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.

Optimal nutrition is essential for preterm infants as they face many barriers to achieving exclusive breastfeeding (EBF) and successfully introducing complementary foods (CF)(1). There is limited evidence of early feeding practices of preterm infants in Aotearoa, New Zealand (NZ). We aimed to investigate the facilitators and barriers to EBF and CF introduction in preterm infants in NZ. A nationwide self-completed electronic questionnaire was disseminated via social media to mothers of preterm infants. The survey collected quantitative data on hospital feeding practices, breastfeeding rates, timing of CF introduction, and fussy eating behaviours. Relationships between feeding practices and maternal and infant characteristics, such as ethnicity and level of prematurity, were explored using the Chi-Square statistical test in SPSS. Qualitative information regarding mothers’ experiences with breastfeeding, CF introduction, type of education and support received about the nutrition of preterm infants were collected for thematic analysis using Nvivo. The survey started in April and will close on 20th August 2023. Here we present preliminary findings of a subset of responses collected to date, and full results will be available for the conference. Up to 1st August 2023, 201 mothers had completed the survey. Most mothers self-identified as of New Zealand European (58%) and Māori (13%) background. Most infants (39%) were older than 12 months of chronological age (CA) and born moderate or late preterm (32+0 – 36+6 weeks’ gestation, 70%). Almost 50% of mothers required in-hospital supplementation of mothers’ milk (infant formula, 28% and donor breastmilk, 20%), and 44% of mothers were EBF at the time of hospital discharge. EBF for 5-6 months of CA was reported by 21% of mothers, and 46% provided any breastmilk for more than 6 months of CA. Among mothers who had introduced CF (n = 138), 74% reported introducing CF between 5-8 months of CA, and the infant’s first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 47%, and food fussiness was significantly associated with a decreased frequency of vegetable (p<0.001) and fruit (p = 0.004) consumption. Challenges with breastfeeding included the infant’s feeding difficulties, low milk supply, maternal stressors, lack of support and education from health professionals. Challenges to CF introduction included fussiness and maternal fears such as choking and lack of confidence. Support from lactation consultants and previous experience with introducing CF were the most common enablers for breastfeeding and timely CF introduction, respectively. Our findings provide the first insight into the early feeding practices of preterm infants in Aotearoa, New Zealand. This information will support strategies to improve the nutritional management of preterm infants by increasing awareness of common challenges mothers face to achieve the recommended breastfeeding guidelines and CF practices in this vulnerable population.

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

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.

Schools provide a unique opportunity to educate and motivate Pacific Island students and the wider Pacific Island community about food systems, food production activities (e.g., gardening and cooking) and to focus on the knowledge and skills needed to make healthy and sustainable food choices. Recent work(1) has identified limited access to appropriate and credible learning and teaching resources and varying integration of food and nutrition in the curriculum across the Pacific Islands (P.I) region. Teachers reported an ardent desire to incorporate nutrition into the curriculum, but were not sure how to do this, or where to source assistance, including credible learning materials. Stakeholders also reported requiring assistance to develop contextualised learning materials, and that there were limited options for upskilling in food, nutrition and agriculture. Recommendations from this work included the development of a tool to assist teachers to bridge the gap between understanding the benchmark or learning outcomes provided in curriculum and designing engaging and authentic activities and assessment to meet these. Therefore, this project aimed to identify food and nutrition curriculum materials available for Pacific Island educators, to inform the development of a web-based resource. In 2022, a systematic desk-based scoping activity was undertaken to identify any resources available to teach food and nutrition in Pacific Island schools (primary and secondary level) and professional development opportunities relevant for educators. The mapping identified over 70 resources, with resources from almost all countries identified. Some are available for specific countries, but few that are designed for use regionally. Some of these resources are directly aligned to food-based dietary guidelines, while others appear to be developed for specific activities by non-governmental organisations. Very few professional development activities were identified. Once a resource was identified, the project team used the CRAAP test(2) to evaluate the credibility of this. If deemed credible, the resource was tagged with key words (e.g., Tonga, gardening) and added for inclusion. The key resource categories (for tagging) were cooking, ocean and waterway foods, food in schools, food safety, healthy eating, sustainability, pacific research, teaching practice, gardening and WASH. A web designer developed the web-based resource through collaboration with the project team. Users can search for resources by country and/or topic. Based on the mapping of professional development activities, a professional development activity based on assessing the credibility of information was developed and added to the L&T toolkit. Users of the hub can share resources (their own) or identify other resources that could be added to the hub. There are limited resources and opportunities for Pacific Island food and nutrition teachers to upskill in food and nutrition education. School educators may benefit from more food and nutrition resources and professional development activities to complement those that are currently available.

With continuing population growth and increased urbanisation, the prevalence of apartment living will also increase. The food practices and diet of apartment residents may differ to those in lower density, detached or semi-detached housing. Food practices may be impacted by physical constraints of apartment kitchens (size, storage, cooking facilities) and the influence of the surrounding community food environment, particularly in smaller apartments. High-rise apartment residents spend a larger proportion of their weekly household budget on eating foods prepared out of the home 1. This is concerning given meals prepared outside the home tend to be of lower diet quality 2 and are associated with higher body weight 3. This study investigated how kitchens, residents’ food practices and hypothesised barriers to healthy eating were portrayed on popular TikTok videos associated with hashtags denoting small apartments. Using the keyword ‘microapartment’, the top four most viewed hashtags relevant to the topic were identified: #studioapartment (190.5 million views), #smallapartment (152.5 million views), #tinyapartment (62 million views), and #microapartment/ #microapartments (4.9 million views combined). The most liked videos (n = 50) from each of these four hashtags and #apartment (as a comparator) were selected for investigation. Using a REDCap survey, two researchers independently coded a random sample of 15 videos, with comparison and discussion to tighten codebook definitions and reduce ambiguity. Subsequently over half of all videos were coded by at least two researchers, achieving acceptable inter-rater reliability (Cohen’s kappa >0.8). Each video was coded for engagement characteristics, user profile, and characteristics of individuals appearing. Further coding included apartment size, kitchen features displayed or mentioned, and food practices (grocery shopping, cooking at home, and eating foods prepared out of the home). Videos were categorised as having positive sentiment if they depicted the apartment in an explicitly positive way, including promoting or encouraging an aspect of apartment living or indicating support for a behaviour. Conversely, videos were coded as being of negative sentiment where they depicted a clear negative position on an aspect of apartment living. Else, the video was coded as neutral sentiment. The majority of videos (87%) portrayed apartment living with a positive or neutral sentiment; with only 2% of videos portraying kitchen size or function negatively. The expected physical constraints of small apartment kitchens were not evident in the videos, nor were interactions with the food environment surrounding the apartment. Indeed, in the small number of videos portraying the food practices of cooking, shopping and eating, the videos highlighted the ability to undertake these practices despite limitations of size and facilities. As the food practices of residents of small apartments are not well researched, it is not known whether their portrayal on TikTok may indeed reflect reality, or may be a glamorisation.

Chronic respiratory diseases (CRDs) are diseases of the respiratory tract and are among the most prominent causes of disability and mortality globally(1). Chronic obstructive pulmonary disease (COPD) and lung cancer are among the leading cause of death among all CRDs(2). Evidence showed that diet, particularly ultra-processed foods (UPFs) are strongly associated with cardiovascular disease, diabetes, cancer, and depression(3). However, the link between UPFs intake and CRDs has rarely been investigated. we aimed to examine the association between UPF consumption and risk of mortality due to CRDs overall, COPD and lung cancer among adults in the USA. A total of 96,607 participants aged 55 years and over were obtained from Prostate, Lung, Colorectal and Ovarian (PLCO) cancer study, a randomised trial designed to investigate the effects of screening on cancer-related mortality. However, data collected also afforded the opportunity to examine the relationships between UPF intake and mortality caused by respiratory diseases. Dietary history of participants was collected at baseline using a validated food frequency questionnaire as was the presence of respiratory diseases. Food items were grouped into one of the four NOVA food classification system(4). Cox regression was fitted to estimate the risk of all-cause mortality and cause-specific mortality due to increased consumption of UPFs over time. Competing risk regression was used to account for the competing risks events and effect of participant loss. During the follow-up period of 1,379,655.5 person-years (median 16.8 years), 28700 all-cause, 4,901 all respiratory, 2,015 lung cancer and 1,536 COPD mortalities occurred. A dose-response association was found between higher UPF intake and mortality from all respiratory diseases and COPD, but not lung cancer. After considering competing events, higher intake of UPF increased the risk of mortality from all respiratory diseases by 10% (HR: 1.10; 95% CI: 1.01, 1.21) and COPD by 20% (HR: 1.20; 95% CI: 1.02, 1.42). After imputation for missing data, the risk of lung cancer increased by 25% among participants in the highest quintile of UPF intake. The PLCO trial data highlighted that consumption of UPF increased respiratory mortality, among those with COPD, however further mechanistic studies are recommended to further clarify the link between UPF and lung cancer. This study also indicated that a high intake of UPF generally increases the risk of mortality of those with respiratory diseases and contributes to a large body of evidence indicating that higher UPF consumption increases the overall risk of mortality.

In New Zealand, the community-based service, Green Prescription (GRx), has a preventative health focus, supporting clients to make lifestyle changes including improving nutrition literacy, which is known to improve health and reduce chronic disease risk and outcomes (1,2). Fourteen GRx services operate in New Zealand, each with staff who have backgrounds in health and/or exercise. Some staff are degree-qualified nutritionists and/or dietitians. Responsibilities of staff may include providing clients with information about nutrition. We aimed to identify the extent of nutrition information delivery in GRx including successes, challenges, and perspectives of staff and clients. An invitation was extended to all 14 GRx services inviting participation from both staff and clients. Semi-structured interviews were conducted with a convenience sample of 15 GRx staff and 18 clients, representing nine and five GRx services respectively. Interviews were completed in-person, over video call, and by phone. Responses from clients and staff revealed both positive and challenging aspects of nutrition information delivery from GRx services. Thematic analysis identified factors that enhance or diminish the delivery of nutrition information including capacity of staff and appropriateness of information. One theme highlighted was expectations from both clients and staff about what is needed, beneficial and feasible. An expectation identified was for GRx staff to provide meal plans and tailored nutrition advice. Provision of this is dependent on the capacity of nutrition-qualified staff as well as confidence of non-nutrition-qualified staff delivering information beyond basic nutrition guidelines. Client respondents reported they benefit from nutrition information but are challenged when their dietary needs require more specific input, which may be beyond the capacity of GRx. From a staff perspective, there is an expectation that clients possess a certain level of basic nutrition literacy and the effect of nutrition on health. However, staff responses identified there is a vast range of nutrition knowledge among clients; limited foundational knowledge, while simultaneously having in-depth understanding of certain nutrition topics. Provision of information is further complicated by misconceptions about nutrition and limited knowledge about specific health conditions where nutrition plays a significant role. Factors that impact the practical implementation of eating more healthfully were identified by both clients and staff, demonstrating there needs to be both sensitivity and adaptability about what is feasible for clients and achievable in GRx service delivery. Greater focus on determining the nutrition literacy a person has and communicating what is practical in both service delivery and clients’ circumstances would aid in aligning the expectations of supporting clients well with nutrition education and enhance available resources within Green Prescription services.

Young children, especially those under one year of age, are at higher risk of choking on food due to their body’s immature physiology and chewing, swallowing and coughing ability(1). In 2020, the Ministry of Education mandated the Ministry of Health’s food-related choking guidance for babies and young children at early learning services (ELS), adding it to the licensing criteria(2). Some ELS managers reported that this policy may negatively influence the food and nutrition environment within ELS(3).This study aimed to assess the impact of the food-related choking policy on the food and nutrition environment within ELS. Data were collected using an online Qualtrics questionnaire from ELS in four District Health Board regions: Waikato, Bay of Plenty, Lakes, and Auckland (N = 1066), sourced from the Ministry of Education, Education Counts database. Responses were received from 179 ELS (17%) and most reported making changes due to the food-related choking guidance. The main changes were to the food provided by the ELS (75%), education for whānau/family (73%), and supervision of children (70%). Over half of the centres reported adjusting staff duties to allow for increased supervision of eating (60%) and changed/ceased celebrations or fundraisers (58%). Over half of the respondents (55%) reported that changes to reduce the risk of food-related choking had affected the ‘cultural kaupapa’ (plan/policy) of the ELS. A key theme from written responses was that centres had ‘not come together as whānau’, which refers to reduced hosting of centre events/celebrations within the centre and externally with children and whānau (families). The main reason appeared to be that the food restrictions in the guidance made the management of ‘shared kai (food)’ too difficult. Approximately two-thirds of centres (61%) reported removing foods from menus, and around half (49%) modified the texture of foods. Fifty-one per cent of ELS reported that there had been no change in parent-supplied food. The main foods removed from ELS menus were fruit, vegetables, hard crackers, sausages/other meats, and popcorn. Soft fruit, e.g., canned fruit, soft crackers, and soft meats (hamburger patties, mince, luncheon, and ham), were the main foods added to menus. ELS have responded to most of the new food-related choking guidance requirements regarding food provision, texture modification, and supervision; however, some ELS may need support to implement fully. Ceasing shared kai events at ELS has reduced opportunities to engage with whānau and limits cultural expression, connection and reciprocal learning and teaching about food and nutrition between the centre and whānau as outlined in Te Whariki Early Childhood Curriculum. Improved communication and support for parents and ELS to implement the recommendations for home and centre-supplied foods is needed. Together with sufficient funding for supervision and nutrition education to support children’s learning and cultural needs around food.

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

Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.

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

Lockdown measures imposed in Australia to slow the transmission of COVID-19 protected most Australians from the virus(1). In some areas in NSW, specifically Western Sydney areas, more stringent lockdown regulations were implemented from July to September 2021, referred to as local governmental areas (LGAs) of concern(2). Preliminary evidence showed that people’s lifestyle such as dietary and physical activity behaviours and mental health during lockdown were altered from before lockdown(3). However, intermediate and longer-term impacts on nutrition and physical health are unclear, especially in LGAs of concern. We aimed to examine the impacts of the lockdown on nutritional behaviour of residents of Western Sydney. Mixed methods were employed including quantitative surveys such as ASA-24 and qualitative focus groups, using R software for quantitative analysis. Data was collected from 523 survey participants in addition to 42 focus group participants. The sample was representative of age, gender, county of birth and area of residence. Sixty-two percent reported decreases in their physical activity level post-lockdown compared with pre-lockdown, and 15% reported increases in their physical activity level post-lockdown compared with pre-lockdown. Sixty-nine percent reported increases in their physical activity levels post-lockdown compared with during the lockdown, and 12% reported decreases. Self-reported weight increased in 50% of the participants post-lockdown compared with pre-lockdown and decreased in 13% of the participants. Forty percent self-reported a decrease in their body weight post-lockdown compared with during the lockdown while 16% self-reported an increase in their body weight post-lockdown compared with during the lockdown. Food security status was reported as much worse in seven percent of the participants post-lockdown compared with pre-lockdown while being unvaried in 93% of the participants. Food security status remained unvaried post-lockdown compared with during the lockdown in 93% of the participants but much better in six percent. Eating habits were self-reported as much worse by 52% of the participants post-lockdown compared with pre-lockdown and much better by nine percent. Forty-eight percent of the participants self-reported their eating habits as much better post-lockdown compared with during the lockdown and 10% as much worse. COVID-19 lockdown negatively impacted eating behaviours, physical activity and body weight of Western Sydney residents with minimal impacts on food security. Further analyses are required to examine the associations between eating patterns, physical activity, body weight and food security and age, gender, country of birth and area of residence of participants. These findings can later be used to draft policies that can be put in practice in case of future pandemics in Australia, or in the case of other common natural disasters, such as bushfires and floods.

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.

National surveys in India, through measures of anthropometry and biomarkers, have identified a triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in adolescents(1). However, there is a dearth of high-quality data on individual dietary behaviour of this population(2) and the importance of sub-national dietary surveys in filling this gap has been identified(3). The objective of this study was to assess the intake of energy (E) and macronutrients and the contribution of macronutrients to E in a random sample of 11–13-year-old schoolchildren in Delhi, India. Method: The study was approved by The University of Adelaide Human Research Ethics Committee and the Independent Ethics Committee of the Centre for Chronic Disease Control, New Delhi. The target sample size of 360 was based on a ± 5% margin of error in estimated sugars intakes. Using the list of private schools in Delhi (n = 1374), a statistician external to the research team generated a random sample of 150 schools stratified by districts (n = 11). Using this list, schools were invited to participate, and recruitment continued until 10 schools consented. Teachers shared study information with parents; interested parents filled in the online consent form. Assent was obtained from schoolchildren. Participants recorded all food and drink consumed over three consecutive days, including one weekend day, in a food diary. Information recorded was entered into an online dietary assessment tool, Intake24 Southeast Asia version, during an interview with each participant. The Intake24 database of over 2400 food photographs of more than 100 foods was used to ascertain portion size. The Intake24 database converts food and drink reported into the intake of nutrients through integrated food compositional tables. Of 514 pupils providing consent, 393 participants (76.4%) (169 girls, 224 boys) completed the study. The median daily E intake was 10.8 (IQR 9.0 −12.5) MJ for girls, and 12.3 (IQR 10.3- 15.2) MJ for boys. For the 97 girls and 144 boys providing body weight data, Physical Activity Level ratios were 2.0 and 2.1 respectively. The median daily intakes for girls were: protein 64.6 (IQR 54.8-79.3) g; carbohydrate 336.5 (IQR 285.3- 393.6) g; and saturated fat 45.6 (IQR 34.8-58.3) g. The respective values in boys were: protein 74.4 (IQR 61.4; 89.4) g; carbohydrate 379.6 (IQR 317.8; 461.8) g; and saturated fat 54.6 (IQR 41.9-69.5) g. There were no significant between-gender differences in percent E from protein (10.2 (IQR 9.2; 11.4)), or carbohydrate (52.4 (IQR 48.7; 56.7)). Girls obtained less E from saturated fat (16.1 (IQR 11.0-18.2) compared with boys 16.3 (IQR 14.2 - 19.1) (P<0.05). In conclusion, in this sample of adolescents from private schools in Delhi, E intake was above FAO recommended levels and median total fat intake exceeded the recommended threshold of 35%(4).

Adolescent obesity requires effective and accessible intervention options and there is potential for intensive dietary interventions to be used as adjunctive therapy to behavioural weight management for some individuals(1). The aim of this study was to determine the effect of two novel diet therapies, delivered in the as part of an intensive behavioural weight management intervention, in adolescents with metabolic complications associated with obesity. The Fast Track to Health study (HREC/17/SCHN/164; ACTRN12617001630303) was a multi-site 52-week RCT, conducted 2018 – 2023, comparing a very-low-energy diet (800kcal/day) followed by i) an intermittent energy restricted (IER) diet; and ii) a continuous energy restricted diet (CER), for adolescents (13-17years) with ≥1 obesity associated complication. Interventions were delivered as part of an intensive behavioural weight management intervention by a multidisciplinary team2. Anthropometry, body composition and cardiometabolic health were assessed at baseline and week-52. The primary outcome was change in BMI z-score at week-52. Dyslipidaemia was defined as HDL <1.03mmol/L and/or triglycerides ≥1.7mmol/l, and elevated liver function tests (LFTs) as ALT and/or GGT ≥1.5 upper limit of 30U/L3. The difference in BMI z-score between groups at week-52 (±4) was assessed using a t-test. Mixed models was used to investigate changes over time. Descriptive statistics were used to describe participants above and below clinical cut-points at baseline and week-52. In total, 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. At week-52, BMI z-score reduced by −0.23 [95%CI −0.37 to −0.22], BMI expressed as a percentage of 95th percentile reduced by −8.86 [95%CI −12.46 to −7.47] and Fat Mass Index reduced by −1.49 [95%CI −2.36 to −1.08]. There was no significant difference for weight or cardiometabolic outcomes between diet groups. The occurrence of dyslipidaemia was unchanged between baseline and week-52 (n = 60 [43%] and n = 37 [43%] respectively) and a small improvement in the occurrence of impaired LFTs (n = 37 [27%] to n = 15 [17.2%] respectively). There were no differences in change of occurrence of dyslipidaemia or impaired LFTs between intervention groups. These findings suggest that both IER and CER, delivered as part of an intensive behavioural weight management program, are equally effective for improving weight and cardiometabolic outcomes for adolescents with obesity.

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.

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

Lutein and zeaxanthin (LZ) are the major constituents of macular pigment (MP), helping to protect the human retina from blue light and oxidative damage(1). Many studies have suggested that higher concentrations of retina LZ may reduce the risk of age-related macular degeneration (AMD) and improve retinal health(1–3). MP and serum L have shown positive linear response with L dose(4) but the combined effect (LZ + omega-3 suppl) has not been fully explored in healthy Australian adults. Understanding their bioavailability in relation to the effect of omega-3 fatty acid intakes along with LZ supplements could provide a useful indication of the potential to reduce the risk of AMD, preserve vision, and improve retinal health. LZ uptake and the associated oxidative stress levels were evaluated in two groups fed with commercially sourced supplements. The control group was given only LZ, while the intervention group was given LZ combined with omega-3 supplements containing Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). 10 men and 6 women with an average age of 31.4 ± 1.3yrs participated in this randomised, non-blinded controlled study for a total of 19-d. The control group (9) consumed the LZ supplement (12mg/d) only, while the intervention group (7) consumed the LZ supplement along with 900mg/d of an omega-3 supplement (540mg EPA + DHA 360mg). Each group adhered to a comprehensive low-carotenoid and omega-3 diet list for the 12-d intervention period and the 7-d washout period. Participants reported daily foods consumed in their diet logbooks, and Automated Self-Administered 24 diet assessment log over the study period. The body composition of each subject from the two groups was assessed before and after the study using a SECA body composition analyser and blood samples (2-time point) collected over a 12-d test period. Mean ± SEM for serum LZ ranged from 2.23 ± 0.24 – 2.98 ± 0.24µg/ml for the control group and 1.10 ± 0.21–3.02 ± 0.73µg/ml for the intervention group. Percentage change in serum LZ concentration from (T0-T312h) and (T312h-T456h) were 26% and 34% (control) and 139% and 175% for (intervention), respectively. The Area Under the Curve (AUC0-456h) differed significantly (P<0.0469) during the entire study period (between groups) and related to the cumulative effect of intakes at various times of blood draw. LZ from the intervention group was 68% more bioavailable than the control group. The highest peak relative response in subjects in the control group was ≈33% (a 9.1-fold increase from baseline) at AUC (168-312h) and ≈46% (a 6.6-fold increase from baseline) at AUC (312-456h) for the intervention group. No significant (p>0.05) effect of omega-3-supplement addition on oxidative stress levels was observed. Omega-3- addition to intakes of supplement LZ was responsible for the increased absorption (intervention) observed but did not affect oxidative stress levels and the Red Blood Cell omega-3-status.

Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand(1). Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health(2). This study aims to test whether an intervention of a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) using behaviour change science can improve the metabolic health of participants and their household/whānau. This is a multi-centre, three-stage trial, with two randomised controlled trials (RCTs), both parallel groups, superiority trials, and a longitudinal cohort study. The first RCT (RCT1) is a comparison of the NZMedDiet pattern implemented using behaviour science compared to usual diet for 12 weeks, and the second (RCT2) is a behaviour-change intervention compared to no intervention for 12 weeks, administered after participants have been exposed to the intervention in RCT1. The third stage is a longitudinal cohort study where all participants are followed for up to a year. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). Two hundred index participants and their household/whānau have been recruited and randomised into the trial. Participants are from four centres, two of which are University research units (University of Auckland (n = 57) and University of Otago, Christchurch (n = 60)), one a community-based traditional meeting place (Tu¯ Kotahi Māori Asthma and Research Trust at Ko¯kiri Marae in Lower Hutt, Wellington (n = 19)), and the other based at a hospital-based research unit (the Centre for Endocrine Diabetes and Obesity Research (CEDOR) in Wellington (n = 64). The trial will test whether the NZMedDiet pattern and behaviour change support improves the cardiometabolic health of people in New Zealand.