Chinese immigrants living in Western countries are at a higher risk of developing chronic diseases compared to those in China, due to the development of unhealthy dietary patterns during the process of acculturation(1). Australia, with 2.3% of its population being Chinese-born(2), serves as a representative country to explore Chinese immigrants’ food choice determinants. Food choice determinants have been widely researched, with numerous factors identified such as affordability, taste preferences and hunger/satiety. Contento (2018) developed a comprehensive framework which identified and categorised over 30 determinants into four socio-ecological groups(3). Therefore, the focus of current research is not the identification of food choice determinants but to explore the interactions among these determinants. Understanding the cultural influence on food choice is vital for target groups with a shared ethnic background. This study aimed to qualitatively explore the similarities and differences in food choice determinants between Chinese people in mainland China and those living in Australia. Ethical approval for this study was obtained from Monash University Human Research Ethics Committee. Eighteen participants were recruited for semi structured in-depth interviews from June 2021 to March 2022, with eight from Australia and ten from mainland China. Convenience and snowball sampling methods were employed to ensure a diverse sample regarding socio-economic background, occupation, health status, age, and education level. Interviews were conducted in Mandarin via in-person or video/voice calls and were audio-recorded and transcribed verbatim. Thematic analysis and investigator triangulation were used for data analysis. Four themes were identified. (a) Food choice determinants were influenced by nutrition perceptions and personal food philosophy. Chinese Australian immigrants were influenced by Western nutrition beliefs to a greater extent than their counterparts living in mainland China. Non-scientific or controversial nutrition beliefs were common. Personal food philosophy (e.g., eating food is for survival only, or for enjoyment, or for health) profoundly influences food choices. (b) Chinese people adjusted their dietary habits in response to clinical symptoms or self-observed physiological changes, such as, gaining weight or digestive issues. (c) Convenience was a predominant food choice determinant due to factors like long working hours, lack of motivation to cook, lack of cooking skills, time restrictions, and viewing cooking as a chore. (d) Different food environments in China and Australia lead to distinctive food choices. Chinese Australians were more price-sensitive, had more food safety concerns, and cooked more frequently at home than mainland Chinese, due to differences in food affordability, accessibility and information exposure between these two countries. Importantly, nostalgia for childhood foods had a unique influence on certain food choice behaviours in Chinese Australians. These cultural characteristics in food choice determinants should be considered by health educators, nutrition professionals, and policymakers when developing culturally appropriate health interventions for Chinese people.

Vegan and vegetarian dietary patterns are known to beneficially modulate risk factors for cardiovascular disease; however, the current literature does not differentiate between various plant-based diets(1). This study aimed to examine the association between various plant-based diets and plasma lipids and glycaemic indices compared to a regular meat-eating diet. A cross-sectional study of Australian adults (n = 230) aged 30–75yrs habitually consuming the following were recruited: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat-eater. Multivariable regression analyses was used to adjust for covariates. Compared to regular meat-eaters, vegans had significantly lower total cholesterol (−0.77 mmol/L, 95% CI −1.15, −0.39, p < 0.001), low-density lipoprotein cholesterol (LDL-C, −0.71 mmol/L, 95% CI −1.05, −0.38, p < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C, −0.75 mmol/L, 95% CI −1.11, −0.39, p < 0.001), total cholesterol/HDL-C-ratio (−0.49 mmol/L, 95% CI −0.87, −0.11, p = 0.012), fasting blood glucose (FBG, −0.29 mmol/L, 95% CI −0.53, −0.06, p = 0.014), haemoglobin A1C (−1.85 mmol/mol, 95% CI −3.00, −0.71, p = 0.002) and insulin (−1.76 mU/L, 95% CI −3.26, −0.26, p = 0.021) concentrations. Semi-vegetarians had significantly lower LDL-C (−0.41 mmol/L, 95% CI −0.74, −0.08, p = 0.041) and non-HDL-C (−0.40 mmol/L, 95% CI −0.76, −0.05, p = 0.026) and lacto-ovo vegetarians had significantly lower FBG (−0.34 mmol/L, 95% CI −0.56, −0.11, p = 0.003) compared to regular meat-eaters. There were no differences in HDL-C and triglycerides between plant-based and regular-meat diets. Plasma lipaemic and glycaemic measures as a collective were more favourable among vegans, whereas among lacto-ovo vegetarians and semi-vegetarians, only some measures were favourable.

Teacher food and nutrition (FN) practices influence their personal health and wellbeing outcomes, with implications for students. As educators, teachers role model FN practices to students and act as health promoters. Our team’s recent scoping review outlined the lack of standardised methods used to assess FN constructs in teachers, with limited validated and composite tools available that measure FN constructs, especially culinary factors, alongside measures of wellbeing(1). The importance of teacher FN education, to facilitate effective school health promotion, is highlighted by the World Health Organization and the United Nations Education Scientific and Cultural Organization. Therefore, understanding the scope of teacher FN practices in relation to teacher wellbeing is critical, yet limited evidence currently exists. This research aims to examine baseline data on teacher FN practices and potential FN predictors of teacher health and wellbeing from the Australian longitudinal teacher FN-related health and wellbeing study. The Teacher Food and Nutrition Questionnaire (TFNQ) consists of nine sub-scales and 21 single-item measures using pre-defined food, nutrition, and wellbeing constructs. This provides a composite evaluation tool to collate data on teacher FN practices for comparison with wellbeing outcomes, including stress and burnout. Descriptive statistics and Pearson correlation coefficient (r) were used to assess relationships between food, nutrition, and wellbeing constructs, and linear regression to determine slope of significant relationships using diet quality (i.e., the Fruit and Vegetable Variety index), wellbeing (i.e., burnout) and professional FN confidence as outcome variable(s) of interest. A total of n = 112 secondary teachers completed the baseline TFNQ (September 2023). Of these, the majority were female (87.5%), aged 31–45 years (52%), with 90% on full time contracts. Mean diet quality score was 92.0 (maximum score (MS) of 190), with sub-scale score for vegetable (63.2/122 MS) and fruit (28.9/68 MS) intake. Of the wellbeing measures, burnout (16.3/24 MS), stress (7.3/10 MS) and coping (6.2/10 MS) were measured alongside teacher food skills confidence (105.7/133 MS) and food agency (40.9/55 MS). Teacher FN confidence to role model healthy FN practices was moderately correlated to food agency r = −0.43 (p < 0.001), and personal subjective wellbeing ‘satisfied’ r = 0.41 (p < 0.001). A moderate correlation was observed between vegetable intake and food skills confidence r = 0.42 (p < 0.001), with a moderate negative correlation observed between food agency and teacher burnout r = −0.43 (p < 0.001). Overall, these baseline data confirm teacher diet quality is suboptimal, with teacher food agency and/or food skills confidence demonstrating moderate correlations with all three study outcomes of teacher wellbeing, diet quality and professional FN confidence. These data provide a snapshot of secondary teachers’ FN practices and wellbeing. Results inform development of professional development to support FN behaviours as a contributing factor for optimal teacher health and wellbeing.

Despite the healthful nature of plant-based diets (PBDs) there is potential for nutrient inadequacies(1). This study aimed to compare dietary intakes and nutritional adequacy in Australians following plant-based diets compared a regular meat-eating diet (RME) in a cross-sectional study of adults (n = 240) aged 30–75yrs. Participants were habitually consuming dietary patterns for ≥ 6 months; vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian or RME (n = 48 per group). Dietary intake was assessed using a validated food frequency questionnaire and dietitian-administered diet histories. Multivariable regression was used to adjust for potential lifestyle and demographic confounders. Compared to RMEs, vegans and lacto-ovo vegetarians had significantly lower dietary intakes of protein (percentage energy intake, EN%), saturated fat, trans fat, cholesterol, vitamin B12, iodine, riboflavin, niacin, sodium, and long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), and higher carbohydrate (EN%), dietary fibre, vitamin E, folate, magnesium, iron, and n-6PUFA, whereas, pesco-vegetarians and semi-vegetarians had intermediate intakes. Individuals adhering to PBD consumed significantly more vegetables, fruit (vegan only), legumes/nuts, and less discretionary choices compared to RMEs. All dietary patterns met adequate intake for protein, exceeded for fat, were below for carbohydrate (EN%) and had adequate serves of fruit and vegetables, but not grains. Including plant-based alternatives, vegans, lacto-ovo vegetarians, and semi-vegetarians had inadequate serves of ‘meat/poultry/eggs/beans/nuts’, and semi-vegetarians and RMEs had inadequate serves of dairy. Vegans and lacto-vegetarians had nutritional inadequacies in vitamin B12, LCn-3PUFA, iodine, and in addition calcium among vegans, pesco-vegetarians in iodine, and semi-vegetarians and RMEs in LCn-3PUFA. PBDs, specifically vegans and lacto-ovo vegetarians, while significantly higher in beneficial nutrients and wholefood groups than RMEs, may lead to nutritional inadequacies if not planned appropriately.

Discretionary foods that are energy-dense and nutrient-poor contribute to over one third of total energy intake in Australian children and adults, and the typical portion sizes of many discretionary foods have increased significantly in the last two decades(1). The portion size norms (described as a typical perception of how much of a given food people choose to eat at a single eating occasion) are likely to have increased concurrently, with larger sizes now being considered the new normal(2). Public health interventions are urgently needed to reduce the portion size norms and consumption of discretionary foods(3), but the acceptability of such interventions remains unknown. Therefore, this qualitative study aimed to gain insights into consumers’ attitudes towards potential interventions targeted at promoting portion control of discretionary foods. Four online focus group sessions were conducted via Zoom with healthy Australian adults who regularly consume discretionary foods. A question guide was developed to gather participants’ perspectives around four potential public health interventions; reduction of the default serving sizes, increasing serving size options, changes to package sizes, and improving serving size labelling. A female facilitator moderated all focus groups, with a second moderator present to capture other relevant details. Collected data were analysed using a hybrid approach combining deductive and inductive thematic analyses. A total of 35 participants completed the study (19 females, mean age 38 ± 14 years). Participants identified the current food environment as promoting overconsumption; larger serving sizes were reported to be more ubiquitous and better value for money than smaller size options. An overall positive attitude towards the proposed interventions was noted. Out of the four proposed interventions, participants considered the most acceptable intervention to be providing a wider range of serving size options while maintaining a consistent unit price. Other acceptable interventions included reducing the default serving sizes with concurrent price reduction; education and clear guidance around portion size selection (for example, the involvement of health professionals to promote portion control, along with relevant recommendations of appropriate portion sizes from health authorities); more practical on-pack serving size suggestions; and innovative package designs that enable better portion control without contributing to food and plastic waste. In conclusion, participants identified a need for and were in support of interventions aimed at the portion control of discretionary foods. Further research should focus on examining the feasibility and effectiveness of the potential interventions to reduce the purchasing and consumption of large serving sizes. More efforts from public health authorities are required to develop practical and tailored recommendations for consumers around appropriate portion sizes for discretionary foods. Collaboration with the food industry and policy makers is also necessary for implementing public health interventions to reduce the excessive intake of discretionary foods.

Childhood obesity persists at historically high rates globally, including an increasing number of children with severe obesity(1–3). Despite the growing demand of families with children needing treatment, effective interventions are largely unavailable or inaccessible(4,5). Using technology to transform such services that are conventionally delivered in person and offering electronic health (e-Health) interventions, may address limitations of current childhood obesity treatment. A randomised control trial (RCT) with a waitlisted control group evaluated the effectiveness of a 10-week family-focused web-based healthy lifestyle program with health coaching sessions, for treating childhood overweight and obesity, over 10 weeks. Outcome measures included change in children’s body mass index (BMI) z-score, waist circumference, dietary intake, physical activity, and quality of life, collected online at baseline and end of the web-based program (10 weeks). A total of 148 children (125 families) aged 7–13 years, with BMI ≥ 85th percentile, living in Victoria, Australia, were recruited and randomised to intervention (Cohort 1) or waitlist control (Cohort 2), of which 102 children (85 families) completed the RCT. Cohort 2 received no intervention during the control period. A clinically meaningful decrease in BMI z-score, in the context of weight maintenance and height growth, was observed in Cohort 1 compared to a negligible change found in Cohort 2 (mean difference in change in BMI z-score Cohort 1 vs Cohort 2 = −0.1; 95% confidence interval, −0.2, –0.0). Compared with Cohort 2, Cohort 1 adopted health-supporting lifestyle behaviours, such as improved diet quality and increased physical activity; and reported a clinically significant improvement in children’s quality of life at 10 weeks. Cohort 2 demonstrated similar changes in outcome measures after receiving the web-based program. Findings from this study furthers the growing body of evidence on the potential of e-Health interventions to upscale childhood obesity treatment. E-Health interventions, including a low-intensity program that requires minimal contact time with health professionals online, can enhance the effectiveness of conventional treatment services.

The obesity prevalence among the Chinese population has increased more than three-fold over the last twenty years.(1) A cross-sectional study involving 15.8 million Chinese adults revealed that in 2023 one in every two Chinese adults was categorised as overweight or obese.(2) Chinese individuals face a higher health risk of developing chronic disease at comparable Body Mass Index levels to Caucasians.(3) Thus, it is urgent to address the increasing obesity prevalence in this population. People’ s perception towards obesity is likely to play an important role in influencing their weight management behaviour.(4) For Chinese people, the unique Confucianism ideology, collectivist society, and modern mass media information exposure may have a profound influence on how Chinese people develop their perceptions about weight issues. It is therefore valuable to understand Chinese people’s obesity-related perceptions as this may inform more culturally appropriate interventions for weight management. To the authors’ knowledge, this is the first bilingual systematic review which aimed to synthesise published literature exploring the perceptions of Chinese adults towards overweight and obesity. Four English databases and two Chinese databases (Medline, APA PsycINFO, Social Science Premium Collection, Scopus, Wanfang Chinese Journal Database, and Chinese Electronic Periodical Services) were searched from inception to 17 Jun 2023. Studies were included if they were published in English or Chinese, investigated perceptions towards overweight and obesity, and focused on Chinese adults living in or outside of Mainland China. All retrieved citations were screened by two reviewers independently. A narrative synthesis method was employed. Forty-eight studies (n = 20 in English, n = 21 in simplified Chinese, n = 7 in Traditional Chinese) were included, involving n= 73910 participants. Females were more often researched. Also, the overall sample consisted more younger and more highly educated people, with 22 studies including solely university students. The collective quality or risk of bias of the studies was suboptimal. Three overarching themes emerged from this review: (i) Chinese adults tend to misperceive their weight status, largely stemming from limited awareness of BMI and societal norms idealizing thinness, leading to high dissatisfaction with body weight and high motivation to pursue weight loss. Females perceived a stricter weight ideal than males; (ii) Despite a pronounced motivation for weight management, study participants lacked practical knowledge regarding sustainable strategies. Non-scientific weight-loss methods and unproductive perceptions were prevalent among this population; (iii) Chinese adults perceived dealing with obesity as a lonely journey, influenced by the pervasive negative societal attitude towards obesity and the prevailing mindset emphasizing personal responsibility for weight-related issues. This review provides a comprehensive profile of perceptions towards obesity among Chinese adults over the last two decades and discusses methodology implications and future research directions.

Social media platforms such as Instagram and TikTok have transformed how individuals seek and engage with dietary advice, leading to the rapid propagation of unverified nutrition information that can result in poor dietary choices, contribute to disordered eating and broader health issues(1). This study aims to measure the accuracy and frequency of nutrition misinformation, identify the types of thematic misinformation, and understand user engagement metrics on Instagram and TikTok. A mixed-methods approach was employed, analysing 500 posts (250 from each platform) collected over a six-month period from September 15, 2023, to March 15, 2024, using keywords like healthy eating, healthy food, diet, and weight loss. Posts were evaluated using a modified, previously developed, Social Media Evaluation Checklist(2) and evidence coding framework to measure accuracy. Results indicated a higher prevalence of misinformation on TikTok compared to Instagram, with a significant portion (p < 0.05) of users lacking relevant credentials. The most common characteristic was cooking/recipes and meal plans. TikTok posts with mostly accurate and completely inaccurate information had higher engagement than Instagram posts. TikTok had a larger proportion of completely inaccurate posts (10.8%), mainly related to weight loss. Descriptive statistics for engagement metrics showed TikTok posts had significantly (p < 0.05) higher likes and comments compared to Instagram posts across various accuracy levels. For Instagram, completely accurate posts had a mean of 4,318 likes and 40 comments, while mostly accurate posts had a mean of 25,153 likes and 186 comments. For TikTok, completely accurate posts had a mean of 146,327 likes and 423 comments, mostly accurate posts had a mean of 75,804 likes and 483 comments. An independent t-test revealed significant (p < 0.05) differences in likes and comments between platforms for posts with varying accuracy levels. The study highlights the need for social media platforms to verify the qualifications of individuals providing nutrition advice and implement measures to promote accurate information. Further research is necessary to develop effective strategies to mitigate the spread of misinformation via social media platforms and its impact on public health.

The colonisation of Australia around 250 years ago resulted in significant disruptive changes to the lifestyle and diet of Aboriginal and Torres Strait Islander peoples. Traditional foods high in micronutrients, including vitamin D, have been largely replaced with energy-dense foods(1). Sun exposure—a primary source of vitamin D—may be reduced due to changes in clothing and housing structure(2). Consequently, there is a high prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D concentration < 50 nmol/L) and low vitamin D intake among Aboriginal and Torres Strait Islander peoples(2,3). There is a need for a public health strategy to improve vitamin D status. Since few foods naturally contain vitamin D (e.g., fish, eggs, and meat), food fortification could be a suitable public health strategy to increase vitamin D intake without changing consumption behaviour. In Australia, besides food mandated for fortification (e.g., edible oil spreads), few foods permitted for voluntary fortification are routinely fortified. We aimed to model vitamin D food fortification scenarios among Aboriginal and Torres Strait Islander peoples. We used nationally representative food consumption data from the 2012–2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (n = 4,109) and analytical vitamin D food composition data(4) to model four food fortification scenarios. Scenario 1 modelled the addition of the maximum permitted amount of vitamin D to all foods permitted for fortification in Australia: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages (e.g., water with added sugar, vitamins and minerals), and iv) selected ready-to-eat breakfast cereal. Scenarios 2a–c included vitamin D concentrations higher than permitted in fluid milks/alternatives (1 μg/day) and butter/margarine/oil spreads (20 μg/day). Scenario 2a: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages. Scenario 2b: as per Scenario 2a plus selected ready-to-eat breakfast cereals. Scenario 2c: as per Scenario 2b plus bread (not permitted for vitamin D fortification in Australia). Vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples by ~3–6 μg/day. Scenario 2c showed the highest potential median vitamin D intake increase from baseline of 2 μg/day to ~8 μg/day. Across all scenarios, the vitamin D intake of all participants remained below the Australian Tolerable Upper Intake Level of 80 μg/day. Our findings demonstrated that vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples in Australia. However, the most impactful vitamin D fortification strategy (Scenario 2c) would require a revision of the Australia New Zealand Food Standards Code to permit the addition of higher amounts of vitamin D than currently permitted and the inclusion of bread as a food vehicle for fortification.

Poor diet is a risk factor for chronic noncommunicable diseases and related mortalities(1). The community food environment is one of the determinant factors for dietary quality(2). In high-income countries, the dietary impact of the community food environment is more pronounced in low socioeconomic areas(3). This study aimed to assess the healthiness of food outlets and its association with Socioeconomic Index for Areas (SEIFA) and Local Government Areas (LGA) in the Illawarra Shoalhaven region, Australia. A desk-based cross-sectional study was conducted using a list of registered food outlets obtained from councils of local government areas. Food Environment Score was used to assess the healthiness of food outlets that classify food outlets as healthy, less healthy, and unhealthy(4). The Index of Relative Advantage and Disadvantage (IRSAD) at statistical area level two was used to define SEIFA and was extracted from the Australian Bureau of Statistics (ABS) 2021 census data. Logistic regression was conducted to identify the association between the healthiness of food outlets with LGA and SEIFA. Of the 1924 food outlets, 52.4% (n = 1008) were in Wollongong, 14.1% (n = 272) in Shellharbour, 8.3% (n = 160) in Kiama, and 25.2% (n = 484) in Shoalhaven LGA. Out of 1924 food outlets, 281 (14.6%) were categorised as healthy, 790 (41.1%) as less healthy, and 853 (44.3%) as unhealthy. Wollongong had 2 times more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 2.0 (95% CI: 1.5, 2.5)), Shellharbour had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.3, 2.3)), and Kiama had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.1, 2.5)). IRSAD 5 had 40% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.6 (0.4, 0.8)) and IRSAD 4 had 50% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.5 (0.3, 0.8)). Large proportion of food outlets were categorised as unhealthy and less healthy. There were disparities in the healthiness of food outlets across LGAs and SEIFA. Intervention strategies need to be designed to increase the availability of healthy food outlets and limit unhealthy food outlets, particularly in low socioeconomic areas.

Claims relating to foods’ nutrition content and potential health benefits have been shown to influence consumer preferences and purchases regardless of the nutritional quality of the product(1). In Australia, permitted claims include nutrition content claims, which refer to the presence or absence of a nutrient, and health claims, which refer to health benefits of foods or nutrients in a product. Health claims include general level health claims, which refer to normal processes and functions, and high level health claims, which refer to a disease or biomarker of a disease. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC), however this is not required for products to make a nutrition content claim. The aim of this study was to examine the use of nutrition content and health claims made on Australian ready meal products and assess the proportion of products displaying claims that meet the NPSC. Analysis of the ready meal category in the 2023 FoodSwitch database, a repository of Australian food packaging images and label data for over 28,000 foods developed by The George Institute for Global Health, was conducted(2,3). Foods in the ready meal category were identified and data from the nutrition information panel was collated to calculate whether they met the NPSC. Nutrition content and health claims were extracted from product images and categorised according to claim type (nutrition or health claim) and claimed nutrient or attribute. The proportion of products meeting the NPSC was then calculated overall and by claim type (nutrition content vs health claims). Data were available for 777 ready meal products. Of these, 682 (87.8%) met the NPSC. In total, 2051 nutrition content or health claims were identified across the ready meal products, with 1909 (93.1%) of these categorised as nutrition content claims. The remaining 142 claims identified were general level health claims, with no high level health claims identified. Almost all (n = 1857, 97.3%) nutrition content claims and all general level health claims were made on products which met the NPSC. The most common claims related to protein, energy and fibre content. The use of claims was prevalent across the ready meal food category in Australia, with claims relating to nutrient content being most common. While most claims were made on products that met the NPSC, there is a need for further research to ensure the NPSC appropriately distinguishes between healthy and less healthy food products. This will ensure consumers are equipped to make informed decisions when purchasing food products.

Women are the primary food providers within Cambodian families, however little is known about what influences their food choices. Despite recent economic improvements, Cambodia remains the second poorest country in south-east Asia(1). Twenty-two percent of Cambodian children have stunting and 16% are underweight(2). Cambodian women of reproductive age exhibit the double burden of malnutrition, with 44% having anaemia and 33% with overweight or obesity(2). Nearly half of Cambodian women do not achieve minimum dietary diversity, with diets consistently low in vitamin A, thiamine, calcium, zinc and iron(3). Strategies to improve Cambodian families’ dietary intake are therefore needed. Factors influencing food choice are complex and multidimensional(4), and no previous studies have explored how Cambodian women make food decisions. This study aimed to understand Cambodian women’s food-related decision-making for themselves and their families. This qualitative study applied a descriptive methodology consistent with the experiential paradigm. Four 90-minute focus groups were conducted in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged 18+ years with at least one child aged under five who have primary responsibility for food provision within their family. Focus groups were facilitated by an Australian researcher (JW), using an interpreter to translate between Khmer and English languages. Groups discussed perceptions about food related to health, prompted by ‘conversation cards’ depicting food sources and nutritional benefits of five key nutrients. Reflexive thematic analysis was used to analyse the focus group data(5). Three themes were identified: 1) food access impacts choice; 2) responsible nurturing food provision role; and 3) dichotomous perceptions of food. Access to food strongly influenced food choices made by Cambodian women. High cost and low availability prompted women to forage for easily accessible ingredients such as water plants, fish, crabs and fruit, or choose cheaper, lower-quality foods from the market. Cambodian women strived to fulfil their responsibility to provide healthy, nourishing meals for their family within their capabilities, prioritising their husband and children over themselves. Nutritional awareness included understanding that fruit and vegetables contained vitamins, and meat was a good source of iron. They perceived certain traditional Khmer soups as ideal healthy meals, providing adequate energy and strength for hard-working husbands and growing children, and preventing sickness. Cambodian women considered healthy food using a range of dichotomous factors beyond their nutritional value, including ‘wet or dry’ food, ‘helpful or harmful’ in relation to immediate body symptom responses to food, cultural food taboos and use of chemicals on fresh vegetables. These findings indicate the need for future nutrition interventions targeting Cambodian communities to address women’s perceptions about the health-related qualities of foods, and access to nutritious foods so that behaviour change strategies are practical, culturally appropriate and acceptable.

Traditional Cambodian recipes have been prepared the same way over time, with their nutritional quality largely unknown. Poor nutritional status is common among Cambodian children with 22% experiencing stunting and 16% underweight(1), while Cambodian women exhibit the double burden of malnutrition with 44% having anaemia and 33% above the healthy weight range(1). Most Cambodian women have inadequate intakes of key nutrients including vitamin A, thiamine, zinc and iron(2). Recent Cambodian studies have focused on increasing nutrient intakes, with improved nutritional quality of mixed dish recipes a novel, potential approach(3). However, the absence of a Cambodian-specific food composition database means nutrient information for common mixed dishes is unavailable. This study aimed to quantify the nutrient profile of traditional mixed dishes commonly consumed by Cambodian women and children. A secondary aim was to qualitatively explore Cambodian women’s receptiveness to nutrient-enhanced traditional mixed dishes. A sequential mixed methods approach was used to collect traditional recipes and nutritionally analyse Khmer mixed dishes, then conduct qualitative focus groups to assess recipe acceptability. Over 900 recipes were collected by Cambodian women who had a child < 5 years via a custom-built smartphone app, as part of a dietary assessment study in Cambodia in 2019 and 2020. After grouping and counting recipes to determine consumption frequency, ingredients and quantities, these were consolidated into 27 commonly consumed recipes. The nutrient composition of consolidated recipes was determined using an INFOODS template(4). Dietitians then created six nutritionally-enhanced versions of Khmer mixed dishes by switching or adding common high-nutritive ingredients. In Siem Reap province four 90-minute focus groups were conducted with Cambodian mothers (two rural, two urban). Three dishes per group were prepared and served with rice, and women’s responses to each nutritionally-enhanced Khmer mixed dish were discussed. Nutrient analysis indicated that a median serve of traditional Khmer fish soup contributed 25% protein, < 10% iron and folate, and < 20% zinc and thiamine required daily for non-lactating women. Initially Cambodian women were sceptical about modifying traditional Khmer recipes, expressing resistance to change: ‘They would wonder, where did you learn that?’. Inspecting each dish, they discussed how strange the ingredients seemed, disbelieving their acceptability: ‘It is weird […], never put other green leaves’. After tasting, women expressed surprise they liked the flavour, describing these modified dishes as ‘unique’ or ‘creative’, recognising they would ‘gain more nutrition’ with this enhanced recipe. Most women declared they would try this modified dish at home ‘I would like to share it to my sister and my friends and family’. Results highlight future interventions promoting nutritionally-enhanced recipes of commonly consumed meals need to support women to overcome initial resistance through trialling them to evaluate acceptability, prompting them to share with their household.

Regulatory requirements for infant formula in the Australia New Zealand Food Standards Code (the Code) have been reviewed and revised for the first time in 20 years(1). The review aimed to ensure infant formula products remain safe and suitable, while accounting for the latest scientific evidence, market developments, changes in the international regulatory context, and updated Australian and New Zealand policy guidance. A multi-disciplinary team assessed and considered the best available evidence on every aspect of infant formula product regulation. This included scientific risk assessments, independent consumer evidence and testing, economic analysis and market surveys. The assessment focused on requirements for the regulatory framework, product category definitions, composition, sale and labelling. In addition, Food Standard Australia New Zealand held seven rounds of public consultation to ensure a transparent and comprehensive review was undertaken. While breastfeeding is the recommended way to feed infants, a safe and nutritious substitute for breast milk is needed for infants who are not breastfed. The regulatory changes ensure products continue to provide formula-fed infants with optimal nutrition for growth and development. The changes also give parents and caregivers important information to make informed choices, and support manufacturers with better alignment with international standards. The review has resulted in amendments to five standards and eight schedules in the Code. Key amendments include:

• • compositional requirements that align with the latest scientific evidence, breast milk concentrations, Australian and New Zealand nutrient requirements and recently updated international regulations

• • mandated presentation of nutrition information that allows comparison across products and better supports caregivers in making informed choices

• • restrictions on the sale of special medical purpose products to healthcare professionals, direct source and pharmacies

• • clarification of existing Code requirements which will continue to prohibit health, nutrition content and ingredient claims on infant formula products

• • new requirements for products to be differentiated using text, imagery and/or colour

• • a prohibition on cross-promotion of infant formula products.

Infant formula product regulations are the most prescriptive of any food as the requirements need to cover every aspect of nutrition to support the normal growth and development of infants from birth to 12 months. The updated regulations will continue to protect the health and safety of infants and ensure appropriate information is provided to parents, carers and health professionals to enable informed choice.

Healthy eating patterns from sustainable food systems are crucial for population and planetary health(1). Primary schools are opportune settings for teaching children about food, nutrition and sustainability(2) (FNS), though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools. A cross-sectional online survey (open from August 2022–October 2023) with closed- and open-ended questions collected data about (i) teacher perceptions/attributes regarding FNS education (e.g., importance, understanding, knowledge/skills, training); (ii) FNS teaching practices (e.g., frequency, teaching approaches); and (iii) factors influencing FNS education (e.g., funding, policies). Statistical analyses were conducted using STATA. Descriptive statistics were generated for all categorical data. Chi-square tests and post hoc analyses using contingency tables and adjusted standardised residuals analysed associations between frequency of FNS education and teaching approaches (cross-curricular subject vs stand-alone subjects vs both) and presence of FNS-related policies, access to funding and teacher training. Statistical significance was set at p < 0.05. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14. Participants were 413 Australian primary school teachers recruited via social media, organisational mailing lists and departmental school listings. Most teachers reported it is extremely/very important to teach students about nutrition (83.8%), food skills (69.7%) and food sustainability (74.1%), and these topics were considered equally important to most mandatory curriculum subjects. FNS was generally taught only 1–2 times per term (29.9%) or 1–2 times per year (31.6%), and 44.1% of teachers taught this as both a stand-alone and cross-curriculum subject. Teachers reported high levels of understanding (89.3%/92.5%/78.7%) and knowledge/skills (70.5%/75.5%/62.5%) to teach students about food, nutrition and sustainability respectively. Less than a third were trained in food (22.8%), nutrition (29.5%) or sustainability (24.5%) education. Less than a third of teachers had access to funding for FNS activities (29.8%) or training (19.9%) or were from schools with policies about including FNS education in the curriculum (28.5%). There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability were more likely to teach this as both a stand-alone and cross-curricular subject (all p < 0.05). Within open-ended responses, teachers described personal factors (e.g., workload) that influenced their FNS teaching practices, as well as factors related to students’ families (e.g., family food practices), the curriculum (e.g., overcrowding) and the school environment (e.g., time, funding, training). Strengthening FNS education in the Australian primary school sector is an important next step for public health. Researchers and policy makers should explore opportunities for training, funding and policies to prioritise FNS within the curriculum.

Dietary intake modulates the gut microbiota by providing fermentation substrates. Both microbiota-accessible nutrients and digestible food components have been shown to modulate microbial abundance and function(1). A range of dietary assessment methods are used to investigate diet-microbe interactions, with two commonly used methods being food frequency questionnaires (FFQ) to assess ‘habitual’ dietary intake and food recalls which measure recent intake proximal to sampling of microbiota. This study aimed to compare diet-microbiome associations identified from habitual and proximal dietary intake aligned with stool microbiota sampling in a healthy adult cohort. Military trainees (n = 35), and non-military personnel (junior doctors during hospital placement; n = 21) self-reported proximal dietary intake using digital (Easy Diet Diary) or paper-based 24-hr recalls. Habitual intake was assessed using the Comprehensive Nutrition Assessment Questionnaire (CNAQ)(2) FFQ. Both measures were assessed at baseline and study completion. Diet recalls matched to the same week of FFQ were analysed using Foodworks 10(3). Stool samples were collected for metagenomic shotgun sequencing and annotated against the Microba Life Sciences platform. MaAsLin2 identified linear associations between nutrients and microbe abundance, controlling for total energy intake and individual variation with repeated measures. Thirty dietary variables common to both dietary assessment methods were used in analysis. Mean daily intakes for total energy and macronutrients were not significantly different between habitual and proximal data. Nutrients that differed between methods were polyols (p < 0.001), sugar (p = 0.006), sodium (p = 0.03), alcohol (p < 0.001), vitamin A equivalents (p < 0.001), b-carotene equivalents (p < 0.001) and dietary fibre (p = 0.01). Associations between nutrient intake and microbes also differed between dietary collection methods. Most significant associations were found with nutrients measured by 24-hr recall. Mean (M) proximal intake of polyols (M = 0.9 g, standard deviation (SD) = 1.8 g) was significantly associated with increased relative abundance of Akkermansia spp. and CAG460 spp. but not with habitual intake (M = 3.4 g, SD = 3.2 g). Proximal alcohol intake (M = 2.5 g, SD = 8.8 g) was associated with CAG1427 spp. and Collinsella spp., which was not identified with habitual intake (M = 4.4 g, SD = 6.7 g). In contrast, habitual sugar intake (M = 149 g, SD = 103 g) was associated with Bacteroides spp. and Blautia spp. This association was not evident for proximal intake (M = 112 g, SD = 68 g), suggesting that some diet-microbiota associations may depend on the dietary assessment method used. These findings demonstrate the relevance of considering both habitual diet and proximal intake when conducting diet-microbiome research. Further analysis will investigate the role of these microbes and further associations between these nutrients and the functional capacity of the microbiota.

The theory of Developmental Origins of Health and Disease (DOHaD) suggests that the foetal origins of adult diseases are determined by perinatal exposure. Therefore, dietary intake during pregnancy is an opportunistic time to influence future disease susceptibility in infants. ORIGINS is a longitudinal birth cohort study aimed to reduce the rising epidemic of non-communicable diseases through ‘a healthy start to life’(1). We aimed to describe the dietary intakes of pregnant women in this cohort in Western Australia and compare this to the Nutrient Reference Values (NRVs) and Australian Recommended Food Score (ARFS)(2). The dietary intakes of women were collected using the Australian Eating Survey (AES), a semi-quantitative Food Frequency Questionnaire (FFQ). A total of n = 374 women completed the AES FFQ(3) at both 18- and 36-weeks’ gestation between 2016 and 2023. A descriptive cross-sectional analysis using STATA, was used to explore the macronutrient, micronutrient and food group intake at the two time points. Participants had a mean age of 32 years, were of Caucasian background (82.6%), had a tertiary education (78.1%), and majority were in the normal (37.7%) or overweight (29.4%) BMI category. Overall, it was found that the energy contribution from carbohydrate was low as compared to the recommended range (44% vs 45–65%); however, total fat (37% vs 30–35%) and saturated fat was high (14% vs < 10%). Participants were below the NRVs for micronutrient intakes for: calcium (~17–21% below NRVs), iron (~52% below NRVs), iodine (~21–23% below NRVs) and folate (~40% below NRVs) at 18- or 36-weeks. Participants consumed double the sodium NRVs (~198–201% above NRVs), and had low diet quality scores for all food groups (score = 35/73) at both timepoints. These findings suggest that despite ongoing promotion of healthy eating during pregnancy, more dietary support and education may be required during pregnancy for both mother and the long-term health of their offspring

Nearly half of all Australians (42.9%) will experience a mental health disorder during their lifetime(1). Preliminary research suggests an association between dietary and tissue advanced glycation end-products (AGEs) and mental health conditions, such as depression(2,3). However, more research is needed to determine the extent to which poor mental health is linked with AGEs(4). This study examined whether dietary consumption of the AGE carboxymethyl-lysine (CML), tissue accumulation of AGEs, or levels of circulating glycated haemoglobin (HbA1c) were associated with depression or anxiety. Fifty adults participated in a cross-sectional study. Depression and anxiety were assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D) and Spielberger’s State-Trait Anxiety Inventory (STAI). Dietary CML intake was assessed from 3-day food records by matching food items to those in published, validated food AGE databases and adjusting for energy intake (CML/MJ). Tissue accumulation of AGEs was measured as skin autofluorescence (SAF) using an AGE Reader. HbA1c was measured in whole blood using a Capillary 3 HbA1c kit. Spearman’s rank correlations were performed to explore relationships between variables. Participants included 14 males and 36 females, aged (median (range)) 30.6 (18–72) years. Participants were predominantly healthy, with a BMI of 23.3 (18.5–31.1) kg/m2 and energy intake of 7889 (5452–12568) kJ/day. Depression scores were 8 (0–40) out of 60. State anxiety scores were 26 (20–53) and trait anxiety scores were 33.5 (20–66) out of 80, where higher scores indicated greater symptom severity. Daily intake of CML was 0.6 (0.2–1.9) mg/MJ/day. SAF was 1.8 (1.2–3.3) arbitrary units (AU), similar to previously reported normal reference values(5). Circulating HbA1c was 5.1% (4.4–6.2%), all within the healthy range(6). Spearman’s correlation tests indicated no significant associations between any of the independent variables (CML/MJ, SAF, HbA1c) and any of the dependent variables (CES-D, STAI) (all p > 0.05). In this population of predominantly of healthy individuals, there was no association between dietary CML intake, tissue AGE accumulation or circulating HbA1c and increased symptom severity for depression or anxiety. The next step of this research is to investigate metabolomic markers in this population and their association with depression and anxiety. In relatively healthy people, dietary metabolites may be more sensitive to uncover whether a relationship exists between AGEs and depression and anxiety.

Nutrition plays a key role in brain development in the first 1000–2000 days of life(1). Furthermore, fussy eating is broadly defined as the inconsistent rejection and acceptance of both familiar and unfamiliar foods(2). Fussy eating is reportedly found in 10–15% of 2–3-year-old children, although typically starts to decrease in prevalence by 4 years old(3). Despite this decrease in the general population, children with neurodevelopmental disabilities, such as autism spectrum disorder, can see a protracted continuation of fussy eating and reject approximately 30% more foods than typically developing children(4). Consequently, for some children with neurodevelopmental disabilities maintaining adequate nutritional intake can be a challenge. Key nutrients for optimal neurodevelopment include iron, omega-3, protein, zinc and folate(1), and underconsumption of these nutrients can lead to poorer developmental outcomes in some children(1). Limited empirical evidence has been published on fussy eating in children with neurodevelopmental disabilities and no studies has examined the effects of poor diet variety on their emotional regulation. This study aims to systematically review current evidence to determine the association between fussy eating, diet variety and experiences of emotional regulation in children with neurodevelopmental disability. The search strategy was designed with the use of database specific index phrasing and was modified and tested several times before the formal search day. The systematic literature review was conducted across Medline, Scopus, Embase, Cinahl and Google Scholar. Studies included were dated from 2014–2024 and must have included children with a diagnosed or suspected neurodevelopmental condition and be aged been 1 to 9 years. Articles were excluded if children were following diets restricted by caregivers such as vegetarianism or ketogenic diets. Studies which focused primarily on a psychological outcome were also excluded due to the scope of the research not being within a nutrition related field. All articles were stored in Endnote, with duplicates removed before screening. The search results yielded 500 articles, following screening 10 full text articles met all inclusion criteria. Following data extraction, results illustrated that children with neurodevelopmental disabilities and observed fussy eating behaviours can experience difficulties regulating emotions. Additionally, diet variety was found to be consisting primarily of processed grains and meats, with minimal wholegrain and vegetable intake. Further research is needed to understand the aetiology and causative pathways between fussy eating, diet variety and emotional regulation for children with neurodevelopmental disability to better inform potential dietary interventions in this population.

The various COVID-19 lockdowns and restriction periods significantly changed both food accessibility and availability, which considerably impacted food practices of Australians. Food insecurity prevalence increased in Tasmania(1), but data from elsewhere in Australia is scarce and other changes in food shopping habits have not been reported. We aimed to explore Australian adults’ self-reported experiences of running out of food, spending on food and food shopping habits during the COVID-19 restriction periods in 2020. An online survey of Australian adults was administered via Qualtrics. Chi-square tests examined bivariate associations between categorical variables (gender, age, change in employment status, education level, main language spoken at home and marital status), and responses to the main research questions. Respondents (n = 764) were predominantly female (86%), primarily from Victoria (48%), with the majority over 55 years of age (57%, mean age [SD] 53.4 [18.1] years). Additionally, half (51%) were not in paid employment. Overall, 11% reported running out of food and not being able to purchase more. There was an association between age and running out of food (4% of the 64–74 and 75+ year old age groups ran out of food compared to 23% of the 18–24 year olds, p < 0.001, chi square). The most reported reasons for running out of food, out of six provided options, were ‘lack of availability in the shops’ (74%) and ‘lack of money’ (34%). There was no association with gender, employment status change, education level, main language spoken at home, or marital status and running out of food. When asked how the amount of money spent on food changed during COVID-19, most respondents (n = 318, 42%) reported spending about the same amount of money as before the pandemic, 284 (37%) reported spending more and 162 (21%) reported spending less on food. About a third of respondents (38%, n = 293) reported buying more food than they needed since the start of COVID-19 and 9% (n = 66) reported wasting more food than usual. This did not differ with age, gender, employment status change, education level, main language spoken at home, or marital status. Nearly two-thirds (63%) reported that they had changed how they bought their food since the start of COVID-19.Of these 75% reported a change in frequency of food shopping and 45% reported a change in the amount of time spent food shopping. Just under half (44%) reported a change in the amount of money spent on food and 42% reported a change in the food bought. The COVID-19 pandemic restrictions caused significant changes to Australians’ food procurement and younger people appeared more at risk of food insecurity. Policies that support young people are important to ensure food security in the most vulnerable groups.