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Diet therapy in disorders of gut–brain interaction (DGBI) is rapidly advancing, with accumulating evidence to support two innovative therapies—manipulation of dietary fibers and enzyme supplementation—that target specific DGBI pathophysiology and modulate digestion. Dietary fibers escape digestion in the upper gastrointestinal tract and can influence gut function by impacting digestion, improving laxation, and interacting with the microbiota. A more nuanced understanding of different fiber types and their ability to impact gut function in highly specific ways has shown that fibers can impact distinct gut symptoms and pathophysiology. By considering their functional characteristics of bulking, gel‐forming, and fermentability, restriction or supplementation of specific fibers can offer clinical value in DGBI. Similarly to fiber specificity, emerging evidence suggests that supplemental digestive enzymes may be targeted to known food triggers with consideration that enzymes are substrate specific. Limited evidence supports use of lactase to target lactose, and α‐galactosidase to target galacto‐oligosaccharides. Application of enzymes during manufacturing of food products may prove to be an additional strategy, although evidence is scant. Both innovative therapies may be utilized in isolation or in combination with other diet and nondiet therapies. Implementation can be guided by the principles that fiber modulation can be targeted to specific symptomology or requirement for alterations to gut function, and digestive enzymes can be targeted to known food triggers. This review aims to summarize recent literature of these two innovative concepts and provide practical suggestions for their implementation in clinical practice. [ABSTRACT FROM AUTHOR]

The FODMAP diet has been a treatment of irritable bowel syndrome (IBS) for many years. Rigorous scientific evaluation and clinical application of the FODMAP diet have generated deep understanding regarding clinical efficacy, mechanisms of action, and potential adverse effects of this dietary approach. In turn, this knowledge has allowed fine‐tuning of the diet to optimize treatment benefits and minimize risks, in the form of the traditional three‐phase diet; the FODMAP‐gentle approach, which is a less restrictive iteration; and a proposed FODMAP‐modified, Mediterranean‐style diet which endeavours to optimise both gastrointestinal symptoms and other health parameters. Furthermore, recognition that IBS‐like symptoms feature in other conditions has seen the FODMAP diet tested in non‐IBS populations, including in older adults with diarrhea and women with endometriosis. These areas represent new frontiers for the FODMAP diet and a space to watch as future research evaluates the validity of these novel clinical applications. [ABSTRACT FROM AUTHOR]

Aims: In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues. Methods: Two engagement events, in 2023, brought together experienced and mid‐ and early‐career nutrition professionals for co‐creation of implementation logic models. Results: One hundred and nine early and mid‐career professionals were involved. A revised model for the decadal plan pillars emerged from synthesis of all logic models. This new model integrated the precision and personalised nutrition pillar with nutrition mechanisms pillar. These combined pillars build towards the national data capability enabling platform and created new cross‐cutting themes for education and training. The need arose for greater focus on respectful engagement with Aboriginal and Torres Strait Islander communities and sustained effort to build cross‐disciplinary collaboration to realise the plan's societal determinants goals. A new alliance for nutrition science is proposed to become a unified advocacy voice and build trust in nutrition professionals. Conclusions: A programmatic approach provides a road map for implementing the decadal plan for the final 5 years. [ABSTRACT FROM AUTHOR]

Aims: Gastrostomy feeding represents a vital component of supportive care provided to people with swallowing or feeding difficulties; however, the rate of specific long‐term complications is currently unknown in the adult population. This study aimed to determine the prevalence of specific long‐term gastrostomy‐related complications and unplanned replacements in adults. Methods: A prospective systematic review of Medline, CINAHL and Embase databases was performed. Key complications of hypergranulation, infection and displacement among studies relevant to percutaneous endoscopic gastrostomy tubes, radiologically inserted gastrostomy tubes and balloon replacement tubes were critically appraised by two independent reviewers. Results were synthesised quantitatively in a meta‐analysis using random effects where the population and condition were sufficiently homogeneous. Results: In total, 453 studies were identified, of which 17 met inclusion criteria. 8.5% of adults with a gastrostomy were found to have had an infection ≥42 days after initial tube insertion (p < 0.01), while 13% had hypergranulation (p < 0.01). Displacement occurred in 10.8% of adults (p < 0.01), with age (p < 0.001) and sex (p < 0.001) presenting as a risk factor (R2 = 75%) following meta‐regression. Conclusions: Approximately 1 in 10 people with a gastrostomy will experience a complication related to either hypergranulation, infection or dislodgement. Age, in combination with sex, may provide a guide for risk of displacement among adult female cohorts, though further studies reporting prevalence of gastrostomy‐related complications along with participant demographics are required. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Results Conclusions Trial Registration This systematic review aims to synthesise existing literature to examine the relationship between natural food chemical components and reported symptoms.A systematic literature review was completed. Databases CINAHL (Ebscohost), Medline (Ovid), Scopus, Informit Health and Google Scholar were searched to identify relevant articles. The population included human studies of adults (≥17 years) and excluded those with IgE‐mediate food allergies. Studies examining food chemical components or ‘food chemical elimination diets’ and symptoms were included. Data was synthesised based on clinical conditions and specific food chemical components examined. The risk of bias was assessed using the Academy of Nutrition and Dietetics ‘Quality Criteria Checklist: Primary Research’.Of the 1659 articles retrieved, 21 met inclusion criteria. This included eight randomised controlled trials, four non‐randomised controlled trials, four cohort studies with placebo‐controlled challenge, one prospective cohort study, three cross sectional cohort studies, one case–controlled study. Available studies support the role of a low‐histamine diet for symptoms in chronic urticaria and low‐salicylate diet for reducing sino‐nasal symptoms in aspirin exacerbated respiratory disease and chronic rhinosinusitis and/or asthma. While further evidence is needed to verify the role of glutamate in respiratory, pain, asthma and gastrointestinal symptoms.Food chemical elimination diets may improve condition‐specific symptoms across the adult cohorts outlined within this review, with the strongest evidence to support the role of a low‐histamine diet for management of symptoms in chronic urticaria and a low‐salicylate diet in aspirin exacerbated respiratory disease and/or asthma. Further well‐designed trials are needed to elucidate the effect of specific natural food chemical components on symptoms.Systematic review number: CRD42022322511. [ABSTRACT FROM AUTHOR]