Evidence-based Nutritional Recommendations Research Articles

The Use of Pictorial Recall Aids Modifies Dietary Assessment Results: Experiences from Quantitative 24-hour Dietary Recalls of Young Children in Nepal and Senegal

BackgroundRecall bias or memory error is a known limitation of recall-based dietary assessment methods and can lead to substantial misrepresentation of diets. Pictorial recall aids have been used by various studies to mitigate recall bias, but their effect on quantitative, 4-pass 24-h dietary recall (24HR) results has not yet been measured. ObjectivesThis article examines uptake of pictorial recall aids among caregivers of young children in Kathmandu Valley, Nepal, and Guédiawaye Department, Senegal; describes what foods/beverages are subject to recall bias in these contexts; and assesses the effect of these recall aids on estimated dietary outcomes. MethodsWe used cross-sectional data from 24HR surveys that provided a recall aid to reduce caregiver recall bias. Young children’s dietary outcomes were calculated from the 24HR data. Logistic regressions were used to compare characteristics and estimated dietary outcomes of children by recall aid uptake. McNemar’s test and paired t-tests were used to compare estimated dietary outcomes in initial 24HR data with revised 24HR data that incorporated omitted items identified by the recall aid. ResultsPictorial recall aids had relatively high uptake by caregivers in both contexts. Beverages, unhealthy snacks, and fruit were most subject to recall bias. Adding omitted items identified by recall aids resulted in statistically significant changes in most dietary outcomes assessed. Children of caregivers who chose to use the recall aid had significantly different estimated dietary outcomes than children of caregivers who did not use the recall aid. ConclusionsThe use of pictorial recall aids modifies 24HR results in these 2 contexts. Rigorous research is needed to fully understand the impact of recall aids on 24HR methodology and results, with an aim to improve the accuracy of dietary assessment and ultimately inform evidence-based nutrition programming, policy, and recommendations.

A Nutrition-Focused Approach During Continuous Glucose Monitoring Initiation in People With Type 2 Diabetes: Using a Theoretical Framework to Unite Continuous Glucose Monitoring and Food Choices.

Continuous glucose monitoring (CGM) has transformed diabetes care, yet opportunities for further innovations still exist. Some research suggests CGM could be an ideal tool to guide food choices and other healthy lifestyle behaviors, especially for people with type 2 diabetes (T2D). Behavior change theories can be used to understand and describe how CGM users make food-related decisions, which could ultimately lead to the design of more tailored and effective interventions. In this commentary, we describe what it looks like to use the behavior change wheel-a theory-based intervention development framework-to design an intervention for people with T2D who will use CGM data to guide food choices aligned with evidence-based nutrition recommendations. Such frameworks may be beneficial when designing or evaluating future technology-focused behavior change interventions.

The association of Fruits and Vegetables consumption and COVID-19: Results from Yazd Health Study and TAMYZ study

Background:: COVID-19 has caused a high health burden worldwide and increased the need to identify factors affecting its risk. Fruits and vegetables are essential for a healthy diet and immune system function. This study investigated the associations between fruit and vegetable intake and COVID-19 incidence in a large sample of Iranian adults. Methods:: In this cross-sectional study, we used data from 9189 participants of Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd (TAMIZ) study aged 20 to 70 years. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). Results:: After adjusting for confounding variables, we found that higher intake of total fruit (OR: 0.42, CI: 0.20–0.83, P-trend =0.05), fresh fruit (OR: 0.46, CI: 0.23– 0.92, P-trend =0.04), green leafy vegetables (OR: 0.48, CI: 0.24–0.96, P-trend =0.08), and vitamin C (OR: 0.38, CI: 0.17– 0.81, P-trend =0.02) were associated with lower odds of COVID-19. No significant associations were observed for fruit juice, dried fruit, fruit compote, cruciferous vegetables, yellow vegetables, total vegetables and dietary fiber intake. Conclusion:: Our study suggests that higher consumption of fresh fruit, total fruit, green leafy vegetables, and dietary vitamin C may reduce the risk of COVID-19. Further studies are needed to confirm these findings and provide evidence-based nutritional recommendations. Furthermore, the current study's findings could be important for similar pandemics.

Optimizing clinical nutrition research: the role of adaptive and pragmatic trials.

Evidence-based nutritional recommendations address the health impact of suboptimal nutritional status. Efficacy randomized controlled trials (RCTs) have traditionally been the preferred method for determining the effects of nutritional interventions on health outcomes. Nevertheless, obtaining a holistic understanding of intervention efficacy and effectiveness in real-world settings is stymied by inherent constraints of efficacy RCTs. These limitations are further compounded by the complexity of nutritional interventions and the intricacies of the clinical context. Herein, we explore the advantages and limitations of alternative study designs (e.g., adaptive and pragmatic trials), which can be incorporated into RCTs to optimize the efficacy or effectiveness of interventions in clinical nutrition research. Efficacy RCTs often lack external validity due to their fixed design and restrictive eligibility criteria, leading to efficacy-effectiveness and evidence-practice gaps. Adaptive trials improve the evaluation of nutritional intervention efficacy through planned study modifications, such as recalculating sample sizes or discontinuing a study arm. Pragmatic trials are embedded within clinical practice or conducted in settings that resemble standard of care, enabling a more comprehensive assessment of intervention effectiveness. Pragmatic trials often rely on patient-oriented primary outcomes, acquire outcome data from electronic health records, and employ broader eligibility criteria. Consequently, adaptive and pragmatic trials facilitate the prompt implementation of evidence-based nutritional recommendations into clinical practice. Recognizing the limitations of efficacy RCTs and the potential advantages of alternative trial designs is essential for bridging efficacy-effectiveness and evidence-practice gaps. Ultimately, this awareness will lead to a greater number of patients benefiting from evidence-based nutritional recommendations.

571-P: Theory-Based Design of a Nutrition-Focused Approach at CGM Initiation for People with T2D

Background: CGM can improve glycemic outcomes and has the potential to help people with T2D adopt evidence-based nutrition recommendations. Effective interventions using CGM data to guide food choices that align with nutrition recommendations are sparse. The objective of this work is to describe development of a nutrition-focused approach (NFA) at CGM initiation using the behavior change wheel (BCW), a theory-based intervention development framework. Methods: The BCW process included 3 parts: 1) specifying the target behavior and existing barriers according to the Capability Opportunity Motivation-Behavior (COM-B) Model and Theoretical Domains Framework (TDF); 2) identifying intervention content to address the barriers (e.g. broad strategies for behavior change and specific behavior change techniques (BCTs)); and 3) assessing feasibility of the intervention and selecting ways to implement content. Rapid literature review, stakeholder discussion, and content analysis were used to achieve these steps. Results: The target behavior was defined as using CGM data to guide dietary changes that align with current nutrition recommendations and improve TIR. Via content analysis, 80 barriers were coded according to the COM-B and TDF constructs. After feasibility assessment and stakeholder discussions, 12 barriers were selected (e.g. an opportunity barrier is lack of tools supporting use of CGM data to guide food choices). These barriers were mapped to 5 behavior change strategies (i.e. intervention functions; such as training and enablement) and associated BCTs (e.g. habit formation and reframing). The final intervention includes three components: a 1-hr in-person session, a 30-min telehealth session, and nutrition-focused CGM-initiation materials. Conclusion: Use of the BCW led to the development of a rigorous but pragmatic theory-driven intervention. Effectiveness of the nutrition-focused approach at CGM initiation intervention will be tested in clinical trials. Disclosure H.Willis: Other Relationship; Abbott Diabetes, Dexcom, Inc., Research Support; Abbott Diabetes. M.Jaka: None. E.A.Johnson: Speaker's Bureau; Medtronic, Medscape. Funding American Diabetes Association (7-22-JDFN-27 to H.W.)

Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption.

Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality. A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures. Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention. The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

The feasibility and preliminary efficacy of early time-restricted eating on diet quality in college students: A randomized study

Meal timing is an important consideration when assessing health. The primary outcome of this pilot study was to examine the feasibility and preliminary efficacy of early time-restricted eating (eTRE) on diet quality in a sample of college students attending a large southwestern university. Cardiometabolic indices and anthropometric measures were also obtained. The study was planned as an eight-week intervention; however, COVID-19 necessitated laboratory closures that disrupted data collection at week eight. Hence, only data obtained at week zero (baseline) and week four were viable for analysis and are presented herein. Twenty-five healthy participants were randomized to the intervention group (eTRE) which consisted of a daily 6-hour eating window or the control group (CON) which consisted of a daily 16-hour eating window. Each week, participants were permitted one day off from their respective study protocol. Seventeen participants completed all aspects of the study, and diet quality data were obtained from one additional participant (n = 18). Preliminary findings indicate that the 6-hour eTRE protocol may be beneficial for weight reduction and for reducing energy-dense foods typically consumed during the evening hours or later at night. Future research should accommodate individual preferences with regard to the initiation time of the eating window while also providing evidence-based nutrition recommendations to improve diet quality.

Prevalence of amenorrhea in elite female competitive climbers.

Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers.MethodsAn anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months.ResultsA total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m2 and 19.9 ± 2.4 kg/m2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively).ConclusionThis study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.

Association Between Precision Nutrition and Microbiome for Targeting Cardiometabolic Diseases, Inflammation and Bone Metabolism

Since ancient times, it is believed that food has a profound influence on the state of health / disease of an individual. To translate genetic information into evidence-based nutritional recommendations it is appropriate to make a critical analysis of the interactions of polymorphisms with nutrition and health. The most recent discoveries on the human genome provide us the tools and the basis for understanding the molecular mechanisms by which individual genes, or combinations thereof, respond to changes in diet and lifestyle. Nutrigenetics concerns the identification of genetic variations in humans that cause differences in the phenotypic response to molecules introduced with the diet, with the aim of assessing the risks and benefits for the individual of certain components of the diet. In the medical field, the new knowledge on the Human Genome has allowed the consolidation of a new molecular dimension of medicine, in particular of a sector defined as "Predictive Medicine", that is a medicine, which, based on the information obtainable from the genetic constitution of an individual, can anticipate an estimate of the latter's risk of developing a given disease during the course of life. In summary, development of personalized nutrition based on the features of the microbiome is currently being attempted.

Nutrition As a Predictor of Microbiome Injury in Allo-HCT

Nutrition As a Predictor of Microbiome Injury in Allo-HCT

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations.

Reports of nutritional deficiencies in patients with thalassemia (Thal) are common. Despite its importance, however, nutritionally focused research in Thal has been limited by inadequate sample size, inconsistent methodology, a lack of control comparisons, and few interventional trials. Due to these limitations, clinicians lack evidence-based nutrition recommendations to support clinical decision-making. This systematic review summarizes observed relationships between nutrition and morbidity in Thal published in the last 3 decades. PubMed, Web of Science, and Embase were screened for articles pertaining to nutrition in Thal using comprehensive search terms. Studies performed in humans, written in English, and published between 1990 and 2020 were included. Over 2100 manuscripts were identified, from which 97 were included. Patients with Thal were most often deficient in vitamins A, C, D, selenium, and zinc. Prevalence of nutritional deficiency was positively correlated with age and iron overload. Evidence to support the role of vitamin D and zinc for bone health was observed; zinc was also found to improve glucose metabolism. Due to the risk for multinutrient deficiency, nutritional status should be assessed annually in patients with Thal with prompt nutrient replacement when deficiency is detected. Routine supplementation with vitamin D and zinc is recommended.

Nutripedia: The Fight against the Fake News in Nutrition during Pregnancy and Early Life.

(1) Background. Early nutrition and lifestyle before and during pregnancy, breastfeeding, infancy, and early childhood can affect the risk of developing common non-communicable diseases during adulthood such as obesity and metabolic syndrome. To support positive long-term outcomes, it is essential to debunk fake news and provide evidence-based nutritional recommendations. “Nutripedia-Informati per Crescere” is a new tool delivering information and education on appropriate nutrition of mothers and babies during pregnancy and the first years of life. (2) Methods. Nutripedia provides the readers with evidence-based scientific contents in an easy-to-access fashion through a website, a social media page and a personalized advice app called “Nutripedia Chatbot”. (3) Results. Forty articles were published on Nutripedia website with more than 220,000 total views. Social channel activation via bloggers reached over 9 million parents. 14,698 users downloaded Nutripedia chatbot, through which a total of 1930 questions were directed to experts while over 24,000 responses were provided by the app. (4) Conclusions. The use of different communication tools delivering evidence-based nutritional information such as Nutripedia is increasing and could offer supportive strategies to provide scientific information to large audiences and contribute fighting fake news. Future research could investigate the effectiveness of this important health campaign.

Can Undergraduate Students Help Change Older Adults' Confidence for Making Nutrition-Related Decisions in a 45-Minute Nutrition Workshop?

Purpose: The Social Cognitive Theory (SCT) suggests health behaviour can be modified by enhancing knowledge of health benefits and outcome expectations of changing behaviour, improving self-efficacy (confidence), and developing goals to overcome barriers to behaviour change. This study aimed to determine the impact of student-led nutrition workshops on participants' confidence related to SCT constructs for making dietary choices that align with evidence-based nutrition recommendations.Methods: Level-4 Science students developed and delivered 9 workshops on nutrition recommendations for the prevention and management of age-related diseases. Participants attending the workshops completed pre- and post-surveys to assess SCT constructs. For each SCT construct, participants rated their confidence on a 10-point Likert scale. The number (%) of participants who rated their confidence as ≥8/10 on the pre- and post-surveys were compared using the χ2 test.Results: Sixty-three community members (60% female, mean ± SD age 71 ± 7 years) attended the workshops. The number of participants rating confidence as ≥8/10 for each SCT construct increased after the workshops (P < 0.05).Conclusion: Undergraduate students can positively influence community members' confidence for making nutrition-related decisions. Involving students in interventions where SCT-structured workshops are used may help conserve health care resources and reach older adults who may not have access to dietitian services.

P111 The Impact of a Culinary Medicine Course on the Nutrition Care Attitudes of Pre-Health Profession Students

<h3>Background</h3> Studies suggest cooking skill-based learning increases knowledge and improves nutrition attitudes and confidence more than traditional knowledge-based approaches. Current educational strategies may not adequately prepare future healthcare professionals to become empathetic and innovative problem-solvers who have the skills to provide evidence-based and practical advice about nutrition. <h3>Objective</h3> The objective of this study was to investigate how a culinary medicine course for pre-health profession college students impacts nutrition care attitudes. <h3>Study Design, Setting, Participants</h3> Twenty-five pre-health profession undergraduate students enrolled in an interprofessional, experiential culinary medicine course participated. This was a skills- and case-based course which focused on food and cooking, and evidence-based nutrition recommendations for chronic disease. <h3>Measurable Outcome/Analysis</h3> Items from the validated Nutrition in Patient Care Survey (NIPS) were administered pre-post course completion to assess nutrition care attitudes. Sociodemographic characteristics such as age, year in college, career aspirations, race, and ethnicity were collected. Data were analyzed using descriptive statistics, paired <i>t</i> tests, Wilcoxon signed rank tests, and ANOVA with <i>post hoc</i> analysis. <h3>Results</h3> Baseline attitudes scores were somewhat high compared to literature from working health professionals. No significant changes were seen in attitude scores, but differences were found based on ethnicity and career aspirations. Students identifying as Hispanic had more negative attitudes regarding nutrition counseling (<i>P</i> = 0.001) and including nutrition in routine patient care (<i>P</i> = 0.013), but had more positive attitudes towards the importance of taste in improving dietary patterns (<i>P</i> = 0.002). Aspiring doctors, dentists, and physician assistants had more negative attitudes about nutrition counseling than future dietitians (<i>P</i> = 0.008) and nurses (<i>P</i> = 0.049). <h3>Conclusion</h3> Although no significant changes were found in attitude scores, the differences based on ethnicity and career aspirations warrant further investigation. Nutrition care is incidental to many health professionals' practice. Strategies to cultivate positive attitudes regarding the role of nutrition across health disciplines should be identified to better develop competency.

Improving Nutrition Education with Second-Year Medical Students: From Take-Home Assignment to Large-Group Application Exercise.

The online version contains supplementary material available at 10.1007/s40670-021-01342-7.

Analysis of Available Nutrition Recommendations to Combat COVID-19: A Scoping Review.

The current COVID-19 pandemic remains severe. There is no doubt that the COVID-19 pandemic is affecting every aspect of our lives. Currently, the spread of inaccurate information or fake news on the internet to the public is causing the community to panic. Thus, this study aims to obtain available information on food and nutrition related to the prevention and treatment of COVID-19 from various sources. A scoping review framework was used to chart the evidence on nutritional recommendations to prevent COVID-19 based on the preferred method in reporting systematic review and meta-analysis extension for scoping reviews (PRISMA-ScR). The articles were categorised into three main groups: i) general dietary recommendations; ii) supplementation with specific micronutrients and iii) their mixtures and supplementation with traditional herbs and miscellaneous foods. A total of 60 articles met the inclusion criteria and were used in the review. This scoping review demonstrates that there is no miracle cure, food or supplement that can cure or prevent COVID-19. Currently, there is no confirmed treatment or vaccine for the disease. Practicing healthy eating habits is the best nutritional recommendation during the pandemic. Hence, this review hopefully will provide evidence-based nutrition recommendations that are available for current COVID-19 treatment. We hope that the authorities can inform the public and media to stop the spread of nutrition pseudoscience in the wake of the COVID-19 pandemic.

Dietary recommendations of magnesium for cardiovascular prevention and treatment. A position paper of the Israel Heart Society and the Israel Dietetic Association.

Modern life and the Western industrial diet has enhanced the reduction of magnesium in our food, which may contribute to a marginal or absolute magnesium deficiency. Magnesium deficiency is evident in, among others, the elderly population, those after myocardial infarction and/or chronic heart failure, and diabetics. In Israel, over 60% of the drinking water originates from desalinated seawater lacking magnesium, which may cause hypomagnesemia. Magnesium deficiency can easily be treated by magnesium supplementation if we are aware of the situation. This paper summarizes the magnesium chapter in a position paper published in April 2021 by the Israeli Cardiology Society together with the Israeli Dietetic Association. It summarizes evidence-based nutritional recommendations for prevention and treatment of cardiovascular disease, with emphasis on the level of evidence and practical recommendations according to the European Society of Cardiology definitions. The best recommendation is to increase consumption of magnesium-rich food, such as leafy green vegetables (mainly spinach), nuts, avocado, whole grains, legumes (e.g., beans, peas and soy beans), chocolate and certain seafood. However, for people who do not get sufficient magnesium from their diet completing the daily amount, as needed, with supplements of up to 600 mg/day should be considered. In addition, serum magnesium levels should be checked at least every six months in patients with heart failure, people taking diuretic therapy, and people taking proton-pump inhibitors. In addition, it may be beneficial to add magnesium following myocardial infarction in people with hypertension and in heart failure patients in order to reduce cardiovascular morbidity and mortality (class of recommendation IIa, level of evidence B).

Diet, adiposity, and the gut microbiota from infancy to adolescence: A systematic review.

Early life gut microbiota are affected by several factors that make identification of microbial-adiposity relationships challenging. This review evaluates studies that have investigated the gut microbiota composition associated with adiposity in infants, children, and adolescents and provides evidence-based nutrition recommendations that address microbiota-adiposity links. Electronic databases were systematically searched through January 2020. Eligible studies were published in English and analyzed gut microbiota and adiposity among individuals aged birth to 18 years. Abstracts and full-text articles were reviewed by three independent reviewers. Of 45 full-text articles reviewed, 33 were included. No difference in abundance was found for Bacteroidetes (n = 7/15 articles), Firmicutes (n = 10/17), Actinobacteria (n = 8/12), Proteobacteria (n = 8/12), Tenericutes (n = 4/5), and Verrucomicrobia (n = 4/6) with adiposity. Lower abundance of Christensenellaceae (n = 3/5) and Rikenellaceae (n = 6/8) but higher abundance of F. prausnitzii (n = 3/5) and Prevotella (n = 5/7) were associated with adiposity. A lack of consensus exists for gut microbial composition associations with adiposity. A healthy gut microbiota is associated with a diet rich in fruits and vegetables with moderate consumption of animal fat and protein. Future research should use more robust sequencing technologies to identify all bacterial taxa associated with adiposity and evaluate how diet effects these adiposity-associated microbes.

First international meeting of early career investigators: Current opportunities, challenges and horizon in critical care nutrition research

Appropriate nutritional support is a key component of care for critically ill patients. While malnutrition increases complications, impacting long term outcomes and healthcare-related costs, uncertainties persist regarding optimal provision of nutritional support in this setting. An international group of healthcare providers (HCPs) from critical care specialties and nutrition researchers convened to identify knowledge gaps and learnings from studies in critical care nutrition. Clinical research needs were identified in order to better inform future nutrition practices. Challenges in critical care nutrition arise, in part, from inconsistent outcomes in several large-scale studies regarding the optimal amount of calories and protein to prescribe, the optimal time to initiate nutritional support and the role of parental nutrition to support critically ill patients. Furthermore, there is uncertainty on how best to identify patients at nutritional risk, and the appropriate outcome measures for ICU nutrition studies. Given HCPs have a suboptimal evidence base to inform the nutritional management of critically ill patients, further well-designed clinical trials capturing clinically relevant endpoints are needed to address these knowledge gaps. The identified aspects for future research could be addressed in studies designed and conducted in collaboration with an international team of interdisciplinary nutrition experts. The aim of this collaboration is to address the unmet need for robust clinical data needed to develop high-quality evidence-based nutritional intervention recommendations to better inform the future management of critically ill patients.

A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.