The FAO states that the term food sovereignty focuses on food for the people by placing people’s need for food at the centre of policies and insists that food is more than just a commodity. Food Sovereignty also promotes knowledge and skills by building on traditional knowledge; using research to support and pass on this knowledge to future generations; and rejecting technologies that undermine local food systems. It is essentially a movement that “recognizes that control over the food system needs to remain in the hands of producers, and is clearly focused primarily on small-scale agriculture of a non-industrial nature, preferably organic”(1). In Māori terms, Kai Sovereignty is drawn first from the relationship of foods to our needs; it is expressed through whakapapa, and has an overarching contribution to food security. Traditional foods abound in Aotearoa. The relationships are longstanding, expressive and contribute to our wellbeing in various ways(2). But the true cultural value of traditional foods is diminishing as new foods, lifestyles and experiences succeed them. Kai sovereignty therefore is at risk of being relegated to historical discourse. The FAO acknowledgement of the intergenerational role of traditional knowledge to support food sovereignty aligns well to the Māori experience. This knowledge covers a myriad of food relationships including foraging, producing, harvesting, processing, cooking and manaakitanga. We are in a renaissance period that seeks to rediscover our relationship with the pātaka, the food store. So much knowledge has been lost, but much also remains. How we draw that together in a way that acknowledges the whakapapa or historical relationship alongside the present and future. The right to achieving kai sovereignty is yet to be properly understood within our communities. The first steps lie in the knowledge space; sharing and acknowledgement of our food traditions before they are lost or misinterpreted.

Pacific Island communities are disproportionally impacted by the effects of climate change, and as teina (younger sibling) to our Pacific tuakana (older sibling), it is our responsibility to ensure these communities have resilience through co-developed solutions to these real-world problems. We focus on marine and freshwater ecosystems, understand their intrinsic links to Pacific communities, while, in partnership with science, empower and enable local knowledge to steer the waka. With more than 20 years’ experience of supporting Pacific communities, we deliver our positive impact through knowledge exchange, capability and capacity development, and problem solving. We strive to learn and grow our own capability, while brokering knowledge between Aotearoa, the Pacific, and our world leading research partners. Our aim is that Pacific Island communities gain a deeper scientific understanding of their aquatic systems, have the tools to rejuvenate and conserve these ecosystems, are empowered to transform their food systems towards more healthy, sustainable, and resilient pathways, and can adapt to the impacts of climate change. We take a systems approach that incorporates adaptive solutions, which are community-led, thereby ensuring a long-lasting positive impact into the future. Our Kete is filled with world-leading expertise from different organizations, which ensures a greater collective impact where it is needed most. This presentation will cover the seven themes within our Pacific Impact area, with a particular focus on food safety and security in relation to ciguatera poisoning (the number one cause of non-bacterial seafood illness affecting Pacific Island communities) (1,2), analytical laboratory development, and transforming food systems.

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the ‘dimensions’). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally.

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

New Zealand has committed to a 50% reduction in greenhouse gas emissions (GHGEs) from 2005 levels by 2030. Dietary changes within New Zealand could simultaneously improve population health and contribute towards the nation’s emissions reduction target, as agricultural emissions are estimated to account for half of New Zealand’s GHGEs(1). This research aimed to quantify the GHGEs associated with household purchases of major food groups in New Zealand and identify the sociodemographic characteristics that are associated with per capita household dietary emissions. Household dietary emissions were estimated using the NielsenIQ Homescan(R) consumer panel — a large sample of households within New Zealand who report purchasing data of take-home food and beverages. The sample is nationally representative in terms of broad geographical regions and selected key demographic characteristics. Carbon emission estimates were assigned to 1,908,485 total food and beverage purchases from 1,775 households over one year (2019) using a process-based life cycle assessment (LCA) dataset initially constructed in the United Kingdom (UK) and adapted for New Zealand(2). This LCA dataset contains estimates of greenhouse gas emissions generated over the life cycle of the production of food products from the following stages: farming and processing, transit packaging, consumer packaging, transport, warehouse and distribution, refrigeration, and overheads. Greenhouse gas emissions are expressed in kg of carbon dioxide equivalents per kg of food product over a 100-year time horizon. Total emissions from purchases of major food groups were then estimated. Multiple linear regression was used to examine the relationships between household variables and per capita dietary emissions. Overall purchases of red and processed meat (35%) and dairy products (19%) were responsible for the greatest proportion of emissions. The age group of the primary household shopper as well as household size were predictors of per capita dietary emissions — households with primary shoppers > 65 years had, on average, 33% (95% CI: 20% to 49%) higher per capita dietary emissions, compared to households with primary shoppers 34 years; and every additional household member was associated with, on average, 11% (95% CI: 9% to 13%) lower per capita dietary emissions. We have shown in this large representative sample of New Zealand households that purchases of just two food groups — red and processed meat, and dairy — were responsible for approximately half of dietary greenhouse gas emissions. Larger households had lower per capita dietary greenhouse gas emissions, and older shoppers had relatively higher greenhouse gas emissions. Whilst similar associations have been reported elsewhere more research is needed to confirm these latter findings. With enhanced understanding of the observed association between age of a household’s primary shopper and per capita dietary emissions, interventions may be devised that encourage shoppers to purchase lower-emitting foods, particularly less meat and dairy.

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

This method abstract details the Green School Program, piloted across three schools in maritime Fijian islands, addresses critical issues faced by Fijian and Pacific Island communities. These encompass malnutrition, food security, health hazards, and the urgency of integrating traditional knowledge, governance, and social-ecological systems approaches into creating healthier school environments. Non communicable diseases have emerged as a pervasive concern within Pacific Island communities, creating a challenge for public health systems, driven greatly by dietary habits(1). This complex health landscape underscores the need to safeguard traditional knowledge and agri-food practices and develop neo-traditional approaches to local food systems(2). Furthermore, the Green School Program recognizes the essential role of schools as community hubs, enabling enhancing heathy school environments by embracing traditional wisdom and sustainable farming practices and foods, ultimately empowering communities to address these multifaceted challenges(3). Developing the school environment as a sustainable setting for governance framework led by women and the school administration, rooted in traditional knowledge and practices. Additionally, it aims to design facilities that support efficient organic farming while integrating these into school activities. Economic sustainability through the sale of surplus farm products, as well as the enhancement of sustainable land-use management, health, wellbeing, and cultural identity. The program unfolds within a distinctive community-based framework with the establishment of robust governance, with a notable emphasis on the leadership of women and mothers who play a pivotal role in steering the green school initiative and ensuring community ownership. Collaborative governance spans multiple stakeholders, including school management, community-based school committees, youth groups, women groups, and traditional leaders. This inclusive engagement ensures both shared responsibility in program design and ownership during implementation phases. Sustainable facilities are strategically designed to include biodigesters, water storage and irrigation systems, composting, organic fertilizers, and seedling nurseries, enhancing the program’s capacity to create healthier school food environments while embracing traditional practices and values. The program has witnessed the active engagement of women in governance roles, promoting community unity and ownership. Traditional knowledge integration has enhanced crop diversity and sustainability. Economic sustainability has been achieved through surplus farm product sales, reducing dependency on external funding sources. Health improvements are evident, with reduced exposure to indoor air pollution from open fires. Cultural identity preservation and increased student engagement are also notable outcomes. The Green School Program’s holistic approach, rooted in traditional knowledge and sustainable practices, has yielded positive outcomes in governance, agriculture, nutritional food security, health, and cultural identity preservation. The program’s success demonstrates the potential for community-based initiatives to address critical issues and empower remote island communities. These results provide valuable insights into sustainable development approaches that prioritize community wellbeing and cultural heritage preservation in similar contexts.

Utilising local and traditional foods in schools presents a significant opportunity within our region to ensure food and nutritional security, support local livelihoods by driving markets and employment opportunities, increasing food literacy, and help students to understand the role of, and develop a preference for these foods. School meals programs (SMP) are increasingly touted as a strategy for food system transformation(1), however, are not widely used in the Pacific Islands(2). Yet, there is increasing interest and momentum towards understanding school food and nutrition environments and the use of SMP in this region, especially with models that support and promote the integration of local, traditional climate-resilient, nutrient rich foods. When a large scale SMP may not be possible, other school food and nutrition activities can be utilised to support nutritious food choice. Evidence collected over the last five years provides information on the current situation, activities, and capacity for providing food in schools across the Pacific Islands (2,3,4). Activities across the region vary from national SMP to gardening programs, nutrition education, providing canteens/tuckshops and other ad hoc activities, for example events for World Food Day. Some activities have a requirement for the use of local food, while some prioritise local foods in gardening programs and work with local farmers. Recently it has been shown that youth are exposed to, and have access to significant amounts of ultra-processed foods (UPF) around schools(3). Mapping of the foods available to students within a 400m radius of 88 schools in Fiji found that sugar sweetened beverages were available in 80%, and lollies/confectionary in just over 60% of outlets. Fresh fruit was available in just over 20% of outlets, while fresh vegetables were available in less than 20% of outlets(3). While there are many challenges to providing local, traditional, nutritious foods in schools, including access to financial, human, and physical resources, stakeholders have told us that one of the most significant is how modernisation and colonisation of food systems have resulted in a preference for hyperpalatable UPF and how this makes it more challenging to incorporate local produce in a way that is accepted by students. This provides an opportunity to further explore and share ways to integrate local, traditional, climate-resilient, nutrient rich foods in schools to support children and adolescents to value, utilise, prefer, and advocate for these foods. There is a need to support the utilisation of traditional, local foods in schools by advocating for policy (at various levels, right from a school level upwards) that drives the use of these foods and creates more supportive school food environments.

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

Childhood obesity and overweight rates in New Zealand are considerably higher than that globally with one in three children aged between 2-14 years being overweight or obese(1). Children’s dietary knowledge and food preferences are influenced by various factors including the food environment. Schools are an excellent setting to influence children’s dietary behaviours since they have the potential to reach almost all children during the first two decades of their lives. However, previous analyses indicate many school canteens and food providers do not supply foods that promote healthy eating and nutrition behaviours (2,3). The Ministry of Health (MoH) recently implemented a ‘Food and Drink Guidance for Schools’ which utilises a traffic-light framework dividing foods into three categories: ‘green’, ‘amber’, and ‘red’(4). The aim of this study was to assess primary school canteen food menus against the newly implemented MoH Guidance. A convenience sample of 133 primary school canteen menus were collected in 2020 as part of the baseline evaluation of the Healthy Active Learning initiative across New Zealand. Four researchers (three nutritionists and one dietitian) developed a menu analysis toolkit to undertake the analysis of all menus collected. The toolkit provided a breakdown of commonly packaged foods and meals/menu items available to purchase within schools based on Health Star Ratings, ingredients, and/or standard recipes. Assumptions were created for menu items requiring additional detail to be categorised according to the guidance through consensus by all four researchers. Primary school menus were coded by two researchers, and intercoder reliability was ensured by independent coding and cross-checking of 10% of menus. Descriptive and inferential analyses were conducted using IBM SPSS and P<0.05 denoted significance. Analyses of canteen menus revealed that most menu items belonged to the less healthy amber (41.0%) and red (40%) food categories. Low decile schools had a lower percentage of green food items (8.6%) and a higher percentage of red food items (48.3%) compared to high decile schools (p = 0.028). Similarly, schools in low deprivation areas had a significantly higher percentage of green food items (14.2%) compared to high deprivation areas (8.6%) (p = 0.031). Sandwiches, filled rolls, and wraps were the most commonly available items (86%) followed by baked foods and foods with pastry (71%). Sugar-sweetened beverages were just as prevalent as water on school food menus (54% each). Over half of in-house catered canteen menu items were classified as 'red’ foods (55.3%). This study highlights that most school canteens were not meeting the guidelines for healthy food and drink provision outlined by the MoH. Improving school food availability for children in socioeconomically deprived areas needs to be prioritised to reduce inequities. Findings suggest the need for more robust national policies and mandated school guidance to improve the food environments in New Zealand schools.

Human nutrition is a key component of the definitions of both sustainable food systems and sustainable healthy diets, and features prominently in the Sustainable Development Goals. However, progress towards complete nutrition and food security for the entire global population is poor, and the burden of malnutrition and food insecurity is felt in countries of all income levels, including in Oceania. While countries like Australia and New Zealand (NZ) are widely perceived as sources of high-quality food exported overseas due to great surpluses above national requirement, this hides domestic issues. The international nutrition community recognises and are demanding that our food systems must be sustainable, which is not yet the case anywhere in Oceania. Food insecurity at the household level is not uncommon, nor are nutrient deficiencies. It is often presumed that, should the inequitable distribution of food be balanced, these challenges would disappear. However, food supply and trade data show that even at the national and regional levels, insufficient food and nutrient supplies to meet population requirements are the established norm. For example, it has been demonstrated that domestic vegetable production falls short of NZ dietary recommendations, with imports making a negligible difference other than via energy dense crops(1). Likewise, after consideration of trade, NZ has undersupplies of calcium, potassium, vitamins C and E, and dietary fibre compared to population requirements(2). A wealth of data exists quantifying food production, trade, and availability and various scales. Increasingly, researchers are matching these to human requirements, whether at the food or nutrient level, to identify gaps(3). Insights generated from these data-driven approaches are being directed at trade policy, enabling decisions that can realise aspirational goals to reduce food insecurity through international trade. Making this data accessible to all via interactive user interfaces promotes wider engagement, understanding, and dissemination of findings. It also allows stakeholders in various countries to identify their own vulnerabilities, both as a result of current undersupplies, and due to high reliance on trading partners for food and nutrition security. Trade data can also be connected to environmental measures to identify scenarios where trade can be leveraged to the benefit of both nutrition and broader sustainability goals(4). High level, data driven approaches are not a substitute for individual-based studies on nutrition, but are a useful complement to them. With regionally or nationally deficient food and nutrient supplies, complete nutrition for individuals cannot be attained. A holistic, system-wide understanding is necessary for any policy decisions to advance nutrition.

Inflammatory Bowel Diseases (IBD) are chronic intestinal disorders, characterised by periods of quiescent disease and episodes of heightened disease activity. The diseases mainly affect the gastrointestinal tract. Often, patients experience a limited quality of life as a result of dietary restrictions, fatigue and other factors leading to mood disturbances, malnutrition, and inactivity amongst others. This presentation will give an overview of work done to identify factors leading the above findings which in our view are to some degree modifiable. We will look at availability and expertise of dietitians supporting patients with IBD, dietary and lifestyle modifications aiming to reduce the Burden of Disease.

Diet is a large influencer of the gut microbiota composition and function across the lifespan. However, information on whether and how diet can affect the brain via bidirectional communication between the gut and the central nervous system (the microbiota-gut-brain axis) is emerging. Immune, endocrine, humoral, and neural connections between the gastrointestinal tract and the central nervous system are important to this axis. The gut microbiota can produce cytokines, neurotransmitters, neuropeptides, chemokines, endocrine messengers, and microbial metabolites (e.g., short-chain fatty acids, branched chain amino acids, and peptidoglycans), some of which can enter the brain, influencing the function of brain cells. Animal studies investigating the potential of nutritional interventions on this axis have advanced our understanding of the role of diet in this bidirectional communication. This includes insights into microbial metabolites, immune, neuronal, and metabolic pathways amendable to dietary modulation. However, several aspects of the gastrointestinal tract and brain of animal models differ to humans, and it is important to consider these differences and similarities when evaluating the transability of the findings to the human context. Randomised clinical trials using dietary interventions in humans in this field are limited but have high potential application for clinical nutrition. In particular, several microbiota-targeted interventions have been explored as potential approaches for mental health. These approaches include probiotics, prebiotics, etc. as well as dietary approaches(1,2,3). However, there are limited clinical interventions with whole-dietary approaches. Most human studies used faecal samples to infer changes in microbiota parameters occurring in the gastrointestinal tract and do not consider the physiological changes in gastrointestinal physiology (e.g., transit time) that can directly or indirectly affect the diversity and composition of the gut microbiome. Future research considerations should include better characterisation of the participants at baseline (dietary patterns, gastrointestinal phenotype, and gut microbiota composition) to identify potential responders to dietary interventions. In addition to gut microbiota assessment, evaluations of physiological parameters, brain function and behavioural measurements should be considered as part of the study protocol. In this presentation, the current state of the literature triangulating the diet, the gut microbiota, and host behaviour/brain processes will be addressed. Future research considerations will also be discussed.

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

A majority of Australians consume a limited range of different dietary fibres and insufficient total dietary fibre(1). This contributes to low intestinal microbial diversity and impaired microbial function, such as capability in producing beneficial metabolites like short-chain fatty acids (SCFA). This diet-induced dysbiosis is associated with poor gastrointestinal health and a broad range of non-communicable diseases(2). Our study aimed to determine whether one dietary change, substitution of white bread with a high fibre bread improves faecal microbial diversity and butyrate-producing capability. Twenty-six healthy adults completed a randomised, cross-over, single-blinded intervention. Over the two intervention phases separated with a 4-wk washout, participants consumed either 3 slices of a high fibre bread (Prebiotic Cape Seed Loaf with BARLEYmax®) or control white bread as part of the usual diet, each for 2 weeks. At the beginning and end of each intervention period, participants completed a 24-h diet recall, a gut symptoms rating questionnaire and provided a faecal sample for microbiome analysis. The composition of faecal microbiome was characterised using 16S rRNA amplicon sequencing (V3-V4) and a marker of butyrate synthesis capability, the faecal content of butyryl-CoA:acetate CoA-transferase (BCoAT) gene was assessed using Real-time PCR. The high fibre bread intervention increased the servings of whole grain from 1.5 to 4 per day and increased total dietary fibre intake to 40 g/d which was double the amount of fibre consumed by participants at baseline or during the white bread intervention. Compared to white bread, the high fibre bread increased richness and evenness (Shannon, p = 0.014) of the gut microbiota and increased the relative abundance of SCFA producing taxa Lachnospiracae ND3007 group (p <0.001, FDR = 0.019). In addition, the high-fibre bread tended to increase relative abundance of butyrate-producing genus Roseburia, and microbial BCoAT gene content compared to white bread. In conclusion, the substitution of white bread with high-fibre bread improved the diversity of gut microbiota, specific microbes involved in SCFA production and may enhance the butyrate production capability of gut microbiota in healthy adults.

Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects up to 13% of reproductive-aged women and is associated with reproductive, metabolic and psychological features. Women with PCOS have a higher prevalence of longitudinal weight gain in population-based cohort studies compared to women without PCOS. On meta-analysis, women with PCOS also have an increased prevalence of overweight, obesity and central obesity, compared with controls. PCOS is therefore associated with an elevated prevalence of overweight and obesity which further worsen metabolic, reproductive and psychological dysfunction. Given the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women, weight management is a logical treatment strategy. This can be defined as prevention of excess weight gain, achieving a modest weight loss and sustaining a reduced weight long-term. This is best achieved through lifestyle management which traditionally refers to a complex multidisciplinary approach that combines dietary modification, physical activity and behavioural interventions. Lifestyle interventions and modest weight loss (5-10% of initial body weight) are associated with improvements in outcomes including central adiposity, hyperandrogenism, insulin resistance and cardiovascular risk factors. In PCOS specifically for dietary interventions, the majority of evidence indicates no differences between dietary approaches Lifestyle management advice should therefore follow general population guidance which states that lifestyle intervention can be achieved through a variety of dietary approaches providing these are tailored to dietary preferences and ensure the nutritional and health status of the individual patient with referral to a nutrition professional where possible. These recommendations are summarised in the 2023 International Evidence-based Guidelines on the Assessment and Management of PCOS. 1 These guidelines are now being translated and implemented internationally.

The traditional Mediterranean Diet (MedDiet) is consistent with a dietary pattern and time-honoured eating behaviours by populations living in the olive-tree growing areas of the Mediterranean basin before the mid-1960’s. The MedDiet is described in the literature as a plant-based dietary pattern, consistent with a high intake of vegetables, fruits, nuts, legumes, wholegrains cereals, and daily use of extra-virgin olive oil incorporated into all meals; moderate consumption of fish, shellfish, fermented dairy products (cheese and yogurt), and wine (typically during meals); and a low or infrequent consumption of meat and processed meat products, processed cereals, sweets, vegetable oils, and butter(1). Being predominately plant-based, the MedDiet is naturally low in saturated fat, and rich in several functional components, including vitamins and minerals, carotenoids, unsaturated fatty acids, and phenolic compounds, depicted by antioxidant and anti-inflammatory properties. As a result of its putative beneficial health effects, the MedDiet is one of the most widely evaluated dietary patterns in the scientific literature(2). In both observational and intervention studies, there is a large and consistent body of evidence to support that a MedDiet is protective against chronic and inflammatory conditions, including cardiovascular disease, metabolic syndrome, management and prevention of type 2 diabetes, central adiposity, cancer, neurodegenerative conditions, and frailty(3). The effect of the MedDiet on women’s reproductive health is an emerging area in the literature. There have been a range of studies (observational and interventional) examining outcomes related to menarche, menstrual cycle, pregnancy, infertility, lactation, and menopause. The MedDiet has also been studied for the management of conditions such as polycystic ovary syndrome and endometriosis. These conditions are often associated with hormonal imbalances, inflammation, and oxidative stress, all of which can be influenced by the diet’s key components. The MedDiet may be a promising nutritional strategy for promoting women’s reproductive health. However, more extensive, and rigorous studies, including randomized controlled trials and longitudinal investigations, are necessary to establish a causal relationship between the MedDiet and women’s reproductive health outcomes. While the adoption of a MedDiet in non-Mediterranean populations is appealing, consideration needs to be given about potential barriers and enablers towards adherence(4). Furthermore, while the primary focus has been on nutritional strategies within the framework of the Mediterranean Diet, equal attention must be given to the eating behaviours and lifestyle factors associated with it.

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

Brown Buttabean Motivation (BBM) is a Māori and Pacific-driven community-based organisation operating in Tāmaki Makaurau (Auckland) and Tokoroa. It provides free community exercise bootcamps and other social and health support programs. BBM’s foundational mission was to reduce, among Māori and Pacific people, the prevalence of obesity in Auckland through exercise and nutrition programs.1 This study aimed to understand participants’ engagement with BBM, and the meaning it has had in their lives, with a focus on nutrition. Combining Pacific Fonofale and Te Whare Tapa Wha frameworks, this was a process evaluation to understand the impact of BBM’s services on the community using qualitative methods and a systems analysis to identify program sustainability and improvement. Semi-structured interviews explored the benefits and values of engagement with BBM. Followed by cognitive mapping interviews (CMI) and group model building (GMB) to identify the motivations and challenges of sustained engagement. Participants described holistic health benefits and impacts on community wellbeing. BBM responds to inequitable nutrition contexts, through its FoodShare (food bank), community kitchen, and BBM Kai (nutrition literacy). Engagement changed family nutrition patterns, and benefits included healthier spending habits, and addressing food insecurity. Social inclusiveness represented the Fonofale foundation (family) and the roof (culture) was described as ethnic cultural practices and BBM culture. Nutrition was not highlighted by BBM participants in CMI or GMB activities. However, participants suggested BBM increase nutrition initiatives to enable all members to improve their health journeys. BBM was seen as not just an exercise program but their own and their family’s new way of life, that health was a journey, not a destination. Moreover, although participants mentioned nutrition and health benefits, there was an overwhelming understanding that the values of BBM, Pacific culture, and social collectivism were the drivers of engagement, motivating healthier practices. BBM could leverage existing strengths by incorporating nutrition-enabling initiatives that are achieved collectively. Opportunities for systematic intervention will be presented.

Providing access to food in schools can serve as a platform for food system transformation, while simultaneously improving educational outcomes and livelihoods. Locally grown and procured food is a nutritious, healthy, and efficient way to provide schoolchildren with a daily meal while, at the same time, improving opportunities for smallholder farmers(1). While there is significant potential for school food provision activities to support healthy dietary behaviours in the Pacific Islands region, there is limited evidence of these types of activities(2), including scope and links to local food production in the region. Therefore, the aim of this scoping study was to understand the current state of school food activities (school feeding, gardening and other food provision activities) and any current, and potential links to local agriculture in the Pacific Islands. A regional mapping activity was undertaken, initially covering 22 Pacific Island countries. The mapping included two steps: 1) a desk based scoping review including peer-reviewed and grey literature (2007-2022) and 2) One-hour semi-structured online Zoom interviews with key country stakeholders. Twelve sources were identified, predominately grey literature (n = 9). Thirty interviews were completed with at least 1 key stakeholder from 15 countries. A variety of school food provision activities were identified, including school feeding programs (n = 16, of varying scale), programs covering both school feeding and school gardens (n = 2), school garden programs (n = 12), and other school food provision activities (n = 4, including taste/sensory education, food waste reduction, increasing canteen capacity for local foods, supply chain distribution between local agriculture and schools). Existing links to local agriculture varied for the different programs. Of the 16 school feeding programs, 8 had a requirement for the use of local produce (policy requirement n = 6, traditional requirement from leaders n = 2). Of the 12 school garden programs, 6 used local or traditional produce in the garden and 5 involved local farmers in varying capacities. Challenges to linking local agriculture into school food provision programs were reported for 17 activities and were context dependent. Common challenges included limited funding, inflation, Covid-19, inadequate produce supply for the scale of program, limited farmer capacity, limited institutional support for local produce, low produce storage life, climatic conditions and disasters, water security, delayed procurement process, and limited professional development and upskilling opportunities. Modernisation and colonisation of food systems resulting in a preference for hyperpalatable foods and challenges in incorporating local produce in a way that is accepted by students was also identified as a challenge. This evidence can be used to develop a pathway to piloting and implementing models of school food provision programs and promoting opportunities for shared learning and collaboration with key stakeholders across the Pacific Islands region.