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.

Approximately 40% of cancers in the UK are attributable to modifiable, lifestyle risk factors such as overweight and obesity and low dietary fibre intake(1). The WCRF and AICR published ten lifestyle- based Cancer Prevention Recommendations with the aim of reducing the risk of cancer and other non-communicable diseases(2). In the UK Biobank cohort, we have found reduced risk of cancer overall and of breast and colorectal cancers with greater adherence to these Cancer Prevention Recommendations (i.e., healthier lifestyles). The present study aimed to investigate whether the magnitude of these associations is modified by the presence of co-morbidities, such as diabetes and cardiovascular disease, at baseline.

We used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank prospective cohort study, recruited between 2006 and 2010 and free from cancer at baseline. Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations was calculated from dietary, physical activity, and body composition data using a standardised score(3). Multimorbidity (list of 43 chronic diseases) was self-reported at baseline and categorised into: 0, 1, 2, or 3+ chronic illnesses. Incident cancer cases were identified using population-based cancer registries available until July 2019 for England and Wales and October 2015 for Scotland. Participants were categorised into approximate score tertiles, and the lowest tertile (lowest adherence, 0-3.5 points) was used as the reference category. Cox proportional hazard models were used to investigate associations between total score and incidence of cancer, adjusting for confounders, and to test for an interaction between total score and multimorbidity.

55,191 (58%) participants had one chronic illness at baseline and 8,430 (9%) had ≥3. Mean total 2018 WCRF/AICR score was 3.8 (SD 1.0) points, and participants with the presence of chronic illnesses had a significantly lower total score (mean for ≥3 illnesses = 3.58 points vs 3.96 points for participants without chronic illness, p<0.001). During a median follow-up of 8 years, 3,303 individuals developed cancer. When investigating associations between score tertiles and the risk of cancer overall, there was a significant interaction between the total score and multimorbidity (HR for interaction: 1.59, p=0.002). There was also evidence for an interaction between total score and multimorbidity with breast cancer risk (HR for interaction: 1.23, p=0.030), but no evidence of an interaction between total score and multimorbidity for risk of colorectal cancer.

We found stronger associations between total adherence score and the risk of cancer in participants with ≥3 chronic illnesses. This suggests that the chemoprotective effects of greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may be particularly beneficial for individuals with multimorbidity.

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.

It is widely accepted that meeting recommended protein intake is protective of muscle mass(1). Insufficient intake is related to accelerated sarcopenia and impaired physical function, contributing to increased mortality and morbidity. The recommended target set by the American dietary guidelines is 0.8 g of protein per kg of body weight, based on data collated by the National Academies published in 2005(2). Currently approximately 50% of women and 30% of men do not meet these targets(3). It is of public interest to analyse current patterns of intake to allow for improved strategy through awareness of factors that impact protein intake.

To investigate the factors which determine an individual’s protein intake and how they can be used to predict daily intake.

A secondary data analysis of longitudinal data collected in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2020 has been carried out(4). Data was accessed from the public domain on the Centers for Disease Control and Prevention (CDC) website. The study protocol received approval from the research ethics review board of the National Center for Health Statistics (NCHS) of the CDC. Average protein intake has been calculated and participant demographics reported. STATA software has been used to carry out a bivariate regression of factors associated with protein intake, an adjusted multivariate regression analysis and a parsimonious model.

19601 participants (52.4% women) aged 20 and over had valid protein data. Adjusted regression analysis generated three model fits, with the parsimonious model excluding BMI categories and household income had a statistically insignificant impact on protein intake. Men consumed 23.99g more protein per day compared to women (p<0.001: 95% CI 23.09 to 24.89). Individuals over 65 consumed 13.92g less protein per day compared to those aged 20-35 years old (p<0.001: 95% CI − 15.25 to −12.59). Mexican American individuals consumed 7.47g more protein than Non-Hispanic White individuals (p<0.001: 95% CI 5.89 to 9.04) and Non-Hispanic White individuals consumed 2.95g more protein compared to non-Hispanic Black individuals (p<0.001: 95% CI 4.13 to 1.77). Those with the lowest educational attainment consumed 10.77g less protein compared to individuals with a college degree (p<0.001: 95% CI −12.79 to −8.74). From 2011 to 2020, there was a gradual decline in protein intake which is statistically significant when comparing 2011/12 with 2015/16 and 2017/2020.

Protein intake can be predicted by an individual’s gender, age, ethnicity, level of education attainment and time period. This study informs policymakers that individuals aged 65 and above are at risk of insufficient protein intake and there has been a general decrease in protein consumption over time. This provides evidence to support initiatives focused on this age category to maximise change and reduce rates of sarcopenia.

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.

1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) < −2 SD), thinness (BMI-for-age z-score (BAZ) < −2 SD) and overweight (BAZ > 1). Iron deficiency was defined as serum ferritin<15μg/L (<70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol<1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein >5 mg/L or α1-acid glycoprotein >1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.

Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.

Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.

Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.

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.

Parkinson’s Disease (PD) is a neurodegenerative disorder in which dopaminergic neurons of the substantia nigra, a region of the brain that controls movement, are lost over time (1). This results in motor symptoms, such as bradykinesia, and non-motor symptoms such as depression (2). Evidence- based resources and programmes utilising exercise for symptom management are widely available (3). However, despite emerging evidence showing that diet changes can improve quality of life and reduce disease severity (4), there are few dietary guidelines and programmes. This study aims to address a current literature gap in qualitative studies assessing the opinions of healthcare professionals (HCPs) towards diet and exercise in PD care, and to identify barriers and facilitators of this in care.

A qualitative design was used to assess the views and beliefs of HCPs. Semi-structured interviews were conducted via telephone, using a topic guide developed by the research team, consisting of 20 questions. The data were analysed using the six-phase process of Reflexive Thematic analysis to determine key themes in the data (5).

Five HCPs participated in this study. One main theme and two subthemes were identified. The main theme was that provisions of care and dietary advice are limited by a lack of knowledge of evidence- based, PD-specific, dietary guidelines. Subtheme 1 was that evidence-based exercise guidelines have been important facilitators in supporting care provision. Subtheme 2 was that lack of dietary guidance has been a barrier to optimum care provision and self-efficacy of HCPs.

HCPs were less likely to discuss diet, due to barriers including lack of available resources or knowledge thereof, self-efficacy to recommend dietary changes, time constraints in the clinic, and less well-established referral pathways for dietitians. HCPs were unaware of the influence of diet in PD treatment, despite diet’s impact on symptoms being discussed in clinic. However, HCPs agreed that evidence-based resources would benefit HCPs’ practice, to improve symptom severity and nutritional status of patients. Exercise was more likely to be discussed, as evidence-based guidelines and empirical understanding meant HCPs were more aware of the beneficial effects on symptoms.

While limited by small numbers, these findings suggest that a lack of knowledge, low self-efficacy, and time pressures mean that patients may not receive dietary guidelines which may be beneficial to their care. Self-efficacy of HCPs should be improved through PD-specific nutritional education, development and dissemination of PD-specific nutrition guidelines and resources. Future research should aim to determine the effectiveness of relevant dietary strategies’ in managing and caring for PD.

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.

Energy restriction is commonly used as body weight-loss interventions (1). However, it modifies secretion of gastrointestinal appetite hormones, which might be expected to upregulate appetite and thus impair the ability to comply with prescribed intervention(1). Supplementation with soluble fibre may potentially counteract this matter (2). This study aimed to investigate whether addition of β- glucan to energy and carbohydrate-restricted meals impacts postprandial responses of gastrointestinal appetite hormones and subjective appetite in overweight adults.

Twenty-three sedentary individuals living with overweight or obesity (age: 36 ± 8.5 years, BMI: 31.12 ± 4.04 kg/m2) participated in a double-blind randomised crossover study with two experimental arms, each lasting over two days. On day 1, participants consumed Counterweight PRO800 meal replacement shakes/soups for breakfast and dinner at home, each providing ~200 kcal and a carbohydrate-restricted lunch providing 35% of their habitual energy intake. On day 2, participants attended the metabolic investigation room where they consumed the same breakfast and lunch as on day 1. On both days, each meal was taken with either 3g β-glucan (Oat Well) or cellulose (Comprecel) as placebo. On Day 2, fasting and postprandial appetite scores were recorded, and fasting and postprandial blood samples were obtained for the measurements of plasma concentration of acylated ghrelin, PYY, and GLP-1. The study is registered at www.clinicaltrials.gov as NCT05981404.

Two-way ANOVA showed that the postprandial concentrations of acylated ghrelin (β-glucan arm, 383 ± 23 pg/ml; placebo arm, 428 ± 23 pg/ml, P=0.02, treatment effect) and composite appetite scores (P=0.003, treatment effect) were significantly lower and PYY concentrations (β-glucan arm, 132 ± 5 pg/ml; Placebo arm, 110 ± 4 pg/ml, P= 0.003, treatment effect) significantly higher in the β- glucan arm than in the Placebo arm. The concentrations of GLP-1 were not different between arms (β-glucan arm, 29 ± 1 pM; placebo arm, 28 ± 0.9 pM, P=0.36, treatment effect).

The obtained data suggests that consuming β -glucan with energy and carbohydrate-restricted meals can be expected to attenuate reduction in satiety and diminish increase in hunger. Therefore, supplementation with β-glucan during energy restriction intervention applied to body weight loss might lead to improve compliance and reduce discomfort of negative energy balance.

Obesity can increase the risk of diseases such as type 2 diabetes mellitus and cardiovascular disease(1). Glucose control is critical to both preventing and managing diabetes and can be achieved by enhancing secretion of insulin, limiting absorption of glucose from the gut and by upregulating the use of glucose in the muscles(2). Abnormalities in glucose management(3) and blood pressure control(4) are known to impair cognitive function. Epidemiological studies report an inverse risk of type 2 diabetes with increased intake of polyphenols. These data are also supported by in vitro and animal studies reporting positive effects of polyphenols on insulin sensitivity, carbohydrate digestion and glucose regulation(5). Here we aimed to evaluate postprandial glucose metabolism, blood pressure and cognitive function following a high carbohydrate meal accompanied by different doses of anthocyanin containing blueberry drinks.

A double-blind, placebo-controlled, dose-response study was designed and received ethical approval and 22 participants were recruited. Each participant attended four study days in a crossover design, separated by a minimum of 5 days during which, they consumed a high carbohydrate meal consisting of two slices of toast and one of three doses of blueberry beverage or a control beverage. Memory performance was assessed using the visual verbal learning test (VVLT), measured at baseline and 90 minutes post consumption. Glucose was monitored every 15 minutes using a continuous glucose monitor which was worn across 10 days, and blood pressure was assessed every 30 minutes for a period of 4 hours in the laboratory. Glucose area under the curve (AUC) were analysed using linear mixed models. Blood pressure and VVLT data were analysed using repeated measures ANOVA.

The analysis was performed blind to condition. In total, 22 participants completed all four study visits (mean age 28 ± 5.9, mean weight 61kg ± 10.4, mean height, 1.64m ± 0.9, mean BMI 22.7 ± 2.27, N=20 female, N=2 male). There was a significant effect of treatment on total words recalled in the VVLT with best performance following condition B compared to condition C, and condition D compared to condition C (p < 0.05). Condition B also resulted in significant systolic blood pressure lowering compared to condition C (-2.47mmHg, P <0.003). There was no effect of treatment on area under the curve for glucose over 3 hours postprandial (p > 0.05).

Taken together these results suggest that condition B conferred greatest benefit for memory performance and that this was associated with anthocyanin related effects on systolic blood pressure.

This study was funded by the Wild Blueberry Association of North America (WBANA).

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.

Carrot consumption reduces tumour development in several animal models. The constituent alpha- carotene has not by itself shown anti-cancer properties, however carrots typically provide >85% of alpha-carotene dietary intake(1-3), justifying its use as an indicator of carrot intake(3). We conducted a meta-analysis to investigate inverse associations of carrot/dietary α-carotene intakes and cancer risk, and to quantify potential dose–response relationships.

PubMed, Cochrane Library, Web of Science, Scopus, EBSCO, and JSTOR were searched (from database inception to August 2021) for studies reporting risk estimates with 95% CIs for the relationship between carrot intake or α-carotene and cancer risk. Meta-analyses were conducted using a random-effects model comparing highest and lowest intakes to estimate summary risk estimates (RRs).

Of 80 prospective studies included, 15 (with 25738 cases) reported data on carrot intake, 35 (26262 cases) on dietary α-carotene intake and 30 (9331 cases) on plasma α-carotene levels. A significantly (P<0.01) decreased risk of overall cancer was associated with carrot intake (RR = 0·90), dietary α- carotene intake (RR = 0·90) and plasma α-carotene (RR = 0·80). In addition, both carrot intake and plasma α-carotene level manifested linear dose-response relationships with cancer risk, with increasing carrot intake reaching 20% risk reduction at 5 servings (400g) per week (p < 0·0001),and successive 50μg/L increments in plasma α-carotene associated with 11% risk reduction (p < 0·0058).

Carrot consumption is robustly associated with decreased cancer risk. Carrot consumption should be encouraged, and the causal mechanisms further investigated.

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.

People with type 2 diabetes are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided Self-Help (GSH) is the recommended treatment for binge eating disorder (1), but there is currently a lack of evidenced treatment for binge eating in individuals living with type 2 diabetes.

The aims of this pilot study were to test the feasibility and acceptability of recruiting and delivering a 12-week, online psychological GSH intervention which has been adapted in an earlier study to the needs of adults with T2 diabetes and binge eating (2).

The intervention comprises GSH materials presented online in 7-sections delivered over 12-weeks, supported by a trained Guide. In total 22 participants were recruited in a case series design, through GP practices, NHS specialist weight management and diabetes services and via social media. Outcome measures were collected pre and post-intervention and at 12-week follow-up. The primary outcome was the Gormally Binge Eating Scale and secondary outcomes included eating disorder psychopathology, depression, anxiety, quality of life and HBA1C. Following the intervention, we conducted semi-structured interviews with 6 participants and 4 Guides. Data were analysed using a random intercept multi-level model.

Results showed at baseline that 67% of the sample met the criteria for moderate to severe binge eating (cut-off (≤17). At post-intervention there was a statistically significant reduction in self- reported binge eating on the Gormally binge eating scale with a reduction in mean score moving from 26.8 to 14.2, (t= -4.181, p < 0.001) and only 9% meeting criteria for binge eating. There were also notable improvements in anxiety, depression and quality of life scores, but not eating disorder psychopathology.

In the interviews both Guides and participants found the adapted online platform easy to use and the sessional support sufficient. They highlighted what a large commitment it was and therefore the importance of the Guide and working in ‘partnership’. The intervention appeared particularly suited to ‘stress eaters’, those experiencing ‘severe binge eating’ episodes and physical symptoms of diabetes. As a result of the intervention, participants reported ‘making broader lifestyle changes’, ‘improvements in their diabetes management’ and ‘confidence’. Guides found the training and supervision helpful but reflected on some ‘challenges with engagement’. On ending the intervention, participants requested ‘ongoing support’, such as an optional follow-up appointment and continued access to the materials.

In conclusion, the study shows preliminary evidence for online GSH tailored to the needs of individuals with T2D as a promising approach to improving binge eating, diabetes management, mental wellbeing and quality of life, however effectiveness evidence is needed.

Parallel to the escalating burden of obesity is the steadily increasing prevalence of metabolic dysfunction associated steatotic liver diseases (MASLD), a chronic condition that progresses from simple steatosis to advanced stages of steatohepatitis, fibrosis, and cirrhosis (1-2). MASLD, regarded as the hepatic manifestation of metabolic syndrome is known to be exacerbated by unhealthy lifestyle choices and the presence of comorbidities such as diabetes, dyslipidemia, and obesity (3-4). Therefore, early identification of the general population at risk of MASLD and the development of multicomponent interventions that can prevent the progression of liver damage and mitigate associated adverse cardiometabolic health outcomes are important. Our study aimed to evaluate the effects of a lifestyle modification program on glucose levels, lipid profile, liver function, and body composition measures in community-living adults with elevated hepatic steatosis index in Mumbai, India.

Adults (n= 231, mean age 46.1(13.7) years), 58.6% men) were screened for risk of MASLD using a non-invasive screening tool, Hepatic Steatosis Index (HSI) (calculated as (HSI)= 8 x (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus) (5). Eligible participants with HSI >36 (predictive of the presence of MASLD) were randomized to receive either a multicomponent lifestyle intervention (experimental group, EG) comprising weekly sessions of individualized dietary counseling (Participants having BMI >23kg/m2 (n = 36) received hypocaloric diets with 40% carbohydrates, 40% fat and 30% proteins (WLD) and those having BMI <22.9kg/m2 (n= 22) received weight maintenance diet (WMD) plans including 55% carbohydrates, 15% protein and 30% fats) and fortnightly group sessions of structured exercise and nutrition education or a standard of care package (control group, CG, n= 43) including general healthy eating and activity guidelines for the 8- week study duration. Paired t test and independent sample t tests were used to determine within and between group changes in variables from baseline to endline.

Trial Registration: This study is registered as CTRI/2022/05/042927.

Overall, the prevalence of MASLD was 52.2%, 32.8% were hypertensive, and 26.7% and 15.4% had diabetes and hypertriglyceridemia respectively. The intervention (WLD) resulted in decreased weight (mean (M)= 3.4 kg, standard error (SE) = 1.88 k, p = 0.02), body fat percent (M = 2.2%, SE = 1.1%, p= 0.042), serum triglycerides (M=28.8mg/dL, SE 8.5mg/dL, p<0.001) and AST (M= 3.8 U/L, SE= 2.2U/L, p <0.05) values. The WMD group reported improvements in serum cholesterol levels, and ALT/ AST ratio as compared to CG (p <0.001). In WMD, HDL-C increased from 45.8 mg/dl to 47.2 mg/dl and the mean AST values reduced from 28.8 (10.6) U/L to 25.6 (9.9) U/L, but these changes were not statistically significant.

Multicomponent lifestyle modification programs integrating diet, physical activity and education are effective strategies to improve liver outcomes and optimize cardiometabolic health in people with MASLD.

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.

Unhealthy dietary patterns stand as the foremost risk factor for noncommunicable disease- associated morbidity and mortality(1). As widely accessible healthcare providers, pharmacy professionals’ potential to catalyze improvements in public health nutrition is substantial, offering a means to combat the escalating epidemic of obesity and NCDs through tailored interventions, services, and education(2,3).

Our study employed a mixed-methods approach to assess the role of pharmacy professionals in promoting nutrition advice and healthy dietary practices.

An online questionnaire (N=200) was designed and conducted to evaluate pharmacy professionals’ nutrition knowledge, the advice given in various diet-related conditions (e.g. obesity, type 2 diabetes, cardiovascular disease risk factors, malnutrition, sustainable diets), practices in delivering diet- related guidance within their routine practice and perceived roles and future ambitions of pharmacy professionals towards nutrition counselling, yielding both quantitative and qualitative insights.

Subsequently, qualitative interviews and focus group discussions (N=19) were conducted, engaging pharmacists, nutritionists and dietitians to gather insights essential for the development of a comprehensive nutrition toolkit tailored for pharmacy practice.

These interviews delved deeper into the subject, with the goal of designing a nutrition toolkit that empowers pharmacists with the knowledge, tools, and resources needed to play a more active and impactful role in promoting nutrition and healthy lifestyle practices among their patients. Thematic analysis was conducted, and emerging themes and subthemes were identified.

Our findings indicate that a significant portion of participants in our study are involved in providing nutrition and diet advice for various health conditions. The majority of pharmacists considered diabetes programmes having a high level of importance (84%), followed by weight management services (78%), hypertension management (86%), and healthy diet campaigns (63.5%). However, our knowledge and confidence rating questions revealed a significant gap in training and a clear need for educational materials tailored for pharmacists to enhance their ability to provide nutrition advice effectively. Key themes identified in open-text questions were referrals and collaboration, training and education needs, wider needs (changes in the public health system, materials/resources, integration and implementation of nutrition in pharmacy practice) and perceived roles as pharmacists in providing nutrition advice (patient support, feeling responsible, specialised focus areas).

Qualitative findings underscore the pressing demand for nutrition training and education to deliver comprehensive services, as well as the necessity for collaborative efforts with dietitians and nutritionists to ensure effective care and the improvement of referral pathways in pharmacy practice.

This research contributes to the advancement of public health nutrition by recognizing the potential role of pharmacy professionals as key players in the dissemination of nutrition knowledge and fostering healthy behaviours within the community. The results will guide us in the collaborative development of a nutrition toolkit tailored for pharmacy practice, employing a co-design approach.