant bioactive) influences disease risk in a sex-specific manner. Interestingly, these sex differences appear to be highly disease-specific. The identification of such sex differences in response to diet stresses the importance of sex stratification in nutritional research.

Dietary guidelines are increasingly promoting plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons(1). It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. Here, we modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55% female) from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using food frequency questionnaires: CDAH-1 (2004–06), CDAH-2 (2009–11), and CDAH-3 (2017–19). The median follow-up duration was 13 years. The cumulative average intake of each food group was calculated to reflect habitual consumption. Insulin sensitivity (%) was estimated from fasting glucose and insulin concentrations at CDAH-3 (aged 39–49 years) using homeostasis model assessment. Applying the partition model(2), we simulated the replacement of one food group with another by including both in the model simultaneously (e.g., red meat and legumes), along with potential confounders and energy intake. The difference between parameter estimates (i.e., regression coefficients and variances) and their covariance were used to estimate the “substitution” effect. We report the simulated percentage point change in log-transformed insulin sensitivity for a 1 serve/day lower intake of one food group with a 1 serve/day higher intake of another food group. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 0·10, 95% CI 0·04–0·16). Adjustment for waist circumference attenuated this association by 61·4%. On an individual basis, replacing red meat with legumes (β = 0·12, 95% CI 0·02–0·21), nuts and seeds (β = 0·15, 95% CI 0·06–0·23), or whole grains (β = 0·11, 95% CI 0·04–0·17) was likewise associated with higher insulin sensitivity. Point estimates were similar when replacing processed meat with plant-based alternatives, but more uncertain due to wide confidence intervals. Our modelling suggests that habitually replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity, and thus, a lower risk of type 2 diabetes. Abdominal adiposity was identified as a potentially important mediator in this relationship. In relation to insulin sensitivity, our findings support the recommendation to choose plant-based sources of protein at the expense of red meat consumption.

The present paper provides an overview of the approach to developing food-based dietary recommendations in the UK. UK dietary recommendations are based on independent advice from the Scientific Advisory Committee on Nutrition (SACN). SACN's remit includes specific reference to the nutrient content of individual foods and advice on diet as a whole, including the definition of a balanced diet. SACN's approach is set out in its Framework for Evaluating Evidence and its assessments are supported by the data provided by the National Diet and Nutrition Survey. SACN's risk assessments have primarily focused on energy requirements, macro and micronutrients and/or the needs of specific population groups. However, dietary patterns or individual foods and health outcomes have been considered where sufficient evidence is available. An example of this is SACN's risk assessment on carbohydrates and health, which included consideration of evidence on sugar-sweetened beverages and the resulting dietary recommendations on free sugars and sugar-sweetened beverages led to a range of policies to reduce sugar intake in the UK, including the soft drinks industry levy. SACN has also recently published a position statement on processed foods and health. Government dietary advice is encapsulated in the UK's national food model, the Eatwell Guide. The Eatwell Guide shows the proportions in which different food groups should be consumed to have a well-balanced, healthier, more sustainable diet, to help meet nutrient requirements and reduce the risk of chronic disease. Any substantive change to government dietary advice is likely to lead to a review of the national food model.

Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4–5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.