BNF Virtual Event:

Nutrition and COVID-19

th
Wed 29 May 2019
13.00-14.00 (GMT)

Tuesday 24th November 2020

9.30-13.00 (GMT)
 Welcome
The Board of Trustees and staff of the British Nutrition Foundation (BNF) welcome you to
this special virtual event and BNF Annual Day.

The event today brings together eminent speakers to share some of the evidence and
thinking that has emerged between COVID-19 and nutrition-related issues.

The BNF Annual Day is an opportunity to celebrate our achievements and impact over the
past year, to thank all those who support our work and to formally congratulate our prize
winners.

About BNF

BNF – Translating evidence-based nutrition science in engaging and actionable ways

The British Nutrition Foundation (BNF), a registered charity, delivers impartial, authoritative
and evidence-based information on food and nutrition. Its mission is to translate evidence-
based nutrition science in engaging and actionable ways, working with an extensive network
of contacts across academia, education and the food chain, and through BNF work
programmes focussing on education in schools and nutrition science communication.

We are proud of our long-established reputation for partnership working. What sets BNF
apart is its ability to bring together those with an interest in food and nutrition from diverse
sectors - academia, medicine, education, communication and the food chain.

The Foundation's governance structure which comprises a Board of Trustees, Advisory

Committee, Scientific Committee, Editorial Advisory Board, Education Working Groups and
a Nominations Committee, on which serve senior/experienced individuals from many walks
of life. The composition is deliberately weighted towards the scientific ‘academic’
community, based in universities and research institutes, and those from education, finance,
media, communications and HR backgrounds.

BNF’s funding comes from a variety of sources including EU projects; contracts with national
government departments and agencies; conferences, publications and training;
membership subscriptions; donations and project grants from food producers and
manufacturers, retailers and food service companies; funding from grant providing bodies,
trusts and other charities. BNF is not a lobbying organisation nor does it endorse any
products or engage in food advertising campaigns, or allow commercial or political pressure
to influence BNF when publishing or disseminating information More details about BNF’s
work, funding and governance can be found at www.nutrition.org.uk/aboutbnf.

We would like to thank our Sustaining Corporate Member for their continued support which
enables us to offer an ongoing programme of events and training.

At BNF events, each participating speaker is responsible for the accuracy of

information and the views, thoughts, and opinions expressed in his/her
presentation. All speakers are requested to declare any relevant interests.

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Key highlights of our work from our last financial year 2019-2020

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 Programme
9:30 Welcome
Prof Judy Buttriss, British Nutrition Foundation

9:45 The evidence-base underpinning diet-disease relationships - advances and

future needs
Prof Christine Williams, University of Reading & Academy of Nutrition Sciences

10:00   Obesity as a risk factor for COVID-19 

Prof Jason Halford, University of Leeds

10:15 Nutrition, immune function and COVID-19   

Prof Philip Calder, University of Southampton

10:30   Vitamin D, COVID-19 and BAME groups:  Current Controversies and Future

Perspectives
Prof Susan Lanham New, University of Surrey

10:45 Comfort break

11:00 BNF in COVID-19 climate: learnings and future plans

Sara Stanner, British Nutrition Foundation

11:15   Emerging evidence for the role of the human gut microbiome in COVID-19
infection outcomes
Prof Glenn Gibson, University of Reading

11:30 Panel discussion - chaired by Prof Judy Buttriss

Speakers, plus Dr Sarah Berry, King’s College London, and Judith Batchelar, Sainsbury’s

12:10 The BNF Awards 2020 – championing nutrition science

Education
Early Career Scientist
Pump Priming
The BNF Prize

12:20 BNF Annual Lecture

Riboflavin and friends; remarkably versatile vitamins
Prof Hilary Powers, University of Sheffield

13:00 Close

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Delegate profile

This webinar has attracted a diverse registrant base, with around 2700 registrations from
the UK and Europe and further afield, including Canada, US, South America, Africa, Asia,
the Middle East and Australasia.

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A number of relevant publications authored by the speakers that may be of
interest can be found at the end of this pack.

Event Chair and Speakers

Prof Judith Buttriss

Director General & Chair
British Nutrition Foundation (BNF)
Professor Buttriss has been the Director General of the
British Nutrition Foundation since 2007; previously the
Science Director (1998-2007). She is a public health
nutritionist, specialising in nutrition science
communication and provision of targeted advice on the
application of science to underpin nutrition strategies.
She originally trained as a dietitian. She has
longstanding links with several universities and, in
2018, was awarded an Honorary Fellowship by the
Nutrition Society and is a Fellow and past trustee of the Association for Nutrition. Since 2019
she has been a Trustee of the Academy of Nutrition Sciences. She has contributed to the
work of a number of government committees, most recently the Family Food Survey user
group and committees concerning nutrient profiling, school food standards, the Eatwell
Guide and health claims. She chairs BBSRC’s DRINC Steering Group and is a member of
MRC’s UK Nutrition Research Partnership committee. She has first-hand experience of a
number of food issues and their interaction with public health. She has written numerous
reviews, articles and book chapters on a wide range of diet and health topics, as diverse as
health claims, plant foods and health, child nutrition, healthy ageing, and environmentally
sustainable diets.

Declaration of interest: Employed by BNF. Details regarding BNF funding can be found
at www.nutrition.org.uk

Prof Christine Williams OBE

Emeritus Professor Human Nutrition
University of Reading University of Reading
& Academy of Nutrition Sciences

The evidence-base underpinning diet-disease relationships – advances and

future needs
Professor Williams was appointed the first Hugh Sinclair
Professor of Human Nutrition at Reading in 1995. She has since
held senior posts at the University including Dean of Life
Sciences in 2006-08 and Pro-Vice Chancellor Research and
Innovation, 2008-2014. Her research has been concerned with
understanding the impact of dietary fats on human health,
particularly in relation to cardiovascular disease and insulin
resistance. Between 1998 and 2001 she was the President of
the UK Nutrition Society. She has been a member and Chair of a number of strategy and
grant awarding panels since 2002, including for the BBSRC and WCRF and continues in
these roles. She is currently a non-executive Director of the Scottish Rural University
College, a Trustee of the British Nutrition Foundation and the Academy of Nutrition

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Sciences. She was awarded an OBE in the Queen’s Honours list in 2013 for her contribution
to Higher Education and nutritional sciences.

Abstract
This presentation, made on behalf of the Academy of Nutrition Sciences, focuses on the
nature of the evidence which underpins dietary recommendations for prevention of non-
communicable diseases. It provides insight into recent developments in nutritional
epidemiology and how these are used by Expert Groups in assessing the quality and
strength of the evidence which links diet and nutrition to risk of non-communicable diseases.
It summarises the frameworks used by these groups to draw conclusions about the
collective evidence. For some cancers, the presentation will briefly illustrate how some
recommendations have remained consistent over many years, whilst others have been
revised as new evidence has become available.

The Academy recognises the innate challenges in this complex area of science including
those relating to dietary assessment, misreporting and the confounding of dietary
associations due to changes in exposures overtime. Lack of systematic approaches that
would allow objective selection of mechanistic data that can support epidemiological findings
is an important gap in the evidence. These important issues will be touched upon briefly but
will be developed more fully in future presentations.

Take home message:

 The main types of evidence used to support recommendations for prevention of non-
communicable disease (NCDs) are: i) randomised controlled trials (RCTs) of diets
for reduced risk of NCDs, and ii) observational cohort studies of associations
between diet, nutrition and NCDs.
 RCTs are considered the gold standard for evidence in clinical medicine; this
approach has been shown to have significant limitations for testing dietary
prevention of NCDs.
 Expert panels use systematic reviews, meta-analyses and advanced statistical
approaches to interrogate cohort studies and RCTs (where available) to assess
strength of the evidence for dietary causation of NCDs.
 Standardised frameworks are used to assess and grade the totality of the evidence
for causal links between diet, nutrition and NCDs.

Declaration of interest: Emeritus Professor, University of Reading; Non-executive Director,

Scottish Rural University College (SRUC) Board, remunerated; Trustee British Nutrition Foundation;
Trustee Academy of Nutritional Sciences; Member EUFIC Scientific Advisory Board; Chair, World
Cancer Research Fund Grant Panel, honorarium; Chair, BBSRC Grant Panels (strategic
programmes), honorarium; Fellow of: the Association for Nutrition, The Nutrition Society, the IUNS.

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Prof Jason Halford
Head of the School of Psychology
University of Leeds
& President Elect
European Association of Obesity (EASO)

Obesity as a risk factor for COVID-19 

Professor Halford is Head of the School of Psychology at the University
of Leeds, President Elect of the European Association of Obesity
(EASO), and former Chair of the UK Association for the Study of
Obesity (ASO). He is a Chartered Health Psychologist. Over the past
10 years his research has focused on drug-induced weight gain, the
effects of nutrients and fibre on appetite and hormone release, the
effects of stress on eating behaviour, the effect of marketing on children,
and on lean-obese differences in the expression of appetite. In 1999,
Jason co-founded the Human Ingestive Behaviour Laboratory at
Liverpool and in 2004 he also co-founded the Liverpool Obesity
Research Network (LORN). Jason is co-ordinator of the SWITCH study, a new trial to
examine the impact of artificial sweeteners on appetite in the context of active weight
management and is one of the co-ordinating leads for the 9m Euro H2020 SWEET project
designed to examine the risks and benefits of using sweeteners to replace sugar in the diet
in the contexts of health, obesity, safety and sustainability. Jason is also local lead for
iKnowFood.

Abstract
A significant association between obesity and COVID-19 severity and poorer clinical
outcomes has been established. Meta-analyses show people living with obesity (PLWO)
have a significantly increased risk of hospitalisation, intensive care unit admission,
intubation and mortality. There are a number of pathways linking obesity to more severe
clinical outcomes in patients with COVID-19, including lower cardiorespiratory fitness,
susceptibility to inflammation, metabolic complications, immune response and increased
viral exposure (shedding and load). But for healthcare professionals and policy makers, it
is important to acknowledge the social determinants of health underpinning obesity and
other chronic diseases, and these severe outcomes from COVID-19, including but not
limited to, access to healthy food and health care, local food environments, food insecurity,
and the wider food environment (local and global food systems).

Lockdowns across the world have led to sustained shifts in dietary patterns and the impact
on mental health is equally well documented. Wave 1 demonstrated strained food systems
and supply chains due to concerns about food shortages, increased reliance on processed
foods at the expense of fresh produce, and resulting changes in eating behaviour, and food
insecurity among vulnerable groups, seen in reduced access to shops and assistance
programmes including school meals, and finally through increased exposure to (and
targeting of) marketing for unhealthy foods. For PLWO, the pandemic meant loss of access
to weight management services, combined with required self-isolation due to medical
vulnerability, undermining weight control efforts and significantly impacting mental
health. One positive point is, at least in the UK, the pandemic has produced long fought-for
changes in health policy including a ban on junk food advertising, calorie labelling in
restaurants, and mandatory front of pack traffic-light labelling. This is more than we have
seen in other countries across Europe. However, as seen recently, the Government has
shied away from addressing issues around the relative costs of healthy verses unhealthy
foods, social inequalities, and food poverty. Better access to weight management services
is an immediate priority that has not been addressed. Failing to treat obesity effectively

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leaves our health services more vulnerable to the effects of the pandemic and other health
emergencies.

The concerns of PLWO communities, include fears over infection, struggles to control eating
behaviour, stress and binge eating, and daily struggles with mental health. Life events play
a critical role in individual’s weight histories. The pandemic has hit PLWO particularly hard,
due to infection fears, self-isolation, and loss of access to support/treatment. This is in
addition to concerns of food, financial loss, and stigma (of having obesity, potentially having
the disease, and thus judged as being at fault), and will certainly be one of the significant
events in their life. To better understand the impact of the pandemic on PLWO across
Europe, we have initiated a study across 10 European countries (Denmark, England,
France, Israel, Italy, Germany, Greece, Spain, Sweden & Portugal) representing differing
experiences of and responses to COVID-19. The study explores the impact of COVID-19
on the family and home environments of PLWO and investigates the impact of food
marketing exposure and media messaging on health and eating behaviours. We hope to
use this research to identify protective strategies for obesity management and design
interventions to support people during times of disruption. Evidence-based support for
national and local health systems is desperately needed in developing useful tools for the
treatment and long-term management of obesity during and beyond this pandemic.

Take home message:

 Living with obesity increases the risk of COVID-19 related hospitalisation, critical
care needs and mortality.
 Social determinants of health, obesity, chronic diseases, and severe negative
outcomes from COVID-19 are interrelated.
 The pandemic has had a negative impact on the diet and heath behaviours of
children and adults including PLWO, further complicated for PLWO with loss of
access to support and treatment.
 Mental health issues are distinctive in PLWO, particularly due to self-isolation,
disruption of usual weight control strategies, reduced access to treatment and food
availability, stress and stigmatisation.

Declaration of interest:
The Universities of Liverpool and Leeds receive funds for Professor Halford (consultancy and
speaking etc.). Companies include Boehringer Ingelheim International GmbH, Dupont, Novo
Nordisk.

Prof Philip Calder

Head of the School of Human Development and Health and Professor of Nutritional
Immunology in the Faculty of Medicine at the University
University of Southampton

Nutrition, immune function and COVID-19   

Professor Philip Calder is Head of the School of Human Development
and Health and Professor of Nutritional Immunology in the Faculty of
Medicine at the University of Southampton, UK. He is an internationally
recognised researcher on the metabolism and functionality of fatty
acids, with an emphasis on the roles of omega-3 fatty acids, and on the
influence of diet and nutrients on the immune and inflammatory
responses. His research addresses both life course and translational
considerations and includes research in cell and animal models and in
healthy humans and patients. He has received many awards and
prizes for his work including the ESPEN Cuthbertson Award and
Lecture (2008), the Ralph Holman Lifetime Achievement Award from

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the American Oil Chemists’ Society (2015), the British Nutrition Foundation Prize (2015),
the prestigious Danone International Prize for Nutrition (2016), and the DSM Lifetime
Achievement Prize in Human Nutrition (2017). Professor Calder was President of the
International Society for the Study of Fatty Acids and Lipids (2009-2012), Chair of the
Scientific Committee of ESPEN (2012-2016) and President of the Nutrition Society (2016-
2019). He is currently President of the Federation of European Nutrition Societies (2019-
2023). He was previously Editor-in-Chief of the British Journal of Nutrition and is currently
an Associate Editor of several journals including Journal of Nutrition and Clinical Science.
Professor Calder has published over 700 scientific articles (excluding abstracts) and
according to ISI Web of Science his work has been cited over 37,000 times with an h-index
of 106 (data from Google Scholar: over 67,500 citations; h-index 135).

Abstract
The immune system protects the host from pathogenic organisms (bacteria, viruses, fungi,
parasites). To deal with this array of threats, the immune system has evolved to include a
myriad of specialised cell types, communicating molecules and functional responses. The
immune system is always active, carrying out surveillance, but its activity is enhanced if an
individual becomes infected. This heightened activity is accompanied by an increased rate
of metabolism, requiring energy sources, substrates for biosynthesis, and regulatory
molecules, which are all ultimately derived from the diet. A number of vitamins (A, B6, B12,
folate, C, D and E) and trace elements (zinc, copper, selenium, iron) have been
demonstrated to have key roles in supporting the human immune system and reducing risk
of infections. Other essential nutrients including other vitamins and trace elements, amino
acids and fatty acids are also important. Each of the nutrients named above have roles in
supporting anti-bacterial and anti-viral defence, but vitamin D, zinc and selenium seem to
be particularly important for the latter. It would seem prudent for individuals to consume
sufficient amounts of essential nutrients to support their immune system in order to help
them deal with pathogens should they become infected. The gut microbiota plays a role in
educating and regulating the immune system. Dietary approaches to achieve a healthy
microbiota can also benefit the immune system.

Take home message:

Good nutrition is important in supporting the immune response.

Declaration of interest: I have research funding from Bayer Consumer Care; act as an
advisor/consultant to BASF AS, DSM, Cargill, Smartfish, Nutrileads, Bayer Consumer Care, GSK
Consumer Healthcare and Danone/Nutricia; have received reimbursement for travel and/or speaking
from Danone, Fresenius Kabi, Baxter Healthcare, B Braun Melsungen, Pfizer (now GSK) Consumer
Healthcare, Abbott, Smartfish, Biogredia and the California Walnut Commission; and is President
and member of the Board of Directors of the European Branch of the International Life Sciences
Institute.

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Prof Susan Lanham New
Professor of Human Nutrition and Head of the Nutrition, Food & Exercises Sciences
Department
University of Surrey

Vitamin D, COVID-19 and BAME groups: Current Controversies and Future

Perspectives
Professor Susan Lanham-New is Professor of Human
Nutrition and is Head of the Nutrition, Food & Exercises
Sciences Department at the University of Surrey. She
led a successful Nutritional Sciences at Surrey
application for the 2017/2018 Queen’s Anniversary Prize
(QAP) for Further & Higher Education. She is a Member
of the Scientific Advisory Committee on Nutrition (SACN)
Main Committee and the SACN Vitamin D Working
Group (2010-2016) that was responsible for setting the
new recommendations for Vitamin D. She is Editor-in-Chief of the Nutrition Society
Textbook Series and first Editor of Nutritional Aspects of Bone Health. Her research focuses
on nutrition and bone health, for which she won the 2001 Nutrition Society Medal for her
work on the role of the skeleton in acid-base homeostasis as well as Young Investigator
Awards at the World Congress of Osteoporosis; the joint IBMS/ECTS Osteoporosis
Conference and the Royal Osteoporosis Society conferences. In 2018/2019 Susan received
the British Nutrition Foundation Prize for her work on nutrition and bone health and in
particular vitamin D. She has published more than 215 peer-reviewed scientific papers;
raised in excess of £8.5M in research income; has supervised 26 PhD students and has an
H index of 45. She is a member of the Nutrition Forum and Academy for the Royal
Osteoporosis Society and is a Trustee of the British Nutrition Foundation. She has recently
been given Fellowship status of the Royal Society of Biology and the Association for
Nutrition and is Honorary Secretary of the Nutrition Society.

Abstract:
Vitamin D is unique - it is a prohormone which is produced in the skin during exposure to
sunlight (UVB radiation at 290-315 nm) with, usually, smaller amounts obtained from food.
During the winter months in areas of middle-high latitude, the solar elevation remains low
throughout the short daylight period, and there is insufficient solar UVB to support
appreciable vitamin D synthesis. For most people, dietary intake does not fully supply the
body’s vitamin D needs and so vitamin D status declines during the winter. Relatively high
prevalence of low vitamin D status globally has been reported over recent decades in a wide
range of population groups but particularly Black, Asian and Minority Ethnic (BAME) groups.
This may be due to environmental factors, such as air pollution, as well as cultural factors
that lead to skin being covered and not subject to sunlight exposure. Older, house-bound
individuals are at particularly high risk of vitamin D deficiency. Vitamin D status is reflected
by the level of the circulating metabolite 25-hydroxyvitamin D (25OHD), which is produced
by hepatic hydroxylation of vitamin D coming from either skin or the gut from oral intake.
The discovery of the expression of nuclear vitamin D receptors (VDR) and vitamin D
metabolic enzymes in immune cells provides a scientific rationale for the potential role of
vitamin D in maintaining immune homeostasis and in preventing the development of
autoimmune processes. It has been hypothesised that there is an association between
seasonal upper respiratory tract infections and low vitamin D status because both occur in
the winter months. However, controversy remains as to whether there is a direct link
between the seasonality of influenza and vitamin D deficiency. Higher influenza incidence
in winter may be due to behavioural reasons including the greater time spent indoors, which
increases individuals’ proximity and hence likely inter-personal transmission. In a recent
systematic review and meta-analysis of individual participant data from vitamin D

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supplementation randomised controlled trials, vitamin D supplementation reduced the risk
of acute respiratory tract infections (ARTI), with the greatest benefit in those with vitamin D
deficiency at baseline. However, it is important to note the limitations to this systematic
review/meta-analysis; there was a high level of heterogeneity in the findings and
concomitantly, the overall significant results in the meta-analysis of the 24 included trials
was dependent on the inclusion of the two studies undertaken in developing countries.
These two trials had specific participants and the findings should not necessarily be
extrapolated to populations from more developed countries. This systematic review and
meta-analysis is currently being updated by the authors and its new findings are likely to be
very important. The continued spread of the novel SARS-CoV-2 virus, and the disease
COVID-19 that is caused by SARS-CoV-2, has led to calls for widespread high dose vitamin
D supplementation. These calls are without support from pertinent studies in humans at this
time, but rather based on speculations about presumed mechanisms. Studies investigating
vitamin D and COVID-19 are currently underway and more are likely to follow. Given that
BAME groups are disproportionately affected with COVID-19, further research is justified,
especially given that there is clear evidence that vitamin D deficiency is particularly common
in these ethnic groups. However, there should be caution against doses higher than the
Upper Limit (4000 IU/d; 100 µg/d) and certainly of very high doses of vitamin D (in some
reports, 10,000 IU/d [250µg/d] of vitamin D are being promoted). Instead, lifestyle strategies
for avoiding vitamin D deficiency, including vitamin D supplementation (particularly in ‘at-
risk’ groups), and ensuring a healthy, balanced diet to support immune resilience is strongly
recommended.

Take home message:

 Vitamin D is essential for good health, especially bone and muscle health.
 Many people have low blood levels of vitamin D, especially in winter or if confined
indoors, because summer sunshine is the main source of vitamin D for most people.
 Government vitamin D intake recommendations for the general population are 400
IU [10 µg] per day] for the UK and 600 IU [15 µg] per day for the USA [800IU [20
µg] per day for >70 years] and the EU). Taking a daily supplement (400IU /d [10
µg/d] in the UK) and eating foods that provide vitamin D is particularly important for
those self-isolating with limited exposure to sunlight.
 Vitamin D intakes greater than the Upper Limit of 4000IU [100 µg] per day may be
harmful and should be avoided unless under personal medical/clinical advice by a
qualified health professional.

Declaration of interest: Two Vitamin D/COVID-19 Webinars for the Nutrition Society and one
Webinar for the Physiological Society. No financial declaration. Written an article on Vitamin D status
in the journal General Practice Nursing and spoke at Vitamin D Webinar (08/07/20). Sponsored by
Thornton Ross. US Talk on Vitamin D and COVID-19 (17/11/20). Sponsored by Council for
Responsible Nutrition. All Honoraria received donated to the Royal Osteoporosis Society and the
University of Surrey Hardship Fund. Research Director for D3Tex Ltd, holds the UK and GCC Patents
for the use of UVB transparent material.

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Sara Stanner
Science Director
British Nutrition Foundation

BNF in COVID-19 climate: learnings and future plans

Sara joined the BNF having completed an MSc in Public Health Nutrition
from the London School of Hygiene and Tropical Medicine. Prior to this
she worked at the Centre of Diabetes and Cardiovascular Risk at
University College London Medical School where her activities included
the coordination of a project in St Petersburg to investigate the relationship
between intrauterine malnutrition and adult cardiovascular disease.
Sara is Science Director at the BNF, where her main role is to ensure the
accuracy and quality of the scientific output of the science team. She is
one of the editors of Nutrition Bulletin and has been involved in editing
several of the BNF’s recent Task Force reports (including Cardiovascular
Disease, Healthy Ageing and Nutrition and Development).

Abstract
Since the COVID-19 pandemic hit the UK, the BNF has been working to provide evidence-
based messages to support people, in particular on the links between nutrition and immunity
and practical ways to have a healthy diet in the changing circumstances we've all faced.
This talk will review BNF's approach so far and look ahead to what's coming next as we
approach the end of 2020. There are links to BNF’s COVID-19 related work at the end of
this pack.

Declaration of interest: Employed by BNF. Details regarding BNF funding can be found
at www.nutrition.org.uk

Prof Glenn Gibson

Professor of Food Microbiology
The University of Reading
Visiting Professor
Imperial College, London (Institute for Global Health Innovation)
Visiting Professor
Northumbria University
Also has honorary positions at research institutes in New Zealand and China.

Emerging evidence for the role of the human gut microbiome in COVID-19
infection outcomes
Professor Gibson currently researches acute and chronic gut
disease. Specific projects on pro/prebiotics, gas production, gut
microbiota development with age, gastroenteritis, obesity and
colonic homeostasis are being carried out. Human trials are a
major facet of the research, with initial principles being tested
in gut models. His PhD was on the bacteriology of sediments
and was awarded by University of Dundee. He then had
research positions at MRC Dunn in Cambridge and Institute of
Food Research in Reading. He has published 8 books and
>490 research papers, is a highly cited author (Clarivate; h factor = 96 Web of Science),
supervised >70 PhD students (some co-supervised) and has been awarded >140 research
contracts.

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Abstract:
Ongoing research has suggested a link between the infection and gut microbiome status.
This is one of several factors that may contribute towards severity of infection. Given the
fact that the gut is heavily linked to immunity, inflammatory status and the ability to challenge
pathogens, it is worthwhile to consider dietary intervention of the gut microbiota as a means
of potentially challenging the viral outcome. Research has appeared showing that gut health
may be compromised by COVID-19 infection and it has also been shown that gut
microbiome status can influence health outcome in patients with COVID-19. To this end,
studies have detected the virus in faeces of patients, further suggesting a gastrointestinal
link, including populations at risk of inflammation. Probiotics (live microbial feeds) and
prebiotics (substrates for beneficial gut microbes) are approaches that modulate the gut
microbiota to benefit the host. They have been used to mitigate infections and decrease
inflammation. This has included studies on respiratory infections such as influenza. A recent
study published by d’Ettorre et al. (2020), examined 70 patients positive for COVID-19
requiring non-invasive oxygen therapy who were provided with hydroxychloroquine therapy
along with antibiotics and tolilzumab. In 28 of these, an oral probiotic mixture was also
administered. Along with improved gut symptoms, the probiotic group had an eight-fold
reduction in risk of developing respiratory failure with less ICU referrals and fatalities. Other
trials are ongoing and under review.

Take home message:

 The gut may act as a reservoir for COVID infection, with many patients experiencing
gastrointestinal symptoms.
 Modulation of the microbiota may help improve outcomes, with studies now
appearing to support the use of probiotics and prebiotics in this regard.

Declaration of interest: Advisor to All Party Parliamentary Group (APPG) on Human

Microbiome and Board Member of International Scientific Association for Probiotics and Prebiotics
(ISAPP). Both are voluntary positions.

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 Panel discussion
Chaired by Prof Judy Buttriss, BNF

Participants include the speakers plus:

Dr Sarah Berry
Senior lecturer in Nutritional Sciences
King’s College London

Sarah Berry is a senior lecturer in Nutritional Sciences. Her research

interests relate to the influence of dietary components on
cardiometabolic disease risk, with particular focus on dietary fat and
postprandial metabolism. Since commencing her research career at
King’s College London in 2000, she has been the academic leader
for more than 30 human nutrition studies in cardiometabolic
health. Sarah is also the lead nutritional scientist on the world’s
largest ongoing programme of postprandial metabolic studies (the
PREDICT studies), assessing the genetic, metabolic, metagenomic,
and meal-dependent effects on postprandial metabolic responses.
She is also one of the scientists on the Covid Symptom Study (CSS) App with more than 4
million users and she is PI of the Diet-Covid Questionnaire (CSS) with 1.5 million
respondents across the UK and US.

Judith Batchelor
Director of Sainsbury's Brand
Sainsbury’s

Judith is responsible for all aspects of Sainsbury’s product offer, from

Policy formation on Ethical and Sustainable Sourcing, through to
Product Technology, Development, Safety, and Packaging along with
Corporate Responsibility and Public Affairs. Driving the Quality and
Innovation agendas whilst protecting and enhancing the reputation of
Sainsbury’s Brand. In addition to her work at Sainsbury’s, Judith is a
Non-Executive Director of both the Environment Agency and the Rugby
Players Association, is Deputy Chair of Farm Africa, sits on the Board
of the Matt Hampson Foundation, the Executive Board of The Princes
Trust Accounting for Sustainability Project, and is also an ambassador for the Woodland
Trust. Judith is a Fellow of both the Institute of Food Science and Technology (IFST), and
the Royal Society of Arts and Manufactures (RSA). From 2013 – 2018 she Co-Chaired the
Government’s AgriFoodTech Council, and currently sits on Defra’s Food and Drink Sector
Council.

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 The BNF Prize Winner 2019: BNF Annual Lecture

The BNF Prize is awarded annually to a person or group for their outstanding achievement
in an area of nutrition. The BNF Prize is awarded by BNF’s Board of Trustees, Advisory
Committee and Scientific Committee, based on a ballot of potential candidates. In 2019, the
BNF prize was awarded to Professor Hilary Powers.

Prof Hilary Powers

Professor Emerita of Nutritional Biochemistry
University of Sheffield

Riboflavin and friends; remarkably versatile vitamins

Hilary Powers is Professor Emerita of Nutritional Biochemistry at the
University of Sheffield, UK. After completing her PhD at the London
School of Hygiene and Tropical Medicine, she continued her research
career at the MRC’s Dunn Nutrition Laboratory in Cambridge. She
undertook research into micronutrient metabolism and the functional
effects of inadequate intakes; some of this work was carried out in West
Africa and has had relevance for optimum nutrition in developing
countries. She left Cambridge to help establish the Human Nutrition Unit
at Sheffield University in 1989. She became Head of this Unit in 2000
and was awarded a chair in nutritional biochemistry in 2004. Professor
Powers conducted research into the role of B vitamins in health and disease, with specific
focus on methyl donor nutrients and HPV-linked cancers, and functional biomarkers of
micronutrient status. She has published over 100 peer-reviewed papers in this field.
Professor Powers sits on the UK Government’s Scientific Advisory Committee on Nutrition
(SACN) and represents SACN on the Project Board for the National Diet and Nutritional
Survey (NDNS). She was a member of the Expert Panel for the World Cancer Research
Fund 2nd Report into Food, Nutrition, Physical Activity and Cancer and was Deputy Chair of
the Continuous Update Panel for the 3rd Expert Report. She is co-editor of the classic
textbook, Human Nutrition (Oxford University Press). Hilary has now retired from the
University of Sheffield although continues to work in an advisory capacity in various settings.

Abstract
Having been awarded the 2019 British Nutrition Foundation Annual prize I had expected to
deliver a lecture to assembled guests at the Annual meeting at the RSM in London, in 2020.
Alas this was not to be; as the Covid-19 Global Pandemic impacted on the wisdom of holding
a face-to-face meeting. In this paper I shall summarise some of the research that I have
carried out during my career as a nutritional scientist. I shall not dwell in too much detail on
any single aspect of my work but rather I shall attempt to show how my research interests
developed over the decades; how one thing led to another, so to speak. My career as a
nutritional biochemist began in the Department of Human Nutrition at the London School of
Hygiene and Tropical Medicine, where I studied functional aspects of riboflavin deficiency,
with a focus on the elderly. I was able to develop my interest in riboflavin further in a
subsequent position at the MRC Dunn Nutrition Laboratories in Cambridge and the MRC
Field Station in Keneba, the Gambia. Our research demonstrated effects of low riboflavin
intakes on measures of haematological status at different life stages; these findings were
supported by mechanistic studies which led to an understanding of the importance of
riboflavin to aspects of the development and function of the gastrointestinal tract. By this
stage in my career I had taken up an academic post at the University of Sheffield, where I
was introduced to the amino acid homocysteine, and the relevance of B vitamins to the
methyl cycle. Our research into B vitamins and homocysteine metabolism included human
trials and mechanistic studies. We developed a model system to demonstrate that the folate
sensitive continuous export of homocysteine from endothelial cells led to the production of

16
free radicals, LDL modification and uptake by macrophages; this contributed to the
understanding of the putative relevance of homocysteine metabolism to vascular disease.
The methyl cycle operates to donate methyl groups to various methyl acceptor molecules
including DNA, and this has importance for carcinogenesis. Our more recent research into
methyl donor nutrients demonstrated a complex relationship between the availability of
methyl donor nutrients and the risk of HPV-linked cervical and oropharyngeal cancers. My
research career has spanned quite a few decades, but the importance of B vitamins to
human health has been the thread linking all aspects of my work. Their versatility is
astonishing.

Take home message:

Riboflavin is sometimes referred to as ‘the forgotten vitamin’. Do not underestimate the wide-
ranging roles this vitamin plays in human metabolism and physiology. Sometimes acting in
association with other B vitamins, riboflavin demonstrates a tremendous versatility of
function; this has relevance to human health worldwide.

BNF Awards for 2020

The BNF Prize 2020:

Professor Gary Frost
Professor Frost qualified as a dietitian in 1982 and has always
maintained a clinical input throughout my career. In 1988 he joined
Hammersmith Hospital as a research dietitian. Over his time at
Hammersmith he gained his PhD in Nutrition and was appointed
Honorary Reader in Nutrition at Imperial College He then joined the
University of Surrey as Professor of Nutrition and Dietetics in 2005. Was
appointed to Professor of Nutrition and Dietetics at Imperial College Jan
2008 to set up the Nutrition and Dietetic Research Group. He is
currently the head of the Section for Nutrition Research and the director
of the Imperial College Centre for translational nutrition and Food research. His research
interests include the role of dietary carbohydrates in human metabolism, new methodologies
processing dietary intake and understanding of changes in the food chain affect nutritional
intake.

BNF Drummond Awards 2020

These Awards have been made possible through BNF’s management of the Drummond Memorial
Fund, established in memory of the work and contribution of Sir Jack Drummond.

BNF Drummond Pump-priming Awards

The Foundation supports the provision of grant to help newly-appointed university lecturers and
research fellows, in human nutrition, to undertake the pilot work needed to generate data that can be
used as the basis of a more substantial grant application. The recipient of the grant in 2019/2020
was:

 Dr Luciana Torquati (University of Exeter)

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 Dr Torquati’s award was for her research project on the role that the gut
microbiome plays in endurance and exercise capacity. Dr Torquati’s study aims
to understand if it is possible to affect exercise performance by increasing
fermentable fibre and acetate production. Fermentable fibre is digested and used
as fuel by the friendly bacteria in the gut. Acetate, which is one of the compounds
produced when gut bacteria ferment fibre, plays a significant role in energy
metabolism and potentially blood flow. Analysing and understanding these two
elements forms the foundation of Dr Torquati’s research. This kind of research builds our
understanding of how the diet affects our gut bacteria and, in turn, the potential for this to impact on
our health and how the body responds to physical activity.

BNF Drummond Early Career Scientist Award

The BNF Drummond Early Career Scientist Award recognises early career excellence in nutrition
science. Applicants are judged on their contributions to nutrition science to date, their potential to
become future leaders in the field, and the scientific merit and clarity of communication of their work.
Winners and runners up are invited to submit a paper to Nutrition Bulletin, to showcase their research
to date.

 Dr Imre Kouw (Australian Catholic University)

Dr Kouw’s award was for her research into the impact of intermittent fasting on
skeletal muscle metabolism. Intermittent fasting is of growing interest in
nutrition science research, and Dr Kouw’s research relates specifically to how
dietary fasting strategies can affect a condition known as sarcopenic obesity,
which is characterised by having a low muscle mass and reduced physical
performance combined with excess body fat; a growing problem in older
people.

 Dr Taryn Smith (University of California, Davis)

Dr Smith has been acknowledged for her work on thiamine (vitamin B1) deficiency;
a condition known as beriberi that is identified in infants that have an inadequate
intake of this vitamin from breastmilk, under circumstances in which the mother
herself has insufficient thiamine intakes and status. She is currently coordinating a
hospital-based study in northern Laos, investigating thiamine responsive disorders
in Laotian infants and young children.

 Dr Nanna Julie Olsen (The Parker Institute, Bispebjerg and Frederiksberg Hospital in
Denmark)

Dr Olsen has been noted for her work looking into the effect consuming sugary
beverages has on a child’s metabolism. Her research on this subject is highlighted
to be of potential public health significance due to its importance in informing
strategies for the prevention of obesity in children.

BNF Drummond Education Awards

The Foundation rewards excellent work in food and nutrition by students and their teachers
throughout the UK. Annual awards, covering each of the Awarding Organisations, are given to
students at GCSE and National 5 levels, and at A-level and Advanced Higher.

18
Due to the pandemic however our usual approach was not possible. In 2020, five Awards have been
given to secondary school teachers from around the UK who have championed food and nutrition
education and have shone in the difficult circumstances of the lockdown period.

 Joe Mann, Torquay Girls’ Grammar School, England

As food teacher, Joe has consistently championed food education, but this year more
than ever Through lockdown he turned his own home kitchen into a food classroom to
broadcast his lessons (with live-streamed lessons and live cook-a-longs), and also
delivered food lessons in school to keyworkers and the vulnerable children.. Over the
last year, Joe has also set up a learner ‘Growing Food Group’ and a ‘Food Feeding
Forum’ to address whole school food policies.

 Lynsey McDermott, Bangor Grammar School, Northern Ireland

Lynsey has established an exceptional Food Technology Department in an all-

boys grammar school. The success is down to her ability to create engaging
lessons, based on sound nutritional evidence, whilst bringing theory to life
through motivational and relevant practical lessons. When classroom teaching
ceased mid-March, Lynsey didn’t stop. At a time when many learners were losing
interest in their education, Lynsey’s learners were more motivated than ever to
cook and learn about their health.

 Siobhan Whelan (Retired August 2020), Sullivan Upper School, Northern Ireland

Siobhan has been a Home Economics teacher for 38 years Siobhan is

passionate about learners developing a positive attitude to food, healthy diets and
sustainability. Her subject expertise connects with learners, fostering genuine
enthusiasm for the subject. This is reflected in one of the highest uptakes of the
subject in Northern Ireland schools. During lockdown, Siohban used Food - a fact
of life to create new curriculum planners and support a range of both theory and
practical lessons which met learner needs.

 Valerie Howe, Garnock Community Campus, Scotland

Valerie is the only Home Economics teacher in a school of 1200 learners. Valerie
has campaigned for many years to have bee hives in the school and they now
have four. Valerie’s food and nutrition learners often come in the top three in
competitions. During lockdown, the Food – a fact of life education programme was
her main resource for lessons and activities with learners sending her evidence of
their achievements and the skills that they had learnt.

 Sian Hedges, St John Baptist Church in Wales High School, Wales

Sian’s work around food and nutrition has had an outstanding impact on the whole
school community. In her work as leader of Food and Nutrition and she has
revolutionised the way learners and their families think about food and nutrition. In
addition, Sian works with the local authority catering team to improve the food
options offered to her school community. All this has led to her school receiving
the Healthy Schools Award. During lockdown, Sian organised regular activities for
learners and staff including a ‘recipe book’ for the school community and families.

19
 Nutrition & COVID-19:
Abstracts, summaries and links that may be of interest

 Buttriss JL (2020) COVID-19: Beware false immune promises

 Williams C on behalf of the Academy of Nutrition Sciences ANS (2020) The

evidence underpinning diet-disease relationships: advances and future needs.
In publication.

 Frühbeck G, Baker J, L, Busetto L et al. (2020) European Association for the

Study of Obesity Position Statement on the Global COVID-19 Pandemic. Obes
Facts 2:292-296.

 Public Health England (2020) Weight management services during COVID-19:

phase 1 insights.
Societal changes required to manage the coronavirus (COVID-19) pandemic may have inadvertently
promoted weight gain, due to the adverse impact on socio-economics, psychological health, and the
resulting metabolic impact of elevated stress, emotional eating and physical inactivity. Evidence on
the impact of COVID-19 has rapidly accumulated, to demonstrate that people living with obesity are
at higher risk of severe illness from COVID-19 infection. It is therefore important to understand what
is happening in terms of weight management practice to develop local and national thinking. This
project explores the impact of the COVID-19 upon the provision of tier 2 and 3 weight management
services (WMS) in England during the lockdown period (phase I; March-June 2020); and determine
what needs to happen in the future.

 Dicker D, Bettini S, Farpour-Lambert N et al. (2020) Obesity and COVID-19: The

Two Sides of the Coin. Obes Facts 13:430-438.
The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus
SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and
economic suffering around the world. The European Association for the Study of Obesity (EASO)
promptly recognised the impact that the outbreak could have on people with obesity. On one side,
emerging data suggest that obesity represents a risk factor for a more serious and complicated
course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak
diverts attention from the prevention and care of non-communicable chronic diseases to
communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease
frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task
Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of
the coin and suggests some specific actions.

 Calder PC (2020) Nutrition, immunity and COVID-19 BMJ Nutrition,

Prevention & Health;bmjnph-2020-000085.
The immune system protects the host from pathogenic organisms (bacteria, viruses, fungi, parasites).
To deal with this array of threats, the immune system has evolved to include a myriad of specialised
cell types, communicating molecules and functional responses. The immune system is always active,
carrying out surveillance, but its activity is enhanced if an individual becomes infected. This
heightened activity is accompanied by an increased rate of metabolism, requiring energy sources,
substrates for biosynthesis and regulatory molecules, which are all ultimately derived from the diet.
A number of vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium,
iron) have been demonstrated to have key roles in supporting the human immune system and
reducing risk of infections. Other essential nutrients including other vitamins and trace elements,
amino acids and fatty acids are also important. Each of the nutrients named above has roles in
supporting antibacterial and antiviral defence, but zinc and selenium seem to be particularly important
for the latter. It would seem prudent for individuals to consume sufficient amounts of essential
nutrients to support their immune system to help them deal with pathogens should they become
infected. The gut microbiota plays a role in educating and regulating the immune system. Gut
dysbiosis is a feature of disease including many infectious diseases and has been described in
COVID-19. Dietary approaches to achieve a healthy microbiota can also benefit the immune system.

20
Severe infection of the respiratory epithelium can lead to acute respiratory distress syndrome
(ARDS), characterised by excessive and damaging host inflammation, termed a cytokine storm. This
is seen in cases of severe COVID-19. There is evidence from ARDS in other settings that the cytokine
storm can be controlled by n-3 fatty acids, possibly through their metabolism to specialised pro-
resolving mediators.

 Lanham-New SA, Webb AR, Cashman KD, et al (2020) Vitamin D and SARS-
CoV-2 virus/COVID-19 disease. BMJ Nutrition, Prevention & Health bmjnph-
2020-000089.
This short original report aims to provide a balanced scientific view on vitamin D and SARS-CoV-2
virus/COVID-19 disease. It provides a succinct summary of the current scientific evidence of
associations between vitamin D, influenza, upper respiratory tract infections (URTIs) and immune
health. Importantly, the paper concludes with lifestyle strategies for avoiding vitamin D deficiency and
ensuring a healthy balanced diet at any time, including during the current pandemic. The overarching
messages are as follows: (1) Vitamin D is essential for good health. Many people, particularly those
living in northern latitudes (such as the UK, Ireland, Northern Europe, Canada and the northern parts
of the USA, northern India and China), have poor vitamin D status, especially in winter or if confined
indoors. Low vitamin D status may be exacerbated during this COVID-19 crisis (e.g. due to indoor
living and hence reduced sun exposure), and anyone who is self-isolating with limited access to
sunlight is advised to take a vitamin D supplement according to their government’s recommendations
for the general population (i.e. 400 IU/day for the UK and 600 IU/day for the USA (800 IU for >70
years)) and the European Union (EU). There is no strong scientific evidence to show that very high
intakes (i.e. mega supplements) of vitamin D will be beneficial in preventing or treating COVID-19.
There are evidenced health risks with excessive vitamin D intakes especially for those with other
health issues such as a reduced kidney function.

 Darling AL, Blackbourn DJ, Ahmadi KR et al. (2020) Very high prevalence of
25-hydroxyvitamin D deficiency in 6433 UK South Asian adults: analysis of
the UK Biobank Cohort British Journal of Nutrition, 1-12.
Little research has assessed serum 25-hydroxyvitamin D (25(OH)D) concentration and its predictors
in Western-dwelling South Asians in a relatively large sample size. This observational, cross-
sectional analysis assessed baseline prevalence of 25(OH)D deficiency in UK-dwelling South Asians
(aged 40-69 years, 2006-2010) from the UK Biobank Cohort. Serum 25(OH)D measurements were
undertaken using the DiaSorin Liaison XL assay. Of 6433 South Asians with a 25(OH)D
measurement, using commonly used cut-off thresholds, 55 % (n 3538) had 25(OH)D < 25 nmol/l
(severe deficiency) and 92 % (n 5918) had 25(OH)D < 50 nmol/l (insufficiency). Of the participants
with a measurement, 20 % (n 1287) had 25(OH)D concentration <15 nmol/l (very severe deficiency).
When 824 participants with undetectable (<10 nmol/l) 25(OH)D measurements were included (total
n 7257), 29 % (n 2105) had 25(OH)D < 15 nmol/l, 60 % (n 4354) had 25(OH)D < 25 nmol/l and 93 %
(n 6749) had 25(OH)D < 50 nmol/l. Logistic regression predictors of 25(OH)D < 25 nmol/l included
the following characteristics: being male; Pakistani; higher BMI; 40-59 years old; never consuming
oily fish; summer sun exposure <5 h/d, not using a vitamin D-containing supplement, measurement
in winter or spring and vegetarianism. In terms of region, median 25(OH)D concentration was 19-20
nmol/l in Scotland, Northern England, the Midlands and Wales. Across Southern England and
London, it was slightly higher at 24-25 nmol/l. Our analyses suggest the need for increased
awareness of vitamin D deficiency in South Asians as well as urgent public health interventions to
prevent and treat vitamin D deficiency in this group.

 Baud D, Dimopoulou Agri V, Gibson GR et al. (2020) Using Probiotics to

Flatten the Curve of Coronavirus Disease COVID-2019 Pandemic. Frontiers in
public health, 8, 186.
Orally administered probiotic strains can reduce the incidence and severity of viral RTIs. At a time
when doctors are using drugs with little anti- COVID-19 data, probiotic strains documented for anti-
viral and respiratory activities (not low-quality undocumented imitations) should become part of the
armamentarium to reduce the burden and severity of this pandemic. Government funding is being
used to test numerous drugs but just as important, they should fund probiotic trials. In addition, use
of recognized prebiotics (e.g., fructans, galactans) to enhance propagation of probiotic strains and
indigenous beneficial microbes should be recommended as part of the overall strategy to flatten the
curve.

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  d'Ettorre G, Ceccarelli G, Marazzato M et al. (2020). Challenges in the
Management of SARS-CoV2 Infection: The Role of Oral Bacteriotherapy as
Complementary Therapeutic Strategy to Avoid the Progression of COVID-
19. Frontiers in medicine, 7, 389.
Background: Gastrointestinal disorders are frequent in COVID-19 and SARS-CoV-2 has been
hypothesized to impact on host microbial flora and gut inflammation, infecting intestinal epithelial
cells. Since there are currently no coded therapies or guidelines for treatment of COVID-19, this study
aimed to evaluate the possible role of a specific oral bacteriotherapy as complementary therapeutic
strategy to avoid the progression of COVID-19.
Methods: We provide a report of 70 patients positive for COVID-19, hospitalized between March 9th
and April 4th, 2020. All the patients had fever, required non-invasive oxygen therapy and presented
a CT lung involvement on imaging more than 50%. Forty-two patients received hydroxychloroquine,
antibiotics, and tocilizumab, alone or in combination. A second group of 28 subjects received the
same therapy added with oral bacteriotherapy, using a multistrain formulation.
Results: The two cohorts of patients were comparable for age, sex, laboratory values, concomitant
pathologies, and the modality of oxygen support. Within 72 h, nearly all patients treated with
bacteriotherapy showed remission of diarrhoea and other symptoms as compared to less than half
of the not supplemented group. The estimated risk of developing respiratory failure was eight-fold
lower in patients receiving oral bacteriotherapy. Both the prevalence of patients transferred to ICU
and mortality were higher among the patients not treated with oral bacteriotherapy.
Conclusions: A specific bacterial formulation showed a significant ameliorating impact on the clinical
conditions of patients positive for SARS-CoV-2 infection. These results also stress the importance of
the gut-lung axis in controlling the COVID-19 disease.

 Walton G, Gibson G, & Hunter K (2020) Mechanisms linking the human gut
microbiome to prophylactic and treatment strategies for COVID-19. British
Journal of Nutrition, 1-36.
The recent COVID-19 pandemic has altered the face of biology, social interaction and public health
worldwide. It has had a destructive effect upon millions of people and is approaching a devastating
one million fatalities. Emerging evidence has suggested a link between the infection and gut
microbiome status. This is one of several factors that may contribute towards severity of infection.
Given the fact that the gut is heavily linked to immunity, inflammatory status and the ability to
challenge pathogens, it is worthwhile to consider dietary intervention of the gut microbiota as means
of potentially challenging the viral outcome. In this context, probiotics and prebiotics have been used
to mitigate similar respiratory infections. Here, we summarise links between the gut microbiome and
COVID-19 infection, as well as propose mechanisms whereby probiotic and prebiotic interventions
may act.

Other information from BNF

 Nutrition & COVID-19 hub

https://www.nutrition.org.uk/healthyliving/covid1
9.html
 Online nutrition training courses
https://www.nutrition.training/
 Food and nutrition programme for schools
https://www.foodafactoflife.org.uk/
 Nutrition Bulletin
 https://onlinelibrary.wiley.com/journal/14673010

For more information on BNF events, go to:

www.nutrition.org.uk or
www.foodafactoflife.org.uk or follow us on
@BNFEvents or @Foodafactoflife

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