Recent studies have documented the importance of postprandial hyperglycaemia in the incidence of chronic diseases, including type 2 diabetes. Inhibition of digestive enzymes, including membrane-bound brush-border α-glucosidases, leads to slowed carbohydrate digestion and absorption, and reduced postprandial glycemia. Nuts are widely eaten around the world and have the potential to inhibit α-glucosidases through their content of polyphenols and other bioactive compounds. According to our recent systematic review(1), no study has investigated the inhibitory effects of nut extracts on human α-glucosidase activities. Almost all studies in this area have been conducted on yeast α-glucosidase, with only a few using rat α-glucosidase. While there is no sequence homology between yeast and human α-glucosidase, there is 74% to 78% sequence homology between rat and human α-glucosidases(1). The lack of studies on the effect of bioactive compounds from nuts on human α-glucosidases, along with the growing attention to nuts as an important component of a healthy diet with the potential to reduce the risk of chronic diseases(2), highlights the need for research to evaluate the inhibitory effect of nut extracts on human α-glucosidases. The aim of the current study is to explore the inhibitory effect of extracts from nuts on human carbohydrate digestive enzymes. Walnuts and almonds were ground and defatted with hexane, extracted in 80% (v/v) acetone, and further purified using solid-phase extraction to obtain phenolic-rich extracts. The Folin–Ciocalteu assay was used to approximate the polyphenol content of the samples. Following our recently published detailed protocol(3), cell-free extracts from human intestinal Caco-2/TC7 cells were used as a source of α-glucosidase in enzyme inhibition assays, with sucrose, maltose and isomaltose as substrates and appropriate controls. The assay products were quantified using high-performance anion exchange chromatography with pulsed amperometric detection (HPAEC-PAD). Glucose production in the presence of various concentrations of phenol-rich nut extracts was compared using a one-way ANOVA and half-maximal inhibitory concentration (IC50) values were calculated. The Folin–Ciocalteu data demonstrate that walnut extracts comprise a relatively high polyphenol content, with 18.1 ± 0.23 mg (epigallocatechin gallate [EGCG] equivalent) per gram of fresh weight, while almond extracts contain 0.87 ± 0.03 mg EGCG equivalent/g of fresh weight. The walnut phenolic-rich extract dose-dependently inhibited human intestinal sucrase and maltase activities (both p<0.01), with IC50 values of 1.67 mg/mL and 2.84 mg/mL, respectively. We demonstrate that phenolic-rich walnut extracts can inhibit human α-glucosidases in vitro and therefore walnuts may contribute to slowing carbohydrate digestion in humans. As such, we plan to assess the effects of walnuts on postprandial glycaemia in vivo.

Minerals and trace elements are essential for human health and wellness. Fruits can be an important dietary source of these micronutrients. For centuries, native Australian fruits have been a vital source of nutrition and well-being for the Indigenous Communities(1). However, comprehensive information on the mineral and trace element composition of these native fruits, including broad-leaved Geebung (Persoonia stradbrokensis), is lacking. Therefore, the aim of the present study was to determine the mineral and trace element composition of broad-leaved Geebung, an important but still underutilised native Australian fruit, at different maturity stages. Inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma-optical emission spectroscopy (ICP-OES) were used to analyse the fruit. Statistical analysis was performed using one-way ANOVA and the means (n = 3) were compared by Tukey’s multiple comparison post hoc test with p < 0.05 as significant. Calcium and potassium could be identified as the main minerals, and iron, zinc and manganese as the main trace elements. The calcium content in broad-leaved Geebung was lower than Australian desert lime, kakadu plum, and riberry, respectively (35.7-271.5 vs. 384.2 vs. 282.5 vs. 307.7 mg/100g dry weight (DW))(2). Potassium has a vital role in the prevention of bone loss and is essential for the heart, kidney, and blood pressure. The potassium content of broad-leaved Geebung fruit was lower than Australian desert lime, kakadu plum, lemon aspen, quandong and riberry (average 516.4 vs. 1287.8 vs. 1905.5 vs. 1512.9 vs. 3456.2 vs. 1715.7 mg/100g DW)(2), which contributes to approximately 15% recommended dietary allowance (RDA). Iron is the main element in the production of hemoglobin and is important for maintaining healthy blood. Iron content in the fruit ranged from 0.8-2.6 mg/100g DW, which was higher than that of Davidson’s plum (1.2 mg/100g DW), but lower than the Green Plum, Australian desert lime, and kakadu plum (3.8 vs. 4.7 vs. 4.0 mg/100g DW) (2,3). Besides, the manganese levels were relatively high in broad-leaved Geebung fruit and considerably higher than in other native Australian fruits such as Kakadu plums, Desert limes and Quandongs (11.2-26.4 vs. 3.5 vs. 0.9 vs. 0.3 mg/100 g DW)(2). Interestingly, the mineral and trace element content decreased (p < 0.05) during fruit maturity. In general, broad-leaved Geebung fruit can provide considerable amounts of essential minerals and trace elements and its potential as a healthy “snack” alternative should be investigated further.

Hot brewed coffee is the most popular hot beverage in the world, and its health properties have been published in the literature(1). Conversely, over the past decade, cold-brewed coffee has gained popularity, but its eventual nutritional properties are unclear. Both hot and cold brewed coffee produces over 6 million tons of spent coffee grounds (SCG) yearly disposed in landfills(1). Interestingly, studies have shown that SCG can improve several metabolic parameters via changes in the gut microbiome in obese and diabetic rats(2), and reduce energy consumption in overweight humans(3). However, studies investigating the nutritional properties of SCG are lacking in the literature. Hence, in this study, we aimed to identify, quantify and compare two main bioactive compounds in hot- and cold-brewed coffee as a beverage, as well as in the SCG. Samples from hot and cold coffee beverages and SCG were obtained from a local coffee shop (n = 3 per group). The coffee beans were composed of Coffea arabica from Papa New Guinea, Brazil, Ethiopia, and Colombia (in order from highest to lowest proportion). All samples were analysed by high-performance liquid chromatography and mass spectrometry (HPLC-MS). The analyses focused on two main bioactive compounds; trigonelline and chlorogenic acid (CGA). Statistical analyses were performed using an unpaired t-test with Welch’s correction and two-way ANOVA with Tukey’s post-hoc test (p<0.05). When compared to hot-brewed coffee beverages, cold-brewed coffee beverages have shown lower (p<0.05) levels of trigonelline (17.26 mg/g + 1.305 vs. 8.46 mg/g + 0.74, respectively) and CGA (9.82 mg/g + 0.93 vs. 5.31 mg/g + 0.48, respectively). In SCG obtained from hot-brewed coffee, a higher concentration of CGA was found (0.12 mg/g + 0.006), when compared to SCG obtained from cold-brewed coffee (0.10 mg/g + 0.03). However, trigonelline in cold-brewed SCG was found in higher (p<0.05) concentration, when compared to hot-brewed SCG (0.11 mg/g + 0.03 vs. 0.09 mg/g + 0.017, respectively). Moreover, hot-brewed coffee beverages showed higher (p<0.05) concentrations of trigonelline and CGA, when compared to hot-brewed SCG. Similarly, cold-brewed coffee beverages showed higher (p<0.05) concentrations of both bioactive compounds, when compared to cold-brewed SCG. Our results indicated that hot brewed coffee beverage contains high concentrations of bioactive compounds (CGA and trigonelline), which possibly explain its health properties. Although SCG obtained from hot and cold-brewed coffee showed lower concentrations of both bioactive compounds than coffee beverages, our results shed light on the possible health benefits of SCG consumption. In a world seeking more sustainable solutions, further studies investigating the potential use of SCG as a functional food are required.

Depression is the leading cause of disability worldwide(1). The microbiota-gut-brain axis may play a role in the aetiology of depression, and probiotics show promise for improving mood and depressive state(2). Further evidence is required to support mechanisms and in high-risk populations, such as those with sub-threshold depression (which may be 2-3 times more prevalent than diagnosed depression)(3). The aims were to assess the efficacy of a probiotic compared with placebo in reducing the severity of depressive symptoms in participants with subthreshold depression, and to investigate potential mechanistic markers of inflammatory, antioxidant status and stress response. A double-blind, randomised, placebo-controlled trial was conducted in participants meeting diagnosis of subthreshold depression (DSM-5); aged 18-65 years; ≥18.5 kg/m2 body mass index; not taking antidepressants, centrally acting medications, probiotics nor antibiotics for at least 6 weeks. The probiotic (4 × 109 AFU/CFU, 2.5 g freeze-dried powder containing Lactobacillus fermentum LF16 (DSM26956), L. rhamnosus LR06 (DSM21981), L. plantarum LP01 (LMG P-21021), Bifidobacterium longum BL04 (DSM 23233)) or placebo was taken daily for 3-months. Data was collected at 3 study visits (pre-, mid- (6 weeks), post-intervention). Self-reported questionnaires measured psychological symptoms (Beck Depression Inventory, BDI; Hospital Anxiety Depression Scale, HADS) and quality of life. Blood and salivary samples were collected for biomarkers including cortisol awakening response (CAR). General linear models examined within-group and between-group differences across all time points. Thirty-nine participants completed the study (n = 19 probiotic; n = 20 placebo) using intention-to-treat analysis. The probiotic group decreased in BDI score by −6.5 (95% CI −12.3; −0.7) and −7.6 (95% CI −13.4; −1.8) at 6 and 12 weeks, respectively. The HADS-A score decreased in the probiotic group by −2.8 (95% CI −5.2; −0.4) and −2.7 (95% CI −5.1; −0.3) at 6 and 12, respectively. The HADS-D score decreased in the probiotic group by −3.0 (95% CI −5.4; −0.7) and −2.5 (−4.9; −0.2) at 6 and 12 weeks of intervention, respectively. No between group differences were found. There were no changes in perceived stress or quality of life scores. The probiotic group had reduced hs-CRP levels (7286.2 ± 1205.8 ng/dL vs. 5976.4 ± 1408.3; P = 0.003) and increased total glutathione (14.2 ± 8.9 ng/dL vs. 9.3 ± 4.7; P = 0.049) compared to placebo, post intervention. Lower levels of CAR were found in the probiotic compared to placebo (−0.04 ± 0.17 μg/dL vs. 0.16 ± 0.25; P = 0.009). A significant reduction in depressive symptoms and anxiety was observed within the probiotic group only. These results were supported by improvements observed in biomarkers, suggesting probiotics may improve psychological wellbeing in adults experiencing sub-threshold depression, by potential pathways involved in central nervous system homeostasis and inflammation. Future analyses are required to understand changes within the intestinal microbiota and to clarify how their metabolites facilitate emotional processing.

Supermarkets have been described as having unprecedented and disproportionate power in the food system, influencing population diets through the products they have for sale, their price, store layouts, and other marketing activities(1).There is growing evidence to suggest that changing the retail food environment to be more health-enabling via in-store interventions is possible. The purpose of this study was to review the available high-quality evidence reporting on the effectiveness of real-world supermarket-based interventions on improving the healthiness of consumer purchases and consumption. First, a systematic search across seven electronic databases was completed in April 2023 to identify reviews describing the effects of intervention strategies that aimed to improve the healthiness of consumer purchasing in supermarkets and grocery stores (overview of reviews). The methodological quality of reviews was assessed using the Risk of Bias In Systematic Reviews for systematic and scoping reviews, and the Scale for the Assessment of Narrative Review Articles for narrative reviews. Review findings were synthesised narratively. Next, high-quality, primary studies from these reviews were further inspected (review of primary studies). In-store interventions were categorised by strategy type(2), and outcome effects were coded as effective (positive/promising), ineffective or mixed/unclear(3). Results were synthesised narratively, and separately for population subgroups. Thirty-eight reviews published between 1989 and 2023 met the inclusion criteria. Most were systematic reviews (n = 29, 76%). The number of primary studies included in reviews ranged between eight and 211. Prompting (n = 19, 50%) and pricing (n = 15, 40%) were the most assessed strategy type, either alone or in combination with another strategy. From the overview of reviews, pricing strategies appeared to be the most promising at improving consumer purchasing. Twenty-three high-quality primary studies met the inclusion criteria for further review. In most studies (n = 21, 91%), the goal was to increase sales of healthy products, most commonly fruit and vegetables, or products with a higher nutritional ranking. Only two studies (9%) aimed to exclusively reduce sales of unhealthy/less healthy products. Promotion was the most assessed strategy type (n = 11, 48%), either alone or in combination with another strategy. Common promotion strategies included providing education to customers about the health benefits of selected products, offering samples of products and giving food demonstrations. From the review of primary studies, promotional strategies used in combination with another strategy appeared to be most successful in the general population, and pricing was successful in subgroups of the population, including socioeconomically disadvantaged individuals, and those living in regional/remote areas. Overall, the evidence reviewed shows that the implementation of health-promoting supermarket interventions are more likely to be successful if they include a substantial pricing initiative (particularly for some subgroups), or the inclusion of promotion in combination with another strategy.

Food environments surrounding secondary schools are a known influence on the purchasing and consumption habits of adolescents(1). Understanding their obesogenic potential is important for informing strategies to create more healthful food environments for adolescents, particularly for those living in regional areas, and is a key component of Australia’s National Obesity Strategy(2). This repeated cross-sectional study examined the food environment surrounding secondary schools in regional and metropolitan New South Wales from 2007-2023. Google Street View was used to collect data regarding food outlets within a walkable distance (1.6 km) of all secondary schools in Wagga Wagga and Blacktown, our regional and metropolitan case study areas respectively, over 17 years. A Food Environment Score(3) tool was used to characterise the healthfulness of food environments by categorising food outlets into Food Outlet Type categories (e.g. Cafés, Fast-Food Franchises, Restaurants etc.) and Healthfulness categories (“Healthful”, “Less Healthful”, “Unhealthful”). Descriptive statistics were used to characterise changes in the food environments by Food Outlet Type and Healthfulness categories from 2007-2023. Chi-Squared tests were used to determine any significant differences in the proportion of healthful, less healthful and unhealthful food outlets between the regional and metropolitan study areas and between 2007 and 2023 in both areas. In both Wagga Wagga and Blacktown, the most common food outlet types surrounding secondary schools from 2007-2023 were classified as less healthful or unhealthful. As of 2023, less healthful food outlets [restaurants (19.4%), cafes (16.8%)] and unhealthful food outlets [fast-food franchises (15.1%), independent takeaway (14.1%)] were the most common food outlet types in Wagga Wagga, making up 52% and 36% of all identified food outlets respectively. These outlet types have remained the most prevalent over the 17-year period, though restaurants and cafes have since surpassed fast-food franchises and independent takeaway stores, by proportion, which were the most common in 2007. Similarly in Blacktown, 2023, less healthful [restaurants (21.1%), cafés (11.1%)] and unhealthful [fast-food franchises (17.4%)] were the most common food outlets, making up 41% and 37% of all identified food outlets. Restaurants, cafés and fast-food franchise outlets were consistently observed to be the most prevalent in Blacktown food environments over the 17-year study period. No significant difference was found when comparing the healthfulness profiles of regional and metropolitan food environments nor were significant changes observed between 2007 and 2023 in Wagga Wagga and Blacktown (p > 0.05 for all). The prevailing high proportion of less healthful and unhealthful food outlets near secondary schools in regional and metropolitan areas upholds the need for public health policies and planning strategies to address the obesogenic potential of school food environments.

Publicly-funded healthcare facilities in Australia(1) and New Zealand(2) have adopted healthy food and drink policies to enable staff and visitors to choose and consume healthier options. However, adopting such policies does not translate to their full implementation and compliance by food providers, who face barriers to providing healthier food and drinks(3). As part of the wider HealthY Policy Evaluation (HYPE) study, we interviewed hospital food providers and public health dietitians/professionals to understand their experiences implementing the voluntary National Healthy Food and Drink Policy introduced in New Zealand in 2016. Semi-structured interviews focused on the awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. All semi-structured interviews were transcribed verbatim, inductively coded with the assistance of QSR’s NVivo software, and analysed using the reflexive thematic analysis method by Braun and Clarke(4). Twelve participants from across New Zealand were interviewed. Time in their roles ranged from one to 14.5 years, and many were not in the position when the Policy was first adopted. There was a discrepancy in the awareness of the voluntary Policy. However, there was agreement that hospitals should be healthy eating role models for the wider community. Reflexive thematic analysis identified three themes relating to the implementation of the Policy in New Zealand: 1) complexities of operating food outlets under the Policy in hospitals; 2) adoption, implementation and monitoring of the Policy as a series of incoherent ad-hoc actions; and 3) the Policy as (currently) not achieving the desired impact. Participants recognised that the current food supply, presence of food outlets nearby hospitals serving unhealthy foods and culture of unhealthy eating, combined with the difficulty of changing people’s eating habits, leaves doubts if the Policy and healthier options served in the healthcare facilities have any tangible positive impact on staff or visitors. Key suggestions to promote successful Policy implementation included adoption of a mandatory National Policy, funding of central government support for implementation (including supportive implementation tools), regular and systematic monitoring of food availability in each region, and frequent and ongoing communication with staff and visitors using positive messaging around healthy eating and non-health related benefits (e.g. sustainability) to increase their buy-in. Findings from stakeholder interviews and the remaining parts of the HYPE evaluation study are informing the update of the National Policy and associated supportive tools, and highlight the potential positive impact a comprehensive policy evaluation could have on improving policy implementation.

Availability of ultra-processed foods is likely to be high in the Pacific(1) however, information on consumption is limited. This study aimed to assess consumption levels and dietary sources of ultra-processed foods (UPFs) in a population of adults in the Central Division of Fiji. A random sample of 700 adults was selected from two statistical enumeration areas (one semi-urban, one rural) in Fiji. Participant characteristics were collected, along with a three-pass 24-hour diet recall. Foods consumed were coded based on level of processing, in alignment with the NOVA categorisation system (1 = unprocessed, 2 = minimally processed,3 = processed and 4 = ultra-processed). UPF contribution to total energy, salt, fat, and sugar intake were estimated. Main sources of UPFs were then estimated by food group. 534 adults participated (76% response rate, 50% female). Preliminary results suggest that UPFs contributed 21.5% (%95 CI, 19.5% to 23.4%) of total energy intake. Further, UPFs contributed to 22.8% (%95CI 20.5% to 25.1%) of total salt intake, 24.0% (%95 CI, 21.4% to 26.6%) of fat intake and 18.6% (%95 CI, 16.5% to 20.7%) of sugar intake. UPFs contributed over 20% of total energy intake in this sample of Fijian adults and over 20% of salt, fat, and sugar. Messages and interventions that encourage consumption of minimally processed foods while reducing consumption of UPFs are likely needed to improve the healthiness of diets.

Healthy eating is a struggle for many families in New Zealand when they cannot adequately afford food. Statistics New Zealand has shown that the food price index rose 12.5 percent over the past year with an increase of 22 percent for fruit and vegetables prices(1). Food prices now rate as the number one concern for New Zealanders(2). To understand the changes households are making in response to increasing food prices 109 main household shoppers were surveyed. The survey was administered via Qualtrics in May/June 2023. Participants were recruited via social media and by direct email from researchers and Heart Foundation staff. Survey participants were asked about food prices, shopping behaviours and changes within specific food categories. Two thirds of the participants were female. The predominant age groups were 20-29 years (29%) and 60 and above (28%). The major ethnicities were European (53%), Pasifika (20%) and Māori (8%). Around 46% of people lived in Auckland with the next highest area being Nelson (and wider Tasman). The results showed 85% of participants expected food prices to get worse over the next year. To manage rising food prices 70% people had changed where they shopped or how they accessed food, 90% changed what they buy and 67% had changed the way they eat (e.g., cooking more at home). The most substantial changes were in the fruit and vegetable category where people changed the types purchased (73%) and purchased less (63%). In many food categories buying cheaper brands, in bulk and when foods were on special were common responses. Rationing or going without was a consistent theme highlighted with meat/poultry, eggs, fish, alcohol and more expensive snack foods. The implications for the Heart Foundation’s work include (1) reinforcing the importance of fruits and vegetables in the diet and to provide tips and tools around ingredient substitution, (2) promote alternative protein sources (e.g., beans and legumes) as an affordable ingredient and recipes to support their use and (3) supporting companies to improve the composition of cheaper brands through food reformulation. With this being a small sample size, it may not be fully generalisable to the entire population however given the survey found a high percentage of people making changes it does indicate the important role health agencies can play providing information, and advice to support people to manage high food prices.

Unhealthy food environments are major drivers of obesity and diet-related diseases(1). Improving the healthiness of food environments requires a widespread organised response from governments, civil society, and industry(2). However, current actions often rely on voluntary participation by industry, such as opt-in nutrition labelling schemes, school/workplace food guidelines, and food reformulation programmes. The aim of the REFORM study is to determine the effects of the provision of tailored support to companies on their nutrition-related policies and practices, compared to food companies that are not offered the programme (the control). REFORM is a two-country, parallel cluster randomised controlled trial. 150 food companies were randomly assigned (2:1 ratio) to receive either a tailored support intervention programme or no intervention. Randomisation was stratified by country (Australia, New Zealand), industry sector (fast food, other packaged food/beverage companies), and company size. The primary outcome is the nutrient profile (measured using Health Star Rating [HSR]) of foods and drinks produced by participating companies at 24 months post-baseline. Secondary outcomes include company nutrition policies and commitments, the nutrient content (sodium, sugar, saturated fat) of products produced by participating companies, display of HSR labels, and engagement with the intervention. Eighty-three eligible intervention companies were invited to take part in the REFORM programme and 21 (25%) accepted and were enrolled. Over 100 meetings were held with company representatives between September 2021 and December 2022. Resources and tailored reports were developed for 6 touchpoints covering product composition and benchmarking, nutrition labelling, consumer insights, nutrition policies, and incentives for companies to act on nutrition. Detailed information on programme resources and preliminary 12-month findings will be presented at the conference. The REFORM programme will assess if provision of tailored support to companies on their nutrition-related policies and practices incentivises the food industry to improve their nutrition policies and actions.

The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet is recommended as a first line therapeutic management strategy for irritable bowel syndrome (IBS)(1). The low FODMAP diet is supported by meta-analytical evidence(2), and demonstrates acceptability and effectiveness for improving symptoms and quality of life (QoL) in 50-75% of individuals with IBS. However, a subset of individuals (25-50%) do not respond to the diet(3). The identification of individual-level predictors of treatment response across all three phases of the low FODMAP diet is currently lacking. The study aims were to assess psychological predictors of symptom and QoL response to the low FODMAP diet in patients with IBS. Adults with IBS underwent a three-phase low FODMAP diet, guided by individualised dietetic education. Predictor variables included levels of depressive, anxiety, and extraintestinal somatic symptoms, stress, treatment beliefs and expectations, behavioural avoidance, and illness perceptions. Symptom severity and QoL were the main outcomes. Questionnaires assessing psychological predictors, symptoms and QoL were administered at five points: pre-dietitian (week 0), post-dietitian, end of elimination (week 5), end of reintroduction (week 13), and end of personalisation (week 25) phases. Latent class growth analysis was used to identify classes of response trajectories for symptoms. Linear mixed models were used to test the effect of baseline psychological scores on symptoms and QoL over time. Cross lagged panel models determined the directional predictive relationship between psychological predictors and symptom severity. 112 participants (89% F) median age 30 ± 17 years were included. There were three classes of symptom response trajectories, including ‘non-improvers’ (21.3% of participants) with high initial symptom severity and minimal improvement, ‘improvers’ (22.5% of participants) with low initial symptom severity and significant improvement, and an ‘intermediate’ group (56.2% of participants) with moderate initial symptom severity and significant improvement. Higher treatment beliefs predicted a stronger initial symptom response (effect on linear slope p = 0.036). Lower gut-specific anxiety, as well as higher levels of personal and treatment control at baseline predicted a stronger reduction in IBS symptom severity and improved QoL from week 0 to week 25. Participants with higher levels of baseline psychological symptoms and negative illness perceptions (i.e., lower emotional representations) predicted a stronger initial and later QoL response (effect on linear (p = 0.006) and quadratic (p = 0.049) slopes). Increased cyclical time beliefs predicted poorer initial and later QoL response (effect on linear (p = 0.015) and quadratic (p = 0.029) slopes). Individuals experiencing lower to mid-range symptom severity at baseline had greater improvement with the low FODMAP diet. Lower anxiety, positive illness views and higher treatment beliefs predict better QoL and symptom response. Personalised strategies are crucial for optimising low FODMAP diet effectiveness in IBS.

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically-refractory ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Whilst quality of life is generally good, as many as 83% of patients associate dietary factors with the onset of symptoms(1) and around two-thirds employ some form of dietary restriction post-pouch creation(2,3). There is growing interest to understand the role of diet (as a whole) on pouch function and how it can be used therapeutically. It is imperative that we know the dietary characteristics of pouch patients before attempting to introduce strategies altering their food choice. Since there is good rationale to assess overall diet quality to identify potential avenues for targeting dietary strategies, this study aimed to examine the frequency of perceived food intolerances and diet quality in patients with an ileoanal pouch and the relationship between these two indices. In this cross-sectional study, patients with an ileoanal pouch completed a food intolerance questionnaire and a validated 297-item semi-quantitative food frequency questionnaire (Monash Comprehensive Nutritional Assessment Questionnaire). Dietary data was used to score diet quality using the 2013 Dietary Guidelines Index (DGI), a scoring system which compares how closely an individual’s dietary intake aligns with the Australian Dietary Guidelines (ADG). The DGI also comprises of 11 subcomponents (scored out of 10 respectively) based on each of the ADG guidelines and provides a total score of 110, with higher scores reflecting greater compliance to the ADG. In order to determine if perceived dietary intolerances was negatively associated with the intake of specific dietary factors, univariable and multivariable linear regression analysis of the correlation of intolerance and diet quality was performed. Of the 58 (10 FAP and 48 UC) patients studied, 81% of UC and 80% of FAP patients reported dietary intolerances. Mean total DGI score was 78 (95% CI: 74-80) of 110 in the overall pouch cohort with no differences across pouch sub-groups. However, only 5% of patients achieved a full score for food variety. Both uni- [OR −0.94 (−1.7,-0.10); p = 0.02] and multivariable analysis (adjusting for age and sex) showed that only intolerances to dairy products were associated with reduced intake of lactose-containing dairy [OR −0.29 (−1.8,-0.08); p=0.03]. No other significant correlations were found for overall or subcomponents of DGI scores. High rates of perceived food intolerances were observed in patients with an ileoanal pouch. However, only those with perceived dairy intolerances restricted their intake of lactose-containing dairy products. Additionally, patients with ileoanal pouch scored highly for overall diet quality but specific gaps in achieving better diet quality, particularly for diet variety were observed. These results provide some starting points for targeted dietary counselling to optimise nutritional health and potentially to improve pouch function these patients.

An acute increase in intestinal epithelium permeability is induced by prolonged exertion in the heat, resulting in the translocation of pathogenic bacteria and endotoxins from the lumen into the circulation, causing a systemic inflammatory response and debilitating symptoms(1). Acute exercise-induced gastrointestinal syndrome mimics chronic health conditions with which an impaired intestinal barrier function is associated, including coeliac disease, inflammatory bowel disease, diabetes, Alzheimer’s and liver diseases(2). Intestinal epithelium permeability is typically assessed using a dual sugar absorption test, by administering a drink containing non-metabolisable sugars (e.g. lactulose [L] and L-rhamnose [R]) that can enter the circulation by paracellular translocation when the epithelium is compromised, and are subsequently excreted and measured cumulatively in the urine(3). We aimed to demonstrate that our recently developed ion chromatography protocol(4) can be used to accurately quantify L/R ratio in the plasma of participants exercising in hot ambient conditions and to determine the impact of nutritional intervention on intestinal epithelium permeability. Further, we hypothesised that measuring L/R in plasma collected at intervals during the post-exercise recovery period would reveal more information about intestinal permeability compared to previously published cumulative urine L/R data(3). Endurance-trained participants completed a set of randomised crossover studies, consisting of 2 h running at 60% V˙O2max in temperate, warm and hot ambient conditions (n = 8) and/or in the heat while consuming water, carbohydrate or protein (n = 9). The dual sugar solution was ingested at 90 min of exercise and blood was sampled at 0, 1, 2 and 4 h post-exercise. Plasma sugars were quantified by high-performance anion exchange chromatography with pulsed amperometric detection (HPAEC-PAD) and L/R ratios were compared by two-way repeated measures ANOVA with Tukey’s multiple comparisons. Plasma L/R increased immediately post-exercise in the heat (0.15 ± 0.11) compared with temperate (0.06 ± 0.04, p<0.001) and warm (0.09 ± 0.08, p<0.01) conditions, while consuming glucose before and during exercise alleviated this (0.02 ± 0.02, p<0.001), and this novel information was otherwise missed when measuring urine L/R. Consuming glucose or whey protein hydrolysate during exercise attenuated intestinal permeability from exertional heat stress throughout recovery, with the mean plasma L/R over 4 h reduced from 0.11 ± 0.05 to 0.04 ± 0.03 (p<0.001) and 0.06 ± 0.04 (p<0.01) with glucose and protein, respectively. We recommend using the dual sugar test with quantification of plasma sugars at intervals by HPAEC-PAD to maximise intestinal permeability data collection in exercise gastroenterology research and beyond, as this gives additional acute response information compared to urinary measurements. Our approach can be employed to investigate and develop personalised nutrition strategies that prevent intestinal hyperpermeability during exertional heat stress. This has implications for athlete performance and safety, and can also build upon occupational health and safety practices and inform chronic disease management.

Diet is implicated in the development of Inflammatory Bowel Disease (IBD). However, the role of diet in reducing inflammation and managing prevalent disease is unclear (1–3). Previous studies have analysed the relationship between dietary patterns and occurrence of flares or symptoms, but not disease activity or inflammation (4–5). It is important to explore the role of habitual diet in management of IBD to provide targeted dietary recommendations. We explored the relationship between dietary intake with disease activity and inflammation in an Australian adult cohort with and without IBD. We analysed dietary and clinical data from the Australian IBD Microbiome (AIM) study. AIM is a prospective longitudinal cohort study of adults and children with Crohn’s Disease (CD), Ulcerative colitis (UC) and healthy controls (HC). Habitual dietary intake of food groups, fibre, polyphenols and fermented foods was collected by merging dietary data from 3-day food records and food frequency questionnaires with PhenolExplorer and the Australian Fibre Categories Database. Dietary patterns were explored using Principal Component Analysis (PCA) and cluster analysis (CA) in IBM SPSS Statistics (V29). Associations between dietary intake, clinical disease activity categorised as remission or active, and faecal calprotectin (FCAL) were explored in adult participants. A total of 412 participants (IBD = 223, HC = 189) were included. FCAL data was available for 211 participants (HC = 100, CD = 49, UC = 62). Median (IQR) FCAL at baseline was 20 (20) mg/kg for HC and 33 (127) mg/kg for IBD, indicating clinically irrelevant inflammation (FCAL >50mg/kg = clinical inflammation). PCA identified 7 distinct dietary patterns for adults with IBD. A dietary pattern of high plant diversity was associated with active CD. In the total IBD cohort, low association to a 'Prudent’ pattern was positively associated with low FCAL, and high association to a 'Meat-eaters’ dietary pattern was positively associated with moderate FCAL. CA revealed 3 distinct clusters amongst participants with IBD. No significant difference between diet cluster and disease activity or FCAL was seen. There were no significant differences in intake of fibre or polyphenols between remission vs active disease in participants with IBD. A significant difference between total, soluble and insoluble fibre and FCAL categories was seen with a higher fibre intake associated with lower FCAL. Higher plant-diversity and 'Prudent’ dietary patterns are associated with active disease and higher FCAL in Australian adults with IBD. Reverse causality cannot be ruled out, with analysis of larger cohorts and clinical trial data needed to clarify this.

Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ).

This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.

Dietary therapies have revolutionised treatment for irritable bowel syndrome (IBS). However, response rates to the diet with the highest evidence of efficacy (the low FODMAP diet) remain at 50-75%, suggesting other potential drivers of symptom onset. A low food chemical elimination-rechallenge diet targeting bioactive food chemicals (including salicylates, amines, glutamate and other additives), is commonly applied in Australia in patients exhibiting both gastrointestinal and extra-intestinal symptoms. One key food chemical, salicylate, has been shown to elicit symptoms in IBS patients with aspirin-sensitivity(1), and 77% of IBS patients have reported amine-rich foods trigger symptoms(2). However, data supporting the full low chemical diet is scant, and safety concerns exist due to its restrictive nature potentially causing nutritional deficiencies and disordered eating. This cross-sectional survey aimed to evaluate the frequency of co-existing extra-intestinal symptoms, as well as explore patient perceptions and use of the low chemical diet in those with IBS and healthy controls. Participants with IBS (IBS-Severity Scoring System (IBS-SSS) >75), and healthy controls (not meeting Rome IV and IBS-SSS ≤75) were recruited via online advertisement. Validated questionnaires were used to assess gastrointestinal symptoms (IBS-SSS), extraintestinal symptoms (extended PHQ-12), nutrient (Comprehensive Nutritional Assessment Tool) and food additive intake (IBD-Food additive questionnaire). Additional questionnaires assessed use of dietary therapies with specific focus on food chemicals. Data was analysed using independent samples t-test and chi-square test. 204 IBS (Total IBS-SSS, 277 ± 79) and 22 healthy controls (36 ± 28, p<0.01) completed the study. IBS participants were more likely to report extra-intestinal symptoms including headaches (p<0.01), migraines (p = 0.03), fatigue (p<0.01), difficulty sleeping (p = 0.03), rhinitis (p = 0.02), urticaria (p = 0.04) and mood disturbance (p<0.01). IBS participants were more likely to report at least one food chemical as a trigger for gastrointestinal (38% vs 13%, p = 0.03) and/or extra-intestinal (30% vs 9%, p = 0.04) symptoms. In the IBS group, the most common suspected dietary triggers for gastrointestinal symptoms were salicylates (19%) followed by MSG (17%) and artificial colours (14%); while for extra-intestinal symptoms, MSG (15%) was most common, followed by amines (14%), and sulphites (12%). There was no significant difference in consumption of ultra-processed, additive containing foods. Twenty-one (10%) IBS participants were following a low chemical diet, with dietary advice provided by a dietitian (n = 13), general practitioner (n = 6), gastroenterologist (n = 6), naturopath (n = 3), family/friend (n = 4) and/or the diet was self-initiated (n = 7). Fourteen of the 21 (67%) reported following both a low food chemical and low FODMAP diet. Patients with IBS are more likely to report extra-intestinal symptoms compared to healthy controls. Despite limited evidence, a low food chemical diet is utilised to manage both gastrointestinal and extra-intestinal symptoms. Of concern, many respondents following a low food chemical diet reported also following a low FODMAP diet, which may have implications for nutritional adequacy.

Eggs are highly digestible, nutrient-rich and are a valuable source of protein and choline, thereby promoting a range of health benefits. Several studies have found an association between protein intake and gastrointestinal microbial diversity(1), while bacterial fermentation of undigested protein in the large bowel can produce short-chain fatty acids, such as butyrate, positively influencing host metabolic health, gut integrity and immune function(2). On the other hand, dietary choline stimulates gastrointestinal bacterial production of trimethylamine and the prothrombotic compound trimethylamine-N-oxide (TMAO)(3). Despite these established links, limited studies have explored the effects of whole egg intake on indices of gastrointestinal health. This systematic literature review aimed to synthesise research that has investigated the impact of egg-supplemented diets or egg consumption on markers of gastrointestinal health including microbiome, function and symptoms. This review was conducted in accordance with PRISMA guidelines. Five databases (Ovid Medline, Embase, CINAHL Plus, SCOPUS, and PsychInfo), and reference lists of relevant papers, were searched from inception until April 2023. Studies were included if they examined the link between whole chicken egg consumption and gastrointestinal health in healthy adults (aged>16). Indices of gastrointestinal health were defined as any outcomes related to gastrointestinal factors, including symptoms, microbiome, inflammation, colonic fermentation and TMAO. Reviews and case studies were excluded. All studies underwent risk of bias assessment. Overall, 548 studies were identified and 19 studies were included after screening. Eight of these were randomised controlled trials (RCTs), 8 cross-sectional and 3 prospective cohort studies. Participants ranged in number between 20-32,166 and in age between 18–84 years. Study periods varied between 3–14 weeks for RCTs and 6 months–12.5 years for prospective cohort studies. RCTs examined intakes between 1–4 eggs/day, with the majority examining 3 eggs/day (n = 6). The primary outcome across 15 articles was TMAO levels, with most reporting no significant associations (n = 13). Five studies examined inflammation with inconsistent findings ranging from no alterations (in TNF-α, IL-8, CRP), increases (in anti-inflammatory marker LTB5, TNF-α), and decreases (in IL-6, CRP). Lastly, 7 studies explored alterations in microbiome. Two RCTs and 2 cross-sectional trials reported no alterations in microbial diversity in response to eggs. Meanwhile, 2 cross-sectional and 1 prospective study linked specific bacteria to consistent egg intake. Eggs were associated with species that produce butyrate (E.rectale, F.prausnitzii, M.smithii, and R.bromii), and protect against metabolic syndrome (A.muciniphila). This systematic review found that egg consumption did not increase levels of the undesirable biomarker TMAO and were associated with butyrate-producing bacteria. Evidence regarding the effect of egg intake on inflammation was inconsistent. This review revealed the general lack of available research investigating whole eggs and gastrointestinal health. Future carefully designed RCTs are required to improve understanding of how eggs may influence the gastrointestinal microbiome and colonic fermentation.

Adequate dietary fibre (DF) intake is recommended to relieve constipation and improve gut health(1). It is often assumed that individuals with constipation have relatively low DF intake and do not meet the recommended adequate intake of 25 g and 30 g for females and males, respectively. The 2008/09 New Zealand Adult Nutrition Survey confirmed that the mean DF was 17.9 grams (g) per day for females and 22.8 g per day for males, which was well below the recommended adequate intake(2). With the continuous shift of dietary patterns over time, we sought to compare the current usual DF intake of two cohorts of New Zealand adults: those who have constipation with those without constipation but with relatively low DF intake. We report baseline dietary data from two randomised controlled dietary studies (Kiwifruit Ingestion to Normalise Gut Symptoms (KINGS) (ACTRN12621000621819) and Bread Related Effects on microbiAl Distribution (BREAD) (ACTRN12622000884707)) conducted in Christchurch, New Zealand in 2021 and 2022, respectively. The KINGS study included adults with either functional constipation or constipation-predominant irritable bowel syndrome to consume either two green kiwifruit or maltodextrin for four weeks. The BREAD study is a crossover study and included healthy adults without constipation but with relatively low DF intake (<18 g for females, <22 g for males) to consume two types of bread with different DF content, each bread for four weeks separated by a two-week washout period. All participants completed a non-consecutive three-day food diary at baseline. Dietary data were entered into FoodWorks Online Professional (Xyris Software Australia, 2021) to assess mean daily DF intake. Fifty-six adults from the KINGS study (n = 48 females, n= 8 males; mean age ± standard deviation: 42.8 ± 12.6 years) and BREAD study (n = 33 females, n= 23 males; mean age: 40.4 ± 13.4 years) completed a baseline food diary. In the KINGS study, females with constipation had a daily mean DF intake of 25.0 ± 9.4 g whilst male participants consumed 26.9 ± 5.0 g per day. In the BREAD study, females without constipation had a mean daily DF intake of 19.4 ± 5.8 g, whereas males had 22.6 ± 8.5 g per day. There was a statistically significant difference in the mean daily DF intake between females with constipation and those without constipation (p < 0.001) but not between males (p = 0.19). These two studies found that DF intakes among females with constipation were not as relatively low as previously assumed, as they met their adequate intake of 25 g. Further data analysis from the KINGS and BREAD studies will reveal the effects of using diet to manage constipation and promote better gut health in these two cohorts of New Zealand adults.

Depression is the largest global contributor to non-fatal disease burden(1). A growing body of evidence suggests that dietary behaviours, such as higher fruit and vegetable intake, may be protective against the risk of depression(2). However, this evidence is primarily from high-income countries, despite over 80% of the burden of depression being experienced in low- and middle-income countries(1). There are also limited studies to date focusing on older adults. The aim of this study was to prospectively examine the associations between baseline fruit and vegetable intake and incidence of depression in adults aged 45-years and older from 10 cohorts across six continents, including four cohorts from low and middle-income countries. The association between baseline fruit and vegetable intake and incident depression over a 3–6-year follow-up period was examined using Cox proportional hazard regression after controlling for a range of potential confounders. Participants were 7771 community-based adults aged 45+ years from 10 diverse cohorts. All cohorts were members of the Cohort Studies of Memory in an International Consortium collaboration(3). Fruit intake (excluding juice) and vegetable intake was collected using either a comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated depression measures, and depression was defined as a score greater than or equal to a validated cut-off. Prior to analysis all data were harmonised. Analysis was performed by cohort and then cohort results were combined using meta-analysis. Subgroup analysis was performed by sex, age (45 – 64 versus 65+ years) and income level of country (high income countries versus low- and middle-income countries). There were 1537 incident cases of depression over 32,420 person-years of follow-up. Mean daily intakes of fruit were 1.7 ± 1.5 serves and vegetables 1.9 ± 1.4. serves. We found no association between fruit and vegetable intakes and risk of incident depression in any of the analyses, and this was consistent across the subgroup analyses. The low intake of fruit and vegetables of participants, diverse measures used across the different cohorts, and modest sample size of our study compared with prior studies in the literature, may have prevented an association being detected. Further investigation using standardised measures in larger cohorts of older adults from low- to middle-income countries is needed. Future research should consider the potential relationship between different types of fruits and vegetables and depression.

Snacking, namely, consuming food and beverages in-between main meals, especially snacks with a high fat, salt and/or sugar content, is a major contributor to excessive energy intake and long-term weight gain(1). There are many potential drivers of snacking behaviours, including physiological (e.g., hunger) as well as social, psychological, and emotional reasons(2). Individual differences, such as personality traits, have been linked to unhealthy snacking. Nevertheless, it is important to examine the potential explanatory pathways, such as motivations for snacking and habit strength, that may explain this relationship between personality and snacking. This cross-sectional study investigated the associations between personality traits, habit strength, motivations for snacking, and snacking behaviour, including choice and consumption. Participants were n = 230 Australian adults (female: n = 164; 71.3%) aged 18-77 years old (M = 34 years, SD = 13.4) who completed an online survey. The survey included assessments of personality traits (The Big Five Inventory 2), habit strength (the Self-Report Habit Index), motivations for snacking (The Eating Motivation Survey), momentary snack food choice (Snack Preference Task), and habitual snack food consumption (Snack Frequency Questionnaire). Overall, the most frequently selected motivations for snacking were ‘liking’, ‘convenience’, and ‘habit’. Correlation analyses were conducted to examine the relationship between motivations for snacking and snacking behaviour. We found that health motivation for snacking was negatively correlated with momentary choice (r = -.042, p <.01) and habitual consumption (r = -.033, p <.01) of unhealthy snack foods and beverages. Hierarchical multiple regression analyses were used to examine whether habit strength and the Big Five personality traits predicted both motivations for snacking and snacking behaviours after controlling for demographic variables. For health motivations for snacking, habit strength (beta = −0.15, p = .025), openness (beta = 0.50, p = .003, and conscientiousness (beta = 0.58, p = .001) were significant predictors. For momentary choice of unhealthy snacks, health motivation (beta = −4.35, p = .004), pleasure (beta = 3.53, p = .029), and visual appeal (beta = 5.29, p <.001) were significant predictors. For habitual consumption of unhealthy snacks, health motivation (beta = −5.39, p = .001), habit strength (beta = 2.89, p = .045) and neuroticism (beta = 5.16, p = .045) were significant predictors. These findings indicate that health motivation for snacking predicts both momentary snack preference and habitual snack food consumption. Moreover, personality traits may be linked with habitual unhealthy snacking behaviour via their association with specific motivations for snacking. Overall, these findings suggest that health promotion messages focusing on health motivation may be important for increasing healthier momentary and habitual snack choices to improve dietary intake and support weight management.