Establishing early healthy eating behaviours in the complementary feeding period through to adolescence is fundamental as it can affect the health trajectory of an infant’s life into adulthood and impact lifelong eating patterns(1). Consumer demand for commercial squeeze pouches is increasing and now expanding from infants to older children. Yet, emerging research suggests that these products are nutritionally poor(2), and are frequently marketed with misleading claims that oppose infant and child feeding guidelines(3). There is a paucity of information to inform public health strategies regarding the use of squeeze pouches throughout infancy and beyond. The aim of this scoping review was to determine the frequency and types of squeeze pouches consumed by children aged 0–18 years, the sociodemographic characteristics of users, and insights from parental experiences when using these products. The scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Three online databases were searched (MEDLINE, Scopus, CINAHL) in addition to grey literature. Screening of papers was completed by two independent reviewers. The database and grey literature search identified 125 articles, of which 16 underwent full-text review and 11 studies across five countries were included. In eight studies, the prevalence of squeeze pouch consumption ranged from 23.5% to 82.8% of infants and children, with studies reporting daily (n = 4; 8.7–29.2%), weekly (n = 7; 20.9–75.2%), and monthly consumption (n = 7; 16.7–70.4%). The predominant types of squeeze pouches consumed were fruit-based and dairy-based squeeze pouches. Frequent squeeze pouch use was 2.5 times more likely among families residing in areas of high deprivation, or if childcare was used. Household composition also impacted squeeze pouch use as families with two or more children were more likely to use these products. Additionally, frequent pouch use was associated with early cessation of breastfeeding and early introduction of solids. Five studies on parental perceptions of squeeze pouches reported benefits including convenience, perceived health, and perceived low cost while four studies expressed concerns relating to waste and environmental impacts, health and nutrition, and perceived high cost. This review highlights that the widespread use of squeeze pouches, particularly fruit and dairy-based pouches among infants and children is driven by convenience, changing family needs and effective marketing strategies. Public health policy is needed to address concerns regarding the nutritional quality of squeeze pouches and regulate marketing strategies to ensure parents are adequately informed about the health implications of these products. Further research should focus on identifying barriers to safe and nutritious complementary feeding practices and developing targeted education programs to promote optimal feeding practices that minimise the use of squeeze pouches in infants and children of all ages.

Asthma is a chronic inflammatory disease of the lungs, characterised by variable airflow limitation and symptoms including shortness of breath, wheezing, coughing and chest tightness(1). One in 9 Australians has asthma and 42% also have obesity(1). The risk of developing asthma doubles in people who have obesity(2). While obesity is associated with increased severity of asthma(3), people with obesity have more severe asthma symptoms, poorer lung function, reduced quality of life and an increased risk of an asthma exacerbation(3). Response to medication also tends to be impaired, therefore limiting the efficacy of pharmaceutical management(4). Obesity is associated with increased systemic inflammation and there is some evidence that this inflammation may extend to the airways of adults with asthma; with research suggesting obesity is associated with increased airway inflammation(5). The impact of weight management on airway and systemic inflammation in asthma is unclear. Weight loss has been shown to improve asthma and, as such, has been recommended in asthma management guidelines(1). However, the ideal approach to sustainable weight loss in people with asthma is unknown. The aim of this systematic review is to determine both the short- and long-term efficacy of different obesity management approaches in adults with obesity and asthma, by systematically reviewing the literature. Medline, Embase, CINAHL, Scopus, Web of Science, Current Contents and Cochrane Central Register of Controlled Trials were searched up to January 2024, for obesity management interventions that assessed changes in clinical asthma outcomes, body composition, inflammation, and/or metabolic parameters. Studies were grouped by intervention type (lifestyle modification, pharmacotherapy, and bariatric surgery) and follow-up duration (< 12 months and ≥ 12 months). Eighteen lifestyle interventions, two pharmacotherapy and 17 surgical studies were included in the systematic review and 15 in the meta-analysis. All (n = 18) lifestyle interventions reported short-term results (< 12 months) and two reported long-term results (≥ 12 months). For surgical interventions, five reported short-term outcomes and 94% (16/17) reported long-term outcomes. 69% (9/13) of the lifestyle interventions observed statistically significant improvement in asthma symptoms in the short-term. Only 2 studies report long-term results (≥ 12 months) with improvements maintained in 50% (1/2) of studies. All surgical interventions (8/8) observed statistically significant long-term (≥ 12 months) improvements in asthma symptoms at twelve months. Research suggests that lifestyle interventions to manage obesity improve asthma symptoms in the short-term; however, the long-term efficacy is less certain due to the small number of studies. Surgical interventions show improved asthma symptoms at 12 months. Additional research is required to better understand the optimal obesity management approach and duration for adults with comorbid obesity and asthma.

Older adults are at an increased risk for both malnutrition and cognitive decline(1,2). However, the relationship between nutritional status and cognitive decline remains unclear, and was investigated in this study. This is a cross-sectional analysis of baseline data from the Capacity of Older Individuals after Nut Supplementation (COINS) study, a randomised controlled trial investigating the effect of peanut butter on functional capacity in older adults. Older adults aged 65 years and over, who were community-dwelling, generally healthy and at risk for falls (simplified fall risk screening score ≥ 2) were recruited as part of COINS study. Nutritional status was measured using the Mini Nutritional Assessment (MNA) tool (score range 0 to 30). An MNA score of ≥ 24 indicated normal nutrition status, while a MNA score of < 24 was indicative of at-risk for malnutrition. Cognitive performance was measured by the validated Montreal Cognitive Assessment MoCA (range 0 to 30), and Trail Making Tests-A and B (TMT-A, TMT-B) (as time taken to complete tasks) tools. The MoCA test further provided scores on visuospatial/executive function, naming, language, attention, abstraction, delayed recall, and orientation domains. Multivariable linear regression analysis was used to investigate the association between nutritional status and cognitive function, adjusted for age, sex and BMI. A total of 118 older adults with complete data were analysed (83% females, age (mean ± SD) = 74 ± 4 years; BMI = 27.5 ± 4.2 kg/m2), of which 93.2% (n = 110) were considered to have normal nutritional status, and the remaining 6.8% (n = 8) were deemed at risk of malnutrition. In terms of cognitive function status, 40.7% (n = 48) had normal cognitive function (MoCA score ≥ 26), 56.7% (n = 68) had mild cognitive impairment (MoCA score 18–25), and 1.7% (n = 2) had severe cognitive impairment (MoCA score 10–17). After adjusting for age, sex, and BMI, MNA score was positively associated with both overall MoCA scores (β (95% CI): 0.29 (0.04, 0.54), p = 0.024) and the visuospatial/executive function (β (95% CI): 0.16 (0.05, 0.28), p = 0.006), but not with other cognitive domains or TMT performance. In summary, our findings suggest that nutritional status assessed via MNA may be predictive of global cognitive function. Future studies are needed to determine if MNA could be a surrogate marker or risk factor for cognitive declines.

Flavonoids, found in plant foods, are becoming increasingly recognised for their health benefits(1). A valid, reliable and short dietary assessment tool is necessary to assess flavonoid intake, as current methods are burdensome for researchers and participants. This study aimed to evaluate the validity and reproducibility of a flavonoid food frequency questionnaire (Flav-Q), which was derived from the Kent & Charlton Flavonoid Food Frequency Questionnaire (FFQ)(2). The Flav-Q contains 23 items and was validated against repeated 24-hour dietary recalls in an Australian adult population (18y+). The Flav-Q was administered at four time-points over 12 months period (n = 80). At each time-point, two 24-hour dietary recall surveys were completed using Intake-24(3). Usual flavonoid intake was assessed by cross-referencing food lists with the Phenol-Explorer database and averaged using the multiple source method (MSM) for participants who had at least 4 recalls. The criterion validity of the Flav-Q at baseline was compared against the usual intake using the Wilcoxon signed-rank test, Spearman’s correlation coefficient, Bland-Altman plots, and Cohen’s kappa (κ)(4). The reproducibility of the baseline Flav-Q (Flav_Q1) was compared with time points 2, 3, and 4. Mean total flavonoid intake was higher for Flav-Q1 compared to usual intake (443.2 mg/day vs 234.4 mg/day, p < 0.001) and overestimated subclass intake except for flavanones. Moderate to strong correlations were found between Flav-Q1 and usual intake for total flavonoids (r = 0.66, p < 0.001; κ = 0.45, p < 0.001) and subclasses flavan-3-ols (r = 0.72, p < 0.001; κ = 0.53; p < 0.001)), flavonols (r = 0.55, p < 0.001; κ = 0.40, p < 0.001), flavanones (r = 0.49, p < 0.001; κ = 0.30, p = 0.007), and a weaker non-significant correlation for anthocyanin (r = 0.38, p < 0.001; κ = 0.15, p = 0.18) and flavones (r = 0.34, p < 0.001; κ = 20, p = 0.07). Bland-Altman plots showed a large bias and wide limits of agreement (61.64%) for total flavonoid intake. Flav-Q demonstrated high reproducibility across all timepoints (Flav-Q1 vs Flav-Q2 r = 0.82, p < 0.001; κ = 0.70, p < 0.001), Flav-Q1 vs Flav-Q3 (r = 0.68, p < 0.001; κ = 0.47, p < 0.001), Flav-Q1 vs Flav-Q4 (r = 0.63, p < 0.001; κ = 0.47, p < 0.001). Mean percentage differences between repeated timepoints for total flavonoid ranged from 19% to 31%, with Bland-Altman plots showing good levels of agreement. Overall, the Flav-Q tool was reproducible and demonstrated some agreement for assessing the intake of total flavonoid and its subclasses. However, further validation to determine reasons for over-estimation is necessary.

A growing number of Australians are experiencing challenges accessing and affording healthy food due to climate-related disasters, global supply chain disruptions, and rapid inflation that is affecting the cost of healthy food(1). There is limited understanding of how participation community-based food cooperatives can address these challenges and improve food security and dietary intake. This study investigated the motivations for joining and impact of participation in a community-based food cooperative called Box Divvy on self-reported food security status and intake of fruits and vegetables among a sample of Australian adults. A cross-sectional online survey was conducted among Box Divvy members, that measured sociodemographic characteristics, motivations for joining, self-reported fruit and vegetable intake (serves/week), and food insecurity status (USDA 6-item short form(2)) before and while using Box Divvy. Participants were classified as being food secure, or experiencing marginal, moderate, or severe food insecurity. Logistic regression assessed demographic predictors and self-reported change in food security status, and ANOVA examined changes in dietary intake before joining and while using Box Divvy. Of participants (n = 2764, 37% aged 35–44 years, 83% European ethnicity, 92% New South Wales residents), most joined Box Divvy to support local farmers (87.3%), and save money on healthy foods (70.6%). Around half of respondents (50.8%) reported experiencing food insecurity before joining Box Divvy (24.5% marginal, 18.4% moderate, 7.9% severe food insecurity). Univariate logistic regression identified age, household structure, and income as significant predictors of food insecurity (p < 0.001). Participants experiencing food insecurity reported significantly lower consumption of fruits and vegetables prior to joining Box Divvy compared to those who were food secure (p < 0.001). While using Box Divvy, 28.2% of participants reported experiencing food insecurity (16.6% marginal, 9.6% moderate, 2.1% severe food insecurity). The odds of food insecurity while using Box Divvy were 62% lower than before joining (OR: 0.38; 95% CI 0.34–0.43; p < 0.001). On average, participants reported their fruit intake increased by 2.5 ± 5.6 serves/week (p < 0.001), and vegetable intake increased by 3.3 ± 5.7 serves/week (p < 0.001). The mean increase was significantly greater among moderately food insecure (fruit mean difference 3.2 ± 6.5 serves/week; vegetable mean difference 3.9 ± 6.9 serves/week) and severely food insecure groups (fruit mean difference 4.4 ± 6.9 serves/week; vegetable mean difference 5.5 ± 7.7 serves/week; p < 0.001). Participation in Box Divvy significantly improved self-reported food security status and fruit and vegetable intake among a large sample of Australian adults. Notably, fruit and vegetable intake significantly increased among those experiencing moderate and severe food insecurity. This underscores the potential of community-based food cooperatives to improve food security and promote healthier eating habits among Australian adults, especially households experiencing food insecurity.

Multiple sclerosis (MS) is a neurodegenerative disease that affects approximately 2.8 million people worldwide. Among other risk factors, such as smoking and history of infectious mononucleosis, diet is emerging as a modifiable risk factor for MS. However, there is little evidence associating plant-based diets and MS risk. The few studies available investigated vegetarian diets and MS risk and found conflicting results: in one study, a vegetarian diet was associated with higher risk(1), the other with lower risk(2). The aim of this study was to investigate associations between plant-based indices and risk of MS. We used data from the UK Women’s Cohort Study, which followed adult women over 20 years (MS cases: n = 88, age = 47.9 years [SD 7.6]; controls n = 25,038, age = 52.1 years [SD 9.2]). We used three plant-based indices: i) plant-based index (PDI), ii) healthy plant-based index (hPDI) and iii) unhealthy plant-based index (uPDI)(3). These indices assign scores according to intakes of three food groups: ‘healthful plant-foods’ (e.g., fruits, vegetables), ‘unhealthful plant-foods’ (e.g., refined grains, sweets) and ‘animal foods’ (e.g., meat, fish). For the PDI, both the healthful and unhealthful plant-foods were positively scored from 1 to 5 according to increasing intakes. For the hPDI, healthful-plant foods were positively scored from 1 to 5 according to increasing intakes; unhealthful plant-based foods were scored in reverse. For the uPDI, unhealthful plant-based foods were scored positively, and the healthful plant-based foods were reverse-scored. Animal foods were reverse-scored for all three indices. MS incidence was ascertained from hospital records based on International Classification of Diseases (ICD-10) code G35. Adjusted (age, smoking, education, energy intake) multivariable cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of MS according to each dietary pattern separately (PDI, hPDI, uPDI) as well as each food group (healthful plant-foods, unhealthful plant-foods, animal foods). A higher PDI was associated with lower risk of MS (HR: 0.95, 95% CI: 0.92, 0.98, p = 0.001). However, the hPDI and the uPDI were not associated with MS risk. A higher intake of healthful (HR: 0.93, 95% CI: 0.88, 0.98, p = 0.004) and unhealthful (HR: 0.91, 95% CI: 0.85, 0.97, p = 0.008) plant-foods was associated with lower risk of MS, while animal foods were not associated with MS risk. These findings suggest that plant-based foods could be beneficial for people at high risk of MS, with no effect of animal products. However, these findings are from one country and for women only and may not necessarily be generalisable to other population groups. Future research investigating the association between plant-based diets and MS risk in other populations is warranted.

Eggs contain several nutrients that are positively linked to neurological function, including phospholipids (regulate neurotransmitter receptors), choline (produces acetylcholine, involved in memory and learning(1), tryptophan (produces serotonin, reduces depression-like symptoms(2), and docosahenaenoic acid (DHA, important for neurogenesis and synaptic plasticity(3). However, most studies examining egg intake and cognition have been observational, primarily focusing on cognitive decline with aging. Few studies have explored the impact of egg consumption on cognition in young people, with a paucity of high-quality study designs used. This randomised controlled trial (RCT) aimed to examine the impact of egg consumption on cognition, including interoception, risk-taking, decision-making and reaction-time in young adults. Ninety healthy young adults (aged 18–40) were recruited to a 6-week parallel-arm RCT. Participants were randomised to either the intervention group (n = 45) who consumed 2 whole eggs/day or the control group (n = 45) who avoided eating eggs. Participants completed 4 computer-based validated cognitive tests at baseline and end-of-study. The Schandry task measured interoception (heartbeat perception (Hb) in 25s, 35s and 55s rounds), the balloon analogue risk task (BART) measured risk-taking, the Iowa Gambling Task (IGT) assessed decision-making, and the Deary-Liewald test measured simple reaction time (SRT) and choice reaction time (CRT). Changes in cognitive task results between groups were analysed via linear mixed models analysis using SPSS, with results controlled for sleepiness (measured by Karolinska Sleepiness Scale) and gender. Continuous data is presented as mean ± SD where parametric, or median (IQR) where non-parametric. Of the n = 90 participants enrolled, n = 89 completed the 6-week program and were included in data analysis (Egg n = 45, Control n = 44). Participants were 71% female, aged 24.0 (9) y with a mean BMI of 23.2 ± 3.4 kg/m2. Most individuals reported a prior habitual egg intake of 2–4 times/week (49.4%). At baseline, cognitive task results between groups were not significantly different. At study completion, interoception was not impacted by egg consumption (Hb: 25s p = 0.931; 35s p = 0.936; 55s p = 0.679), nor was risk-taking (BART p = 0.828), decision making (IGT p = 0.923), or reaction-time (SRT p = 0.625, CRT p = 0.839). Consuming 2 eggs/day for 6-weeks did not affect cognitive test results in healthy young adults, when compared to those who avoided eggs, suggesting no detrimental effect of regular egg consumption (14 eggs per week). This is the first RCT to explore the impact of egg consumption on the above parameters of cognition. Given the null findings, future research should explore longer intervention durations or alternative cognitive assessments to fully understand the potential cognitive effects of egg consumption.

Nutrition professionals are needed to be change agents for promoting healthy and sustainable food systems, however, the best methods for preparing students are unclear(1,2). Experiential learning opportunities, such as hands-on activities with sustainable food systems, could bridge the gap between theoretical knowledge and practical application(3). This study aimed to evaluate how an experiential learning activity using Farmwall Vertical Garden, an aquaponics system for growing nutrient-dense microgreens, influenced third-year university nutrition students’ perceptions, awareness, and knowledge of local food systems, as well as their attitudes and behaviours towards sustainability and local food consumption. Pre-surveys assessed students’ baseline knowledge, attitudes, and diet quality was measured using the Australian Recommended Food Score (ARFS)(4). The hands-on activity with Farmwall, including a seeding activity and recipe development, aimed to deepen their understanding of local food systems, sustainable diets, and links to future professional practice. Post-surveys measured changes in these areas, intentions for behaviour change, and their main learnings from the activity. Quantitative data analysis included descriptive statistics, Chi-Square tests, linear regression models, and McNemar-Bowker tests. Qualitative data was analysed thematically. In the pre-survey, students (n = 58) reported limited knowledge of local food systems (60.3%) but recognised their importance (77.6%) and positive environmental impact (73.3%). Sustainable practices students valued most included purchasing minimally packaged foods (69.0%), ethically certified products (56.9%), and locally grown produce (58.6%), with less emphasis on consuming plant-based (27.6%) and organic foods (31.0%). Chi-square tests revealed that students who believed sustainable food practices were important were significantly more likely to engage in these behaviours (p < 0.05). The average ARFS diet quality score was 39.7 ± 8.4, classified as ‘excellent ‘. Linear regression revealed that engagement in sustainable practices, such as growing own food (B = 4.4; p = 0.047) and buying locally grown (B = 5.2; p = 0.029) and seasonal foods (B = 5.8; p = 0.021), was associated with significantly higher diet quality score. The Farmwall activity significantly increased students’ knowledge of local food systems (p < 0.001) and increased their intentions towards buying locally grown foods (pre = 57.9% to post = 86.8% p < 0.001) and growing their own food (pre = 36.8% to post = 78.9% p < 0.001). Post-activity responses highlighted students’ learning about the complexity of sustainability, the benefits of sustainable dietary practices, and the relationship with the future professional practice. In conclusion, an experiential learning activity with Farmwall significantly improved students’ knowledge, attitudes, and intentions regarding sustainability and local food systems. Integrating similar experiences into the curriculum could enhance theoretical knowledge with practical skills, better preparing nutrition professionals to advocate for and implement sustainable practices into future professional practice.

In Australia and other high-income countries, communities are experiencing diet-related diseases due to social inequities and food systems that promote the production and consumption of unhealthy foods(1). Community food hubs have the potential to strengthen local food systems and improve access to healthy, affordable, culturally appropriate food by selling local food to local people(2). The primary aim of this rapid review was to identify short- and medium-term outcomes and long-term impacts associated with community food hubs. In January 2024, four databases and the grey literature were searched for relevant studies and reports published in English between 2013 and 2023. Empirical evaluations of food hubs in high-income countries that included a physical market selling healthy local food were eligible for inclusion. A narrative synthesis was conducted, and descriptive statistics were used to summarise outcomes and impacts under five categories: economic development and viability; ecological sustainability; access to and demand for healthy local food; personal and community wellbeing; and agency and re-localisation of power(3,4). A total of 16 studies/reports were included, reporting on 24 community food hubs (USA n = 16; Australia n = 7; Canada n = 1). Food hubs were often described as farmers’ markets (n = 9, 37% of food hubs), some of which offered financial incentives/subsidies to people living on low incomes. Some food hubs also sold food wholesale and/or provided nutrition education and community gardens. Across the 24 food hubs, a total of 83 short- and medium-term outcomes were assessed. No long-term impacts were evaluated. Outcomes were considered ‘positive’ if evaluation results reflected desirable changes. Overall, 86% of outcomes were positive (n = 71). Within the personal and community wellbeing category, 42 outcomes were assessed, and 83% (n = 35) were positive (e.g., increased fruit and vegetable consumption, increased community connection). Within the access to and demand for healthy local food category, 25 outcomes were assessed, and 96% (n = 24) were positive (e.g., increased access to and/or demand for affordable local produce). Outcomes under the remaining three categories were assessed less frequently. Within the economic development and viability category, 6 outcomes were assessed, and 50% (n = 3) were positive (e.g., access to new markets for food hub suppliers). Within the ecological sustainability category, 6 outcomes were assessed, and 100% (n = 6) were positive (e.g., reduction in food packaging and food waste). Within the agency and re-localisation of power category, 4 outcomes were assessed, and 75% (n = 3) were positive (e.g., integration of community members from low income and cultural minority groups into local food systems). Community food hubs can promote personal and community wellbeing, access to and demand for healthy local food, economic development and viability, ecological sustainability, and agency and re-localisation of power. Future research should focus on methods for evaluating long-term impacts under all five categories.

Parents are pivotal in shaping healthy eating, physical activity and screentime behaviours in the early years(1). Early Childhood Education and Care (ECEC) services provide an ideal setting for parent communication initiatives to promote positive lifestyle behaviours in young children(2). This study aimed to determine the feasibility, acceptability and potential efficacy of the Healthy Adventures Book (HAB) pack in increasing parent and carer capacity to support positive dietary intake, physical activity and screen use behaviours of their 3–5-year-old children. ECEC services in western Sydney (n = 136) and families with 3–5-year-old children (n = 258) participated in the study. Families were provided with a HAB pack to take home, consisting of a scrapbook containing health information, a vegetable-shaped toy and story book. Families were encouraged to read the information and story book, and to support their child to complete the activity in the book. A quasi-experimental mixed-methods design was used. Parents completed pre- and post-intervention questionnaires that included questions on demographics, and readiness and confidence to support behaviour change. Process data were collected from parents and ECEC directors. Semi-structured interviews were conducted with parents post-intervention. Changes in parent readiness and confidence were analysed using Mann Whitney U tests. Thematic analysis was conducted on parent interview data. There was a significant improvement in parent confidence to support physical activity from pre- to post-intervention (p < 0.01). No significant changes were found for other behaviours. Process evaluation showed high acceptability, with 93% of parents reporting children were excited to use the pack, 91% finding it easy to complete, and 86% finding it useful for learning about healthy behaviours. All ECEC directors agreed the pack was well-received, easy to implement, appealing to families, and facilitated conversations about health behaviours. Qualitative analysis revealed six key themes: whole family involvement, easy access to relevant health information, reinforcement of key health behaviours, vegetable intake, screen time, and continuation of learning. Parents reported the pack encouraged family engagement, provided useful strategies, and reinforced health messages. However, parents expressed that they would like ongoing support to maintain behaviour changes. Study limitations included a small sample size, no control group, and potential selection bias of already health-conscious families. In conclusion, the HAB pack was feasible and acceptable to both ECECs and families, demonstrating potential as a health promotion tool, particularly for encouraging physical activity. Further, it has the capacity to improve communication between the ECEC setting and home environment to ensure consistency of health messaging to children. More research is needed to determine efficacy and explore strategies for sustained behaviour change.

Delaying carbohydrate digestion and glucose absorption, via inhibition of gastrointestinal α-amylase, α-glucosidase and glucose transporter activities, is an effective strategy to alleviate postprandial hyperglycaemia, which is a major risk factor for the development of insulin resistance and metabolic diseases such as type 2 diabetes. Oral antihyperglycaemic agents (OHAs) can be used alone or in combination with other medications or insulin to manage diabetes. However, OHAs are associated with a risk of hypoglycaemic events and numerous side effects, especially gastrointestinal symptoms, and are contraindicated in patients with irritable bowel syndrome and/or kidney, liver or cardiac dysfunction(1). Hence, there is interest in food-based compounds, such as (poly)phenols, with similar but milder effects to reduce hyperglycaemia and risk of metabolic disease, and to manage diabetes. Our complete and highly sensitive in vitro protocol can measure human carbohydrate digestive enzyme activities(2) and glucose transport(3)accurately. The sugars in enzyme assays (both substrates and products) and transcellular glucose transport assays (including lactulose, which is added as a control for cell monolayer integrity) are quantified directly by specialised ion chromatography. We use commercially-available human α-amylases to assess starch hydrolysis and brush border α-glucosidases derived from differentiated human intestinal Caco-2/TC7 cells to assess disaccharide hydrolysis, while 2-deoxy-D-glucose transport is measured across Caco-2/TC7 cell monolayers cultured on transmembrane supports. Enzyme and glucose transporter activities are measured in the presence of various concentrations of phenolic compounds or phenol-rich extracts and compared to the controls using one-way ANOVA. The potency of potential inhibitors is evaluated by calculating the half-maximal inhibitory concentration (IC50). We have successfully used this protocol to screen for potential inhibition by dietary (poly)phenols and uncover specific mechanisms of action and structure-function relationships. For example, we confirmed that quercetagetin, a polyphenol in spinach, inhibits human salivary α-amylase by binding to both starch and the enzyme (p < 0.05 vs quercetagetin-free control; IC50 = 30.1 ± 2.1 μM), while also inhibiting human α-glucosidase activities. Anthocyanidins found in berries directly inhibit pancreatic α-amylase (p < 0.05 vs anthocyanidin-free control), especially peonidin (IC50 = 25.8 ± 1.9 μM) and petunidin (IC50 = 28.5 ± 0.8 μM), while polyphenols found in walnut inhibit both salivary and pancreatic α-amylases and intestinal glucose transport. Notably, we have identified several plant-derived inhibitors that may be useful in regulating postprandial glycaemia in vivo. Such mechanisms may partially explain why a diet that is high in fruits and vegetables results in lower metabolic disease risk. Dietary (poly)phenols offer the potential to manage insulin resistance by diet and adjunct therapies with lesser side effects than OHAs. Further, our accurate and reliable method will benefit researchers involved in the discovery and development of novel agents for the prevention and management of diabetes.

A recent umbrella review found that overall greater exposure to ultra-processed foods (UPF) was associated with worse outcomes. For cancer incidence overall (k = 7) and for colorectal cancer (k = 7) there was suggestive low-quality evidence of a positive association. There was no evidence for association with cancers of other sites(1). Analysis of data from EPIC found positive associations for UPF consumption with head and neck cancer, and oesophageal adenocarcinoma, with a small proportion of the association mediated via adiposity(2). This study aims to examine the association between UPF consumption and incidence of cancer, using data from the Melbourne Collaborative Cohort Study (MCCS). Adults aged 40–69 years and born in Australia, Greece or Italy (n = 41,513) were recruited between 1990 and 1994; invasive cancer incidence was identified up until June 30th, 2021, by linkage to cancer registries. Dietary data was collected using a food frequency questionnaire developed for the MCCS, and the NOVA classification was used to identify UPF(3). After exclusions, 35,039 (n = 21,244 females and 13,795 males) people were included in the analysis. UPF consumption (% of total grams intake) was modelled as quintiles and as a continuous variable. Flexible parametric models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk associated with UPF consumption after adjusting for sex, country of birth, socio-economic position, average lifetime alcohol intake (grams/day), smoking status and intensity, education, physical activity score. Overall cancer, overall obesity-related cancer, and individual obesity-related cancers where there were more than 100 cases, were considered as the outcomes. There were 10,445 incident cancers identified, of which 4,237 were considered as obesity-related, with more than 100 cases for cancers of pancreas (n = 270), colorectum (1369), endometrium (n = 223), kidney (n = 216), ovary (n = 159), multiple myeloma (n = 187), and post-menopausal breast (n = 1479). The highest UPF consumers included more males and people born in Australia than the lowest consumers. Positive associations were observed for all cancers: HR for continuous variable 1.03, 95% CI (1.01, 1.05); Q5 vs Q1HR 1.09, 95% CI (1.02, 1.16); obesity-related cancers: HR for continuous variable 1.04, 95% CI (1.01, 1.08); Q5 vs Q1HR 1.10, 95% CI (1.00, 1.22), and post-menopausal breast cancer: HR for continuous variable 1.07, 95% CI (1.00, 1.14); Q5 vs Q1HR 1.12, 95% CI (0.90, 1.41). Direct associations between UPF consumption and cancer outcomes were found, although some of those associations were weak. Limiting the consumption of UPF may reduce cancer risk.

A clear understanding of nutrient intake at a national scale is important to ensure food security into the future. National nutrition surveys are expensive and slow, with the latest data in Australia from 2011–13. However, nutrients available for consumption in Australia can be easily accessed from the food balance sheets produced by the Food and Agriculture Organization of the United Nations (FAO), with the latest data from 2021. This project compares nutrient intake and nutrient supply data from 2011–2013 to determine whether nutrient supply data is an acceptable surrogate measure for estimating national nutrient intake levels. To compare national nutrient intake and supply, data were collected from the Australian Health Survey 2011–13(1); the 2011–2013 FAO food balance sheets(2); and Nutrient Reference Values (NRVs) for Australia and New Zealand for 23 essential nutrients(3). Nutrient supply data were adjusted with both consumer waste and inedible portions, and inedible portions alone. Nutrient intake and nutrient supply per capita per day were converted to a relative percentage of the target value from the NRVs. One-sample, two-tailed t-tests were conducted to identify statistical differences between intake and supply of individual nutrients. A p-value < 0.01 was considered a significant difference between nutrient intake and nutrient supply. For 18 nutrients there was a significant difference between nutrient intake and supply adjusted for inedible portions only. For 15 nutrients there was a significant difference between nutrient intake and nutrient supply adjusted for both consumer waste and inedible portions. There was no difference between intake and supply adjusted for inedible portions of calcium, dietary fibre, iodine, riboflavin, and long- chain omega-3 fatty acids. For r calcium, magnesium, zinc, iron, iodine, riboflavin, long-chain omega-3 fatty acids, and folate equivalents there was no difference between intake and supply adjusted for consumer waste and inedible portions. When supply data was adjusted for both consumer waste and inedible portions this reduced the differences between intake and supply, making it a better representation of nutrient intake data. This study found that nutrient supply data from the FAO, even after adjustment for inedible portions and consumer waste, was not suitable for estimating nutrient intake of the Australian population. A key limitation was the unavailability of consumer food waste data specific to Australia (the data used was representative of Oceania), which may further reduce the differences between supply and intake data. Assessing national dietary intake is challenging(4,5) but current survey practice cannot easily be replaced for understanding the nutrient intake of Australians.

Throughout a three-year undergraduate nutrition degree, students learn the theoretical knowledge and technical skill set required to become a nutritionist. However, nutrition curriculum does not always include an opportunity to practice the application of knowledge and skills in a real-world setting or develop an understanding of the transferable skills required in a workplace, thus, general employability skills and information on workplace expectations are not developed(1). A mixed methods research study was undertaken to understand student perspectives of employer expectations and general employability skills. A validated work-ready tool(1) was used to survey undergraduate nutrition students at Australian universities (n = 171); students who participated in an industry placement were interviewed pre/post placement (n = 22); nutrition industry experts and employers (n = 9) were interviewed and an industry focus group (n = 6) was conducted to develop a deeper understanding of the impact of including curriculum that developed employability skills and exposure to workplaces and expectations. Survey data showed 74% of students had an understanding of how to effectively use their skills in the workplace, 75% indicated they knew what was expected of them if they used their skills in the workplace, and 64% understood the steps in the process of using their skills. Students who completed an employability subject at one university were invited to complete the same survey upon completion and 100% of students reported having this knowledge and understanding. Thematic analysis of student interviews revealed multiple benefits of placement such as industry insights; role clarity; deeper understanding of workplace expectations; the opportunity to practice application of knowledge and skills, identify unknown information, gain experience; networking opportunities; feeling better prepared for interviews and job searching post-degree and improved confidence across all themes identified. Thematic analysis of industry interviews and focus groups also revealed themes related to the benefits of a placement experience for students. Employers identified placement as an opportunity for students to develop an understanding of graduate and workplace expectations; better understand roles and industry; practice application of knowledge and skills; and to develop networks and confidence. Employers also identified a lack of confidence in some students asking for help; students’ inability to translate scientific knowledge to a range of lay audiences; and an understanding of how nutrition works with or within other departments, and suggested that employability skills should be developed within courses and/or on placement to better prepare students for the workplace. The results indicate that the inclusion of employability development and/or placements within the curriculum develops an understanding of the employability skills required by nutrition graduates, builds greater awareness of employment expectations, roles, industry, and workplaces, and provides an opportunity to practice the application of their knowledge and skills resulting in improved graduate confidence.

The role of nutrition in diseases such as diabetes, cancer and cardiovascular disease has been widely explored; however, less is known about the role nutrition plays in the development and progression of chronic obstructive pulmonary disease (COPD). Despite limited research, studies have identified favourable associations between diets high in fruits and vegetables and a reduction in COPD incidence and severity. There are several potential mechanisms through which consuming adequate fruits and vegetables may decrease the risk and severity of COPD(1). These mechanisms include protection of the lungs due to increased consumption of antioxidants and soluble fibre(1,2). The aim of this systematic review was to synthesise evidence on the effects of fruit and vegetable intake on COPD risk. A systematic search was completed across six databases up to July 2023. Studies reporting COPD risk and fruit and vegetable intake in COPD vs non-COPD were assessed for inclusion. 26 studies met our inclusion criteria and, of these, 21 were eligible for meta-analysis. This review found that both fruit and vegetable consumption are linked to a reduced risk of developing COPD. The meta-analysis confirmed that higher intakes of fruit and vegetables were significantly associated with greater reduction in COPD incidence. Specifically, individuals who consumed higher amounts of fruit had a 17% lower risk of COPD compared to those with lower fruit intake (Odds ratio, OR = 0.83; 95% CI: 0.73–0.94, n = 2107, p = 0.004, I2 = 84%). Over a mean follow-up period of 13.07 years, the protective effect of fruit consumption against COPD appeared to be even more pronounced, with a 25% reduction in risk observed (hazard ratio, HR = 0.75; 95% CI: 0.67–0.84, n = 3770 p = < 0.00001, I² = 0%). Vegetable consumption was also associated with a significant reduction in COPD risk, with a 24% lower risk observed in individuals with higher vegetable intake compared to those with lower intake (OR = 0.76; 95% CI: 0.66–0.88, n = 2107, p = 0.0003, I² = 97%). Further analysis focusing on fibre content of fruits and vegetables demonstrated that high fruit fibre intake was associated with a 27% reduction in the risk of developing COPD (HR = 0.73; 95% CI: 0.65–0.83, n = 3901, p < 0.00001, I² = 0%) and higher vegetable fibre intake was associated with a 12% reduction in COPD risk (HR = 0.88; 95% CI: 0.79–0.99, n = 3901, p = 0.03, I² = 62%). The results from this review strongly support the beneficial effects of fruit and vegetable consumption in reducing the risk of COPD. Further work is warranted to understand the mechanisms that lead to these benefits.

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth (PTB) are prevalent pregnancy complications that adversely affect maternal and neonatal health during pregnancy, and increase women’s risk of future type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD)1–5. Pregnancy and postpartum, including intrapartum periods, are critical windows of opportunity to deliver care to support sustained behaviour change(6). There is currently a gap in lifestyle (diet and physical activity) interventions specific to cardiometabolic disease risk awareness and prevention during and following pregnancy(5,7). These are key life stages where early risk factors for cardiometabolic disease may present, women are actively engaged in the healthcare system and their health priorities are shifting as they transition into parenthood. Early intervention in pregnancy may enable commencement of pharmacological and/or lifestyle intervention to reduce the risk or severity of cardiometabolic pregnancy complications(8), whereas postpartum intervention may enable commencement of sustainable lifestyle change for reduction of long-term cardiometabolic risks(9). There are a range of settings where pregnant and postpartum women receive healthcare, including hospitals, primary care clinics, community health institutions and online platforms(8,10,11). The optimum timing and setting to deliver an intervention to these high-risk women is not known. Designing interventions to align with the needs and priorities of stakeholders is a critical first step in developing an acceptable intervention. The aims of this research were to explore stakeholder perspectives and prioritise the optimal timing and setting to deliver a lifestyle intervention to improve long-term cardiometabolic health amongst women at high-risk of or diagnosed with a cardiometabolic pregnancy complication. An embedded mixed-methods research design was utilised. Facilitator-led workshops were used to prioritise the preferred timing (pregnancy or postpartum) and setting (hospital, general practice, community health program, maternal and child health services or online) for an intervention. Women with prior GDM, HDP, IUGR and/or PTB (n = 9), and research partners (n = 15) (obstetricians, endocrinologists, community health representatives, researchers, midwife, general practitioner, dietitian) participated. Workshops were audio recorded, transcribed verbatim and thematically analysed using template analysis. Online polls were used to assess participants preferred timing and setting for an intervention. Women preferred a postpartum intervention delivered online, whereas research partners preferred a pregnancy intervention delivered via hospital antenatal care. Both groups suggested commencing interventions during pregnancy and continuing postpartum. Participants recommended ensuring interventions consider healthcare system barriers to intervention delivery, equity and sustainment, as well as consumer-specific barriers to intervention engagement and lifestyle change during pregnancy and postpartum. Commencing patient-centred interventions during pregnancy and continuing postpartum should be considered to support continuity of care and improve health outcomes across both life stages for this high-risk group of women.

Malnutrition is prevalent in older adults and frequently coexists with sarcopenia(1), a condition characterised by low muscle mass and physical performance(2). Malnutrition and sarcopenia are associated with adverse outcomes in older adults including mortality(3), and thus require early detection. The Mini Nutrition Assessment (MNA) is a validated nutrition screening and assessment tool in older adults(4), but its ability to predict poor muscle mass and physical performance is unclear. This study aimed to determine the association between MNA-determined (risk of) malnutrition and muscle mass and physical performance in community-dwelling older adults. This is a cross-sectional analysis of baseline data from the Capacity of Older Individuals after Nut Supplementation (COINS) study, a randomised controlled trial investigating the effect of peanut butter on functional capacity in older adults. Participants were generally healthy and at risk for falls (simplified fall risk screening score ≥ 2). Participants were screened for malnutrition risk (MNA-Screening score range 0–14; at-risk or malnourished if < 11), followed by assessment (MNA-Assessment score range 0–16) to obtain MNA-Total score (range 0–30; at-risk or malnourished if score < 23.5). Skeletal muscle mass index (SMMI) was derived from bio-impedance analysis. Physical performance including muscle strength, gait speed, balance and power, was objectively measured using multiple standard tests. Linear regression analyses were performed and adjusted for age and sex. A total of 120 participants were included (70% females, age 74.8 ± 4.5 years). MNA-Screening, MNA-Assessment and MNA-Total scores were (median [IQR]) 14 [12–14], 14 [13.5–15] and 27.5 [26.0–28.4] respectively. Malnutrition (or risk) was found in 18 (15.0%) and 8 (6.7%) participants according to MNA-Screening and MNA-Total, respectively. A higher MNA-Screening score was associated with higher knee extension strength [β = 1.36 (Standard Error, SE 0.65) kg, p = 0.039]. A higher MNA-Assessment score was associated with higher gait speed [β = 0.04 (0.01) kg/m2, p = 0.007] and shorter timed up-and-go test time [β = −0.19 (0.09) seconds, p = 0.035]. MNA-Total score was not significantly associated with muscle mass or physical performance. Malnutrition status as determined by MNA-Screening score (but not MNA-Total score) was associated with lower muscle mass (SMMI [β = −0.52 (0.26) kg/m2, p = 0.043]), but not strength and physical performance. In summary, the MNA-Screening score was predictive of muscle mass and strength, whereas the MNA-Assessment score predicted physical performance, particularly gait speed, in community-dwelling older adults at risk of falls. Periodic malnutrition screening by MNA may help early detection of poor muscle mass and function in generally healthy older adults.

The current Australian Guide to Healthy Eating (AGHE) is based on whole foods, distinguishing between core and discretionary foods. Despite poor adherence to the AGHE, there has been limited exploration of the acceptability and appropriateness of alternative food classification systems that could be used for nutrition guidance in Australia. The NOVA system was developed in Brazil and is a four-group food classification system based on the ‘nature, extent and purposes of industrial processing’ (unprocessed/minimally processed food, processed culinary ingredients, processed food, and ultra-processed food)(1). It is gaining recognition both as a nutrition guidance and research tool in different parts of the world, although it does have detractors. Currently the acceptance of the NOVA classification system among Australian Nutrition professionals is unknown. This study was carried out between June and December 2021 (n = 165) surveying Australian dietitians, nutrition professionals and academics to determine their awareness, understanding and preferences around the NOVA food classification system compared to the current Australian Dietary Guidelines. Respondents worked across a range of nutritional occupations and often in multiple roles (clinical dietitians 35%, community or public health dietitians 34%, academics 24%, nutritionists 14%, food service/industry 8%, students 4%). They were mostly female (93%), and nearly half (42%) had more than 15 years nutrition experience. Many of the 165 respondents reported a limited knowledge of the NOVA system (39%) and were not familiar enough with it to implement it clinically (36%). A strong understanding of the system was reported by 25%, with 36% of respondents stating they could classify foods based on the 4 NOVA categories, but only 6% using the NOVA system clinically. Those with knowledge of NOVA (n = 117) considered that it may be useful in one or more contexts including research (n = 73), clinical education (n = 41), population level guidance (n = 69), and nutrition policy (n = 76), however others felt that it was not useful in any of these applications (n = 22). There was limited knowledge on the evidence base for using the system, with 41% unfamiliar with any research. When comparing the value of NOVA to the AGHE there were mixed responses (unsure 30%, no value 5%, less value 16%, similar value 18%, more value 7%, other 6%); however, 18% stated the systems could not be compared. This is reflected in qualitative responses with some suggesting NOVA was not useful, but others suggesting a broad range of clinical applications and possible integration into future versions of the AGHE. Despite wide promotion, there remains some uncertainty about the value and use of the NOVA classification system among Australian nutrition professionals. This survey is being repeated to determine any change over the last 3 years.

Low vegetable intake is a key contributor to the health burden experienced by young adults in rural communities(1). Digital interventions provide an accessible delivery model that can be personalised to meet the diverse preferences of young adults(2). This study aimed to determine the feasibility, acceptability and efficacy of a personalised digital intervention to increase vegetable intake (Veg4Me), co-designed to meet the needs of young adults living in rural Australian communities(3). A 12-week assessor-blinded, two-arm, parallel randomised controlled trial was undertaken from August 2023 until April 2024. Young adults (18–35 years; consuming < 5 serves of vegetables/day; with an internet-connected device) living in Loddon Campaspe or Colac Otway Shire in Victoria, Australia, were recruited via social media and local government networks. Participants were randomised to receive 12 weeks of personalised (intervention) or non-personalised (control) support via a free web application (app; Veg4Me). Key features included 1) recipes personalised to users’ dietary and cooking preferences, 2) geo-located food environment map, 3) healthy eating resources, 4) goal-setting portal and 5) personalised e-newsletters. The primary outcome was feasibility: recruitment, participation and retention rate. Secondary outcomes were usability and user experience, perceived changed in vegetable intake, self-reported vegetable intake, and confidence to cook fresh green and root vegetables. Regression analyses (adjusted for baseline) were used to test for significant differences between groups. A total of n = 536 individuals registered on the Veg4Me website. After excluding fraudulent and duplicate responses (n = 289), n = 124 were eligible and provided consent to participate, n = 116 were randomised and n = 83 completed postintervention data collection. The recruitment rate was 47%, participation rate was 93% and retention rate was 72%. Compared to the control, more intervention participants were satisfied with Veg4Me (76% vs 52%). Most intervention participants reported that access to personalised recipes gave them confidence to eat a wider variety of vegetables (83%), while 76% accessed the food environment map, 63% accessed the healthy eating resources, 78% accessed the goal-setting function and 90% reported that the e-newsletters prompted them to access Veg4Me. Compared to the control, more intervention participants perceived that their vegetable intake had changed in the last 12 weeks (85% vs 57%; p = 0.013). Mean vegetable intake at 12 weeks in intervention and control participants was 2.7 (SD 1.0) and 2.7 (SD 1.4) serves/day, respectively (p = 0.67). Confidence to cook fresh green vegetables at 12 weeks in intervention and control participants was 93% and 91%, respectively (p = 0.24), while for root vegetables this was 88% and 81%, respectively (p = 0.11). Findings demonstrate the feasibility and acceptability of the Veg4Me intervention, and some evidence of efficacy. This study introduces a new strategy that has promise for addressing diet and health inequities experienced by young adults living in rural communities.

Current clinical guidelines for people at risk of heart disease in Australia recommend nutrition intervention in conjunction with pharmacotherapy(1). However, Australians living in rural and remote regions have less access to medical nutritional therapy (MNT) provided by Accredited Practising Dietitians (APDs) than their urban counterparts(2). The aim of the HealthyRHearts study was to trial the delivery of MNT by APDs using telehealth to eligible patients of General Practitioners (GPs) located in small to large rural towns in the Hunter New England region(3) of New South Wales, Australia. The study design was a 12-month pragmatic randomised controlled trial. The key outcome was reduced total cholesterol. The study was place-based, meaning many of the research team and APDs were based rurally, to ensure the context of the GPs and patients was already known. Eligible participants were those assessed as moderate-to-high risk of CVD by their GP. People in the intervention group received five MNT consults (totalling two hours) delivered via telehealth by APDs, and also answered a personalised nutrition questionnaire to guide their priorities and to support personalised dietary behaviour change during the counselling. Both intervention and control groups received usual care from their GP and were provided access to the Australian Eating Survey (Heart version), a 242-item online food frequency questionnaire with technology-supported personalised nutrition reports that evaluated intake relative to heart healthy eating principles. Of the 192 people who consented to participate, 132 were eligible due to their moderate-to-high risk. Pre-post participant medication use with a registered indication(4) for hypercholesterolemia, hypertension and glycemic control were documented according to class and strength (defined daily dose: DDD)(5). Nine GP practices (with 91 participants recruited) were randomised to the intervention group and seven practices (41 participants) were randomised to control. Intervention participants attended 4.3 ± 1.4 out of 5 dietetic consultations offered. Of the132 people with baseline clinical chemistry, 103 also provided a 12-month sample. Mean total cholesterol at baseline was 4.97 ± 1.13 mmol/L for both groups, with 12-m reduction of 0.26 ± 0.77 for intervention and 0.28 ± 0.79 for control (p = 0.90, unadjusted value). Median (IQR) number of medications for the intervention group was 2 (1–3) at both baseline and 12 months (p = 0.78) with 2 (1–3) and 3 (2–3) for the control group respectively. Combined DDD of all medications was 2.1 (0.5–3.8) and 2.5 (0.75–4.4) at baseline and 12 months (p = 0.77) for the intervention group and 2.7 (1.5–4.0) and 3.0 (2.0–4.5) for the control group (p = 0.30). Results suggest that medications were a significant contributor to the management of total cholesterol. Further analysis is required to evaluate changes in total cholesterol attributable to medication prescription relative to the MNT counselling received by the intervention group.