bluuebunny/crossref_metadata_2025 huggingface dataset:
Achieving adequate nutrition in a malnourished world: the role of sustainable diets and animal source foods
Authors: Beal T.
Published: May 2024

Malnutrition affects over half the world’s population, manifesting in myriad forms. Nearly 1 in 4 children never reach their full growth potential, while 1 in 2 lack key micronutrients essential for health and development.1 Furthermore, 1 in 3 women suffer from anemia, and 2 in 3 do not get enough vital micronutrients. At the same time, over 2 in 5 adults are overweight or obese, and 1 in 5 live with high blood pressure. These various forms of malnutrition lead to physical and cognitive impairments, increased susceptibility to infections and chronic diseases, and reduced quality and length of life. They also impose immense economic, social, and health burdens. In addition to harming human health, our food system damages the planet, generating greenhouse gas emissions that drive climate change and depleting freshwater reserves. It also causes deforestation and habitat destruction which drive species to extinction. These grave harms to both human and environmental wellbeing demand urgent action. Transforming our food systems is imperative to promote nutritious diets that deliver adequate nutrition and protect against noncommunicable diseases, while simultaneously protecting our planet, its biodiversity, and natural resources. As a response, many call for drastically limiting consumption of animal source foods like meat, eggs, and dairy. They argue that these foods jeopardize both human health and environmental sustainability. However, is it possible to meet the nutritional needs of the global population with few animal source foods? What are the full impacts, both positive and negative, of animal source foods on human health and the environment? In this presentation, I will review the latest scientific evidence surrounding these questions. I will examine whether mindfully produced and consumed animal source foods can be part of the solution. Join me to explore these critical issues concerning sustainable nutrition and the role of animal source foods in our food system transformation.
Modelling the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity in a cohort of Australian adults
Authors: Goode J.P. , Smith K.J. , Breslin M. , Kilpatrick M. , Dwyer T. , Venn A.J. , Magnussen C.G.
Published: May 2024

Dietary guidelines are increasingly promoting plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons(1). It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. Here, we modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55% female) from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using food frequency questionnaires: CDAH-1 (2004–06), CDAH-2 (2009–11), and CDAH-3 (2017–19). The median follow-up duration was 13 years. The cumulative average intake of each food group was calculated to reflect habitual consumption. Insulin sensitivity (%) was estimated from fasting glucose and insulin concentrations at CDAH-3 (aged 39–49 years) using homeostasis model assessment. Applying the partition model(2), we simulated the replacement of one food group with another by including both in the model simultaneously (e.g., red meat and legumes), along with potential confounders and energy intake. The difference between parameter estimates (i.e., regression coefficients and variances) and their covariance were used to estimate the “substitution” effect. We report the simulated percentage point change in log-transformed insulin sensitivity for a 1 serve/day lower intake of one food group with a 1 serve/day higher intake of another food group. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 0·10, 95% CI 0·04–0·16). Adjustment for waist circumference attenuated this association by 61·4%. On an individual basis, replacing red meat with legumes (β = 0·12, 95% CI 0·02–0·21), nuts and seeds (β = 0·15, 95% CI 0·06–0·23), or whole grains (β = 0·11, 95% CI 0·04–0·17) was likewise associated with higher insulin sensitivity. Point estimates were similar when replacing processed meat with plant-based alternatives, but more uncertain due to wide confidence intervals. Our modelling suggests that habitually replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity, and thus, a lower risk of type 2 diabetes. Abdominal adiposity was identified as a potentially important mediator in this relationship. In relation to insulin sensitivity, our findings support the recommendation to choose plant-based sources of protein at the expense of red meat consumption.
Nutrition and physical activity in schools in Pacific Island Countries
Authors: Singh P.
Published: May 2024

The increasing rates of obesity among children and adolescents are significant issues worldwide and in the Pacific Island Nations(1). An energy imbalance between calorie intake and expenditure is linked to overweight and obesity for children and adolescents. Epidemiological, nutritional, and technological changes are linked to altered eating habits, including an increase in energy consumption. Conversely, technological advancements and market globalization are responsible for declines in physical activity (PA)(2). During COVID-19 outbreak a more sedentary lifestyle than before the outbreak has been adopted by children and adolescents as a result of lockdown measures, which include shutting of schools, restrictive travel outside the home, and limiting social interactions has made the issue worse(3). Studies have shown that 40% to 70 % of obese children become obese adults(4). Since children spend a large portion of their day in school and eat their main meals there, school settings are suitable for interventions aimed at preventing childhood obesity. Additionally, school environments will reduce the number of dropouts brought on by problems with accessibility or transit(5). The selection of primary school children is important for interventions as the dietary and physical activity habits acquired at this age are ingrained in children and continue into adulthood. So, it is important to have a robust nutrition and physical activity curriculum in all the primary schools. There are many challenges faced by the governments in implementing such curriculum which includes lack of trained in country staff, limited infrastructures in schools for physical activity, culturally relevant information which can be easily understood by local populations, proper monitoring, and evaluation of the existing guidelines. Community engagement and partnership with local health ministries and departments are crucial for the success of these curriculum (6). To fill this gap robust evidence on effectiveness and implementation of school-based wellness intervention programs in primary schools are in dire needs in Pacific Island nations. Given this, the project titled “Healthy Child Promising Future-Promoting health in primary school settings was conducted in all schools in Wallis & Futuna and piloted in one urban school in Fiji. A knowledge, attitude, practice (KAP) questionnaire was used to evaluate the effectiveness of the intervention which was conducted for all the children (7-9 years) and their care takers. Intervention was conducted on 15 pre identified themes by face-to-face sessions every week and 30 minutes physical activity session was conducted every day in all the schools for children. For caretakers intervention was conducted around 5 themes. In both the countries the intervention had shown significant improvement in KAP scores both for caretakers and children related to the healthy diet consumption and promotion of physical activity. The results indicate that the developed intervention package had a positive impact on KAP.
Reduction in systolic blood pressure following dietary fibre intervention is dependent on baseline gut microbiota composition
Authors: Snelson M. , Jama H.A. , Rhys-Jones D. , Head G.A. , Mackay C.R. , Marques F.Z.
Published: May 2024

Uncontrolled hypertension is a primary cause of non-communicable diseases and death globally(1). The gut microbiota plays a role in hypertension and dietary interventions high in fibre have been shown to lower blood pressure (BP)(2). Not all participants respond to dietary fibre interventions, for reasons which are unclear. Here we aimed to identify responders of a high fibre intervention based on their baseline gut microbiome. Twenty treatment-naive participants with hypertension received either placebo or 40g per day of prebiotic acetylated and butyrylated high amylose maize starch (HAMSAB) supplementation for 3 weeks in a phase II randomised cross-over double-blind placebo-controlled trial. Blood pressure was monitored at baseline and each endpoint by 24-hour ambulatory BP monitoring, with those experiencing a reduction between timepoints of ≥ 2 mmHg classified as responders. Baseline stool samples were collected and the V4-V5 region of the 16S gene sequenced. Taxonomy was assigned by reference to the SILVA database. The MaAsLin2 package was used for assessing the relationship between baseline gut microbiota and response to dietary intervention. Overall participants had significant reduction in 24-hour systolic BP (–6.1 mmHg, p = 0.03), with 14 individuals classified as responders and six individuals as non-responders. 13 genera were found to be differentially abundant between responders and non-responders. Genera significantly enriched in responders included Dialister (β = 1.29, q = 1.921x10-134), Coprococcus (β = 1.26, q = 3.282x10-121), Bifidobacterium (β = 1.67, q = 1.11x10-81), Ruminococcus (β = 0.161, q = 1.11x10-8) and Roseburia (β = 0.82, q = 4.275x10-2). Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased level of bacterial genera known to contain species that produce short-chain fatty acids (e.g. Bifidobacterium, Roseburia and Ruminococcus) at baseline. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension.
Transforming Public Health in Samoa: Battling Non-Communicable Diseases through Dietary Interventions and Government Initiatives
Authors: Pupi F.D.L.
Published: May 2024

Non-communicable diseases (NCDs) have become a major health concern worldwide, with Samoa being no exception(1). This presentation delves into the intricate dynamics of NCDs in Samoa, from the historical perspective before colonization to the contemporary challenges and initiatives taken by the government to address this pressing issue. Samoa, before colonization, maintained traditional diets that were largely plant-based and rich in local fruits and vegetables(2). The evolution of these diets over time has played a significant role in the rise of NCDs. The incorporation of imported processed foods, high in sugars and unhealthy fats, has led to a shift in dietary patterns. Recognizing the urgency of the situation, the Samoan government has initiated a series of policies aimed at addressing NCDs. These include the NCD Policy and Nutrition Policy, which focus on promoting healthier lifestyles through dietary changes and increased physical activity(3). The Samoa Health System Strengthening Program for Results is a crucial component of the government’s approach to combat NCDs. It encompasses several key areas, including the “First 1000 Days” initiative, emphasizing the importance of proper nutrition during pregnancy and early childhood, and breastfeeding promotion, vital for the health and development of infants(4). Furthermore, the School Nutrition program is designed to instill healthy eating habits from a young age(5). Nutrition guidelines, monitored quarterly, are in place to ensure the quality of school meals, with a strong focus on reducing the consumption of instant noodles and sugary drinks among schoolchildren. For adults, the “Healthy eating for Adults” program is pivotal. It introduces Food-Based Dietary Guidelines in Samoa that categorize foods into carbohydrates (energy foods), proteins (body-building foods), and fruits and vegetables (protective foods)(6). These guidelines also recommend reducing the intake of sugary foods, salt, and foods high in fats and oils. An intriguing approach to improving dietary habits is the “Grow the Colors of the Rainbow” initiative, which encourages the consumption of a diverse range of colorful fruits and vegetables(7). By emphasizing the importance of a balanced diet, this initiative aims to address the imbalance that has contributed to the NCD epidemic. Through this presentation, attendees will gain a comprehensive understanding of the historical, dietary, and governmental aspects surrounding NCDs in Samoa. It highlights the urgency of addressing NCDs in the region and underscores the importance of ongoing efforts to promote healthier eating habits and lifestyle choices. By examining government policies and initiatives, as well as the challenges faced, we aim to shed light on the path toward a healthier, NCD-free Samoa.
Monitoring Australian Foods and Diets
Authors: Sobolewski R.
Published: May 2024

Monitoring the food supply including composition and what people are eating is an important aspect of maintaining public health and safety. The Food Composition Program at Food Standards Australia New Zealand (FSANZ) is responsible for generating, compiling and publishing data on the nutrient content of Australian foods to support FSANZ standards development work and monitoring activities. This work also supports broader Government public health policies and initiatives such as National Nutrition Surveys, Front of Pack labelling and reformulation. Having robust up to date food composition and dietary intake data that represents the current food supply and consumption patterns provides the strong evidence base needed to support FSANZ activities(1). FSANZ has been working with the Australian Bureau of Statistics since 2019 to support their work on the 2023 National Nutrition and Physical Activity Survey (NNPAS)(2). Our role has been to assist in customising the survey instrument Intake24 used to collect the 24-hour recall data from the NNPAS and to generate the datasets required to allow food, dietary supplement and nutrient intakes to be estimated from the survey and enable reporting against the Australian Dietary Guidelines. This presentation will discuss FSANZ role in monitoring foods and healthy diets in Australia, with a particular focus on the methods and tools for generating and reporting data for the 2023 NNPAS.
Adapting Intake24 for Aotearoa - New Zealand
Authors: Follong B. , Mackay S. , Haliburton C. , Grey J. , Maiquez M. , Ni Mhurchu C.
Published: May 2024

National nutrition surveys play a pivotal role in shaping public health policies and programmes by providing valuable insights into dietary intake and the nutritional wellbeing of a population. A team from the University of Auckland and Massey University worked alongside the Ministry of Health and the Ministry for Primary Industries to develop the methods and tools for a future New Zealand Nutrition Survey. Throughout these developmental stages, we partnered and engaged with Māori as tangata whenua, and other key ethnic groups in Aotearoa - New Zealand, ensuring that their unique dietary practices and preferences were accurately captured. This presentation centres on the adaptation of Intake24, an innovative web-based 24-hour dietary recall tool, to optimize dietary data collection within the New Zealand context. The adaptation process involved several key steps including rationalisation of a New Zealand-specific food list, incorporating cultural dishes, adding new portion size estimation aids, and further customisation of the user interface(1). We provide new insights into the user experience and the tool’s functionality, sharing findings from field testing and valuable user feedback. This approach ensures collection of dietary data that is truly representative of the New Zealand population and acknowledges the rich diversity and dietary nuances within the country. As such, this adapted New Zealand version of Intake24 could serve as an essential tool for use in a future National Nutrition Survey or other research initiatives to collect accurate, culturally sensitive, and actionable nutrition data providing evidence to inform future public health programmes and policies.
Parents’ perceptions of the Tasmanian School Lunch Project - interim findings
Authors: Smith K.J. , Cleland V. , Dunbabin J. , Fraser B. , Reardon M. , Galloway C. , DePaoli K. , Sutton L. , Proudfoot F. , Jose K.
Published: May 2024

Most Australian school students take a packed lunch to school(1). However, parents have reported many barriers to packing a healthy lunch(2). Subsequently, foods eaten during school hours are not consistent with the Australian Dietary Guidelines, with discretionary foods providing about 44% of energy consumed during this time(3). In addition, some children go to school without any food for lunch or money to buy lunch. The Tasmanian School Lunch Project provides free nutritious cooked lunches for Kinder to Year 10 students attending 30 government schools (15 commenced 2022, 15 commenced 2023) in areas of high socioeconomic disadvantage. The lunches were provided 1-3 days/week. The menu and recipes were designed by dietitians. This analysis aimed to describe parents’ perceptions of the School Lunch Project during the first year. Six of the 15 schools that commenced in term 2 2022 were invited, and agreed, to participate in the evaluation. During term 3 or 4 2022, parents completed online or written surveys (n = 159) and/or participated in discussion groups (n = 26) to share their thoughts on the menu, their concerns, likes, and willingness to pay. Survey data were analysed descriptively and open-ended survey responses and discussion group data thematically. During 2022, 78,832 nutritious cooked lunches were provided to 1,678 students. Most parents felt there was enough variety on the menu (66%) and the right amount of food was served (69%). Most students (79%) ate the lunches every day they were provided yet 52% of parents continued to provide a packed lunch. Parents enjoyed that their child was having a healthy lunch (66%) and trying new foods (74%). Some parents in the discussion groups indicated positive flow on effects at home with students trying new foods and sitting down together as a family to eat the evening meal. Half the parents (50%) had no concerns about the school providing lunches. The most commonly reported concerns were their child might not like the food (36%) or their child does not try new foods (8.6%). These concerns were also raised in the discussion groups. Most parents (93%) were prepared to pay for the lunches in future (median $3, range $1-$12) and 85% thought there should be a family discount. Parents acknowledged some payment was necessary for the sustainability of the program but some expressed concern for those who may struggle to pay. More direct communication with families about the meals offered, the availability of bread (from term 4 2022) for students who choose not to eat the cooked lunch or want more to eat, and allowing families time to adjust to the new lunch system, may address some of the concerns raised. Further data on parents’ perceptions of the school lunches will be collected during term 3 2023.
Intakes from healthy and unhealthy food groups and obesity among 5- to 9-year-old South African children
Authors: Kruger H.S. , Faber M. , van Zyl T. , Monyeki M.A. , Kruger R.
Published: May 2024

The global pandemic of paediatric overweight and obesity, along with undernutrition among children in low-income countries pose challenges for future health. Unhealthy dietary intake among children is of great concern(1). The aim of this study was to determine the association between intakes from healthy and unhealthy food groups and adiposity among 5- to 9-year-old South African children (n = 920). Conventional dietary intake assessment methods are burdensome; therefore, a short unquantified food frequency questionnaire was developed based on the WHO Global school-based student health survey, which focused on healthy and unhealthy food groups. The new questionnaire includes four healthy food groups (fruits, vegetables, milk, meats) and six unhealthy food groups (hot sugar-sweetened beverages (SSBs), cold SSBs, cookies, candies, salty snacks, fast foods) with five different responses of frequency of intake per week. The food groups reflect foods generally eaten by South African school children. The questionnaire was completed by the parents. Weight and height were measured and WHO BMI z-score (BAZ) was calculated(2). Descriptive statistics were reported using median and interquartile range. Frequency of intakes from food groups were compared across tertiles of BAZ using the Kruskal-Wallis test. The correlation between frequency of intakes from different food groups, and between the food groups and BAZ was calculated. The children reported similar daily intakes from the milk (35.3%), cold SSBs (33%) and hot SSBs groups (27%). Fruit (14%) and vegetables (9.6%) were consumed daily by a small percentage of children, while animal source protein foods (meat, fish, poultry, eggs) were consumed daily by 39% of children. The most frequent daily consumed snacks were salty snacks, e.g. crisps (13.2%), candy (11.1%) and cookies (5.3%), while fast foods were consumed once per week by the largest proportion of children (60.7%). Based on the WHO BMI z-scores, 15.2% of children were overweight, 4.4% were obese and 3.8% were underweight. Children in the highest two tertile groups of BAZ had a higher median weekly frequency of SSB intake (5, IQR 1,7), compared to those in the lowest BAZ tertile (3, IQR 1,7). No other differences were found between frequency of food group intake across BAZ tertiles. There was a weak positive correlation between BAZ and the frequency of SSB intake (r = 0.08, = 0.015), as well as between frequency of milk intake and frequency of SSB intake (r = 0.13, P<0.001), but a weak negative correlation between the frequency of vegetable intake and frequency of SSB intake (r = −0.08, P = 0.01). In conclusion, low fruit and vegetable intakes, combined with regular SSB intakes are evident in this group of children. The frequency of SSB intake was positively associated with adiposity, and SSB intake apparently replaced vegetable intake, but not milk intake among the children.
Dietary intake of adolescent rowers - analysis of energy intake
Authors: Speedy J. , Beck K. , Watts S. , Badenhorst C.
Published: May 2024

Adequate energy intake (EI) is essential for adolescent athletes to support health, performance, and growth(1). Rowing is a physically demanding sport where intense training begins in adolescence. Research is needed to assess whether current EI is sufficient to support healthy physiological functions and training in adolescent rowers. The aim of this study was to evaluate the energy status (energy availability (EA) or energy balance (EB)) including EI and exercise energy expenditure (EEE) of adolescent rowers in New Zealand. A total of 35 rowers (23 females, 16.8yrs ± 1.9yrs; 12 males, 17.3yrs ± 1.6yrs) who had been rowing for at least one season participated. A bioimpedance analyser measured body composition in 11 participants (8 females, weight 63.0±7.0kg, fat free mass (FFM) 50.8 ± 6.5kg; 3 males, weight 78.5 ± 15.9kg, FFM 70.7 ± 12.2kg) enabling calculation of EA. Due to COVID-19 restrictions, the remaining 24 participants (15 females, 9 males) provided estimated body weight (74.7 ± 9.2kg) and EB was then used to evaluate energy status. All participants completed four days of food and training diaries, two ‘recovery’ and two ‘hard’ training days. EI was determined in FoodWorks10 software using the New Zealand Food Composition Database. For training, metabolic equivalent of tasks (MET)(2) were assigned using bodyweight, heart rate, and rating of perceived effort to estimate EEE. Paired sample t-tests or Wilcoxon Signed Rank test (non-parametric data) was used to determine differences between EI, EEE, EA, and EB on the high and low training days for each gender. Significance was set at p< 0.05. The average EI for females on hard and recovery days was 10837 ± 3304kJ and 10461 ± 2882kJ respectively, and for males was 15293 ± 3971kJ and 13319 ± 4943kJ, respectively. No significant differences were found between EI on hard vs. recovery days in both genders. Significant differences between average EEE on hard vs. recovery days were found in both genders (females, hard day 4609 ± 2446kJ, recovery day 3146 ± 1905kJ, p<0.001; males, hard day 6589 ± 1575kJ, recovery day 3326 ± 2890kJ, p = 0.001). EA on hard and recovery training days was classified as suboptimal at 142 ± 80kJ/FFMkg/day and 167 ± 79kJ/FFMkg/day respectively with no significant difference in EA between hard and recovery days (p = 0.092). Average EB on hard training days was −484 ± 4267kJ and on recovery training days was 572 ± 3265kJ, with no significant difference between training days (p = 0.177). Both genders showed no significant difference in EB between hard and recovery training days (females p = 0.221, males p = 0.978). The results suggest that adolescent rowers do not adjust their nutritional intake to match EEE. This may increase the risk of adolescent rowers presenting with suboptimal EB or EA, with females being at a greater risk than males.
Macronutrient intakes of adolescent rowers for growth, development and sports performance
Authors: Watts S. , Beck K. , Speedy J. , Badenhorst C.
Published: May 2024

Dietary intake plays a key role in athletic performance in rowing(1). Suboptimal nutrition within the adolescent rowing population may negatively affect performance, normal growth and development, professional athlete development, and career longevity. Previous research has indicated that suboptimal carbohydrate intakes are a common issue in rowing(2). The quality of nutritional intake in adolescent rowers has seldom been explored. During moderate training, adolescent athletes should aim for 5-7g.kg-1 of carbohydrates, 1.3-1.8g.kg-1 of protein, and 20-35% energy from fat(3). This study aimed to examine the dietary intake of adolescent rowers in New Zealand and compare it with nutritional guidelines for normal growth, development, and sports performance. A cross-sectional study design involved data collection on two ‘hard’ training days, and two ‘recovery’ days from rowers (14-21 years) recruited from clubs and secondary schools around New Zealand. Participants completed four 24-hour collection periods, recording food intake, training duration and intensity. The food records were verified for accuracy, and dietary data was entered into Foodworks software for nutritional analysis. IBM SPSS software was used to calculate mean intakes for carbohydrate, protein, fat, and standard deviations. Independent t-tests were used to compare carbohydrate and protein intakes between males and females. Of the initial 40 participants, 35 fully (n = 23 females, 16.8 ± 1.9 years and n = 12 males, 17.3 ± 1.6 years) completed the study. Participants consumed 319 ± 116g (4.5 ± 1.7g.kg-1/day) of carbohydrates, 121 ± 56 g (1.7 ± 0.7 g.kg-1/day) of protein and 113 ± 46 g (1.6 ± 0.6g.kg-1/day) of fat per day. Females consumed 290 ± 80g (4.4 ± 1.3g.kg-1/day) of carbohydrates and males consumed 400 ± 78 g (5.0 ± 1.4g.kg-1/day) per day, with no significant difference between males and females intake per kilogram of bodyweight per day (p = 0.165). Minimum carbohydrate levels of 5g.kg-1 per day were only achieved by 7 females (30.4%) and 4 (33.3%) males. Females consumed significantly less protein per day, 106 ± 38g (1.6 ± 0.6 g.kg-1/day), in comparison to males who consumed 164 ± 46 grams (2.0 ± 0.5 g.kg-1/day) per day (p = 0.04). Fourteen females (60.9%) and 10 males (83.3%) consumed more than the minimum requirement of 1.3g.kg-1 of protein per day. The findings suggest that 2 out of 3 adolescent rowers in New Zealand fail to reach the minimum recommendations for carbohydrate intake(3), and males more readily meet the recommended intakes of protein when compared to females. Nutrition education for adolescent rowers in New Zealand should emphasise adequate carbohydrate and protein intakes that meet sports nutrition guidelines in order to support normal growth, development and optimised performance for these athletes.
Is higher fruit and vegetable intake associated with a reduced risk of depression in middle-aged and older adults? Data from 10 diverse international cohorts
Authors: Matison A. , Flood V. , Lam B. , Lipnicki D. , Tucker K. , Preux P. , Guerchet M. , d’Ors E. , Skoog I. , Scarmeas N. , Gureje O. , Shahar S. , Anstey K. , Ho R. , Brodaty H. , Sachdev P. , Reppermund S. , Mather K. ,   for Cohort Studies of Memory in an International Consortium (COSMIC)
Published: May 2024

Depression is the largest global contributor to non-fatal disease burden(1). A growing body of evidence suggests that dietary behaviours, such as higher fruit and vegetable intake, may be protective against the risk of depression(2). However, this evidence is primarily from high-income countries, despite over 80% of the burden of depression being experienced in low- and middle-income countries(1). There are also limited studies to date focusing on older adults. The aim of this study was to prospectively examine the associations between baseline fruit and vegetable intake and incidence of depression in adults aged 45-years and older from 10 cohorts across six continents, including four cohorts from low and middle-income countries. The association between baseline fruit and vegetable intake and incident depression over a 3–6-year follow-up period was examined using Cox proportional hazard regression after controlling for a range of potential confounders. Participants were 7771 community-based adults aged 45+ years from 10 diverse cohorts. All cohorts were members of the Cohort Studies of Memory in an International Consortium collaboration(3). Fruit intake (excluding juice) and vegetable intake was collected using either a comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated depression measures, and depression was defined as a score greater than or equal to a validated cut-off. Prior to analysis all data were harmonised. Analysis was performed by cohort and then cohort results were combined using meta-analysis. Subgroup analysis was performed by sex, age (45 – 64 versus 65+ years) and income level of country (high income countries versus low- and middle-income countries). There were 1537 incident cases of depression over 32,420 person-years of follow-up. Mean daily intakes of fruit were 1.7 ± 1.5 serves and vegetables 1.9 ± 1.4. serves. We found no association between fruit and vegetable intakes and risk of incident depression in any of the analyses, and this was consistent across the subgroup analyses. The low intake of fruit and vegetables of participants, diverse measures used across the different cohorts, and modest sample size of our study compared with prior studies in the literature, may have prevented an association being detected. Further investigation using standardised measures in larger cohorts of older adults from low- to middle-income countries is needed. Future research should consider the potential relationship between different types of fruits and vegetables and depression.
Changes in psychological outcomes and sleep quality following energy restriction with and without almonds
Authors: Carter S. , Carter A.J. , Hill A.M. , Do V. , Buckley J.D. , Dorrian J. , Tan S-Y. , Rogers G.B. , Coates A.M.
Published: May 2024

Associations between obesity and mental illness have been identified, but they are complex and bidirectional(1). Weight loss interventions have been proposed as a potential strategy to improve mental health in individuals with overweight or obesity, but the evidence remains inconclusive(2). Additionally, the role of specific foods in a weight loss diet and mental health outcomes is not well understood(3). This study aimed to explore the association between weight loss (with and without almonds) and self-administered psychological and sleep assessments, including the Profile of Mood States (POMS), the Perceived Stress Scale (PSS), the Zung Self-Rating Depression Scale (ZSDS), and the Pittsburgh Sleep Quality Index (PSQI). Participants (n = 140, 47.5 ± 10.8 years) with overweight or obesity (BMI: 30.7 ± 2.3 kg/m2) were randomised to an energy-controlled almond-enriched diet (AED) or nut-free diet (NFD). Psychological and sleep assessments were conducted at baseline, after 3 months of weight loss, and after 6 months of weight maintenance. Data were analysed using mixed-effects models and linear regression. For POMS, total mood disturbance score (TMDS) (60.2%, p = 0.01), fatigue-inertia (21.2%, p = 0.003), and vigor-activity (19.9%, p<0.001) improved over time (with no different between groups), with improvements associated with the magnitude of weight loss (TMDS: β = 0.059, p = 0.02; fatigue-inertia: β = 0.268, p = 0.016; vigor-activity: β=-0.194, p = 0.048). No significant changes were observed in tension-anxiety, depression-dejection, anger-hostility, or confusion-bewilderment. A significant group x time interaction (p = 0.048) was found for the PSS, which increased in the NFD group (10.1%) and decreased in the AED (1%) during the weight maintenance phase. No significant changes were observed for the ZSDS. The PSQI demonstrated significant improvement in both groups over time for sleep quality (11.3%, p<0.001), sleep latency (24.3%, p<0.001), sleep disturbance (39.2%, p = 0.04), and daytime dysfunction (290.4%, p<0.001), but not for sleep duration or habitual sleep efficiency. Summed scores, generating the global sleep score (GSS), demonstrated an overall significant improvement in both groups over time (33.5%, p<0.001), and these improvements were associated with weight loss (GSS: β = 0.863, p<0.001). The findings emphasise the importance of evaluating mental health outcomes in weight loss interventions and highlight the potential influence of weight management on mood and sleep quality. Further research is warranted to explore the impact of diet composition on perceived stress and other mental health outcomes.
Comparison of body composition assessment tools in infancy
Authors: Lyons-Reid J. , Derraik J.G.B. , Albert B.B. , Kenealy T. , Cutfield W.S. , Ward L.C. , Tint M-T. , Chan S-Y. , Monnard C.R. , Ramos Nieves J.M. , Godfrey K.M.
Published: May 2024

The prevalence of childhood obesity is increasing globally(1). While BMI is commonly used to define obesity, it is unable to differentiate between fat and muscle mass, leading to calls to measure body composition specifically(2). While several tools are available to assess body composition in infancy, it is unclear if they are directly comparable. Among a subset of healthy infants born to mothers participating in a randomised controlled trial of a preconception and antenatal nutritional supplement(3), measurements were made at ages 6 weeks (n = 58) and 6 months (n = 70) using air displacement plethysmography (ADP), whole-body dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance spectroscopy (BIS). Estimates of percentage fat mass (%FM) were compared using Cohen’s kappa statistic (κ) and Bland-Altman analysis (4,5). There was none to weak agreement when comparing tertiles of %FM (κ = 0.15–0.59). When comparing absolute values, the bias (i.e., mean difference) was smallest when comparing BIS to ADP at 6 weeks (+1.7%). A similar bias was observed at 6 months when comparing DXA to ADP (+1.8%). However, when comparing BIA to DXA at both ages, biases were much larger (+7.6% and +4.7% at 6 weeks and 6 months, respectively). Furthermore, there was wide interindividual variance (limits of agreement [LOA] i.e., ± 1.96 SD) for each comparison. At 6 weeks, LOA ranged from ± 4.8 to ± 6.5% for BIA vs. DXA and BIA vs. ADP, respectively. At 6 months, LOA were even wider, ranging from ± 7.3 to ± 8.1% (DXA vs. ADP and BIA vs. DXA, respectively). Proportional biases were apparent when comparing BIS to the other tools at both ages, with BIS generally overestimating %FM more among infants with low adiposity. In addition to differences according to tool type, within-tool factors impacted body composition estimation. For ADP measurements, the choice of FFM density reference (Fomon vs. Butte) had minimal impact; however, choice of DXA software version (GE Lunar enCORE basic vs. enhanced) and BIS analysis approach (empirical equation vs. mixture theory prediction) led to very different estimates of body composition. In conclusion, when comparing body composition assessment tools in infancy, there was limited agreement between three commonly used tools. Therefore, researchers and clinicians must be cautious when conducting longitudinal analyses or when comparing findings across studies, as estimates are not comparable across tools.
Does continuous glucose monitoring influence adherence to time-restricted eating?
Authors: Tater J. , Roy M. , Taylor R.
Published: May 2024

Obesity is a significant health issue in Aotearoa; effective and pragmatic strategies to facilitate weight loss are urgently required. Growing recognition of the circadian rhythm’s impact on metabolism has popularised diets like time-restricted eating (TRE)(1). The 16:8 TRE method involves limiting food intake to an 8-hour daily eating window and can lead to weight loss without other substantial changes to diet(2). Nonetheless, TRE requires accountability and tolerating hunger for short periods. Continuous glucose monitors (CGM) are small wearable biofeedback devices that measure interstitial glucose levels scanned via smartphones. By providing immediate feedback on the physiological effects of eating and fasting, CGM use may promote adherence to TRE(3). This pilot study aimed to 1) investigate how CGM affects adherence to TRE and 2) assess the feasibility of CGM use while undertaking TRE. This two-arm randomised controlled trial enrolled healthy adults from Dunedin, assigning them to TRE-only or TRE+CGM groups for 14 days. Successful adherence to TRE was defined a priori as maintaining an 8-hour eating window on 80% of days. CGM feasibility was defined a priori as scanning the glucose monitor thrice daily on 80% of days. Secondary outcomes included well-being, anthropometry, glucose levels, and overall TRE and CGM experiences via semi-structured interviews. Twenty-two participants were randomised into two groups: TRE-only (n = 11) and TRE+CGM (n = 11, with n = 2 excluded from analysis post-randomisation for medical reasons). Participants had a diverse range of ethnicities, the mean age was 32 (+/-14.9) years, and 55% were female. The TRE+CGM group adhered to the 8-hour eating window for an average of 10.0 days (range 2-14) compared with 8.6 days (range 2-14) in the TRE-only group. Both groups had similar mean eating window durations of 8.1 hours. Five (56%) participants in the TRE+CGM group achieved the a priori criteria for TRE adherence, compared to 3 (27%) in the TRE-only group. Participants in the TRE+CGM group performed an average of 8.2 (+/-5.6) daily scans, with n = 7 (78%) of participants meeting the a priori CGM feasibility criteria. Neither group reported consistent adverse psychological impacts in DASS-21 and WHO-5 scores. Interviews highlighted that CGM increased hunger tolerance during fasting as participants felt reassured by their normal glucose levels. CGM aided TRE accountability by acting as a biological tracker of food intake. Participants reported that TRE led to improved energy and self-efficacy, a more productive daily routine, and healthier food choices. Promisingly, 72% of participants would use CGM and undertake TRE in future. This study demonstrates that using CGM while undertaking TRE is feasible and can improve adherence by enhancing hunger tolerance and accountability. Overall, participants experienced increased awareness of eating habits and physiological mechanisms. Over the longer term, this simple and synergistic approach may be a helpful weight loss strategy.
Strengthening national salt reduction strategies using mixed methods process evaluations – case studies from Malaysia and Mongolia
Authors: Mckenzie B. , Lo Y-R. , Mustapha F. , Battumur B-E. , Batsaikhan E. , Sukhbaatar B. , Untoro J. , Chandran A. , Michael V. , Webster J. , Trieu K.
Published: May 2024

Almost half of countries globally are implementing national strategies to lower population salt intake towards the World Health Organization’s target of a 30% reduction by 2025(1). However, most are yet to lower population salt intake(1). We conducted process evaluations of national salt reduction strategies in Malaysia and Mongolia to understand the extent to which they were implemented and achieving their intended outcomes, using the findings to generate insights on how to strengthen strategies and accelerate population salt reduction. Mixed methods process evaluations were conducted at the mid-point of implementation of the strategies in Malaysia (2018-19) and Mongolia (2020-21)(2). Guided by theoretical frameworks, information on the implementation, mechanism and contextual barriers and enablers of the strategies were collected through desk-based reviews of documents related to salt reduction, interviews with key stakeholders (n = 12 Malaysia, n = 10 Mongolia), and focus group discussions with health professionals in Malaysia (n = 43) and health provider surveys in Mongolia (n = 12). Both countries generated high-quality evidence about salt intake and salt levels in foods, and culturally-specific education resources in 3 and 5 years respectively. However, in Malaysia there was moderate dose delivered and low reach in terms of education and reformulation activities. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach but with moderate dose and reach among the general population. There were challenges in both countries with respect to implementing legislative interventions and both could improve the scaling up of their reformulation and education activities to have population-wide reach and impact. In the first half of Malaysia’s and Mongolia’s strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale salt reformulation in foods. However, both faced challenges in implementing regulatory policies and the scaling up of their reformulation and education activities to have population-wide reach and impact could be strengthened. Similar process evaluations of existing salt reduction strategies are needed to strengthen intervention delivery and inform areas for adaptation, to aid achievement of the WHO’s global target of a 30% reduction in population salt intake by 2025.
Children are exposed to much more alcohol advertising when a liquor store is sited near a school
Authors: Mandzufas J. , Lombardi K. , Johnston R. , Bivoltsis A. , Howard J. , Trapp G.S.A.
Published: May 2024

The physical location of liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol(1). As children transit to and from school, it is feasible that the presence of liquor stores near schools could also increase their exposure to alcohol advertising. Cumulative exposure to advertising influences alcohol attitudes, intentions and alcohol use(2), so reducing children’s exposure to alcohol advertising is important to delay the initiation of drinking and reduce future harms. As this has not yet been investigated in Australia, the aim of this study was to investigate whether the presence of a liquor store near a school was associated with an increased prevalence of outdoor alcohol advertising in Perth, Western Australia. We identified all outdoor alcohol advertising within a 500m radius (audit zone) of 64 randomly selected primary and secondary schools from low and high socio-economic areas across metropolitan Perth. We recorded the size, type, setting, and location of each advertisement during field data collection. Each zone was categorised by the presence or absence of at least one liquor store within the school audit zone, and results compared across these stratifications. Over half (56%) of the 64 school audit zones had at least one alcohol advertisement. On average, there were 5.9 alcohol advertisements per zone. School audit zones that contained a liquor store (59%) had over thirty times the average number of alcohol advertisements compared with audit zones that did not contain a liquor store (9.7 vs 0.3). The majority of all the alcohol advertisements identified (63%) were located outside a liquor outlet as opposed to other food businesses (2%), along the roadside (31%), on a bus shelter (3%) or on/outside another business (0.5%). Our findings that Perth schools with a liquor store nearby had more outdoor alcohol advertising within a 500m radius, compared with schools without a nearby liquor store, were independent of school type (primary or secondary) or the socio-economic status of the area. This poses significant concerns about the exposure of underage populations to outdoor alcohol advertising, and the resultant influence on alcohol use. These results underscore the necessity for policy interventions to mitigate children’s exposure to alcohol marketing, especially during the daily school commute, by regulating the location of liquor stores and alcohol promotion near schools. It will be important to incorporate the voices of children when developing future policies to assert their right to be consulted, heard and appropriately influence their environments.