Up to 40% of dementia cases could potentially be prevented through targeting modifiable risk factors(1). South Asian communities are at increased risk for dementia, having an earlier onset and greater cumulative life-course exposure to dementia related risk factors(2). Research on dietary patterns, such as the Mediterranean Diet(3), has shown promise as a non-pharmacological strategy to reduce cognitive decline. Acculturation and the assimilation of dietary habits to that of the host country can mean that minority ethnic groups require tailored dietary advice to suit their needs(4). Therefore, cultural adaptation of dietary interventions is required to ensure that advice for brain health is culturally relevant. Research concerning which culturally adapted, or country-specific dietary interventions are brain healthy, is currently lacking. The aim of this research was to understand the perceived barriers and facilitators towards dietary change for dementia risk reduction among British South Asians.

Five focus groups were conducted with individuals of South Asian ethnicity (n =38) living in the North East of England. Patient and Public Involvement contributors from preliminary engagement activities supported recruitment from community and voluntary organisations. Data were transcribed and analysed using template analysis(4). This involved deductively analysing the data using relevant a-priori themes; pre-identified themes generated based on previous experience of the research team, and from a broad literature review.

Participants were aged between 26-82 years with the majority being female (n = 26, 68.4%), unemployed (n = 22, 57.9%), Pakistani ethnicity (n = 28, 73.7%), with an education level of college attendance or higher (n = 22, 57.9%). Themes identified included a lack of awareness of dementia, and the link between diet and dementia. Shame and stigma surrounding dementia was highlighted as a major issue that could influence willingness to engage in preventative strategies. Participants reported the main barriers to dietary change as: the influence of religious beliefs; issues with interpretation, accessibility, and lack of culturally appropriate resources; engrained dietary habits; time, cost, and convenience. Generational influences relating to differences in eating habits and awareness of healthy eating were highlighted as both a barrier and facilitator to behaviour change. Peer support strategies and the provision of practical, culturally sensitive dietary advice were viewed as facilitators.

This qualitative study highlights the need to increase awareness surrounding dementia prevention, specifically the role of diet, and to address this in a culturally sensitive way, that supports ethnic minority communities to improve their understanding and willingness to openly talk dementia. These findings will inform the development of a prototype for a dietary intervention, guided by the Medical Research Council guidance for complex interventions, and co-developed with the South Asian community, to explore how dietary advice for dementia prevention can be implemented in a culturally acceptable and feasible way in a community setting.

While adherence to a healthy diet is known to reduce dementia risk, the impact varies by diet type. This study examines the association between six dietary scores and dementia incidence.

In this prospective analysis, 210,269 participants aged 60 and above (mean age 64.1 years, 52.7% women) from the UK Biobank were included. Dietary adherence was assessed using six scores: Mediterranean Diet Adherence Index (MEDAS-14), Recommended Food Score (RFS), Healthy Diet Indicator (HDI), Mediterranean Diet Score (MDS), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), and a meat consumption index (MCI). Dementia incidence (allcause, Alzheimer’s, vascular, and non-vascular) was the primary outcome, analyzed using Cox proportional hazards models. The lowest quintile (low adherence) was used as reference group. Analyses were conducted using a 2-years landmark and adjusted for sociodemographic (age, sex, ethnicity and deprivation), lifestyle (physical activity, alcohol and smoking) and health-related factors (multimorbidity and BMI).

Among the participants, 4,151 developed dementia during the 8.9 years follow up. Those with the highest adherence to dietary patterns (Quintile 5) showed a reduced risk of all-cause dementia: 49% with MDS (HR: 0.51, CI: 0.42−0.62), 38% with MIND (HR: 0.77, CI: 0.60−0.99), and 19% with MEDAS-14 (HR: 0.81, CI: 0.64-1.00). No significant associations were found with HDI. Individuals reporting low meat consumption (<5 times a week) exhibited a 15% lower dementia risk compared to high meat eaters (≥5 times a week, HR: 0.85, CI: 0.77−0.94). No associations were observed with pescatarian or vegetarian diets. These patterns were consistent across both vascular dementia and Alzheimer’s disease.

Our findings suggest that higher adherence to certain healthy dietary patterns, particularly the Mediterranean and MIND diets, is associated with substantially lower risk of dementia. These findings emphasise the potential for achieving better brain health among older people by improving overall dietary pattern.

Dehydration during hospital stays is a significant concern, particularly affecting older adults(1). The ageing process associated with pathological changes and conditions such as dementia makes older adults especially vulnerable to both chronic and acute dehydration (1,2). Recent studies indicate that conventional signs and symptoms of low-intake dehydration may not consistently indicate its presence in older inpatients, leading to missed or incorrect assessments. It can result in significant morbidity through falls, constipation, delirium, respiratory and urinary tract disorders, and even death (2,3). Diagnosing low-intake dehydration at the early stage is challenging, leading to treatment delays which further compound the negative consequences of dehydration (1,3). There is a need to determine the scope and practice of detecting and managing low-intake dehydration in ‘Medicine for Older People’ (MOP) wards at University Hospital Southampton (UHS). The primary aim of this study was to explore the current practices and challenges in detecting and managing low-intake dehydration in older inpatients within the MOP wards at UHS.

Using a sequential, explanatory mixed-method design, a prospective chart review study (phase 1) was conducted at all the MOP wards at UHS over one month. The study included 50 adults aged 65 and above admitted to the medical wards for various reasons and now deemed ‘Medically Optimised for Discharge’ (MOFD). The quantitative aspect involved reviewing the completion of a local hydration assessment tool and the proper documentation of hydration and fluid balance charts for at-risk patients. The qualitative component (phase 2) consisted of semi-structured interviews with 10 participants—four doctors and six nurses with years of experience ranging from 4 to 12 years—to understand the perceptions of hospital staff on hydration care, its barriers and facilitators.

The quantitative phase found that all patients were at risk for dehydration and underwent assessment through the hydration risk assessment, with hydration chart reviews during early, late, and night shifts. 20% did not have hydration assessment within 24h of admission and there were some missing reviews during various shifts. Most 24-hour fluid balance sheets were not completed for patients in the red category (start 24-hour fluid balance chart). Qualitative findings revealed that staff had ‘(1) experiential knowledge of hydration understanding the risks of dehydration in older adults’, ‘(2) difficulty in dehydration assessment and diagnosis due to resources’ and ‘(3) challenges related to staff levels and skills’ as well as (4) patient attributes contributing to difficulty in dehydration assessment.

The mixed-methods study underscores the importance of addressing low-intake dehydration in older inpatients on MOP wards and highlights gaps in current practices. The findings emphasise the need for improved training, awareness, and standardised protocols to prioritise hydration care among healthcare professionals and provide optimal hydration care for older inpatients.

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.

The POWER study (NCT05688956) is a 12-week randomised controlled trial (ongoing) investigating the effectiveness of a novel protein-based oral nutritional supplement combined with an online resistance training programme for community-dwelling adults aged 70+ who require home care and are at risk of sarcopenia. Older adults reliant on home care are an understudied cohort acknowledged as vulnerable to sarcopenia(1) and malnutrition(2). This study aims to report the preintervention (baseline) functional status and dietary intake of older adults recruited to the POWER study.

Community-dwelling adults (≥70 y) living in Ireland receiving supportive home care and at risk of sarcopenia. Sarcopenia was screened for using the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire with a cut-off score of ≥1(3) (out of 10). Participants were recruited into the POWER study between July 2023 and January 2024. Data on participant demographic, nutritional status (anthropometric measures and 24-hour multiple-pass dietary recall) and muscle strength (handgrip strength (Jamar® dynamometer) and five times sit-tostand) were obtained during pre-intervention home visits. Dietary intake was analysed using NutriticsTM software (version 5.96). Intakes of protein and kilocalories were calculated as grams per kilogram body weight (g/kgBW) and as kilocalorie per kilogram body weight (kcal/kgBW) respectively. Statistical analysis was performed using RStudio (2023.06.2).

Seventeen adults aged 70+ were recruited over a 7-month period (12F, 5M; age range 71-87 years). Ten participants were receiving informal home care (i.e., from a relative) with seven receiving professional home care. All participants had a SARC-F score over 4, with a mean score of 5±1.3. Median BMI was 28.7 (range 17.1-36.2) kg/m2. One participant was underweight (BMI 17.1 kg/m2), five were overweight (BMI ≥24.9 kg/m2) and six were living with obesity (BMI ≥30 kg/m2). Using the Mini-Nutritional Assessment-Full Form (MNA-FF), nine participants were at risk of malnutrition (MNA-FF 17–23.5), and one was malnourished (MNA-FF =16.5). Mean intake of protein was 0.84±0.23 g/kgBW/day, with only two participants consuming ≥1.0 g/kgBW/day. Mean daily energy intake was 1,488 kcal or 17.0 kcal/kgBW. Time taken for five times sit-to-stand was 21±8 seconds (>15 seconds for five rises(4)) and handgrip strength was 15±6 kg (<16 kg for females(4)) and 21±12 kg (<27 for males(4)) for females and males, respectively.

Analysis of the pre-intervention data from the POWER study indicates that older adults at risk of sarcopenia are not meeting recommended daily protein intakes of 1-1.2 g/kgBW(5). Participants also demonstrated poor muscle strength. This highlights the need for a multi-component approach to support dietary intake and muscle strength in older adults reliant on home care.

Muscle strength and mass decline as we age, typically starting around 35–40 years, and can eventually lead to the development of sarcopenia(1). There are currently no effective drug treatments available for either the prevention or treatment of this condition(2) and whilst resistance exercise has efficacy(3) its effectiveness is limited due to issues with uptake and adherence(4). However, emerging research suggests that nutrition may offer a potentially effective approach to delay the age-related decline in muscle mass and function among older individuals(5), with LCn-3 PUFA emerging as a strong candidate.

The main objective of the current study was to perform a systematic literature review with the purpose of exploring the impact of long-chain n-3 polyunsaturated fatty acid (LCn-3 PUFA) relative to control oil supplementation on muscle strength, with secondary outcomes of muscle mass and physical function in older individuals under conditions of habitual physical activity/exercise.

The review protocol was registered with PROSPERO (CRD42021267011) and followed the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement(6). The search for relevant studies was performed utilizing databases such as PubMed, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2023. Randomized controlled trials (RCTs) in older adults comparing the effects of LCn-3 PUFA with a control oil supplement on muscle strength were included.

Five studies(7,8,9,10,11) involving a total of 488 participants (348 females and 140 males) were identified that met the specified inclusion criteria and were included. Upon analyzing the collective data from these studies, it was observed that supplementation with LCn-3 PUFA did not have a significant impact on grip strength (standardized mean difference (SMD) 0.61, 95% confidence interval [−0.05, 1.27]; p = 0.07) in comparison to the control group. However, there was a considerable level of heterogeneity among the studies (I2 = 90%; p < 0.001). As secondary outcomes were only measured in a few studies, with significant heterogeneity in methods, meta-analyses of muscle mass and functional abilities were not performed. Papers with measures of knee extensor muscle mass as an outcome (n = 3) found increases with LCn-3 PUFA supplementation, but studies measuring whole body lean/muscle mass (n = 2) and functional abilities (n = 4) reported mixed results.

With a limited number of studies, our data indicate that LCn-3 PUFA supplementation has no effect on muscle strength or functional abilities in older adults but may increase muscle mass, although, with only a few studies and considerable heterogeneity, further work is needed to confirm these findings.

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.

Alzheimer’s disease (AD) is the most common progressive central nervous system neurodegenerative disease globally(1). At present, the treatment of AD involves only symptomatic medications which have continually demonstrated little efficacy(2). Hericium erinaceus (HE), commonly known as lion’s mane mushroom, has not yet been fully utilised among western pharmacology for its medicinal purposes, demonstrating a possible omittance of a highly beneficial neuro-altering substance. To date, studies that have investigated the potential medicinal properties of HE have found that various neuroprotective effects are exerted when following consumption(3). The aim of this review is to systematically investigate the neuroprotective pathways impacted by dietary supplementation of HE, determine specific bio-compounds responsible, and highlight the importance of continued research to determine the true potential relevance of this therapeutic treatment for AD.

Electronic databases were systematically searched for studies investigating the relationship between HE and AD. For inclusion in this review, human studies must have been of a clinical design involving adults >30 years that are healthy, have mild cognitive impairment, probably AD or memory deficits. Animal studies were required to involve interventions that directly impact AD-related mechanisms. The exclusion criteria involved any observational studies that involved participants with other neurological implications, or any studies that noted existing interventions (i.e., medications, post-surgery, dietary intervention). A study quality assessment was conducted for all qualified studies using Cochrane RoB2 tools. Data extraction was undertaken according to PRISMA guidelines.

A total of 16 studies (including 3 human clinical trials and 13 animal model studies) met the criteria for inclusion. All studies included either behavioural, biochemical, ophthalmic, and neuroimaging assessments which demonstrated to be directly influenced by HE intake and highlighted key mechanisms previously associated with neurohealth promotion or neuropathological decline. Behavioural and biochemical clinical trial results revealed statistical differences (p < 0.05) between result comparison between HE and control groups and various week intervals. Animal model behavioural and biochemical assessments demonstrated positive findings. Histological assessments of AD-induced rodents following HE administration revealed statistically significant results (p < 0.05) in cholinergic transmitter and NGF concentrations, β-amyloid peptide plaque accumulation, and microglia and astrocyte activation compared to control groups.

Evidence suggests that an intake of HE, specifically the compound erinacine-A may be an appropriate and relevant candidate for the future therapeutic treatment for the prevention and delayed progression of AD. Application of HE demonstrated numerous improvements in AD-related behaviour, biomarker parameters, histological features, and physiological mechanisms while neuroprotective and neurotrophic properties were also clearly established. Nevertheless, the review highlights the necessity for continued research specifically human clinical trials to contribute continued evidence surrounding the use of HE for AD, to provide direction for future research and provide constructive methods for the possible future targeting of AD populations.

During weight loss the loss of body mass is associated not only with body fat reduction but also with a decrease in fat-free mass (FFM), related to the reduction in muscle mass and function(1). Supplementation with long-chain n-3 fatty acids (LCn-3 PUFA), in the absence of caloric restriction, results in a significant decrease in fat mass and an increase in FFM(2) along with improvements in muscle mass and strength(3). However, the impact of supplementation with LCn-3 PUFA during weight loss) remains unknown. Therefore, the aim of this study was to explore the effects of LCn-3 PUFA supplementation, in the form of Krill oil (KO), during alternate day fasting (ADF) on body weight, fat mass loss, FFM and muscle function changes in healthy overweight and obese adults.

A total of 41 men and women (age: 39.35 ± 10.4 years, BMI: 31.05 ± 4.2 kg/m2) completed the study (NCT06001632), in which they were randomised into either a KO or Placebo (PL) groups. Both groups carried out 8-weeks of ADF combined with intake of 4 g/day of the corresponding supplements. ADF involved consuming no more than 500 calories on the 'fast day’ and consuming food ad libitum on each 'feed day’. Data on body weight and body composition (TBF-300, Tanita, Manchester, UK), handgrip strength (Handheld Hydraulic Dynamometer, Vernier Jamar; England, UK), and time to conduct 5 repetition of chair rising test were obtained pre-and post-intervention. Changes from baseline within groups were assessed using paired samples t-test. Mixed analysis of variance (Mixed-ANOVA) was used to measure 2-way interactions between time and group to identify the differences between groups. All statistical analysis were conducted using IBM Statistical Package for the Social Sciences SPSS 28.0.

In both groups, body mass decreased significantly (KO:-4.7 ± 0.4kg, p<0.001; PL:-4.5 ± 0.4kg, p<0.001), along with a significant reduction in fat mass (KO:-2.4 ± 0.5kg p<0.001; PL:-2.3 ± 0.5kg p<0.001), and FFM (KO:-0.6 ± 0.2kg p<0.001; PL:-0.7 ± 0.2kg, p<0.001), with no differences between groups. In the PL group, there was a reduction in handgrip strength (-0.9 ± 0.7 kg, p<0.001), while there was no change in KO group (-0.2 ± 0.5 kg, p=0.1), with a significant difference between groups (p<0.001). In the KO group there was a significant reduction in time to conduct chair rising test (-1.8 ± 0.9s, p<0.05), with no change in the PL group (-0.3 ± 1.3s, p=0.2), with a significant difference between groups (p<0.001).

Supplementation with LCn-3 PUFA (4 g/day) during 8 weeks of ADF, applied to individuals living with overweigh and obesity, does not facilitate body or fat mass loss and does not diminish the reduction in FFM. However, it attenuated the reduction in muscle function in healthy overweight and obese adults.

This abstract was awarded the Student Competition Prize.

Periconception is the period spanning the weeks directly before and after conception and is a crucial window for optimising neurodevelopment in offspring(1-4). Iron and omega-3 fatty acids (n-3 FAs) are two vital nutrients for the development of the nervous system however, little research has been conducted into their importance during the periconceptional window(5-8). This study investigated whether supplementing iron and n-3 FA deficient (ID and n-3 FAD) rat dams before conception compared to after conception results in different neurodevelopmental outcomes in offspring. We hypothesised that initiating iron and n-3 FA supplementation in deficient dams after conception would not be as efficacious in preventing impaired offspring neurodevelopment induced by double- deficiency, compared to initiating supplementation before conception.

Female rats consuming an ID and n-3 FAD diet were randomly allocated to receive iron and DHA/EPA supplementation either 10 days before (Pre-Fe+DHA/EPA) or 10 days after conception (Post-Fe+DHA/EPA). Dams and offspring (Pre-: n = 24; Post-: n = 26) were subsequently maintained on supplemented diets throughout the experiment. Between postnatal days 31–41, cognitive and behavioural tests were conducted on offspring. Offspring were euthanised between postnatal day 42–45 and n-3 FAs, iron and monoamine concentrations were measured in the hippocampus, striatum and frontal cortex. All outcomes were compared to offspring who were either iron and n-3 FA deficient (ID+n-3 FAD: n = 24) or sufficient (Control+Fe+DHA/EPA: n = 22). One-way ANCOVA, with sex as a covariate, was used to determine between-group differences and two-way ANOVA was used to explore diet-sex interactions.

There were no differences in brain iron or n-3 FA levels between Pre- and Post-Fe+DHA/EPA offspring (P > 0.05). Female Post-Fe+DHA/EPA offspring had greater norepinephrine concentrations in the frontal cortex (Pre-: 3.21± 0.57 ng/mg vs Post-: 2.50± 0.55 ng/mg; P = 0.014) and consumed less sucrose in the sucrose preference test (Pre-: 96.16± 1.73%; Post-: 90.15± 1.66%; P = 0.010) compared to Pre-Fe+DHA/EPA offspring. Female Post-Fe+DHA/EPA offspring also had significantly lower liver iron concentrations compared to female Pre-Fe+DHA/EPA offspring (Pre-: 537± 47.13 μg/L vs Post-: 310± 45.28 μg/L; P = 0.034). There were no other significant differences in monoamine concentrations or behavioural tests.

Our results indicate that supplementing ID and n-3 FAD mothers both before and after conception is efficacious in preventing neurodevelopmental deficits associated with deficiency. However, ID and n-3 FAD during the periconceptional period may alter reward-based learning in female offspring(9-11). Additionally, optimising iron provision during periconception may have important implications for the prevention of postnatal ID-anaemia, particular during early infancy(12).

Chrononutrition studies the effect of timing, regularity and frequency of eating on body metabolism and health. Diurnal eating patterns may be obtained based on time-of-day and regularity and its association with health outcomes investigated in national representative samples(1,2).

In this study we focus on the Italian population over 50 and we aim to study how their sociodemographic characteristics, such as sex, civil and professional status, geographical area of residence, affect their energy intake at different times of the day.

We used INRAN-SCAI national representative survey conducted in 2005/2006(3), including sociodemographic information from questionnaires and 3-day-diet-diaries on 1317 over-50 subjects. The energy intake has been aggregated according to Italian dietary habits into 6 time-slots (6-9am/9am-12/12-3pm/3-7pm/7-10pm/10pm-6am). For each time-slot, we applied multilevel analysis including 3 levels (repeated measures within individuals, between individuals and due to specific sociodemographic strata), to estimate the respective components of intake variability. The third-level stratification resulted in 40 clusters based on sex, professional status, geographic region of residence and civil status. The study further applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)(4) to analyze how sociodemographic factors influence daily calorie intake, comparing two mixed effect models, one “null” model including also fixed effects of other potential confounders (age, smoking, alcohol, total intake) as well as the day of data collection, and one “main” model, which, additionally, included the main effects for the variables determining the strata.

In terms of fixed effects, results showed significant energy intake variations in energy at different time-slots, depending on the area of residence (on average 47 kcal less at breakfast and 164 kcal more at lunch in the South compared to North-West, p<0.001) and data collection day (122kcal more at lunch on the third day falling in the weekend, compared to first day in the week, p<0.001). Furthermore, people who worked (on average 29 kcal more at dinner) and those who didn’t live alone (26 kcal more at lunch) tended to consume more calories during some main meal times while those living alone were more likely to have out-of-meal eating patterns (13 kcal more at afternoon and night snacking times).

MAIHDA demonstrated that only dinner and night times had an intersectional effect, i.e. 56% and 86% percent of their variability respectively was not explained by main effects and was therefore attributable to the interaction among sex, region, professional and civil status.

Our study offered a detailed description of how selected social and demographic factors were related to dietary behaviors held during the 24-hours. The findings are critical for crafting tailored nutritional advice to help mitigate the health threats faced by an aging population. The analysis will be extended to more recent survey samples of the Italian population, when available.

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.

Sub-optimal status of one or more of the interrelated B-vitamins (folate, B12, B6 and riboflavin) is common among older adults1, and considerable observational evidence links low B-vitamin status (and/or elevated concentrations of the related metabolite, homocysteine) with a higher risk of agerelated diseases2,3. These nutrients are interlinked though their roles in one-carbon metabolism, but very few studies have investigated the major contributors to status of all four B-vitamins or the trends in B-vitamin biomarkers with advancing age. The aim of this study, therefore, was to investigate the contribution of fortified foods and supplements to dietary intakes and biomarkers of B-vitamins in older adults.

From a total sample of community-dwelling older adults (n = 5,186; ≥ 60 years) initially recruited to the Trinity-Ulster-Department of Agriculture (TUDA) study from 2008–2012, an eligible subset (n = 953) was re-investigated between 2016 and 2019. Dietary intake was assessed using a 4-day food diary (over four consecutive days) in combination with a food-frequency questionnaire. Mean daily energy and B-vitamin intakes were calculated using a customised version of the nutritional software package Nutritics (V.4). Non-fasting blood samples were collected at initial sampling and at follow-up to measure corresponding B-vitamin biomarkers. Statistical differences between categories of fortified food consumption and supplement use were assessed using ANCOVA (with adjustment for relevant covariates), while relationships between dietary and corresponding biomarker variables were examined using Pearson correlation coefficients.

As dietary intakes of fortified foods increased (from 0 to > 7 portions per week), biomarkers of each B-vitamin improved in a stepwise manner (P<0.001), and there was a corresponding decrease in plasma homocysteine concentrations (P<0.001), and the highest B-vitamin biomarkers were observed in those taking B-vitamin supplements. Although mean values for B-vitamin biomarkers generally compared favourably with normal ranges, deficient status of individual B-vitamins at initial sampling (2008 – 2012) was identified in: serum folate (8%), vitamin B12 (8%), vitamin B6 (8%), riboflavin (23%). Non-consumers of fortified food or supplements were at greatest risk of deficiency for each B-vitamin. Dietary intakes from foods were significantly correlated with corresponding biomarkers for serum folate (r = 0.458, P<0.001), plasma pyridoxal-5-phosphate (PLP; r = 0.192, P 0.002) and erythrocyte glutathione reductase activation coefficient (EGRac; r =−0.197, P 0.001), whereas no significant correlation was observed for vitamin B12 intake with status.

In conclusion, regular consumption of fortified foods is an effective means to improve intakes and status of folate and related B-vitamins, reduce homocysteine concentrations and lower the prevalence of B-vitamin deficiency. These results emphasise the importance of fortified foods and supplements in contributing to status and highlight potential opportunities for the food industry to develop a wider range of foods fortified with sufficient levels of B-vitamins to optimise status and support healthy ageing.

Gastrointestinal (GI) disorders are becoming increasingly common in young people in India and globally (1). Diet (eating habits, nutrient intake, and dietary diversity) and mental health (stress and anxiety levels) factors can independently and synergistically regulate gut health through dietary modulation of gut microbiota composition and gut-brain axis-related mechanistic pathways (2-3). However, few studies have investigated the associations between diet, mental health, and GI-related disturbances. Hence, this observational study was conducted to explore the possible effects of eating behaviors and stress and anxiety symptoms on self-reported measures of gastrointestinal health among 18-45-year-old adults in India.

A purposive cluster sampling method guided the recruitment of participants (n=407). Two non- consecutive day 24-hour diet recalls were conducted to estimate nutrient intakes and calculate Individual Diet Diversity (IDD) and Food Variety Scores (FVS). Gastrointestinal health was assessed using a validated instrument comprising 35 items related to gastric, small intestine, and colon function, and GI inflammation. Perceived Stress Scale (PSS-10 scores 0 to 40 with higher scores representing higher levels of stress), and Generalized Anxiety Disorder Scale (GAD-7 scores >5 (mild), >10 (moderate), and >15 (severe)) were used to evaluate perceived stress and anxiety (4-5). Socioeconomic status and eating habits were self-reported and the anthropometry measurements were recorded. Multivariable logistic regression analysis was performed using sociodemographic characteristics, anthropometry measurements, eating habits, and stress and anxiety levels as independent (predictor) variables, and composite gastrointestinal health risk scores as the dependent variables.

Participants reported mild anxiety (mean (M) = 7.09, standard deviation (SD)= 3.25) and moderate stress (M=18.44; SD= 9.89) with preponderance among females, higher age groups (> 35 years), and lower socioeconomic status. Overall, 38.8% and 45.3% were at high-risk score categories for gastric function and GI inflammation respectively. Higher energy and fat consumption, frequent breakfast skipping, and lower IDDS and FVS scores were associated with higher scores for stress and anxiety. Moreover, participants having moderate to severe anxiety reported a higher frequency of GI symptoms such as indigestion (M= 3.23 SD= 2.1-4.6, p= 0.023), excessive belching (M= 2.36 SD =1.21, p=0.043), and post-meal lower abdominal discomfort and cramps (M= 3.07, SD = 2.22, p < 0.001) as compared to those having nominal/mild anxiety. Age-adjusted regression models showed higher waist circumference (OR= 4.69, 95% CI =1.33- 7.28, p= 0.034), and stress scores (OR= 1.66, 95% CI= 1.32-1.90, p = 0.042), lower IDDS (OR= 2.34, 95% CI=1.80- 2.91, p <0.001) and presence of > 2 co-morbid conditions (OR= 8.12, 95% CI = 5.34- 11.21, p < 0.001) as predictors of higher GI disorder risk scores.

The preliminary findings of the study highlight associations between diet, stress, and GI health, presenting opportunities to modulate diet and optimize mental health to prevent and reduce the severity of GI disorders.

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.

Multiple-long term conditions (MLTCs), also known as multimorbidity, are commonly defined as the presence of two or more long-term medical conditions in one individual(1). More than half of all adults over 60 years are affected by multimorbidity worldwide(2) and its increasing prevalence demands a shift in focus for research and healthcare towards multiple clusters of disease, rather than single conditions(3).

Current epidemiological evidence on diet as preventative lifestyle factor in relation to MLTCs is limited(4). Therefore we reviewed the existing evidence to summarise methods of assessment of diet and multimorbidity measure to identify further research needs in a scoping review.

Medline, Embase, CINAHL, Web of Science and Scopus were searched systematically following the methodological approach for scoping reviews by PRISMA. The protocol was published on Open Science Framework under DOI10.17605/OSF.IO/9FP5D. The search yielded a total of 10,937 results. After de-duplication, title and abstract screening and a final inclusion round of in-text screening by two reviewers, 53 articles met the inclusion criteria. Observational studies were included if they examined the relationship between any dietary factor and the prevalence/or development of MLTCs in community-dwelling adults.

Publication dates of included research papers ranged from 2014 to 2023, with over half of studies published in the last three years. There was high variability between dietary assessment methods used: in the majority of studies (n=21, 39.6%) fruit and vegetable intake was the only diet-related variable reported. A priori diet quality scores were used in n=15 (28.3%) studies and n=6 (11.3%) studies used a posteriori approaches to identify dietary patterns, n=11 used other methods (20.8%). Only n=3 (5.7%) studies also focussed on micronutrients. MLTCs were generally defined as presence of ≥2 chronic conditions by most papers, however the number of qualifying conditions ranged from 2-60 conditions.

Overall, 60.4% (n=32) of studies were cross-sectional with various dietary components and patterns showing either mixed results, (n=10, 31.3%), no association (n=5, 15.6%) or inverse associations (n=12, 37.5%), i.e. higher diet score/adherence/consumption of diet components was associated with lower MLTCs, to positive relationships e.g. individuals with MLTCs consumed higher intakes of fruit and vegetables (n=5, 15.6%). Varying results were also found in longitudinal studies (n= 21, 39.6%). Some studies found inverse associations (n=8, 38.1%) i.e. higher adherence/more healthy food consumption was associated with lower MLTCs. However, other studies showed either no significant association (n=4, 19%), mixed results (n=5, 23.8%) or positive associations (n=4, 19.1%).

The evidence relating MLTCs to dietary intakes is relatively recent with most studies being reported within the last 3 years. Studies showed various outcomes and more detailed information is needed on the effect of dietary patterns and their compounds on the prevalence and development of multimorbidity. Following a standardized method of multimorbidity-quantification is highly important.

There is strong evidence that low muscle strength and muscle mass are associated with an increased the risk of mortality and morbidity.⟨1⟩ Muscle mass and strength progressively decline from around the fourth decade⟨2⟩, a process known as sarcopenia, for which there is no effective pharmacological treatment.⟨3⟩ Current literature indicates that resistance exercise and/or supplementation with n-3 fatty acids can be beneficial for muscle strength and mass in older adults.⟨4⟩ However, the sample sizes in these studies are relatively small and are restricted to only resistance exercise. The relationship between dietary n-3 fatty acid intake, rather than supplements, and general physical activity, rather than resistance exercise, and muscle strength and mass remain unknown. The aim of the current study, therefore, was to investigate the associations of n-3 fatty acid intake with handgrip strength and muscle mass indices in older adults. A secondary aim was to investigate whether these associations differed by physical activity status.

Analyses included 53,994 participants from the UK biobank study (25,773 men and 28,221 women). Participants were aged 60 years or older with complete data for outcome, predictor and covariate variables. Multivariable linear regression analyses were performed to explore the associations between n-3 fatty acid intake and grip strength index (kg/m²) and muscle mass index (kg/m²) in three separate models. All analysis were performed stratified by sex and physical activity status (active/inactive). Model 1 was adjusted for age, ethnicity, deprivation index and month of assessment. Model 2 was also adjusted for total energy intake and model 3 was also adjusted for multimorbidity count.

In model 3 there were positive associations between n-3 fatty acid intake and grip strength index in women with a 0.03 kg/m² (95% CI 0.00 to 0.06 kg/m²) higher grip strength index seen in those who were active and a 0.04 kg/m² (95% CI 0.00 to 0.08 kg/m²) higher grip strength index in those who were inactive for each additional gram of n-3 fatty consumed per day, with no associations in active (p = 0.355) or inactive (p = 0.186) men. In model 3, no association between n-3 fatty acid and muscle mass index were seen in men who were active (p = 0.981) or inactive (p = 0.331) and in women who were active (p = 0.843) or inactive (p = 0.058).

Although n-3 fatty acid intake was significantly associated with grip strength index in older women, regardless of their activity status, the magnitude of this association was very small and unlikely to be clinically relevant. Additionally, n-3 fatty acid was not associated with muscle mass index. Therefore, manipulation of n-3 fatty acid intake within the normal dietary range is unlikely to be an effective strategy to prevent and/or treat sarcopenia and n-3 fatty acid supplements are likely required.

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.