bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative bioavailability of lutein and zeaxanthin in the presence of Omega-3- supplements and oxidative stress levels in humans
Authors: Kalu K. , Lin S. , McMonnies C. , Arcot J.
Published: May 2024

Lutein and zeaxanthin (LZ) are the major constituents of macular pigment (MP), helping to protect the human retina from blue light and oxidative damage(1). Many studies have suggested that higher concentrations of retina LZ may reduce the risk of age-related macular degeneration (AMD) and improve retinal health(1–3). MP and serum L have shown positive linear response with L dose(4) but the combined effect (LZ + omega-3 suppl) has not been fully explored in healthy Australian adults. Understanding their bioavailability in relation to the effect of omega-3 fatty acid intakes along with LZ supplements could provide a useful indication of the potential to reduce the risk of AMD, preserve vision, and improve retinal health. LZ uptake and the associated oxidative stress levels were evaluated in two groups fed with commercially sourced supplements. The control group was given only LZ, while the intervention group was given LZ combined with omega-3 supplements containing Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). 10 men and 6 women with an average age of 31.4 ± 1.3yrs participated in this randomised, non-blinded controlled study for a total of 19-d. The control group (9) consumed the LZ supplement (12mg/d) only, while the intervention group (7) consumed the LZ supplement along with 900mg/d of an omega-3 supplement (540mg EPA + DHA 360mg). Each group adhered to a comprehensive low-carotenoid and omega-3 diet list for the 12-d intervention period and the 7-d washout period. Participants reported daily foods consumed in their diet logbooks, and Automated Self-Administered 24 diet assessment log over the study period. The body composition of each subject from the two groups was assessed before and after the study using a SECA body composition analyser and blood samples (2-time point) collected over a 12-d test period. Mean ± SEM for serum LZ ranged from 2.23 ± 0.24 – 2.98 ± 0.24µg/ml for the control group and 1.10 ± 0.21–3.02 ± 0.73µg/ml for the intervention group. Percentage change in serum LZ concentration from (T0-T312h) and (T312h-T456h) were 26% and 34% (control) and 139% and 175% for (intervention), respectively. The Area Under the Curve (AUC0-456h) differed significantly (P<0.0469) during the entire study period (between groups) and related to the cumulative effect of intakes at various times of blood draw. LZ from the intervention group was 68% more bioavailable than the control group. The highest peak relative response in subjects in the control group was ≈33% (a 9.1-fold increase from baseline) at AUC (168-312h) and ≈46% (a 6.6-fold increase from baseline) at AUC (312-456h) for the intervention group. No significant (p>0.05) effect of omega-3-supplement addition on oxidative stress levels was observed. Omega-3- addition to intakes of supplement LZ was responsible for the increased absorption (intervention) observed but did not affect oxidative stress levels and the Red Blood Cell omega-3-status.
Exploring the potential of objective metabolite measures in dietary assessment: randomised cross over feeding study
Authors: Shahin A. , Ross A. , Mann J. , Reynolds A.N.
Published: May 2024

Reliable dietary assessment is key to our understanding of diet-health interactions(1). Most current dietary assessment methods are self-reported, making them prone to a range of biases(2). Objective markers, such as certain metabolite concentrations in human tissue, may prove a more reliable method of dietary assessment in the future while reducing participant burden(2,3). An example of these metabolite markers are alkylresorcinols, a family of compounds found in the bran layer of common grains. High concentrations of alkylresorcinols reflect high wholegrain intakes, very low levels indicate only refined grain intake, while no alkylresorcinols would indicate a gluten-free diet. We conducted a randomised crossover feeding study of three interventions (one standardisation day followed by a feeding day where known amounts were consumed under observation). Each feeding day differed by which food groups were provided (e.g., chicken, legumes, and fruit) or entirely absent (e.g., grains, fish, and dairy). Participants provided 24-hour urine samples on all six days (standardisation days and feeding days), as well as a 24-recalls and fasted blood samples the morning after each day. Known metabolite markers of dietary intake (approximately 70) were identified in blood and urine with LC-MSqToF, and semi-quantified with a known standard. Twenty-four hour urine sodium content was also measured as the current best known objective marker of dietary intake(4). Twenty-four participants (74% female, age (SD) 24.8 (6.1), BMI 24.1 (4.0)) commenced the study, with 21 (88%) completing all three interventions. Mean energy intake on feeding days (11720 kJ (2943.01)) was higher than self-reported energy intake on standardisation days (9243.57 kJ (3582.92)). Meals were well tolerated, with mean (range) intakes of 9.8 (6.3 – 16.1) serves whole grains, 2.4 (1.6 – 4.8) serves fish, 3.1 (1.9 – 5.5) serves dairy, 5.6 (4.5 – 9.1) serves chicken, 8.2 (7.0 – 14.1) serves legumes, 3.1 (1.3 – 4.6) serves fruit, 3.9 (2.6 – 6.4) serves red meat, 1.7 (1.35 – 2.6) serves nuts and seeds, or 13.4 (9.4 – 19.5) serves vegetables on their respective feeding days. The three feeding days provided clearly identifiable clusters when assessing the overall metabolic profile, both in terms of what was measured on the feeding days, and the difference in metabolite concentrations between standardisation day and feeding day. The relative correlations between self-reported intakes and individual metabolite concentrations reflecting specific foods or food groups with the known dietary intakes from feeding days will be presented first at the conference.
Investigating the effect of polyphenols from nuts on human carbohydrate digestion in vitro
Authors: Farazi M. , Houghton M.J. , Murray M. , Cardoso B.R. , Williamson G.
Published: May 2024

Recent studies have documented the importance of postprandial hyperglycaemia in the incidence of chronic diseases, including type 2 diabetes. Inhibition of digestive enzymes, including membrane-bound brush-border α-glucosidases, leads to slowed carbohydrate digestion and absorption, and reduced postprandial glycemia. Nuts are widely eaten around the world and have the potential to inhibit α-glucosidases through their content of polyphenols and other bioactive compounds. According to our recent systematic review(1), no study has investigated the inhibitory effects of nut extracts on human α-glucosidase activities. Almost all studies in this area have been conducted on yeast α-glucosidase, with only a few using rat α-glucosidase. While there is no sequence homology between yeast and human α-glucosidase, there is 74% to 78% sequence homology between rat and human α-glucosidases(1). The lack of studies on the effect of bioactive compounds from nuts on human α-glucosidases, along with the growing attention to nuts as an important component of a healthy diet with the potential to reduce the risk of chronic diseases(2), highlights the need for research to evaluate the inhibitory effect of nut extracts on human α-glucosidases. The aim of the current study is to explore the inhibitory effect of extracts from nuts on human carbohydrate digestive enzymes. Walnuts and almonds were ground and defatted with hexane, extracted in 80% (v/v) acetone, and further purified using solid-phase extraction to obtain phenolic-rich extracts. The Folin–Ciocalteu assay was used to approximate the polyphenol content of the samples. Following our recently published detailed protocol(3), cell-free extracts from human intestinal Caco-2/TC7 cells were used as a source of α-glucosidase in enzyme inhibition assays, with sucrose, maltose and isomaltose as substrates and appropriate controls. The assay products were quantified using high-performance anion exchange chromatography with pulsed amperometric detection (HPAEC-PAD). Glucose production in the presence of various concentrations of phenol-rich nut extracts was compared using a one-way ANOVA and half-maximal inhibitory concentration (IC50) values were calculated. The Folin–Ciocalteu data demonstrate that walnut extracts comprise a relatively high polyphenol content, with 18.1 ± 0.23 mg (epigallocatechin gallate [EGCG] equivalent) per gram of fresh weight, while almond extracts contain 0.87 ± 0.03 mg EGCG equivalent/g of fresh weight. The walnut phenolic-rich extract dose-dependently inhibited human intestinal sucrase and maltase activities (both p<0.01), with IC50 values of 1.67 mg/mL and 2.84 mg/mL, respectively. We demonstrate that phenolic-rich walnut extracts can inhibit human α-glucosidases in vitro and therefore walnuts may contribute to slowing carbohydrate digestion in humans. As such, we plan to assess the effects of walnuts on postprandial glycaemia in vivo.
Bioactive compounds of spent coffee grounds and their potential use as functional food
Authors: Bevilacqua E. , Rose’Meyer R. , Singh I. , Grice D. , Mouatt P. , Brown L. , Cruzat V.
Published: May 2024

Hot brewed coffee is the most popular hot beverage in the world, and its health properties have been published in the literature(1). Conversely, over the past decade, cold-brewed coffee has gained popularity, but its eventual nutritional properties are unclear. Both hot and cold brewed coffee produces over 6 million tons of spent coffee grounds (SCG) yearly disposed in landfills(1). Interestingly, studies have shown that SCG can improve several metabolic parameters via changes in the gut microbiome in obese and diabetic rats(2), and reduce energy consumption in overweight humans(3). However, studies investigating the nutritional properties of SCG are lacking in the literature. Hence, in this study, we aimed to identify, quantify and compare two main bioactive compounds in hot- and cold-brewed coffee as a beverage, as well as in the SCG. Samples from hot and cold coffee beverages and SCG were obtained from a local coffee shop (n = 3 per group). The coffee beans were composed of Coffea arabica from Papa New Guinea, Brazil, Ethiopia, and Colombia (in order from highest to lowest proportion). All samples were analysed by high-performance liquid chromatography and mass spectrometry (HPLC-MS). The analyses focused on two main bioactive compounds; trigonelline and chlorogenic acid (CGA). Statistical analyses were performed using an unpaired t-test with Welch’s correction and two-way ANOVA with Tukey’s post-hoc test (p<0.05). When compared to hot-brewed coffee beverages, cold-brewed coffee beverages have shown lower (p<0.05) levels of trigonelline (17.26 mg/g + 1.305 vs. 8.46 mg/g + 0.74, respectively) and CGA (9.82 mg/g + 0.93 vs. 5.31 mg/g + 0.48, respectively). In SCG obtained from hot-brewed coffee, a higher concentration of CGA was found (0.12 mg/g + 0.006), when compared to SCG obtained from cold-brewed coffee (0.10 mg/g + 0.03). However, trigonelline in cold-brewed SCG was found in higher (p<0.05) concentration, when compared to hot-brewed SCG (0.11 mg/g + 0.03 vs. 0.09 mg/g + 0.017, respectively). Moreover, hot-brewed coffee beverages showed higher (p<0.05) concentrations of trigonelline and CGA, when compared to hot-brewed SCG. Similarly, cold-brewed coffee beverages showed higher (p<0.05) concentrations of both bioactive compounds, when compared to cold-brewed SCG. Our results indicated that hot brewed coffee beverage contains high concentrations of bioactive compounds (CGA and trigonelline), which possibly explain its health properties. Although SCG obtained from hot and cold-brewed coffee showed lower concentrations of both bioactive compounds than coffee beverages, our results shed light on the possible health benefits of SCG consumption. In a world seeking more sustainable solutions, further studies investigating the potential use of SCG as a functional food are required.
The influence of food prices on what we purchase, prepare and eat. Survey results and implications for the Heart Foundation’s work
Authors: Monro D. , Conning S. , Le Grange H.
Published: May 2024

Healthy eating is a struggle for many families in New Zealand when they cannot adequately afford food. Statistics New Zealand has shown that the food price index rose 12.5 percent over the past year with an increase of 22 percent for fruit and vegetables prices(1). Food prices now rate as the number one concern for New Zealanders(2). To understand the changes households are making in response to increasing food prices 109 main household shoppers were surveyed. The survey was administered via Qualtrics in May/June 2023. Participants were recruited via social media and by direct email from researchers and Heart Foundation staff. Survey participants were asked about food prices, shopping behaviours and changes within specific food categories. Two thirds of the participants were female. The predominant age groups were 20-29 years (29%) and 60 and above (28%). The major ethnicities were European (53%), Pasifika (20%) and Māori (8%). Around 46% of people lived in Auckland with the next highest area being Nelson (and wider Tasman). The results showed 85% of participants expected food prices to get worse over the next year. To manage rising food prices 70% people had changed where they shopped or how they accessed food, 90% changed what they buy and 67% had changed the way they eat (e.g., cooking more at home). The most substantial changes were in the fruit and vegetable category where people changed the types purchased (73%) and purchased less (63%). In many food categories buying cheaper brands, in bulk and when foods were on special were common responses. Rationing or going without was a consistent theme highlighted with meat/poultry, eggs, fish, alcohol and more expensive snack foods. The implications for the Heart Foundation’s work include (1) reinforcing the importance of fruits and vegetables in the diet and to provide tips and tools around ingredient substitution, (2) promote alternative protein sources (e.g., beans and legumes) as an affordable ingredient and recipes to support their use and (3) supporting companies to improve the composition of cheaper brands through food reformulation. With this being a small sample size, it may not be fully generalisable to the entire population however given the survey found a high percentage of people making changes it does indicate the important role health agencies can play providing information, and advice to support people to manage high food prices.
Menstrual health knowledge amongst active females in Aotearoa/New Zealand
Authors: Fletcher D. , Pedofsky L. , Badenhorst C.E.
Published: May 2024

Poor menstrual health literacy is a factor that contributes to females not seeking medical help for abnormal menstrual symptoms that may impact their mental, social, and physical health(1). Few studies have focused on testing baseline functional knowledge of the menstrual cycle (MC) outside the context of pregnancy and menopause. The primary objective of this study was to investigate MC knowledge levels of physically active females residing in New Zealand. A secondary objective was to understand where females get their MC information from, what sources they consider to be trustworthy and what information on the MC they would like to know more about. A MC knowledge questionnaire was developed by the research team (n = 3), and reviewed by academics (n = 4), medical experts (n = 4), sporting organisation staff (n = 5), and target population (n = 10) to ensure content validity. Active females (n = 203) between the ages of 16-40 years completed an online questionnaire. The questionnaire included a total of 25 knowledge questions and was split into four categories: menstrual cycle (Q = 9), menstruation (Q = 7), symptoms (Q = 5), and health outcomes (Q = 6). Responses (single and multiple answer multi-choice questions) were analysed using descriptive statistics which were presented as mean, SD and frequency (%). The overall knowledge score was 51.8% (22.8 ± 3.4). The highest knowledge scores were noted for symptoms (80.5%), followed by menstruation (79.8%), and the menstrual cycle (64.2%). Females scored poorly when asked about health outcomes related to the MC (20.4%). 61.5% of participants (n = 123) identified the internet as their main source of MC information. Friends (n = 82, 41%), school sex education (n = 73, 36.5%) and social media (n = 73, 36.5%) were the next most common sources of MC information. The most trustworthy sources of information were doctors/GPs (n = 96, 48%) and healthcare professionals (n = 70, 35%). The most common topics that females wanted to know more about were diet and the MC (n = 115, 57.5%), training and the MC (n = 115, 57.5%), MC tracking (n = 78, 39%), MC and mood (n = 75, 37.5%) and RED-S/LEA/Female athlete triad (n = 71, 35.5%). Overall functional knowledge levels of the MC and associated health outcomes is low in active females. Healthcare professionals and doctors are the most trustworthy sources of information; however, they are not the most common sources of information that females will engage with. Developing online educational resources on the MC, associated health outcomes and lifestyle factors (diet, physical activity) with medical and healthcare professionals may be considered in future female health education.
The effect of pre- and probiotic supplementation on inflammatory markers in postmenopausal women
Authors: Branch R. , Kruger M.C. , Kuhn-Sherlock B. , Ilesanmi-Oyelere B.
Published: May 2024

Chronic inflammation is linked with several deleterious diseases, including cardiovascular disease, obesity, diabetes mellitus, irritable bowel disease, and osteoporosis (1,2). Post-menopausal women are at a heightened risk of developing these diseases due to the remission of oestrogen, further amplifying a pro-inflammatory state (3,4). This study aimed to critically examine the combined effect of pre- and probiotic supplementation (synbiotics) and exercise in the form of ≥7,000 steps per day on inflammatory markers hs- CRP, IL-1β, IL-6, IL-8, IL-10, INF-γ and TNF- α in sedentary post-menopausal women. Eighty-seven healthy post-menopausal women were allocated to receive either a synbiotic supplement or placebo for 12 weeks. Participants’ demographics and physical activity levels were determined using questionnaires, and their diet was assessed using self-reported 3-day diet records. Body composition measures of height, weight and BMI were measured at baseline, while total body mass, lean body mass, total fat mass and total body fat percentage at baseline and week 12 using dual-energy X-ray absorptiometry. Fasted venous blood samples were collected to analyse inflammatory status before and after the intervention. Statistical analysis was performed using SPSS version 24, where outcome variables with multiple time points, were analysed using repeated measures ANOVA with the model, including time (baseline vs 12 weeks), intervention group (placebo vs synbiotic), and their interaction as fixed effects. The results showed no significant differences between the intervention group’s demographics, physical activity levels, and dietary intake (p > 0.05). The 12-week study duration (time) was found to have had a statistically significant effect on lowering hs-CRP (p <0.018), IL-8 (p <0.001), IFN-γ (p <0.001), TNF-α (p <0.001) and increasing IL-6 (p <0.001) and IL-10 (p <0.001) in both groups. However, the observed decrease in IL-1β (p <0.348) over time was not significant. The intervention type (synbiotic or placebo) significantly impacted IL-10 (p < 0.003). No significant interactions between time and group were observed across all other inflammatory markers (p > 0.05). The study duration increased total lean body mass (p <0.015) and decreased total body fat percentage (p <0.022) in both the placebo and synbiotic groups. At the same time, the intervention type (synbiotic or placebo) had no effect on total lean body mass, total fat mass, total body mass and percentage body fat in both groups (p > 0.05). The current study showed no notable differences between the placebo and synbiotic groups suggesting synbiotic supplementation is likely ineffective at reducing chronic inflammation in overweight, sedentary post-menopausal women living in New Zealand. However, future studies are needed to confirm these findings. Additionally, studies should investigate the effects of exercise and synbiotic supplementation separately in this population.
Understanding barriers and facilitators to diet and physical activity modification in people with polycystic ovary syndrome: a mixed method systematic review
Authors: McGowan M. , Garad R. , Wadhwani G. , Torkel S. , Rao V. , Maunder A. , Osei-Safo E. , Cowan S. , Moran L.J.
Published: May 2024

Polycystic Ovary Syndrome PCOS is an endocrine disorder affecting 8 to 13% of reproductive aged women(1). Dietary and physical activity changes are the first-line therapy to assist with symptom and weight management and to reduce the risk of reproductive, metabolic and psychological comorbidities(2). However, women with PCOS have a higher weight, experience weight gain, and a higher prevalence of living in a larger body. Health care professionals (HCPs) play a crucial role in delivering diet and physical activity advice for people with PCOS. Thus, the aim of this systematic review is to understand the barriers, facilitators, experiences, and perceptions of engagement and compliance with diet and physical activity modifications in people with PCOS and in HCPs providing or referring people with PCOS to diet and physical activity modifications. A mixed-method systematic review was conducted with quantitative studies narratively synthesised and all studies thematically analysed. There were 68 eligible papers, including n = 59 (n = 5198) people with PCOS and n = 17 (n = 2,622) HCPs. Several themes were identified as impacting people with PCOS’ ability to make diet and physical activity changes. HCP education on PCOS management through diet and physical activity was viewed by HCPs and people with PCOS to be inadequate, further impacting the quality of care and health outcomes. Dietary and physical activity advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. Both people with PCOS and HCPs agreed that there was a need for individualised and PCOS-specific diet and physical activity advice. However, HCPs viewed that there was limited evidence supporting these recommendations and a lack of time to deliver this care. Weight stigma was identified as impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that diet and physical activity are overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including receiving diet and physical activity advice that meet the individual’s needs, are necessary for leading to long-term sustainable changes and improvements in health outcomes. A multidisciplinary team approach and an overhaul of HCPs’ perceptions and mentality of weight and weight-centric care for those with PCOS are essential in delivering effective diet and physical activity advice.
Assessing the influence of preconception diet on female fertility: a systematic scoping review of observational studies
Authors: Alesi S. , Habibi N. , Silva T.R. , Cheung N. , Torkel S. , Tay C.T. , Quinteros A. , Winter H. , Teede H. , Mousa A. , Grieger J.A. , Moran L.J.
Published: May 2024

Preconception diet is a proposed modifiable risk factor for infertility(1). However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility. A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evidence gaps, and to provide information for nutritional recommendations for couples planning a pregnancy. In this systematic scoping review, four electronic databases (Medline and EMBASE via Ovid processing, CAB Direct, and CINAHL via EBSCO) were searched for observational studies (prospective and retrospective cohort, cross-sectional, and case–control studies) from inception to 27 September 2021. Eligible studies included women of reproductive age during the preconception period, and evaluated exposures related to preconception diet and outcomes related to fertility. Results were synthesised using a descriptive approach. A total of 36 studies were eligible for inclusion (31 prospective, 3 cross-sectional, and 2 case–control studies) and were published between 2007 and 2022. Of the assessed dietary exposures, increased adherence to the Mediterranean diet displayed the strongest and most consistent association with improved clinical pregnancy rates. Reducing trans fatty acids (TFAs), saturated fatty acids, and discretionary food intake (fast food and sugar-sweetened beverages) were associated with improvements in live birth, clinical pregnancy rates, and related ART outcomes. The dietary components of seafood, dairy, and soy demonstrated inconsistent findings across the few included studies. Due to heterogeneity and the limited available literature on most exposures, there is insufficient evidence to support any specific dietary approach for improving fertility. However, following some of the dietary approaches outlined in this review (anti-inflammatory diets, reducing TFA, and discretionary food intake) are consistent with broad healthy eating guidelines, have little to no associated risk, and offer a plausible set of possible benefits. This warrants further exploration in randomised controlled trials.
Insights into feeding preterm infants in Aotearoa, New Zealand: a mixed-method study
Authors: Cooper S. , Muelbert M. , Alexander T.
Published: May 2024

Optimal nutrition is essential for preterm infants as they face many barriers to achieving exclusive breastfeeding (EBF) and successfully introducing complementary foods (CF)(1). There is limited evidence of early feeding practices of preterm infants in Aotearoa, New Zealand (NZ). We aimed to investigate the facilitators and barriers to EBF and CF introduction in preterm infants in NZ. A nationwide self-completed electronic questionnaire was disseminated via social media to mothers of preterm infants. The survey collected quantitative data on hospital feeding practices, breastfeeding rates, timing of CF introduction, and fussy eating behaviours. Relationships between feeding practices and maternal and infant characteristics, such as ethnicity and level of prematurity, were explored using the Chi-Square statistical test in SPSS. Qualitative information regarding mothers’ experiences with breastfeeding, CF introduction, type of education and support received about the nutrition of preterm infants were collected for thematic analysis using Nvivo. The survey started in April and will close on 20th August 2023. Here we present preliminary findings of a subset of responses collected to date, and full results will be available for the conference. Up to 1st August 2023, 201 mothers had completed the survey. Most mothers self-identified as of New Zealand European (58%) and Māori (13%) background. Most infants (39%) were older than 12 months of chronological age (CA) and born moderate or late preterm (32+0 – 36+6 weeks’ gestation, 70%). Almost 50% of mothers required in-hospital supplementation of mothers’ milk (infant formula, 28% and donor breastmilk, 20%), and 44% of mothers were EBF at the time of hospital discharge. EBF for 5-6 months of CA was reported by 21% of mothers, and 46% provided any breastmilk for more than 6 months of CA. Among mothers who had introduced CF (n = 138), 74% reported introducing CF between 5-8 months of CA, and the infant’s first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 47%, and food fussiness was significantly associated with a decreased frequency of vegetable (p<0.001) and fruit (p = 0.004) consumption. Challenges with breastfeeding included the infant’s feeding difficulties, low milk supply, maternal stressors, lack of support and education from health professionals. Challenges to CF introduction included fussiness and maternal fears such as choking and lack of confidence. Support from lactation consultants and previous experience with introducing CF were the most common enablers for breastfeeding and timely CF introduction, respectively. Our findings provide the first insight into the early feeding practices of preterm infants in Aotearoa, New Zealand. This information will support strategies to improve the nutritional management of preterm infants by increasing awareness of common challenges mothers face to achieve the recommended breastfeeding guidelines and CF practices in this vulnerable population.
COVID-19 lockdown impacts on eating patterns and lifestyle behaviours of residents of Western Sydney: Fact not Fiction
Authors: Mekanna A.N. , Panchal S.K. , Li L.
Published: May 2024

Lockdown measures imposed in Australia to slow the transmission of COVID-19 protected most Australians from the virus(1). In some areas in NSW, specifically Western Sydney areas, more stringent lockdown regulations were implemented from July to September 2021, referred to as local governmental areas (LGAs) of concern(2). Preliminary evidence showed that people’s lifestyle such as dietary and physical activity behaviours and mental health during lockdown were altered from before lockdown(3). However, intermediate and longer-term impacts on nutrition and physical health are unclear, especially in LGAs of concern. We aimed to examine the impacts of the lockdown on nutritional behaviour of residents of Western Sydney. Mixed methods were employed including quantitative surveys such as ASA-24 and qualitative focus groups, using R software for quantitative analysis. Data was collected from 523 survey participants in addition to 42 focus group participants. The sample was representative of age, gender, county of birth and area of residence. Sixty-two percent reported decreases in their physical activity level post-lockdown compared with pre-lockdown, and 15% reported increases in their physical activity level post-lockdown compared with pre-lockdown. Sixty-nine percent reported increases in their physical activity levels post-lockdown compared with during the lockdown, and 12% reported decreases. Self-reported weight increased in 50% of the participants post-lockdown compared with pre-lockdown and decreased in 13% of the participants. Forty percent self-reported a decrease in their body weight post-lockdown compared with during the lockdown while 16% self-reported an increase in their body weight post-lockdown compared with during the lockdown. Food security status was reported as much worse in seven percent of the participants post-lockdown compared with pre-lockdown while being unvaried in 93% of the participants. Food security status remained unvaried post-lockdown compared with during the lockdown in 93% of the participants but much better in six percent. Eating habits were self-reported as much worse by 52% of the participants post-lockdown compared with pre-lockdown and much better by nine percent. Forty-eight percent of the participants self-reported their eating habits as much better post-lockdown compared with during the lockdown and 10% as much worse. COVID-19 lockdown negatively impacted eating behaviours, physical activity and body weight of Western Sydney residents with minimal impacts on food security. Further analyses are required to examine the associations between eating patterns, physical activity, body weight and food security and age, gender, country of birth and area of residence of participants. These findings can later be used to draft policies that can be put in practice in case of future pandemics in Australia, or in the case of other common natural disasters, such as bushfires and floods.
Mediterranean Diet adherence and wellbeing: a preliminary analysis of the MedWalk trial
Authors: Bracci E.L. , Davis C.R. , Murphy K.J.
Published: May 2024

Diet and diet quality have been linked to improvements to psychosocial health and wellbeing(1). However, data from national health surveys indicate that most Australian’s have poor diet quality and consume a Western style diet high in saturated fat, discretionary foods and added sugars and salt(2). The Mediterranean Diet (MedDiet), a predominantly plant-based diet rich in bioactive foods and nutrients, has been shown to improve mood and wellbeing. However, long-term effects beyond 6-months have not been thoroughly explored in older adults. MedWalk compares a 12-month MedDiet and Walking intervention with habitual lifestyle (HabDiet) in 160 older adults residing in retirement villages across South Australia and Victoria. Data from the South Australian cohort at baseline (n = 83) and 6-months (n = 74) are presented in this preliminary analysis.

To determine dietary compliance, participants completed the 14-point MedDiet Adherence (MEDAS) questionnaire which assesses the intake of key MedDiet foods such as legumes, fish, and extra virgin olive oil; higher scores reflect higher adherence. Wellbeing was assessed using the Flourishing Index, which assesses life satisfaction, relationship satisfaction, happiness, mental and physical health. The total flourishing score includes 10 questions with a maximum of 100 points reflecting highest flourishing, while the secure flourishing score includes two additional questions related to safety, housing, and access to food with a maximum of 120 points to indicate highest flourishing. Group and time interactions for MEDAS and flourishing scores were analysed using linear mixed effects modelling. There were no significant differences between groups for MEDAS score at baseline (MedDiet 5.78 ± 0.34 vs HabDiet 5.74 ± 0.32). At 6 months, the MedDiet group had significantly increased their MEDAS by 4.16 points (P<0.001), (MedDiet 10.0 ± 0.42 vs HabDiet (5.85 ± 0.39). At baseline there were no significant differences between groups for the total 10-point flourishing score (MedDiet 83.5 ± 2.01 vs HabDiet 82.1 ± 2.0) or 12-point secure flourishing score (MedDiet 100.6 ± 2.2 vs HabDiet 100.4 ± 2.2). At 6 months there was a significant between-group difference in total flourishing index scores with a mean difference of 6.97 points in the MedDiet group (MedDiet 85.8 ± 1.9 vs HabDiet 78.8 ± 1.8, P = 0.010). Similarly, the secure flourishing index score was 6.18 points higher in the MedDiet group compared to the HabDiet at 6-months (MedDiet 102.9 ± 2.2 vs HabDiet 96.8 ± 2.07, P = 0.046). Adhering to a MedDiet and walking intervention may lead to positive improvements to wellbeing in an older population. The flourishing index may need to be compared with other wellbeing questionnaires and instruments to better understand the relationship between wellbeing and MedDiet adherence as there was a cross-sectional association but no positive correlation at 6-months.
Comparison of snack characteristics by diet quality: findings from a nationally representative sample of Australian adolescents
Authors: Girma Sisay B. , Lacy K.E. , McNaughton S.A. , Leech R.M.
Published: May 2024

Snacking is a common eating behaviour among adolescents accounting for more than a quarter of their total energy intake but the relationship between snacks and overall diet quality remains unclear(1). Hence, the aim of this study was to examine characteristics of snacks among Australian adolescents (12-18 years) according to their level of diet quality. This secondary analysis uses one day of 24-hour dietary recall data from the 2011 - 2012 National Nutrition and Physical Activity Survey (n = 935). Snacks were defined based on participant-identified eating occasions(2). The Dietary Guideline Index for Children and Adolescents (DGI-CA) was used to assessed adherence to the Australian Dietary Guidelines(3), with the highest tertile of the DGI-CA score indicating high adherence. The means (95% confidence intervals [CI]) for daily snack frequency and snack energy density (ED; kJ/g) were estimated for boys and girls, using linear regression, adjusted for age, area-level disadvantage, and energy misreporting. The differences in means and proportions across tertiles of DGI-CA scores were tested by using F- and Chi square-tests, respectively. The results show no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores in either boys (lowest tertile mean = 2.2, 95% CI [2.0, 2.4] snacks/day, highest tertile = 2.1 [1.9, 2.3]) or girls (lowest tertile = 1.9 [1.7, 2.1] snacks/day, highest tertile = 2.2 [1.9, 2.4]). The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.42, 95% CI [7.1, 10] kJ/g, highest tertile = 6.32 [5.4, 7.4] kJ/g) and girls (lowest tertile = 8.99 [7.8, 10.3] kJ/g, highest tertile = 5.92 [5.1, 6.9] kJ/g). As DGI-CA scores increased, the proportion of both boys and girls consuming discretionary foods at snacks (such as soft drinks) decreased, while foods from the five food groups (such as apples) increased (p-values < 0.05). In conclusion, snack ED, but not frequency, and the types of foods consumed by adolescents at snacks varied by a level of diet quality. Snack ED decreased with increasing diet quality and adolescents with higher diet quality had higher intakes of foods from the five food groups and lower intakes of discretionary foods at snacks. Encouraging the consumption of lower-ED foods from the five food groups at snacks presents an opportunity to enhance adolescent diet quality. Future studies should explore snack-specific strategies to improve overall diet quality of adolescents.
Use of herbs and spices in cooking and food preparation in Australia
Authors: Wilson N.A. , Mantzioris E. , Villani A.
Published: May 2024

The Mediterranean diet (MedDiet) is largely a plant-based dietary pattern which is associated with a reduced risk of numerous chronic diseases(1,2). A traditional MedDiet contains a wide variety of wild herbs and spices, which are frequently used in cooking and food preparation(3,4), and are a valuable source of antioxidants. However, little is known about herbs and spices use in Australian households. Therefore, the aim of this study was to determine the types of herbs and spices used in cooking and food preparation in Australian households. A cross-sectional study was undertaken amongst Australian adults aged ≥18 years. Participants were recruited via social media platforms requesting voluntary participation in an online survey. The survey tool included questions related to the types of herbs and spices used and consumed in Australian households, frequency of use, and the perceived level of confidence for use of herbs and spices in cooking and food preparation. Given the lack of a previously validated and reliable survey instrument, the authors developed a prototype questionnaire that was initially piloted against a separate representative sample for face validity. A total of n = 400 participants responded and completed the survey. Participants were mostly female (n = 340; 85.0%) with a mean age of 46.5 ± 14.7 years and were overweight (BMI: 26.4 ± 6.0 kg/m2). In the previous 12 months, two-thirds of participants (n = 258; 64.8%) reported consuming herbs and spices 1-2 times per day, which were most commonly consumed as part of lunch or dinner meals (n = 372; 94.2%). Basil (n = 391; 97.8%), pepper (n = 390; 97.5%), and garlic (n = 387; 96.8%) were the most frequently used and consumed herbs and spices. A quarter of participants reported using basil 1-3 times per month (n = 104; 26%), while a quarter reported using pepper (n = 104; 26%) and garlic (n = 103; 25.8%) daily. The majority of participants identified that they were extremely confident (n = 159; 39.8%) or very confident (n = 149; 37.3%) using herbs and spices in cooking and food preparation. Most participants (n = 282; 70.5%) reported growing herbs and spices in their own homes. This cross-sectional analysis of Australian households shows that most Australian adults consume herbs and spices daily, with basil, pepper, and garlic being the most frequently consumed. Further investigation into the quantities needed to elicit potential health benefits of herbs and spices when incorporated into a healthy dietary pattern warrants future research.
Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities
Authors: Livingstone K.M. , Rawstorn J.C. , Alston L. , Partridge S.R. , Bastian A. , Dullaghan K. , McNaughton S.A. , Hendrie G.A. , Blekkenhorst L.C. , Maddison R. , Zhang Y. , Barnett S. , Mathers J.C. , Godrich S.L.
Published: May 2024

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.
Implementing eHealth-based behaviour change support within a nutrition intervention trial improves adherence to study-related behaviours in healthy young adults
Authors: Worthington A. , Gillies N. , Roy R. , Hannaford R. , Braakhuis A.
Published: May 2024

Nutrition intervention trials play a key role in informing clinical and dietary guidelines. Within these trials, we need participants to change their behaviours; however, researchers seldom systematically consider how to support participants with these changes, contributing to poor adherence. Here we evaluate how using a behaviour change framework to develop support within a dietary intervention impacts young adults’ adherence to required trial behaviours. In the Protein Diet Satisfaction (PREDITION) trial, 80 young adults were randomised to a flexitarian or vegetarian diet for 10-weeks to investigate the psychological and cardiometabolic effects of moderate lean red meat consumption as part of a balanced diet(1). To understand these outcomes, it was key that participants within the trial (i) ate a healthy, basal vegetarian diet (excluding meat, poultry, and fish not provided by research team) and (ii) reported their dietary intake daily on a smartphone application (required to evaluate intervention compliance). To enhance adherence to these behaviours the Nine Principles framework was used to develop behaviour change support (BCS)(2). Key components of the BCS included access to a dietitian-led Facebook group, text reminders, and food delivery. Effectiveness was measured using the following analyses of the 78 participants who completed the study: pre-post change in targeted dietary habits over time using a subscore of the Healthy Diet Habits Index, adherence score to reporting over 10-weeks, Facebook group engagement, and impact evaluation. Analysis included linear imputation modelling, t-tests, and chi-square analysis. The total Healthy Diet Habits Index subscore out of 16 significantly increased from baseline to week 10 (10.6 ± 2.6 to 11.2 ± 2.6, p = 0.011), demonstrating maintenance of a healthy diet. Overall adherence to reporting was high across the 10 weeks, with the total population mean reporting score 90.4 ± 14.6 out of a possible 100. This strengthens study validity, allowing us to confidently report if participants complied with study requirements of consuming the intervention protein (red meat or plant-based meat alternatives) on top of a basal vegetarian diet. Although relatively low active Facebook engagement was observed (on average <1 ‘react’ per post), most participants agreed the text messages and Facebook groups supported them to adhere to recording (63%) and eating healthily (60%), respectively. This is the first study to provide an example of how a framework can be used to systematically develop, implement, and assess BCS within a nutrition trial. This appears to be a promising way to enhance adherence to study-related behaviours, including the burdensome task of reporting dietary intake. We believe this has great potential to improve research validity and decrease resource waste, not only for the PREDITION trial but in future dietary intervention trials.