The aim of this study was to explore associations between habitual dietary fibre intake, adiposity, and biomarkers of metabolic health in Pacific and New Zealand European women who are known to have different metabolic disease risks. Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18-45years) were recruited to the PROMISE cross-sectional study(1) based on normal (18-24.9kg/m2) and obese BMI (≥30kg/m2). Body fat percentage (BF%), measured using whole body DXA, was used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute method, involving a 5-day-food-record and a semi-quantitative FFQ. Fasting blood was analysed for glucose, insulin, and lipid profile. NZ European women in the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (median 23.7g/day [25-75-percentile, 20.1, 29.9]; 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; 17.8 [15.0, 20.8]; both p<0.001), respectively. Pacific women consumed a higher proportion of their total fibre intake from discretionary fast foods, in contrast NZ European women consumed more dietary fibre from wholegrains. Regression analysis controlling for ethnicity, age, socioeconomic deprivation, energy intake, protein, total carbohydrate, and fat intake showed significant inverse associations between higher dietary fibre intake and BF% and visceral fat% (β = −0.47, 95% CI = −0.62, −0.31, p<0.001; β = −0.61, [−0.82, −0.40], p<0.001, respectively) among both Pacific and NZ European women. LDL-C (β = −0.04, [−0.06, −0.01]) was inversely associated with fibre intake following further adjustment for BF%-groups in NZ European women. Despite differences in intake, dietary fibre was inversely associated with adiposity and metabolic disease risk in both Pacific and NZ European women. However younger woman living in areas of higher socio-economic deprivation who consumed a higher proportion of total dietary fibre intake from discretionary fast foods were more likely to have low dietary fibre intakes than older, wealthier women. These women were also more likely to be Pacific women. Increasing habitual dietary fibre intake could help to reduce adiposity and metabolic disease risk; so implementing policies that make health-promoting high fibre foods more affordable, ensuring households have sufficient income to purchase nutritious food and limiting the amount of unhealthy food marketing that low income communities are exposed to should be public health priorities.

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

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

Non-Communicable Diseases (NCDs) constitute the most notable single killer of the population of Pacific Small Island Developing States (SIDS). It is therefore not surprising that the leaders of Pacific SIDS recognize NCDs as a crisis(1). But just as it is in many parts of the world, addressing NCDs in the Pacific is a complex challenge for many reasons. For example, and in the midst of recurrent climate change disasters, it would be fair to wonder if Pacific SIDs and development stakeholders – and academia included - have not become overwhelmed in obtaining more clarity about the main causes of NCDs, and tackling them with the relevant prioritization, policy environments that address economic and market forces, coordinated interventions, good examples from leaders, actions driven leadership, not blaming the victims, and a lot more. Maybe it is too uncritical and simplistic to continue to make the historical argument that the population of Pacific SIDS are obese, overweight, suffer from micronutrient deficiencies, stunting, and so forth because they choose poor diets and physical inactivity, or simply because all of this is cultural.

The foregoing context demands more criticality and contributes to the rise of several philosopher kings who so easily describe NCDs as a disease that requires a health approach in absolutism. But if we were to invest more into obtaining deeper insights about the causes of NCDs in the Pacific, there could be a possibility for stakeholders to increasingly advocate for a systems approach to addressing NCDs in the Pacific. A systems approach would for example, recognize that as economic development receives more investments, people will conversely reduce walking in favor of vehicle transportation, children will spend less time playing outside in favor of watching television, more highly processed food of high salt, sugar and fat contents will be marketed and affordable than locally grown food, people will work in the service sector to the detriment of traditional gardening. A systems approach would account for a combination of biomedical, food systems, educational, religious, socio-cultural, recreational, etc… approaches.

As one of the development stakeholders, the Food And Agriculture Organization of the United Nations (FAO) joins efforts with others to address NCDs in the Pacific(2). The entry point for FAO is through promoting the production and consumption fresh, safe, nutritious and healthy foods. My intervention at the 2023 Joint Conference of the Nutrition Societies of New Zealand will provide insights into FAO’s work from this vantage point.

Establishing healthy lifelong eating habits in young people is important for short and long-term health(1). Schools are ideal setting to improve diet. However, research shows that many school food environments are unhealthy(2). In New Zealand (NZ), the canteen is a popular food provision, particularly in secondary schools. This research aimed to explore the barriers and enablers to providing healthy food and beverages in NZ secondary school canteens. In 2022, 6 secondary schools were purposively selected to participate in semi-structured interviews about foods and beverages sold in schools’ canteens and the factors that influenced this. In total, 11 stakeholders representing six schools and one staff member of an external catering company completed interviews. The interviews were transcribed and analysed using a reflexive thematic analysis approach(3). Four themes were developed. Theme 1 Action-oriented school policies that are based on healthy eating principles can facilitate healthier canteens highlighted the use and characteristics of policies. The subtheme highlighted that Mandatory policies are more enforceable. Theme 2 Multiple component opt-in programs or interventions facilitate a healthier school food provision shows that opt-in government interventions (e.g. Ka Ora, Ka Ako, the NZ free school lunch initiative) with funding, monitoring, and incentives can improve food provision. The subtheme Health-enhancing changes in the school environment has flow-on effect to canteens showed that these changes can affect the entire school food environment. Theme 3 Healthy canteens get lost in the “pecking order” of what’s important highlights that while schools and key stakeholders may believe healthy eating is important, other factors related to well-being and education were more important to prioritise within the school’s limited resources. Theme 4 People’s values, attitudes and beliefs may help and hinder the healthiness of canteens and explores the role champions have in influencing the healthiness of the canteen. Champions were those with a positive, proactive attitude, value healthy eating and are capable. Subtheme 1 Meet student preferences while providing healthy food was a common barrier many champions worked hard to overcome. The final subtheme identified how A collaborative approach within schools and their communities can overcome barriers to healthy canteens. Government mandates and interventions can positively impact the canteen and other food provisions. This research supports a recommendation for schools to create and implement school policies around food encompassing a whole-school approach.

School-provided lunch programs offer numerous benefits to primary school students including improved school attendance and performance, reduced undernutrition, reduced food insecurity, the opportunity to learn healthy eating, and the development of healthy dietary habits(1–3). Australia does not have an ongoing national school-provided lunch program that provides food for all students. To successfully implement a school-provided lunch program in Australian primary schools, it is essential to obtain the opinions of all key stakeholders, including parents. This study aimed to examine Victorian primary school parents’ opinions about a potential school-provided lunch program. An online cross-sectional survey with open- and closed-ended questions was conducted in Victoria, Australia, in 2022. Descriptive statistics and chi-square analyses were performed using SPSS software; thematic analysis was carried out using NVivo. Three hundred and fifty-nine parents responded to the survey. Fifty-seven percent of respondents said they would allow their child to participate in a school-provided lunch program, 34% were unsure and only 9% said they would not. The opportunity for hot-cooked lunches at school and the perceived convenience for parents were the top two reasons for favouring such a program. Fifty-eight percent were in favour of hybrid-type funding from both the government and parents, while 30% were in favour of being fully funded by the government. The most preferred amount to pay per meal was AUD5-6 (43%), followed by AUD3-4 (25%). When respondents were asked to rate the importance of six options in school-provided lunches (vegetarian, nut-free, dairy-free, gluten-free, egg-free, and vegan options), almost one-third of them selected having ‘vegetarian’ options as important or very important, whilst one-fifth selected ‘nut-free’, ‘dairy-free’, and ‘gluten-free’ options as important or very important. There were no associations between the parents’ or children’s socio-demographic characteristics and the likeliness of letting their children use school-provided lunches, funding preference, the amount willing to pay for school lunches, and the importance of different options. Respondents’ written responses revealed that they expected school-provided lunches to be healthy and made from whole food and cater to the special dietary and cultural needs of their children. Their other expectations included food being tasty and offered in a child-friendly way, having a variety of food offered, and having backup options if the children would/ could not eat those meals. They also expected enough time to be provided for eating lunches so children could eat and enjoy the meals. The findings of this study suggest that Victorian primary school parents are open to the idea of a school-provided lunch program, but they do have several expectations regarding the menu and time for eating. Program planners could use the findings of this study to create a school lunch program that aligns with the parents’ expectations and preferences.

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

Mealtime environments and food provision contexts in primary school influence students’ food behaviours(1) and are an opportunity for nutrition intervention(2). This study aims to explore primary school food provision contexts including eating environments and food provision models and policies. A quantitative cross-sectional online survey of Australian primary school teachers undertaken between August 2022-July 2023 collected data about: (1) designated eating times and locations for lunch and snacks; (2) teacher use of mealtimes for food and nutrition education; and(3) presence of food services and food-related policies. Descriptive statistics were generated using Stata 17.0 statistical software. Participants were 239 teachers recruited via social media advertising and education/nutrition networks. The majority of teachers reported their school provided allocated time for children to eat a morning snack (n = 201, 84%) and lunch (n = 234, 98%). Around three quarters of teachers reported an allocated eating time of 10 minutes or less for morning snack (n = 146, 73%) and 15 minutes or less for lunch (n = 174, 74%). Teachers stated lunch was most commonly eaten in the classroom with time to finish in the yard (n = 90, 38%) or in the yard as a group (n = 70, 30%). It was most common for morning snack to be eaten in the classroom (n = 119, 59%). Most teachers stated they had the opportunity to eat lunch with their students at least sometimes (n = 159, 67%). Of these teachers, 31% (n = 50) reported they used this time to teach students about food and nutrition, for example, in a pedagogical lunch. Of 109 teachers who did not use lunch time to teach students about food and nutrition, 43% (n = 69) stated they would be interested in doing this in the future. When asked about the availability of food services at their school, 62% (n = 147) of teachers reported their school had a canteen, 28% (n = 67) reported their school offered lunch orders via an external food outlet and 35% (n = 83) reported their school had a breakfast program. Only 34% of teachers reported their school had policies about the foods available from school food services. From these findings we conclude that a variety of mealtime and food provision contexts exist within Australian primary schools, and that there is opportunity to leverage eating occasions and food provision models and policies for nutrition intervention. This includes the opportunity to utilise mealtimes for delivering food and nutrition education, for example, through the concept of a pedagogical lunch.

Food-related infrastructure in primary schools can be used to deliver healthy and sustainable food education from a young age(1), though little is known about the presence and use of such infrastructure in primary schools. The aim of this study is to explore the use of physical infrastructure in healthy and sustainable food education in Australian primary schools. A quantitative cross-sectional online survey of primary school teachers undertaken between August 2022-July 2023 collected data about the presence and teaching-related use of food gardens, cooking facilities and food waste management systems in primary schools. Descriptive statistics were generated using Stata 17.0 statistical software. Participants were 239 teachers recruited via social media advertising and education/nutrition networks. The majority of teachers agreed that primary schools should have a food garden (n = 194, 81%), cooking facilities (n = 196, 82%) and a food waste system (n = 205, 86%) that can be used for teaching. Whilst three quarters of participants stated their school had a food garden (n = 181, 76%), just over half reported their school had cooking facilities (n = 130, 54%) or a food waste system (n = 131, 55%) that could be used for teaching purposes. More than 60% of participants reported they used such infrastructure within their teaching when it was available. Food waste systems were most commonly reported to be used more than once a week (n = 30, 33%) to teach students about food waste (n = 69, 77%), food sustainability (n = 65, 72%) and the environment (n = 63, 60%). Food gardens were most commonly reported to be used once a week (n = 33, 30%) to teach students about gardening skills (n = 97, 87%), the environment (n = 77, 69%), healthy eating (n = 67, 60%) and food sustainability (n = 67, 60%). Cooking facilities were most commonly reported to be used once or twice a term (n = 21, 23%) to teach students about food preparation and cooking (n = 71, 84%) and healthy eating (n = 62, 73%) and for tasting food (n = 55, 64%). From these findings we conclude that primary school teachers consider food gardens, cooking facilities and food waste systems to be important for delivering healthy and sustainable food education. Whilst food gardens appear to be common in Australian primary schools, there is variability in their use as an educational resource. Further variability exists regarding the presence and use of cooking facilities and food waste systems in primary school settings. There is future scope to (1) extend the presence of food-related infrastructure in primary schools; and (2) develop resources and training opportunities for teachers to support their use of such infrastructure in delivering healthy and sustainable food education for primary school students.

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

As concerns grow about the impact of animal farming on the environment, the appeal of plant-based diets has increased(1). The most extreme of these diets is the vegan diet which excludes all animal and insect sourced products. The vegan diet is often lauded as being beneficial for cardiovascular health, with the exclusion of saturated fats from animal meats, and the high intake of fibre from fruit and vegetables. More lately, however, there has been an exponential increase in the availability of vegan ultra-processed (UPFs), ready to eat foods which may not be so heart healthy. This study aimed to audit the vegan-labelled, plant-based meat and dairy analogues (PBMAs and PBDAs) available in New Zealand supermarkets. The objective was to compare the nutrient content against foods of animal origin that these products emulate. The audit was completed between March and June 2022 using a combination of on-site data collection and online sources. Data were collected from New Zealand’s five major supermarkets, Countdown, Fresh Choice, New World, Pak’nSave and Four Square. The audit recorded vegan and plant-based labelled products imitating animal meats (chicken, mince, beef, sausage, burgers, bacon, nuggets), and dairy (milk, cheese, yoghurt). Nutrient composition was taken from the Nutrition Information Panel (NIP) for each product and then a mean (SD) derived from a sample of each category. Nutrient composition for the comparison meat and dairy products was taken from NZ FOODFiles(2). All nutrients were reported per 100g or100ml. The PBMAs generally had higher energy, sodium and fibre, and lower protein than their meat counterparts. For example, plant-based burgers compared with beef burgers had 863kJ vs 761kJ energy, 436g vs 130g sodium, 2.3g vs 1.2g fibre, 15g vs 19g protein per 100g. Total fat and saturated fat were mostly lower in the meat products than in PBMAs, except for sausages. The plant-based milk analogues were lower in protein and fat than dairy milk, except soy (protein) and coconut (fat) milks. PBDAs were either completely lacking in calcium or were fortified to a similar level as dairy milk. Most plant-based cheeses and yoghurts were not fortified with calcium and were higher in energy, total fat and saturated fat than dairy. Vitamin B12 fortification of all plant-based products varied widely but contained less than meats and dairy. The wide range of plant-based UPFs included in this audit demonstrated little or no health advantage over animal derived meats and dairy products. The high salt and saturated fat content of these products suggest increased cardiometabolic risk if consumed as a regular part of the vegan diet despite higher fibre content.

Flexitarian, vegetarian and vegan diets are increasingly popular, particularly amongst young adults. This is the first randomised dietary intervention to investigate the health, wellbeing, and behavioural implications of consuming a basal vegetarian diet that additionally includes low-to-moderate amounts of red meat compared to one containing plant-based meat alternatives (PBMAs) in young adults (NCT04869163)(1). The objective for the current analysis is to measure adherence to the intervention, nutrition behaviours, and participants’ experience with their allocated dietary group. Eighty healthy young adults participated in this 10-week dietary intervention as household pairs. Household pairs were randomised to receive approximately three serves of beef and lamb meat (average of 390 g total cooked weight per person per week, flexitarian group) or PBMAs (350–400 g, vegetarian group) on top of a basal vegetarian diet. Participants were supported to adopt healthy eating behaviours, and this intervention was developed and implemented using a behaviour change framework(2). Diet adherence (eating allocated meat or PBMA, abstaining from animal-based foods not provided by researchers) was monitored daily, with total scores calculated at the end of the 10-week intervention period. Eating experiences were measured by the Positive Eating Scale and a purpose-designed exit survey, and a food frequency questionnaire measured dietary intake. Analyses used mixed effects modelling taking household clustering into account. The average total adherence score was 91.5 (SD = 9.0) out of a possible 100, with participants in the flexitarian group scoring higher (96.1, SD = 4.6, compared to 86.7, SD = 10.0; p < 0.001). Those receiving meat were generally more satisfied with this allocation compared to those receiving the PBMAs, even though a leading motivation for participants joining the study was an opportunity to try plant-based eating (35% expressed that that interest). Participants in both intervention groups had increased vegetable intake (p < 0.001), and reported more positive eating experiences (p = 0.020) and satisfaction with eating (p = 0.021) at the end of the 10-week intervention relative to baseline values. Behavioural methods to encourage engagement with the trial were successful, as participants demonstrated excellent adherence to the intervention. The flexitarian and vegetarian diets elicited different responses in adherence and eating experience. This holds relevance for the inclusion of red meat and PBMAs in healthy, sustainable dietary patterns beyond this study alone.

Fish and other seafood are a major component of New Zealanders’ diet; the 2018/2019 and 2019/2020 New Zealand Health Survey found that nearly three quarters of New Zealanders eat seafood at least once a week(1). Environmental and ethical factors influence New Zealand consumers’ purchase of seafood and consumers prefer to get their information about seafood at the point of purchase(2). However, environmental claims are not regulated under the Australia New Zealand Food Standards Code, unlike health and nutrition claims. Some seafood products are certified by programmes (e.g. Best Aquaculture Practice (BAP)), ensuring the seafood was sourced according to specific criteria related to environmental management, but other products carry self-declared environmental claims that have not been independently verified. This study aimed to describe labelling practices, including environmental claims, on fish and seafood packaged products sold in major New Zealand supermarkets and available in the 2022 Nutritrack database. Nutritrack is an annual survey conducted by trained fieldworkers who take photographs of all packaged food and beverage products displaying a nutrition information panel (NIP) from 4 major supermarkets in New Zealand. Information from the photographs, including the NIP and the ingredients list is entered into the Nutritrack database. For this study, data (including fish species, harvest location, processing country, fishing method, environmental certifications and self-declared environmental claims) were extracted from the archived photographs of all sides of the packaged fish and seafood products in the 2022 Nutritrack database. Self-declared environmental claims were assessed against the ISO 14021 standard for “Environmental labels and declarations — Self-declared environmental claims (Type II environmental labelling)” on specific criteria that were relevant for seafood products, including if the self-declared claim mentioned the word “sustainable” (as this term is difficult to substantiate and should be avoided); was vague and non-specific; or overstated the benefits (to imply multiple benefits from a single environmental change). There were 369 fish and seafood products included in this study. Eighty-eight products (23.8%) displayed a certification; the Marine Stewardship Council’s certification (MSC) for wild fish was the most common and was featured by 72 products (19.5%). One hundred and fifty-two products (41.2%) displayed at least one self-declared claim. Thirty-three distinct self-declared environmental claims were identified, 16 (48.5%) of which breached the ISO 14021 standard for environmental declarations because they used the term “sustainable” and 26 (78.8%) of which breached the ISO 14021 standard because they were vague. This analysis suggests that stricter regulation is needed for self-declared environmental claims on fish and other seafood products available for purchase in New Zealand, to prevent greenwashing and to provide consumers transparent, accurate and substantiated information.

Replacing dietary animal protein with plant protein has a positive impact on greenhouse gas emissions(1) and preventing death from chronic disease(2). Despite being ideally situated to re-design menus, foodservices in hospitals have not focused on changing protein sources(3). Implementation in hospitals requires cooperation from stakeholders across the foodservice system e.g., managers, dietitians, menu planners, purchasers, cooks. A qualitative descriptive study design using semi-structured interviews explored perspectives of hospital foodservice stakeholders on increasing the proportion of plant to animal protein in hospital patient menus and outlined actions required to do this. Interviews were based on participatory backcasting with a “desirable future” defined as hospital patient menus containing, on average, more plant-based protein foods (PBPF) (i.e., legumes, nuts, plant-based meat alternatives) than animal-based protein foods (ABPF) (i.e., beef, lamb, pork, poultry, fish, eggs, dairy) by the year 2050. Analysis was completed using a general inductive approach. Thirty-five stakeholders participated (foodservice dietitians n = 10; foodservice managers, n = 6; dietetic professional leads n = 4; chef/cooks n = 4; information technology n = 4; manager [contracts] n = 4; manager [other] n = 3). Most (n = 25) supported patient menu changes to increase the proportion of plant to animal protein foods, though all described barriers. Common concerns were that patients wouldn’t eat the meals (n = 32), that menu re-design would have a negative impact on protein intake and malnutrition rates (n = 30), and that cost of PBPF was too high making the change unfeasible (n = 25). Benefits were an improvement in the nutrition profile of the menu and subsequent improvement to health (n = 16), lower cost of legumes compared to meat (n = 10), improvements in greenhouse gas emissions (n = 10) and opportunity to use the menu as an education tool (n = 8). We developed a model describing the required actions which began with a trigger for change followed by a cyclical design process, preparation, implementation and monitoring. The cyclical design process included stakeholder consultation, setting a target, choosing a strategy, developing a menu and recipes, finding product, planning the system and operation, and checking it worked. Participants valued gradual changes and maintaining choice during the change process. When prompted about specific strategies, stakeholders were most supportive of replacing ABPF with PBPFs in familiar recipes or replacing entire menu items (n = 21), adding PBPF options (n = 25), and moving PBPFs before ABPF-based items on the menu (n = 22). Hospital foodservices and policy makers wishing to increase the proportion of plant to animal protein in hospital patient menus can use the process and actions identified to plan pathways and communicate these to stakeholders. Future research should explore strategies for increasing the proportion of plant to animal protein while maintaining some ABPF on hospital menus, and evaluating effects of changes uptake, cost, estimated greenhouse gas emissions, satisfaction, dietary intake and health outcomes.

Adolescence is an important life-stage during which shifts towards more healthy and sustainable diets can be promoted. Adolescents have increasing influence over their food choices informed by their developing personal knowledge and values, impacting long-term dietary behaviours into adulthood(1). We aimed to review the recent literature regarding adolescents’ perceptions of environmentally sustainable diets, and interventions to support adolescents to eat sustainably. We reviewed published literature that focussed on adolescent participants and their perceptions of, or interventions to support, sustainable dietary habits. Five electronic databases were searched to include studies published since 2012 that met the inclusion criteria. The JBI approach and PRISMA-Sc checklist(2) was used for source screening, data extraction and presentation of data. Data was extracted including study characteristics, methodology and results in relation to each research question. The extracted data was reported, synthesised and discussed in the context of the food system framework(3) and broader research. Twenty-eight articles were included in the review. Findings suggest that adolescents’ understanding of what constitutes sustainable eating is low. Most adolescents, when asked, were unsure of what constitutes sustainable eating, or a plant-based diet. The environmental impact of the production methods, transport and packaging of foods was most commonly reported when adolescents considered the environmental impact of their foods. The most commonly perceived barrier to consuming sustainable foods mentioned was cost, particularly by adolescents from lower socioeconomic backgrounds. Other barriers include unappealing taste, appearance or smell of ‘sustainable’ food items (particularly those that were vegetarian). Geographical limitations impacting the ability to grow or purchase local and organic products were also mentioned as barriers to consuming sustainable foods. Adolescents reported a lack of understanding of sustainable diets, and distrust of sustainability-related claims from fast-food outlets regarding the quality or source of ingredients, making it difficult to make informed food choices. Additionally, behaviours conflicting with personal and/or group norms were noted as barriers to adopting sustainable dietary habits. Adolescents that had previously received relevant education, valued nature and health, or were from a rural or indigenous community, were more likely to value environmentally sustainable food choices. Interventions which target adolescents’ cognitive understanding and aspiration to make sustainable food choices appear to improve their attitudes towards sustainable food, whereas interventions to increase the availability of sustainable foods improved the environmental sustainability of adolescents’ dietary intake. Multicomponent, tailored and community-based interventions were most effective however the long-term effect of these interventions remains unclear. More research is needed in diverse countries and settings, with consideration of adolescents’ level of autonomy in food choice and long term-effectiveness of interventions.

Based on the World Health Organization’s definition(1), sustainable healthy diets are “dietary patterns that promote all dimensions of an individuals’ health and well-being; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable”. Over the past decade, there has been an increasing interest in the environmental sustainability of diets, but little attention has been paid to the nutrient adequacy, consumer acceptability and affordability of such diets. Such knowledge is particularly scarce in New Zealand where approximately 40% of adults and 20% of children may live under severe to moderate food insecurity(2,3). The iOTA Model® is a dietary optimisation tool designed to fill this gap by bringing the various aspects of diet sustainability together and providing evidence-based knowledge on not just the environmental impact of food but also its economic and nutritional sustainability at a national level. The iOTA Model® was constructed using mixed integer linear programming by integrating New Zealand-specific dietary data. This underlying data was obtained from various open-access sources including but not limited to New Zealand’s Food Composition Database, New Zealand Total Diet Study and the nutrient reference values published by the Ministry of Health. Diet-related greenhouse gas emissions were also incorporated into the model based on the data obtained from the scientific literature. Results derived from the preliminary development of the iOTA Model® suggest that meeting nutrient adequacy is possible with minimal dietary pattern changes in New Zealand. It is also evident that adhering to dietary guidelines may provide 26% reduction in dietary greenhouse gas emissions. This is consistent with the findings of previous studies showing that following dietary guidelines alone assists reduction of dietary greenhouse gas emissions. Further features such as digestibility and bioavailability considerations have also been incorporated as part of the iOTA Model®, allowing for a more accurate estimation of nutrient supply. The model will be available as an open-access tool and will allow users to explore various sustainability implications of their diet.

Within rural Australia, only 47% and 9% of adults meet recommendations for fruit and vegetable intake, respectively, which is a leading contributor to the increased risk of non-communicable disease. Previous literature has identified barriers and facilitators to increasing fruit and vegetable intake in rural Australian settings, such as having greater access to fresh produce(1). However, this literature is limited by observing fruit and vegetables as a single food group and small sample sizes. This study aimed to determine the barriers and facilitators to meeting fruit and vegetable recommendations (as separate food groups) in rural Australian adults. It was hypothesised that barriers and facilitators to consumption of fruits and vegetables would be identified at the individual, social-environmental and physical-environmental levels of a socio-ecological framework and these would differ between fruit and vegetables(2). Data from the 2019 Active Living Census were used, completed in the Loddon Campaspe region of north-west Victoria, Australia. Data were available at the level of the individual (socio-demographic characteristics, health behaviours, education level, financial stability), social-environment (household size), and physical-environment (use of community gardens). Information on fruit and vegetable consumption was collected using two open-ended questions asking how many serves were consumed each day. Survey weighting was used to account for the survey design. Descriptive statistics were reported for continuous (mean and standard errors [SE]) and categorical (frequencies) data. Multivariate logistic regression analyses were used to determine odds ratios (OR) and 95% confidence intervals (CI) for meeting fruit and vegetables recommendations according to barriers and facilitators at the individual, social-environmental and physical-environmental level. A total of 13,464 adults with complete data were included in the analysis (51% female; mean age 48 (0.17) years). Mean fruit intake was 2.85 (0.02) serves per day and mean vegetable intake was 1.56 (0.01) serves per day. A total of 48% of participants consumed the recommended two serves of fruit daily, while 19% consumed the recommended five serves for vegetables. Multivariate analyses determined distinct barriers and facilitators to consumption between fruit and vegetables. For example, a larger household size facilitated meeting vegetable recommendations (OR: 1.41; 95% CI: 1.22, 1.63), but not fruit, and greater alcohol consumption was a barrier to meeting fruit recommendations (OR: 1.47; 95% CI: 1.31, 1.64), but not vegetables. Common facilitators across both fruit and vegetables included higher age, lower BMI, being a non-smoker, and engaging in more vigorous activity. The results of this research will help inform future policies to increase both fruit and vegetable intake in rural communities, therefore contributing to efforts to improve the health of rural Australians.

Cooking at home and eating together provide opportunities to improve family nutrition and promote healthy dietary habits. Commercial meal kit subscription services (MKSSs) (e.g. HelloFresh™, Marley Spoon™, EveryPlate™) may support parents to overcome obstacles to family meal provisioning and facilitate food literacy development. A gap exists in our understanding of how and why meal kits may elicit behaviour change, and opportunities to increase their behaviour change capability. This study aimed to examine the theoretical potential of Australian MKSSs to promote parental food literacy using the Behaviour Change Wheel (BCW)(1) and associated Theoretical Domains Framework (TDF)(1) and Behaviour Change Technique Taxonomy v1 (BCTTv1)(2). A one-week subscription was purchased for all Australian-based MKSSs (n = 9) and key meal kit components (subscription and meal planning features, meal kit delivery and website content) were coded using the retrospective application of these behaviour change frameworks. Parental food literacy-related behaviours were informed by a Food Literacy framework(3). Identified BCTs were mapped to the TDF using the Theory and Techniques Tool to identify theoretical mechanisms of action. The key meal kit components identified mapped to eight of the nine BCW intervention functions. These components primarily served the functions of enablement and environmental restructuring to support cooking at home. Thirty-five of the 93 possible BCTs were identified across the nine MKSSs reviewed, ranging from 19 to 29 BCTs per company, and linked to 13 of the 14 TDF domains. The most frequently identified mechanisms of action (TDF) targeted changes in motivation (n = 27) and capability (n = 19) to influence parental food literacy. Australian-based MKSSs incorporate a wide range of BCTs that target mechanisms of action associated with food literacy-related behaviours. These findings provide a strong theoretical evidence-base for the potential of commercial MKSSs to enhance parental food literacy. However, the extent to which these services may influence behaviour change or impact family food intakes is currently unknown. Therefore further research is required to evaluate the healthfulness and effectiveness of MKSSs.

Food cravings are one of several important complexities between psychological and physiological triggers for food consumption. Cravings are commonly cited as contributing to over-consumption of hyperpalatable foods (sugary, salty, and fatty foods) and may be causal in obesity(1). The Mediterranean dietary pattern (MedDiet) is linked to reduced disease risk and improved health and wellbeing(2). Despite a lower intake of sugary and salty foods compared to a Western diet, free-living adults switching to the MedDiet find it satiating and achieve high adherence in Western countries. The MedDiet is known to improve mood and wellbeing, is high in fibre, monounsaturated fat and low in added sugar, and has a low glycaemic load, which could separately and synergistically reduce food cravings. The relationship between adherence to the MedDiet and food cravings has never been investigated. In the MedLey randomised controlled trial, we investigated the effects of a MedDiet on food cravings, compared with a habitual Australian diet (HabDiet)(3). Adherence to the MedDiet was scored out of 15 (maximum adherence). Participants completed three food cravings questionnaires at baseline and 6-months. The State questionnaire measures momentary cravings and has a maximum score of 75, indicating maximum food cravings. The Trait-reduced questionnaire measures general cravings and has a maximum score of score of 126, indicating more frequent and intense cravings for foods. The Food Cravings Inventory (FCI) measures cravings for four food domains: fatty foods, fast foods, sugary foods, and high carbohydrate (CHO) foods. MedDiet group (n = 58) responses were compared with the HabDiet group (n = 53) across visits using linear mixed effects modelling. Predicted differences were obtained for adherence scores of ≤8 (median adherence) and ≥9. Means ± SD or CIs are presented. Mean adherence increased from 7.1 ± 1.8 to 10.7 ± 1.48 in the MedDiet group (P<0.01), with no change in the HabDiet group (P = 1.00). Trait-reduced scores were not significantly different between groups at 6-months (P = 0.11), although there was a 5.57-point reduction within the MedDiet group (CI −12.56, −1.96, P = 0.04). State score was significantly lower in the MedDiet group than the HabDiet at 6-months (−4.4 (CI −7.53, −0.39), P = 0.03), and was significantly lower than at baseline (−5.9 (CI −9.33, −0.24,) P = 0.04). There were no differences between groups for the four domains of the FCI (P>0.05). Cravings for sugary foods was significantly reduced within the MedDiet group (−0.26 (CI −0.46, −0.05) P = 0.01). The predictive modelling suggested moving from an adherence score of 8 to 9 was associated with lower cravings for sugar (−0.03 ± 0.01, P = 0.03), fast food (−0.04 ± 0.02, P = 0.02) and CHO foods (−0.05 ± 0.02, P = 0.02). These results are suggestive that higher adherence to a MedDiet could reduce cravings compared to the Australian diet and suggest that the MedDiet may specifically reduce sugar cravings. Further investigation is warranted, through observational and intervention trials.

When and what you eat can be linked to circadian preference (i.e., chronotype) and occupation (e.g., shift worker). Evening chronotypes, with a later circadian preference, tend to have meals later, distribute energy intake toward the end of the day(1), and more unhealthy eating habits than morning chronotypes(2); whereas night shift work is associated with later mealtimes and poor diet quality as a result of circadian disruption due to their work(3). What is unclear is whether chronotype influences the occupation-induced dietary patterns observed in shift workers. This study aimed to investigate associations between chronotype, temporal patterns of eating and diet composition in shift and non-shift workers. Adults from shift (SW) and non-shift (N-SW) populations were recruited. A Chrononutrition Questionnaire captured chronotype, duration of eating window (DEW), time of first eating occasion (FEO) and last eating occasion (LEO) while diet composition (energy, protein, total fat, saturated fat, carbohydrate, fibre, alcohol) was extracted from 7-day food diaries. Associations between chronotype and DEW/FEO/LEO, and between DEW/FEO/LEO and diet composition were determined by Spearman Rank Coefficients. 95 participants were enrolled (N-SW: n = 39; SW: n = 56); predominantly female (71%), morning chronotype (37%), on average 40.46 ± 15.08 years with BMI of 27.04 ± 5.77kg/m2. 84 returned food diaries. Later chronotype was positively associated with later times of FEO (N-SW: r = ,50, SW: r = ,69) and LEO (N-SW: r = ,63, SW: r = ,54) on free (non-work) days (p≤.002), and longer DEW (r = ,42) and later LEO (r = ,60) on workdays for non-shift workers (p<.01). However, there were no significant differences in diet composition by day/shift type between chronotypes across the study population. On afternoon shifts, longer DEW was associated with greater energy (r = ,60) and total fat intake (r = ,60) and later LEO with greater alcohol intake (r = ,59) (p<.05). On night shifts, a longer DEW was associated with lower alcohol intake (r=-.45, p<.05). Amongst non-shift workers, later FEO was associated with lower fibre intake on workdays (r=-.58, p<.001). Additionally, non-shift workers who were later chronotypes had later LEO, which on workdays associated with lower fibre (r=-.45) and alcohol intake (r=-.43); and on work-free days, associated with lower alcohol intake (r=-.45) (p<.05). Not surprisingly, evening chronotypes across the study population had longer and/or later eating windows on work-free days (i.e., free of constraints), as did non-shift workers on workdays, while the influence of chronotype on DEW, FEO, and LEO across shifts were less clear. Hence, for shift workers, occupation appeared to be a greater driver of temporal eating patterns than chronotype. Additionally, later eating times of evening chronotypes was not associated with negative diet composition. The exception was lower fibre intake amongst non-shift workers; but regardless of chronotype, shift workers may benefit from having a shorter and earlier DEW on afternoon shifts to minimise energy, fat, and alcohol intake.