Alexandra Cremona

Optimal nutrition at conception culminates in the best pregnancy outcomes for both mother and foetus. Compromised nutritional status is associated with increased risk of premature birth, low birth weight and pre-eclampsia. Infants born of low birth weight or subject to nutrient insults in utero have altered growth in infancy and childhood and are at increased risk of disease in adulthood. The maternal diet must provide sufficient macro- and micronutrients to meet maternal requirements, as well as the needs of the developing foetus. Some of the increased nutrient requirements may be met by physiological adaptation, such as increased absorption; however, the increased requirements for some nutrients may require supplementation. In addition, particular nutrient requirements of some groups of pregnant females, including those who are very young, are having multiple births, or are living with obesity, require additional considerations. This chapter provides an overview of the physiological changes that occur during pregnancy and outlines the energy and micronutrient requirements needed to support maternal and foetal health, along with considerations for supplement use and nutrient bioavailability.

Iron overload (IOL) results from excessive iron accumulation and presents as primary (genetic) or secondary (from transfusions or iron therapy). Management is predominantly invasive—phlebotomy and iron chelation—which, while effective, are costly and can impair quality of life. No standardized dietary guidelines exist. The aim of this scoping review was to map the evidence on diet and dietary factors in the therapeutic management of IOL–associated conditions. We followed Joanna Briggs Institute (JBI) scoping review methodology and a Population/Concept/Context (PCC) framework to define eligibility. A targeted, JBI 3-step search strategy was run in PubMed (National Library of Medicine), Web of Science (Clarivate), Embase (Elsevier), and CINAHL Ultimate (EBSCO), supplemented by gray-literature sources. Records were managed in Covidence; duplicates were removed, then citations were screened by title/abstract using prespecified eligibility criteria and research questions. Search quality was guided by the Peer Review of Electronic Search Strategies (PRESS) checklist, and the study selection is reported in a PRISMA-ScR flow diagram. Research articles were assigned JBI levels of evidence. Evidence was synthesized descriptively and mapped by dietary factor in narrative summaries and tables. Forty sources (38 peer-reviewed articles; 2 gray-literature articles) met the inclusion criteria. The reported dietary factors potentially relevant to IOL management included polyphenols; vitamins and minerals; diet alteration; foods/food additives; alcohol; and amino and fatty acids. The findings were integrated into a visual workflow, and the current evidence on dietary factors in the therapeutic management of IOL was mapped. Substantial gaps were identified, including limited high-quality clinical trials and inconsistent reporting of the effects of specific dietary factors on iron metabolism. The available literature suggests that diet and selected dietary factors may contribute to improved patient outcomes, highlighting the need for rigorous, well-designed studies to develop unified, evidence-based dietary strategies to complement the standard therapies.

Introduction: Optimal glycaemic control in adolescents with type 1 diabetes (T1D) is essential to prevent complications but remains challenging due to changing lifestyle behaviours. Objective: This pilot study aims to assess whether adolescents with T1D in Ireland meet current nutrition and physical activity (PA) guidelines and to explore the impact of nutrition and PA on glycaemic variability (GV). Methods: Seven adolescents with T1D recorded their PA, diet and blood glucose levels over seven consecutive days. GV was determined using continuous glucose monitoring (CGM) data. Results: The majority of participants demonstrated low levels of PA, with 72% falling below recommended levels, and 86% consuming excessive amounts of saturated fat. Blood glucose levels were in the very high and high ranges for 23.6% ± 25.2% and 22.6% ± 7.3% of the time, respectively, with only 52.6% ± 21.8% of the time spent within the target range. Although no significant associations were found between PA or nutrition and GV, participants who met or exceeded PA and protein guidelines and consumed less fat exhibited better GV parameters. Conclusion: Adolescents with T1D in Ireland are not meeting recommended PA and nutrition guidelines and show poor glycaemic control. As a pilot study, the small sample size limited statistical power, but observed trends suggest that adhering to lifestyle recommendations could improve glycaemic control in this population.

Nutrition is crucial for enhancing performance and overall health among athletes. However, detailed dietary assessments are often time‐consuming, challenging to conduct accurately, and burdensome. Therefore, there is a need for a more time and cost‐effective method for assessing dietary intake among Irish athletes. This study aimed to validate a modified Athlete Dietary Index (mADI) as a screening tool for use among Irish athletes. Eligible participants included team and individual sport athletes over the age of 18 years, currently competing in competitions. Participants completed the electronic mADI followed by a 7‐day food record (7DFR) using Qualtrics and Nutritics software platforms. Misreporting was assessed using the Goldberg cut‐off. Validity for each food group was evaluated based on weighted kappa, two‐way mixed effects intraclass correlation coefficient (ICC), relative bias, and Bland‐Altman graphs. Eighty athletes (28.74 ± 9.77 years) completed the mADI and 7DFR. Poor validity was found for servings per day (% bias > 20%, ICC < 0.50). Only eggs showed good validity for servings per week (−1.7% bias, ICC = 0.55). Acceptable to good validity (% bias < 10.9%) was observed for days per week, with 54% of food groups demonstrating good validity. Weighted kappa indicated an acceptable level of agreement for 62% of the comparisons. Overall, ICC suggested poor reliability for all but three food groups (eggs 0.55; fish 0.52; plant‐based protein 0.63). The mADI demonstrated limited validity in assessing diet quality among athletes but showed potential as a screening tool to evaluate habitual dietary intake patterns in large groups of Irish athletes.

Background The incidence of end-stage renal disease (ESRD) in Ireland has increased by 2.3% annually over the last decade. Patients undergoing haemodialysis are particularly susceptible to protein-energy malnutrition (PEM), a critical predictor of morbidity and mortality. The subjective global assessment (SGA) tool is commonly used to assess nutritional status, but its effectiveness in detecting malnutrition within this cohort remains uncertain. Similarly, handgrip strength (HGS) has been proposed as an indicator of PEM due to its association with poorer renal outcomes. However, there is no standardized protocol for HGS measurement, and data on the optimal timing of assessment are limited. Aim This study aims to determine the optimal timing for HGS measurement to assess malnutrition status in patients receiving haemodialysis treatment. Methods A total of 101 participants were recruited from dialysis units in Galway, Ireland. The SGA tool and three repeated HGS measures were administered to each patient before, during, and after dialysis. Malnutrition status was assessed using the SGA tool and the Irish Nutrition and Dietetic Institute (INDI) HGS reference values. Results The sample comprised 101 participants (64.4% males, 35.6% females) with a median age of 69 years (range: 30–95). Pre-dialysis HGS measurements were higher than those recorded during dialysis (median: 23.5kg [IQR: 16.3] vs. 22.7kg [IQR: 14.7], p < 0.0001). No significant difference was found between pre- and post-dialysis measurements (23.5kg [IQR: 16.3] vs. 23.0kg [IQR: 14.8], p = 0.052). HGS values during dialysis were lower than post-dialysis (22.7kg [IQR: 14.7] vs. 23.0kg [IQR: 14.8], p = 0.047). The SGA identified 18.8% (n = 19) of participants as malnourished, with 16.8% (n = 17) being mildly/moderately malnourished and 2% (n = 2) severely malnourished. In contrast, 64.4% (n = 65) were considered at risk of PEM according to the INDI reference values for HGS. Conclusions Pre-dialysis HGS measurements were the highest among the three time points, indicating that HGS should be measured before haemodialysis to assess nutritional status accurately. The SGA tool showed limited sensitivity in detecting malnutrition compared to the INDI reference values for HGS.

Objective: Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status.Design: Prospective observational study.Setting: Women ≤18 weeks’ gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of ≥30·0 kg/m² and ≥27·5 kg/m² when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher’s exact test for independence analysed differences in variables. A P value of 2 ± 5·2 kg/m². 23·8 % (n 78) were classified as obese. 96·5 % (n 315) were taking folic acid and 95·7 % (n 314) supplemented daily. 30·2 % (n 99) commenced supplementation 12 weeks prior to conception. Overall, 57·9 % (n 190) of women met folic acid supplementation dose requirements. 89·1 % (n 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (P =< 0·001).Conclusion: Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.