Dr Beverley O'Hara

There is a need to design low-cost population based dietary interventions that improve diet quality to reduce population risks for poor health outcomes linked to diet. Currently, much attention and research funding are focused on ‘ultra-processed foods’; an alternative approach to improving diet quality is use of positively framed, ‘eat more’ health messages in relation to minimally refined, or ‘intact’ plant foods. Since intake of plant foods is associated with stool weight (1), there is potential for monitoring of faecal output to act as a proxy for diet quality. Despite exponential interest in gut microbiome research, bowel function in healthy individuals is perhaps the least understood and least studied of all human bodily functions. One likely reason for this is that the subject of bowel movements is still a social taboo; bodily secretions, including faeces, are a widely reported elicitor of disgust (2). This disgust appears to be profound, extending even to aversion to take part in bowel cancer screening (3). It is important to better understand attitudes toward bowel movements so that that the potential for operationalisation of this bodily function may be explored. This study aims to investigate 1) beliefs about the link between faeces and health and 2) attitudes towards and acceptability of using a stool chart as feedback on diet quality. Seven focus groups (n=32) were held at Leeds Beckett University between February and March 2024. Participants were recruited via community posters, email lists and social media. Inclusion criteria were: aged 18-60 and in good general health (e.g. no bowel disease, or constipation). Sessions lasted 60 minutes and were facilitated by a trained moderator following a semi-structured interview guide. A second researcher recorded notes on group dynamics and non-verbal communication. All sessions were video recorded with participant permission. Data saturation was considered achieved when no new themes emerged from the analysis. Audio recordings were transcribed verbatim by an experienced qualitative researcher. Data were analysed using thematic analysis (4). Participants predominantly associated stool monitoring with bowel cancer detection rather than general health assessment. Some participants recalled their mothers observing their stool characteristics and relating these observations to their diets—a practice they perceived as less common in contemporary society. When discussing stool appearance, participants primarily referenced colour variations while generally overlooking considerations of form or size as potential health markers. Participants demonstrated broad acceptance of using stool charts as tools for monitoring dietary health. These results suggest that there is scope for operationalising bowel movement monitoring as a personalised marker of good nutritional health.

Abstract

Background/aims  Fortified breakfast cereals (FBCs) are an important source of iron in the UK diet. In order to quantify their contribution to iron nutrition, food composition data for these products must be accurate. The very large amount of products available, together with inter‐brand differences in iron content mean that discrepancies between the iron content of many FBCs and values in standard food composition databases (FCD) exist. The variation in reported iron contents of FBCs was examined and the impact of this variation on measurement of iron intake using standard food composition tables was investigated.

Method  Data on the reported iron content of 128 FBCs were collected. Completed food diaries from 291 participants of the UK Women's Cohort study were used in the analysis. Mean iron intake from a 4‐day food diary was calculated using UK food tables’ values for FBCs. This was repeated using values reported by the manufacturer for each brand of cereal. The two sets of results were then compared.

Results  There is wide variation in iron content of breakfast cereals available in the United Kingdom. Use of FCD values instead of brand‐specific values under‐ or overestimates an individual's iron intake by as much as 28 or 22% respectively. These results suggest that use of FCD values for breakfast cereals is potentially a source of substantial error in measurement of individuals’ iron intake.

Conclusion  Dietitians need to be aware of inter‐brand differences in iron content and formulate advice accordingly. Failure to collect brand‐specific data for the iron content of FBCs could lead to measurement error in measuring iron intake in dietary studies.

Introduction Intake of free sugars in European countries is high and attempts to reduce sugar intake have been mostly ineffective. Non-nutritive sweeteners and sweetness enhancers (S&SEs) can maintain sweet taste in the absence of energy, but little is known about the impact of acute and repeated consumption of S&SE in foods on appetite. This study aims to evaluate the effect of acute and repeated consumption of two individual S&SEs and two S&SE blends in semisolid and solid foods on appetite and related behavioural, metabolic and health outcomes. Methods and analysis A work package of the SWEET Project; this study consists of five double-blind randomised cross-over trials which will be carried out at five sites across four European countries, aiming to have n=213. Five food matrices will be tested across three formulations (sucrose-sweetened control vs two reformulated products with S&SE blends and no added sugar). Participants (body mass index 25–35 kg/m2; aged 18–60 years) will consume each formulation for 14 days. The primary endpoint is composite appetite score (hunger, inverse of fullness, desire to eat and prospective food consumption) over a 3-hour postprandial incremental area under the curve during clinical investigation days on days 1 and 14. Ethics and dissemination The trial has been approved by national ethical committees and will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed open-access scientific journals. Research data from the trial will be deposited in an open-access online research data archive. Trial registration number NCT04633681.

‘Ultra-processed’ foods (UPFs) have received increasing attention over recent years, with concerns around the potential link between high intake and adverse health outcomes. However, there is a lack of clear evidence supporting the link between consumption of UPFs and disease. The current narrative around UPFs may lead to confusion around healthy eating; given that nurses are frequently perceived as trusted healthcare professionals and have a role in supporting healthy eating in clinical and community settings, an understanding around current guidance, diet and consumption of UPFs is needed. This article presents an overview of current evidence and provides nurses with practical approaches for discussing diet and healthy eating with patients, as well as reflecting on their own dietary intake.

Despite being acknowledged as a complex and multi-faceted condition, the prevailing view within society is that obesity is result of individual choices and can be reversed simply by “eating less and moving more”. This is oversimplistic and leads to the view that obesity is the individual’s fault and is therefore their responsibility to remedy. These views are grounded in individuals’ beliefs around health and contribute to weight bias and stigma. In the present study, participants (n = 143) completed a cross-sectional survey which explored views around weight and health, and whether weight bias or stigma differ based on demographic characteristics, weight status, and prior experience of weight stigma. Results indicate differences in the way individuals living with overweight and obesity are viewed in comparison with those of healthy weight, with the former viewed in a more negative light. Interestingly, while females presented with higher weight bias scores (p = 0.036), males scored higher for externalised weight stigma (p = 0.001). Weight status was seen as an important factor contributing to overall health. These results demonstrate that weight bias and stigma are prevalent and highlight the need for further measures to reduce stigmatising views of people living with overweight and obesity.

BACKGROUND: Public health policy to prevent iron deficiency through food fortification or other measures may be disadvantageous to people with hereditary hemochromatosis. METHODS: From a cohort of U.K. women, 2531 women were typed for C282Y and H63D mutations in the hemochromatosis gene. These women completed food frequency questionnaires and provided blood for iron status. RESULTS: C282Y homozygotes (n=31) had serum ferritin concentrations 2.4 times higher (95% confidence interval=1.9-3.1) than wild types (n=1774), but heterozygotes (n=726) were not different from wild types. H63D genotype had no effect on its own. The effect of heme iron intake (from meat, fish, and poultry) was 2.0 times greater (1.2-3.2) on C282Y homozygotes than other groups. Nonheme iron had little effect. CONCLUSIONS: There may be scope for dietary intervention in women homozygous for the C282Y mutation. C282Y heterozygotes and H63D homozygotes and heterozygotes have similar serum ferritin concentrations to wild type and need not reduce their meat intake other than as part of a normal healthy diet.

BACKGROUND: Gene mutations associated with iron overload have been identified. How food and nutrient intakes affect iron status in persons who may be at risk of iron overload because their genetic status is unknown. OBJECTIVE: The objective was to determine the relation between food and nutrient intakes, HFE genotype, and iron status. Foods and nutrients associated with iron stores, with adjustment for gene mutations associated with hemochromatosis, were explored. DESIGN: A prospective cohort of women aged 35-69 y (the UK Women's Cohort Study) provided information on diet through a questionnaire and food diary; 6779 women in the cohort provided cheek cell samples, blood samples, or both, which were genotyped for C282Y and H63D mutations, and 2489 women also had their iron status assessed. Relations between serum ferritin and iron intake were investigated by using multiple linear regression, with adjustment for potential confounders. RESULTS: The strongest dietary association with serum ferritin concentration was a positive association with heme iron and not with nonheme or total iron. Weaker positive associations were seen with red and white meat, and negative associations were seen with total energy and white and brown whole-meal bread, independent of genotype and other potential confounders. The effect of genotype on ferritin concentrations primarily occurred after menopause, at which time a strong interaction between genotype and heme iron intake was observed. Other factors associated with serum ferritin concentrations were age, body mass index, blood donation, menopausal status, and HFE genotype. CONCLUSIONS: Postmenopausal women eating a diet rich in heme iron and who were C282Y homozygotes had the highest serum ferritin concentrations.

Background Sweeteners and sweetness enhancers (S&SE) are used to replace energy yielding sugars and maintain sweet taste in a wide range of products, but controversy exists about their effects on appetite and endocrine responses in reduced or no added sugar solid foods. The aim of the current study was to evaluate the acute (1 day) and repeated (two-week daily) ingestive effects of 2 S&SE vs. sucrose formulations of biscuit with fruit filling on appetite and endocrine responses in adults with overweight and obesity. Methods In a randomised crossover trial, 53 healthy adults (33 female, 20 male) with overweight/obesity in England and France consumed biscuits with fruit filling containing 1) sucrose, or reformulated with either 2) Stevia Rebaudioside M (StRebM) or 3) Neotame daily during three, two-week intervention periods with a two-week washout. The primary outcome was composite appetite score defined as [desire to eat + hunger + (100 − fullness) + prospective consumption]/4. Findings Each formulation elicited a similar reduction in appetite sensations (3-h postprandial net iAUC). Postprandial insulin (2-h iAUC) was lower after Neotame (95% CI (0.093, 0.166); p < 0.001; d = −0.71) and StRebM (95% CI (0.133, 0.205); p < 0.001; d = −1.01) compared to sucrose, and glucose was lower after StRebM (95% CI (0.023, 0.171); p < 0.05; d = −0.39) but not after Neotame (95% CI (−0.007, 0.145); p = 0.074; d = −0.25) compared to sucrose. There were no differences between S&SE or sucrose formulations on ghrelin, glucagon-like peptide 1 or pancreatic polypeptide iAUCs. No clinically meaningful differences between acute vs. two-weeks of daily consumption were found. Interpretation In conclusion, biscuits reformulated to replace sugar using StRebM or Neotame showed no differences in appetite or endocrine responses, acutely or after a two-week exposure, but can reduce postprandial insulin and glucose response in adults with overweight or obesity.

Despite being acknowledged as a complex and multi-faceted condition, the prevailing view within society is that obesity is the result of individual choices and can be reversed simply by “eating less and moving more”. This is oversimplistic and leads to the view that obesity is the individual’s fault and is therefore their responsibility to remedy. These views are grounded in individuals’ beliefs around health and contribute to weight bias and stigma. In the present study, participants (n = 143) completed a cross-sectional survey which explored views around weight and health and whether weight bias or stigma differed based on demographic characteristics, weight status, and prior experience of weight stigma. Results indicate differences in the way individuals living with overweight and obesity are viewed in comparison with those of a healthy weight, with the former viewed in a more negative light. Interestingly, while women presented with higher weight bias scores (p = 0.036), men scored higher for externalised weight stigma (p = 0.001). Weight status was seen as an important factor contributing to overall health. These results demonstrate that weight bias and stigma are prevalent and highlight the need for further measures to reduce stigmatising views of people living with overweight and obesity.

There has been a significant transformation in the way that obesity is conceptualised, moving away from notions of individual responsibility and moral failure towards acceptance that it is a complex, progressive and relapsing chronic disease. The way in which obesity is defined or understood has significant implications for clinical practice and patient care. Therefore, it is essential that nurses continue to develop their knowledge of obesity-related theory, practice and clinical guidelines to enable them to provide compassionate, person-centred and evidence-based care and support to patients. This article provides an overview of contemporary concepts of overweight and obesity and the associated influencing factors. The authors also discuss concepts of weight bias and weight stigma and provide practical guidance for nurses on the delivery of person-centred care of individuals with overweight or obesity.