bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Nutrition Society of Australia Mentoring Program for Registered Nutritionists
Authors: Vandegraaff M. , Dordevic A.L. , Livingstone K.M. , Papendorf H. , Choi T.
Published: May 2024

Mentoring is an established method of promoting networking, professional growth and learning, and career development in many health professions(1). For a non-vocational profession such as nutrition with a diverse scope of practice, the impact of mentoring remains unclear. In 2020, the Nutrition Society of Australia (NSA) developed and implemented a mentoring program for registered nutritionists. The individually matched mentoring facilitates a 12-month relationship between nutritionists who opted-in to the program. This qualitative case study research aimed to understand the conceptualisation and development of the NSA mentoring program and explore the experience from the viewpoints of both mentors and mentees in the program. First, a 60-minute focus group was conducted with the NSA program organising committee to explore the initial conceptualisation, objectives of the program, expected outcomes, and related training provided to mentors and mentees. Then, a 34-item questionnaire was sent to 63 participants from the first three program cohorts to collect their demographic information as well as expectations, perception and experience of the mentoring. Twenty-one questionnaire responses from 10 mentors and 11 mentees were collected. Participants were from a range of nutrition professions across NSW, VIC, QLD, and WA. Ten questionnaire participants (four mentors and six mentees) further participated in in-depth interviews to provide narratives of their experience. Thematic analysis was conducted with employment of theory-building structure within the case study(2). Our findings indicated that despite an explicit discussion of mentoring focus on employability skills, e.g. communication, professionalism, advocacy, etc., many mentees perceived mentoring as a gateway to employment and career pathway development. The perceived benefits of mentoring were highly dependent on matching of mentor/mentee, which was complicated by the diversity of practice within the profession, and unstated expectations of individual mentees. Regardless of the perceived quality of their mentoring experience, participants reported that the NSA mentoring program added value to the society’s membership and were supportive of program continuity. In conclusion, the NSA mentoring program was a value-adding strategy to the society membership and it could play an important role in career pathway support into the diverse areas of practice in the nutrition profession. More explicit discussion of expectations between mentors and mentees at the beginning of mentoring could enhance the mentoring experience.
Private practice dietetics workforce: A review of the literature
Authors: Donnelly J. , Lane R. , Dalton M. , Walsh L. , Hughes R.
Published: May 2024

Private practice is the fastest growing employment sector for dietitians in Australia, including for new graduates(1). There is an anecdotal concern that current graduate cohorts are not adequately prepared for private practice. The present study aims to assess the existing literature relevant to workforce development specific to private practice dietetics, including areas such as workforce size, distribution, competency, practices and global challenges. The secondary aim is to identify gaps in the literature to inform future priority areas and to inform private practice dietetics workforce development research. Five databases were systematically searched from inception to August 2023 and grey-literature was searched using the Google search engine using key search terms to identify studies for inclusion. Of the 2361 peer-reviewed publications and 1800 grey literature, eighty were included. Directed content analysis and qualitative constant comparison technique were used to deductively extract data from eligible private practice literature. Intelligence sources covering the following themes proved to be limited: workforce size, distribution, attributes, demography, supply/preparation, competencies, continued professional development and challenges. However, clear structural issues present workforce challenges for private practice dietitians. There is an overwhelming paucity of comprehensive literature on the private practice dietetics workforce across the world. Private practice dietetics workforce development research is warranted to address current research gaps in a coordinated, collaborative approach to ensure this rapidly expanding workforce is well supported.
Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving
Authors: Baek Y. , Iuliano S. , Robbins J. , Poon S. , Seeman E. , Ademi Z.
Published: May 2024

Older adults in aged care homes account for 30% of the population burden of hip fractures(1). Nutritional interventions to correct protein and calcium inadequacies reduce these and other debilitating fractures, perhaps partly by reducing falls and slowing deterioration in bone morphology. We aimed to determine whether a nutritional approach to fracture risk reduction in aged care homes is cost-effective. Costing was estimated based on results of a prospective two-year cluster-randomised controlled trial involving 3313 residents in 27 aged care homes (intervention using high dairy menus), 3911 residents in 29 aged care homes (controls consuming from normal menus) and cost of ambulance, hospital, rehabilitation, and residential care incurred after fracture. The incremental cost-effectiveness ratios per fracture averted within a 2-year time horizon were estimated from the Australian healthcare perspective applying a 5% discount rate on costs after the first year. Intervention resulted in a total of 3.5 servings of milk, yoghurt and/or cheese daily, achieving 1,142mg calcium and 69g protein versus usual daily intakes of 700mg calcium and 58g protein consumed by controls. This intervention reduced all fractures by 33% at a daily cost of AU$0.66 per resident. The base-case results showed that intervention was cost-saving per fracture averted, with robust results in a variety of sensitivity and scenario analyses. Scaling the benefits of intervention to the Australian community equated to a saving of AU$66,780,000 annually in Australia and remained cost saving up to a daily food expenditure of AU$1.07 per aged care resident. Averting hip and other non-vertebral fractures in older adults in aged care homes by restoring nutritional inadequacies of protein and calcium is cost saving and supports the wide-spread implementation of this type of nutritional intervention in similar settings.
Exploring the concerns, attitudes and experiences of health professionals regarding a vegan diet during pregnancy and early life; a mixed-method study
Authors: Soh B.X.P. , von Hurst P. , Batty R. , Conlon C.
Published: May 2024

Vegan diet consumption is gaining popularity globally and in New Zealand. However, plant foods provide absent or limited quantities of important micronutrients such as vitamin B12, iron, zinc, and omega-three fatty acids(1). A restrictive and unplanned vegan diet may thus increase risks of nutrient deficiencies especially during pregnancy and early life if the nutrient demands are not fulfilled. Health professionals who provide primary support for pregnant women and their children are important figures in monitoring the nutritional statuses during the antenatal and postnatal periods(2). (Being knowledgeable about the nutritional risks of poorly-planned vegan diets, and having access to appropriate educational resources would support vegan mothers and children to achieve a well-balanced diet. Currently, there are insufficient studies investigating the perspectives of New Zealand’s health professionals within the realm of vegan diets during pregnancy and early life. The aim of the research is to utilise a mixed-methods approach to explore these concerns, attitudes, and experiences. Healthcare professionals, including dietitians, nurses, general practitioners and midwives were invited to participate in the study. Knowledge and attitude scores were collected with an online questionnaire and scores were recorded as a proportion of the participants. Subsequently, descriptions of experiences, concerns, and perspectives about the adoption of vegan diets during pregnancy and early life were collected with semi-structured interviews. A total of 14 health professionals completed the study. All health professionals showed positive attitudes towards the adoption of vegan diets during pregnancy but some exhibited greater concern about their restrictive nature especially in early childhood. Achieving intake adequacy and subjecting young children to intensive assessments for nutrient adequacy were among the concerns raised. More than 90% of health professionals were concerned about iron and vitamin B12 deficiencies while less than 50% were concerned about deficiencies in protein, omega-three fatty acids, iodine, zinc and vitamin D. Less than 50% of participants were aware that plant foods do not provide sufficient vitamin B12. More than 50% disagreed that sufficient information about vegan diets during pregnancy and early life is available. Insufficient evidence-based consensus and government guidelines, and limited access and referrals to dietitians for guidance on vegan diets were highlighted as challenges that reduce the overall knowledge and confidence. Hence, continual professional education and updated evidence-based resources would be important steps to support health professionals in providing guidance to individuals on vegan diets.
Dietary fat intakes and food sources in early childhood: results from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program
Authors: Tesfaye T.S. , Szymlek-Gay E.A. , Campbell K.J. , Zheng M.
Published: May 2024

Dietary fat is a major energy source and an essential nutrient that supports healthy growth and development in young children(1). Despite the important role of dietary fat in early childhood, our understanding of fat intake trends during this period is limited, particularly among Australian children. Insufficient evidence has led to the establishment of an Adequate Intake (AI) for infants aged 0-12 months in Australia, while no recommendation is available for children ages 1-5 years. This study aimed to comprehensively describe fat intake and major food sources in young Australian children. The data of children at ages 9 months (n = 393), 18 months (n = 284), 3.5 years (n = 244), and 5 years (n = 240) from the Melbourne InFANT Program were used(2). At each time point, child dietary intake data were collected via three 24-hour recalls. Food measurement booklets were utilised to estimate food portions. Food groups and nutrient intakes per day were calculated using the 2007 AUSNUT Food Composition Database. Daily energy (kJ/d) and fat (g/d) intake, the contribution of fat to total energy intake, and key food sources of fat intake were calculated. Descriptive statistics (mean and SD) were used to summarise all data. The mean daily energy intake increased from 3490 kJ/d at 9 months to 5889 kJ/d at 5 years. The mean (SD) fat intake (g/d) was 33.7 (8.0) (Australian AI is 30 g/d) at 9 months, 37.5 (9.5) at 18 months, 44.6 (13.4) at 3.5 years, and 49.0 (15.1) at 5 years. The WHO/FAO recommends that total fat intakes should constitute a minimum of 35% of energy (%E) for children aged 6-24 months, gradually reducing to a range of 25% to 35 %E for children aged 2 to 5 years(3). Notably, 40% of children at 9 months, 76% at 18 months, 14% at 3.5 years, and 12% at 5 years had fat intakes below the WHO/FAO recommendations. In contrast, 24% of children at 3.5 years and 28% at 5 years exceeded the recommendation. At 9 months, the primary source of fat was formula/breastmilk, while at later ages, the major sources were milk/milk products, cakes/cookies, and breads/cereals. The proportion of fat from discretionary foods, such as cakes/cookies, processed meats, butter, oil or fat spreads, increased with age. The percentage of total fat from fish, nuts, and seeds was low, contributing <4 %E at all time points. The study highlights a significant proportion of children exceeding or falling below fat intake recommendations. Moreover, the results suggest low consumption of healthy fat sources such as fish, nuts, and seeds. The study findings will contribute to the refinement of fat recommendations in young Australian children and contribute to interventions that aims to improve fat intakes.
The effects of parental perception of children’s weight on children’s weight change: a systematic review and meta-analysis of longitudinal studies
Authors: Yujia C. , Daqiao Z.
Published: May 2024

Childhood obesity has been a public health concern worldwide(1). Parents are a crucial part of the weight monitoring of children(2). But effects of parental perception of children’s weight on children’s weight change remain inconclusive. This systematic review and meta-analysis aimed to evaluate the effects. A systematic search of six databases was conducted from inception to March 2023 based on Cochrane guidelines. Longitudinal studies were included. Data were synthesised using a semi-quantitative approach and meta-analysis. Finally, nine studies with a total of 25,475 respondents were included in the systematic review and meta-analysis. The pooled results showed that compared to children perceived as normal weight, children who were perceived as overweight or obese by their parents had a statistically significantly greater weight gain (pooled coefficient β = 0.43, 95% confidence interval (CI): 0.1, 0.76, p<0.05) during follow-up. Conversely, children perceived as underweight presented less weight gain (β=-0.16, 95%CI: −0.3,-0.02, p<0.05) during follow-up compared to children perceived as normal weight. However, parental misperception of their children’s weight was not statistically significantly associated with children’s weight change (underestimation: β = 0.04, 95% CI:-0.37, 0.44, p>0.05; overestimation: β=-0.09, 95% CI:-0.06, 0.23, p>0.05). We found that parental perception of children’s weight, not parental misperception, might influence children’s subsequent weight change. Longitudinal and intervention studies using validated measurements and including potential confounders and mediators are needed to confirm the causalities.
Factors associated with dietary iron intakes among pregnant women in Ifako-Ijaiye, Lagos, Nigeria
Authors: Adeboye T.E. , Okekunle A.P.
Published: May 2024

Iron deficiency anaemia (IDA) in pregnancy is a significant public health problem worldwide, but little is known about factors associated with dietary iron intake among pregnant women especially from low- and middle-income countries(3). This study assessed factors associated with dietary iron intake among pregnant women attending primary health centres in Ifako-Ijaiye Lagos, Nigeria. Sociodemographic information and dietary intakes were elicited from 432 apparently healthy singleton pregnant women using a pre-tested questionnaire and 24 hour- dietary recall, respectively. Dietary iron intakes was estimated from foods and drinks reported using the West African Food Composition Table and adjusted for energy intakes using the residual method(1). Chi-square test and one-way ANOVA was used to compare categorical and continuous variables respectively by tertiles of energy-adjusted dietary iron intakes at a two-sided P<0.05(2).Mean age and dietary iron intake was 28.5 ± 4.6years and 20.3 ± 3.3mg/day, respectively for all respondents. Energy-adjusted iron intakes by tertiles of energy-adjusted dietary intakes were; 16.6 ± 1.4mg/day for the first tertile, 19.7± 1.0mg/day for the second tertile and 23.7 ± 2.0mg/day for the third tertile. Age, gestational age, parity, education, marital status, and income differed insignificantly by tertiles of energy-adjusted dietary iron intakes. Current evidence suggests a statistically insignificant association between sociodemographic factors and dietary iron intakes in this sample, but further studies are vital for designing culturally relevant interventions to promote the consumption of iron-rich foods among women in this population.
Women with Gestational Diabetes Mellitus do not have compromised polyunsaturated fatty acid status
Authors: Meyer B.J. , Dekker-Nitert M. , Cortie C. , Freeman D.J. , Barrett H.L.
Published: May 2024

Pregnant women who develop pre-eclampsia (PE) and/or intra-uterine growth restriction (IUGR) have reduced polyunsaturated fatty acid (PUFA) status compared to healthy pregnancy(1). It is unknown if pregnant women diagnosed with Gestational Diabetes Mellitus (GDM), and their offspring, also have compromised PUFA status. To determine if women with GDM, and their offspring, have altered PUFA status compared to healthy pregnancy. Pregnant women were recruited from Glasgow Scotland, and Brisbane, Australia from antenatal clinics for this cross sectional study. Third trimester maternal blood samples were collected after an overnight fast and cord blood samples were collected at delivery. Plasma fatty acids were analysed using gas chromatography from women with GDM (n = 37) and healthy pregnancies (n = 27) and their respective offspring (n = 31, from women with GDM, and n = 27 from healthy women). T-tests were used to determine significant differences between maternal with GDM and healthy pregnancy, as well as for their offspring and significance was set at p<0.05. Previously, erythrocyte fatty acids were analysed from women with PE (n = 21), IUGR (n = 13) and healthy pregnancies (n = 86)(1). All results were expressed as mol percent of total fatty acids. There were no differences in maternal plasma arachidonic acid (4.51 ± 1.23 vs. 4.72 ± 0.64, p = 0.39) and plasma EPA & DHA (2.33 ± 0.74 vs 2.69 ± 1.04, p = 0.14) in women with GDM and healthy pregnancies, respectively. There were no differences in fetal plasma arachidonic acid (11.58 ± 2.26 vs. 12.63 ± 1.69, p = 0.08) and plasma EPA & DHA (4.44 ± 1.17 vs. 4.44 ± 1.00, p = 0.89) in offspring from women with GDM and healthy pregnancies, respectively. Women with PE and IUGR had approximately 25% lower erythrocyte EPA & DHA and 35% lower erythrocyte arachidonic acid compared to healthy pregnant(1). Offspring from women with PE and IUGR had approximately 25% lower erythrocyte EPA & DHA and 22% lower erythrocyte arachidonic acid compared to healthy pregnancy(1).Women with PE and IUGR had lower PUFA status likely due to reduced PUFA synthesis(1) and offspring from women with PE and IUGR had reduced PUFA status likely due to ectopic fat in placenta tissue(2). Women with GDM do not have compromised PUFA status suggesting there is no reduced synthesis and transport of PUFA. Offspring from women with GDM do not have reduced PUFA status suggesting there is no problem with PUFA transport across the placenta, unlike offspring from women with PE and/or IUGR. Women with GDM, and their offspring, do not have compromised plasma PUFA status compared to healthy pregnancy.
Factors related to breastfeeding length among Filipino migrant women in South Korea
Authors: Dai Z. , Dhestina W. , Lee JE.
Published: May 2024

Breastfeeding is vital to infants’ health and development during their first year. The quality and quantity of breastmilk are closely linked to the mother’s nutrition [1]. However, for migrant women who become new mothers, various social, economic, and family factors can pose challenges that negatively affect their dietary and breastfeeding practices. Due to the limited research evidence, this study aimed to investigate the factors associated with breastfeeding duration in migrant women. The study sample was drawn from the Filipino Women’s Diet and Health Study (FiLWHEL). These women migrated to South Korea through marriage. At baseline (2014-2016), 504 women provided survey data, including demographic characteristics such as age, marital status, education, employment, income, and language proficiency. Anthropometric measures such as body mass index (BMI) and lifestyle factors were also recorded. Dietary intake of each food group was assessed using 24-hour recalls. We derived the Minimum Dietary Diversity for Women (MDD-W) from the ten food groups [2]. Breastfeeding (any) duration was defined as the average length in months per child. Multivariable logistic regression was used to evaluate the associations between participants’ characteristics and breastfeeding duration, with a cut-off of 12 months (<12 months; > = 12 months). Linear regression analysis was used to assess the relationship between each of these factors and breastfeeding duration in months. Out of the initial 504 women, 271 met the eligibility criteria, with the median age of 35 [interquartile range (IQR): 30,40] years, median breastfeeding duration of 4 [IQR: 1, 10] months, mean BMI of 23.8kg/m2, median (IQR) o fruits, vegetables, and legumes of 162.2 [76.9, 265.9] grams/day, and median of MDD-W score of 5 [IQR:4, 6]. Over 50% of the sample held a university degree or higher, but only 47.8% were employed. Most women were married (90%) and earned less than 20 million won (~AU$23,114.58) per year (65%). Over half had a good understanding of the Korean language. The cross-sectional regression analysis found no associations for breastfeeding length, except for the total fruit, vegetable, and legume intake. Women in the highest tertile of this consumption had a two-fold likelihood of breastfeeding for 12 months or longer [adj.OR (95% CI): 2.15 (0.99-4.68)]. While the MDD-W score had a positive association with breastfeeding for at least 12 months, it did not reach statistical significance [adj.OR: 1.11 (0.92-1.34)]. In the linear regression analysis, only vegetable consumption (per gram increase) was positively related to the length of breastfeeding (beta-coefficient: 0.016; SE: 0.006; p = 0.01). This study among Filipino migrant women in Korea suggests that higher consumption of fruit, vegetables, and legumes positively linked to breastfeeding for at least 12 months. Given the study’s small sample size, interpreting these results should be cautious and warrants further validation in other studies.
Estimated intake of vitamin D is low in Aboriginal and Torres Strait Islander people
Authors: Neo B. , Nannup N. , Tilbrook D. , Daly A. , Dunlop E. , Shepherd C. , Black L.J.
Published: May 2024

Despite high UVB radiation from the sun in Australia (the primary source of vitamin D), vitamin D deficiency (serum 25-hydroxyvitamin D concentrations [25(OH)D] <50 nmol/L) is prevalent among Aboriginal and Torres Strait Islander peoples (27% of adults nationally; 39% of adults living in remote areas)(1). Vitamin D deficiency affects musculoskeletal health and may be associated with non-communicable diseases, such as type 2 diabetes and cardiovascular diseases, prevalent in Aboriginal and Torres Strait Islander peoples.(2, 3) Alternative to UVB radiation, vitamin D can also be obtained from foods (e.g., fish, eggs, and meat) and supplements. However, vitamin D intake in Aboriginal and Torres Strait Islander peoples is currently unknown. Hence, we aimed to provide the first estimate of absolute vitamin D intake in Aboriginal and Torres Strait Islander peoples. We used food consumption data from the 2012-2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey and vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2. Absolute vitamin D intake was estimated by sex and remote and non-remote areas using bioactivity factors (BF) of 1 and 5 for 25(OH)D, which may be up to five times more bioactive than vitamin D. The estimated average requirement for vitamin D intake recommended by the Institute of Medicine is 10 μg/day(4). The estimated absolute vitamin D intake from food and beverages was low for Aboriginal and Torres Strait Islander peoples. The mean estimated absolute vitamin D intake of Aboriginal and Torres Strait Islander peoples was 2.9 μg/day and 5.3 μg/day for BF 1 and 5, respectively. Males had a higher mean intake (3.2 μg/day, BF 1 and 5.9 μg/day, BF 5) than females (2.6 μg/day, BF 1 and 4.7 μg/day, BF 5). Vitamin D intake was 2.9 μg/day (BF 1) and 5.2 μg/day (BF 5) in non-remote and 2.8 μg/day (BF 1) and 5.4 μg/day (BF 5) in remote areas. The high prevalence of vitamin D deficiency and low vitamin D intake highlights a need to promote vitamin D sufficiency through public health policies. The results from this study can be used to model food fortification strategies to provide evidence for the development of nutrition policies to improve the vitamin D status of the Aboriginal and Torres Strait Islander population.
Micronutrient intake from complementary foods of Asian New Zealand infants
Authors: Hall C. , Conlon C. , Haszard J. , Taylor R. , Beck K. , von Hurst P. , Te Morenga L. , Heath A-L.
Published: May 2024

The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.
Cognitively testing Aotearoa’s food security questionnaire in the modern context
Authors: Follong B. , Haliburton C. , Mackay S. , Grey J. , Maiquez M. , Ni Mhurchu C.
Published: May 2024

The eight well-known food security indicators were developed in 1997 using a stepwise process that involved five focus group interviews (one Māori, one Pakeha, two Pacific, and one mixed ethnicity) of 8-16 people, all of whom were either on a low income or were government beneficiaries(1). As part of the development of the tools and methods for a future New Zealand National Nutrition Survey, these eight indicators were considered for inclusion. The Māori and Technical Advisory Groups convened for the development of the National Nutrition Survey foresaw issues with the interpretation of some of the questions given the changes in the food environment and sources of food assistance in the last 25 years and recommended that cognitive testing should be conducted to see if changes were required. Participants were recruited through two community organisations, a local marae, and community Facebook pages. Participants were given the option of participating in a one-on-one interview or as part of a focus group. During each session, participants were asked five (three original and two new) questions relating to food security (running out of basics, use of food assistance, household food preparation and storage resources). After each question, the participants were asked a series of additional probing questions to ascertain whether they had interpreted the question as intended. All interviews were audio recorded and transcribed, and a qualitative analysis was performed on the transcripts to determine areas of concern with each question. A total of 46 participants completed the cognitive testing of the food security questions, including 26 aged 18-64 years, and 20 aged 65+ years. Participants also spanned a range of ethnicities including 8 Māori, 15 Pasifika, 15 Asian, and 8 New Zealand European or Other. Just over half of the participants (n=24) reported themselves to be financially secure, 16 participants reported that their financial security was borderline, 1 participant reported that they were not at all financially secure, and 5 participants declined to answer. Variable interpretations of terms by participants were found in all questions that were tested. Therefore, answers to the food security questions may have not reflected the actual experience of participants. This study also identified other dimensions of food security not assessed by the current eight indicators (e.g., lack of time, poor accessibility). These findings indicate that the food security questions need to be improved to ensure they are interpreted as intended and that new questions are needed that considers all dimensions of food insecurity (i.e., access, availability, utilisation, and stability). These new and amended questions should be cognitively tested in groups that are more likely to be experiencing food insecurity.
Dietary fibre from seeds of Australia native Plantago species as modulators of quality and glycaemic response in starch gels
Authors: Strkalj L. , Cowley J.M. , Yakubov G.E. , Burton R.A.
Published: May 2024

Dietary fibre (DF) is a non-digestible nutrient which has important roles in the digestive system including mantaining regularity, and reducing the risk of certain cancers and non-communicable diseases, such as metabolic syndrome. Even though the positive health effects of DF have long been established, it has been shown that DF intake for children and adults in Australia is below the recommended range – less than 20% of adults met the suggested intake for reducing risk of chronic diseases(1). Plantago ovata, also known as psyllium, is widely used as DF supplement with evidence showing positive effects on weight control, hyperglycaemic response, cholesterol levels, and irritable bowel syndrome(2). P. ovata seed husk produces a highly viscous gel called mucilage when seeds are exposed to moisture. This mucilage is nearly pure DF and has an intricately layered structure which can be further fractionated and studied as a proxy for different gelling systems. Interestingly, Australia is home to many mucilage-producing Plantago species, most of which are underexplored and underutilised, but show remarkable gelling properties and hypoglycaemic potential(3). In this work, we compare structural and functional properties of fractionated DF from P. ovata, and two promising Australian native relatives, P. turrifera and P. drummondii, and their effect on enzymatic hydrolysis in potato starch gels. Using a 3-step fractionation method, we have separated distinct fractions and explored their individual properties(4). P. turrifera and P. drummondii have higher water absorbing capacity, DF yield, and viscosity compared to P. ovata. Monosaccharide composition of all three species is similar – they are highly substituted heteroxylans with minor pectic component. Notably, arabinose to xylose ratio in all species increases with further extraction steps, which is different from cereal arabinoxylans. In an attempt to explore impact of DF in starch-rich systems, we have fabricated DF-potato starch gels and measured enzymatic hydrolysis (with porcine pancreatic α-amylase), freeze-thaw stability, and colour change. Addition of DF reduced syneresis (water separation) during 15 day freeze-thaw cycle measurement, which can lead to prolonged storage stability and has positive implications for shelf life. Colour change was most noticeable when P. drumondii DF were added, while colour of P. ovata and P. turiferra DF gels was similar to control potato starch gel. Effects on α-amylase starch hydrolysis were significant as well, and depended on species and fractions. Certain DFs had impacts on constant k (speed of hydrolysis), while effects on the extent of hydrolysis are still being explored. In conclusion, utility of Australia native P. turrifera and P. drumondii DFs are evident when applied to starch gels, and should be further explored in food products such as bread to increase DF intake and possibly lower glycaemic index.
Increasing consumption of milk, yoghurt, and cheese in older adults in aged care reduces falls and fractures without adverse effects on serum lipids: a cluster randomised controlled trial
Authors: Iuliano S. , Hare D.L. , Vogrin S. , Poon S. , Robbins J. , French C. , Seeman E.
Published: May 2024

Correction of dietary calcium and protein undernutrition using milk, yoghurt, and cheese in older adults in aged care homes is associated with reduced fractures and falls(1). As these foods contain potentially atherogenic fats, we aimed to determine whether these dietary changes adversely affect serum lipid profiles. Sixty aged care homes in Australia were randomised to intervention (n = 30 milk, yoghurt, and cheese enriched menu) or control (n = 30 regular menu) for 2 years. A sample of 159 intervention and 86 control residents (median age 87.8 years) had dietary intakes recorded using plate waste analysis and fasting serum lipids measured at baseline and 12 months. Diagnosis of cardiovascular disease and use of relevant medications were determined from medical records. Data were analysed using mixed effects linear regression model adjusting for clustering (aged care home) and other confounders. Intervention increased daily dairy servings from 1.9 ± 1.0 to 3.5 ± 1.4 (p<0.001) while controls continued daily intakes of £ 2 servings daily (1.7 ± 1.0 to 2.0 ± 1.0 (p<0.05). No group differences were observed for serum total cholesterol/high-density lipoprotein-C (TC/HDL-C) ratio, Apoprotein B/Apoprotein A (ApoB/ApoA) ratio, low-density lipoprotein-C (LDL-C), non-HDL-C, or triglycerides (TGs) at baseline and 12 months. Among older adults in aged care homes, correcting insufficiency in the daily intake of calcium and protein using milk, yoghurt and cheese does not alter serum lipid levels, suggesting that this is a suitable intervention for reducing the risk of falls and fractures.
He Rourou Whai Painga, an Aotearoa New Zealand Dietary Pattern for Metabolic Health and Whānau Wellbeing: Protocol for a randomised controlled trial
Authors: Lithander F.E. , Braakhuis A. , Gearry R. , Merry T. , Foster M. , Ross C. , Parry Strong A. , Krebs J. , Conroy D. , Rolleston A. , Weatherall M. , Mullaney J.
Published: May 2024

Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand(1). Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health(2). This study aims to test whether an intervention of a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) using behaviour change science can improve the metabolic health of participants and their household/whānau. This is a multi-centre, three-stage trial, with two randomised controlled trials (RCTs), both parallel groups, superiority trials, and a longitudinal cohort study. The first RCT (RCT1) is a comparison of the NZMedDiet pattern implemented using behaviour science compared to usual diet for 12 weeks, and the second (RCT2) is a behaviour-change intervention compared to no intervention for 12 weeks, administered after participants have been exposed to the intervention in RCT1. The third stage is a longitudinal cohort study where all participants are followed for up to a year. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). Two hundred index participants and their household/whānau have been recruited and randomised into the trial. Participants are from four centres, two of which are University research units (University of Auckland (n = 57) and University of Otago, Christchurch (n = 60)), one a community-based traditional meeting place (Tu¯ Kotahi Māori Asthma and Research Trust at Ko¯kiri Marae in Lower Hutt, Wellington (n = 19)), and the other based at a hospital-based research unit (the Centre for Endocrine Diabetes and Obesity Research (CEDOR) in Wellington (n = 64). The trial will test whether the NZMedDiet pattern and behaviour change support improves the cardiometabolic health of people in New Zealand.
Role of Extracellular Vesicles (EVs) in Mediating Antioxidant Response to a Glucoraphanin Rich Meal
Authors: Mitra N. , Ramzan F. , Phua H.H. , Blenkiron C. , Artuyants A. , Pook C. , Lithander F. , Foster M. , Mithen R.
Published: May 2024

Aging is associated with increasing oxidative stress and declining antioxidant defences, making the body susceptible to various chronic conditions. Cruciferous vegetables contain glucoraphanin, which is metabolised into sulforaphane (SFN) in the gut(1). SFN activates a mechanism enhancing antioxidant defences that may contribute to a reduction in risk of age-related chronic diseases. Our hypothesis proposes that consuming cruciferous vegetables releases hepatic extracellular vesicles (EVs), which carry with a cargo of antioxidant proteins, into the systemic circulation(2) that are transported to ‘at risk’ tissues. We seek to characterise the antioxidant protein content of EVs from blood samples of healthy human volunteers from a prospective dietary intervention study trial called (GLOBE). The GLOBE study employs a randomised, single-blind, two-arm crossover design and involves 12 healthy male or female adults aged >55 years, at the time of enrolment, have a BMI in the range of 18.5-30 kg/m2, and have self-reported healthy (are not suffering from current illness like cancer, and gastrointestinal diseases including coeliac, Crohn’s, colitis, and irritable bowel syndrome) and not using any medications like antacids, laxatives and antibiotics which can interfere with normal digestive or metabolic processes. The dietary intervention consists of two commercially available treatments, one of which is a glucoraphanin-rich vegetable soup, while the other vegetable soup lacks glucoraphanin. Our initial focus lies in optimizing and standardizing a method for routinely characterizing EVs derived from healthy volunteers participating in dietary intervention studies. We specifically aim to extract EVs from a minimal plasma volume (2ml) using size exclusion chromatography (SEC). Subsequently, we intend to employ this method to analyse EVs obtained from 161 plasma samples collected from 12 participants during the GLOBE study for different time points like 0, 120, 240, 360, 480 min, 24 and 48 hr. Our goal is to gain insight into the role of EVs as part of the mechanisms by which consuming a moderate quantity of cruciferous vegetables may confer health benefits. Our research carries the potential to establish a standardised approach to the characterisation of EVs from healthy individuals which has several applications in nutrition research.
A 12-month randomised controlled trial using intensive dietary interventions for adolescents with obesity associated complications
Authors: Lister N.B. , House E.T. , Kwok C. , Inkster M. , Day K. , Lang S. , Grunseit A. , Gow M.L. , Jebeile H.
Published: May 2024

Adolescent obesity requires effective and accessible intervention options and there is potential for intensive dietary interventions to be used as adjunctive therapy to behavioural weight management for some individuals(1). The aim of this study was to determine the effect of two novel diet therapies, delivered in the as part of an intensive behavioural weight management intervention, in adolescents with metabolic complications associated with obesity. The Fast Track to Health study (HREC/17/SCHN/164; ACTRN12617001630303) was a multi-site 52-week RCT, conducted 2018 – 2023, comparing a very-low-energy diet (800kcal/day) followed by i) an intermittent energy restricted (IER) diet; and ii) a continuous energy restricted diet (CER), for adolescents (13-17years) with ≥1 obesity associated complication. Interventions were delivered as part of an intensive behavioural weight management intervention by a multidisciplinary team2. Anthropometry, body composition and cardiometabolic health were assessed at baseline and week-52. The primary outcome was change in BMI z-score at week-52. Dyslipidaemia was defined as HDL <1.03mmol/L and/or triglycerides ≥1.7mmol/l, and elevated liver function tests (LFTs) as ALT and/or GGT ≥1.5 upper limit of 30U/L3. The difference in BMI z-score between groups at week-52 (±4) was assessed using a t-test. Mixed models was used to investigate changes over time. Descriptive statistics were used to describe participants above and below clinical cut-points at baseline and week-52. In total, 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. At week-52, BMI z-score reduced by −0.23 [95%CI −0.37 to −0.22], BMI expressed as a percentage of 95th percentile reduced by −8.86 [95%CI −12.46 to −7.47] and Fat Mass Index reduced by −1.49 [95%CI −2.36 to −1.08]. There was no significant difference for weight or cardiometabolic outcomes between diet groups. The occurrence of dyslipidaemia was unchanged between baseline and week-52 (n = 60 [43%] and n = 37 [43%] respectively) and a small improvement in the occurrence of impaired LFTs (n = 37 [27%] to n = 15 [17.2%] respectively). There were no differences in change of occurrence of dyslipidaemia or impaired LFTs between intervention groups. These findings suggest that both IER and CER, delivered as part of an intensive behavioural weight management program, are equally effective for improving weight and cardiometabolic outcomes for adolescents with obesity.
Exploring the anti-inflammatory activity of the plant-derived phytochemical sulforaphane from cruciferous vegetables
Authors: Treasure K. , Harris J. , Williamson G.
Published: May 2024

Dysregulation of immune responses results in the development of chronic inflammatory conditions. The current frontline therapy, glucocorticoids, are effective immunosuppressive drugs but come with a trade-off of cumulative, debilitating side effects with sustained use. Clearly, alternative drug options with improved safety profiles are urgently needed. Macrophage Migration Inhibitory Factor (MIF) is a pleotropic pro-inflammatory cytokine and integral component of immune and inflammatory responses. MIF counter-regulates the immunosuppressive effects of glucocorticoids and promotes NLRP3 inflammasome activation.1, 2 Elevated MIF is a feature of multiple diseases, including multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematous. Given the association of increased MIF in serum with multiple disease models, it is considered MIF may be a plausible, specific druggable target in treatment of chronic inflammatory and autoimmune diseases, particularly as a target for glucocorticoid-sparing therapy to reduce the dose or duration of glucocorticoid treatment. The organosulfur isothiocyanate phytochemical sulforaphane (SFN) is extracted from cruciferous vegetables, including broccoli and Brussel sprouts following hydrolysis of its inactive precursor, glucoraphanin. SFN has antioxidant and cancer chemoprotective properties, and promotes NRF2 antioxidant signalling to upregulate the expression of numerous antioxidant enzymes. SFN has been shown to covalently modify MIF with high reactivity and is a potent inhibitor of MIF tautomerase activity. However, to date, no such study has evaluated the role of SFN as a novel inhibitor of MIF-mediated inflammatory pathway activation. Using cell-based assays, we have sought to investigate the role of SFN as an inhibitor of multiple inflammatory pathways which have previously implicated MIF as a possible regulator. Our initial work has examined SFN as an inhibitor of NF-κB activity, inflammasome activation, and evaluated if MIF is required for this effect. RAW264.7 murine macrophage cells stably expressing NF-κB-luciferase reporter construct were pre-treated with SFN (2.5 µM) before the induction of inflammation, via LPS (100ng/mL). For NLRP3 inflammasome activation, cells were subsequently treated with the NLRP3-specific inflammasome activator, nigericin (10 µM). TNF, IFN-β and IL-1β cytokine expression was measured by ELISA and NF-κB activity by luciferase reporter assay. We found SFN is a potent inhibitor of NF-κB activity and inhibits release of the pro-inflammatory cytokine IL-1β through inhibition of NLRP3 inflammasome activation. Finally, co-incubation of SFN with the glucocorticoid dexamethasone significantly suppressed TNF and IFN-β expression, demonstrating steroid sparing activity of SFN in vitro. Thus, SFN may be a suitable treatment for disruption of inflammatory pathways and suggest some of these effects may be mediated through direct interactions with MIF.