Generally, young adults in Australia have poor diet quality, increasing their risk of chronic disease(1). Young adults use social media for nutrition-related information (SMNI), including recipes, product details and dietary advice(2,3). Such social media use may have implications for nutrition knowledge, confusion, and backlash towards nutrition science, which could impact dietary behaviours including diet quality and restrained eating. The purpose of this study was to examine young adults’ use of SMNI, and the association between nutrition-related social media use, diet quality and restrained eating and the role of potential mediators. A cross-sectional survey of young adults (aged 22–29) living in Australia was conducted (n = 200). The exposure variable, use of SMNI, was measured using questions adapted from existing measures investigating sources of health- and nutrition-related information. Outcome measures, diet quality and dietary restraint, and mediator variables nutrition knowledge, confusion, backlash, and social comparison were measured using established measures. Mediation analyses were conducted using path analysis. One hundred and eleven young adults (55.5%) reported using SMNI at least once within the last year and 93 (46.5%) within the last month. Recipes was reported as the main reason for use. Use of SMNI within the last month was positively associated with nutrition knowledge (β = 0.19 [95% CI: 0.06, 0.32]), which was positively associated with diet quality (β = 0.25 [95% CI: 0.12, 0.38]). There was a positive indirect effect between SMNI and diet quality, via nutrition knowledge (Ind = 0.05 [95% CI: 0.01, 0.09]), providing evidence of mediation. Nutrition confusion was positively associated with backlash (β=0.46 [95% CI: 0.34, 0.59]), which was negatively associated with diet quality (β = −0.31 [95% CI: −0.47, −0.15]). Use of SMNI was not significantly associated with restrained eating. Almost half of the young adults in this study reported use of SMNI at least once in the last month and recipes was the most common type of information sought. This finding is consistent with the literature(2,3) and indicates that social media is a popular source of nutrition-related information and recipe content among young adults. SMNI was positively associated with diet quality and was mediated by nutrition knowledge. These findings suggest that social media may be an important tool to distribute high quality nutrition-related information and for nutrition promotion aimed at young adults, however, experimental research is required to investigate causal pathways. The growth and ubiquity of social media and its potential for effective and wide-reaching nutrition promotion highlight social media as a priority area for research in the field of public health nutrition and aligns with the priority area outlined in the Decadal Plan for the Science of Nutrition to harness the reach of social media for nutrition promotion(4).

One year after stroke incidence, stroke survivors present a 50-fold higher risk of dementia compared with people without a history of stroke(1). Considering the importance of modifiable factors in the prevention of cognitive impairment, we aimed to systematically review the current evidence on the effect of diet on post-stroke cognitive impairment and dementia. MEDLINE, Embase, Scopus, and CINHAL were searched for clinical trials, cohort, case-control, and cross-sectional studies published in all languages until 01 May 2024. Studies examining the association of any nutritional intervention/exposure and cognitive function or dementia in stroke survivor adults were included, except when the intervention was combined with non-nutritional treatment. ROB2 (RCT), ROBINS (non-randomised clinical trial, cohort and case-control) and NIH (cross-sectional) tools were used for quality assessment. Twelve RCTs, 2 non-randomised clinical trials, 5 cohort, 2 case-control and 5 cross-sectional studies met the inclusion criteria and were included in the review. Most of them had moderate (13) to high risk (13) of bias. RCTs revealed no benefits of supplementing a high-dose of vitamin D (300,000 UI), vitamin C or B-vitamins (folic acid, B6, B12) for post-stroke cognitive performance, while the supplementation of B-vitamins combined with omega-3 improved temporal orientation. Cognitive function was also not associated with vitamin C intake (1000 mg/d) as reported in a case-control study. A cross-sectional study reported that stroke survivors with and without cognitive impairment had similar daily intakes of B-vitamins, vitamins C and D, while omega 3 and 6 fatty acids intakes were higher in participants without cognitive impairment. A higher risk of incident dementia was reported in calcium supplement consumers compared to non-consumers with a history of stroke, according to a cohort study. Four RCTs showed that while increasing energy and protein intake did not change cognitive outcomes, daily supplementation of N-Pep-12 (peptides and amino acids mixture) increased global cognitive function. Four trials on different phytochemical supplements (Ginkgo biloba extract, pomegranate polyphenols, guipitang and pycnogenol) reported mixed effects on global cognitive function. Finally, six observational studies on dietary patterns and food components indicated that higher adherence to the MIND diet (a combination of Mediterranean and DASH diets), and higher consumption of fish and fruits were related to a lower risk of cognitive impairment. Further, the regular consumption of coffee (0.5–1 cup/d) and tea (2–3 cups/day) was reported to halve the risk of post-stroke dementia. Despite limited evidence, this review indicates that healthy dietary habits with the addition of some key foods such as fruits, fish, coffee and tea offer possible benefits to reduce the risk of post-stroke cognitive impairment, while the consumption of supplements seems to have mixed effects. Thus, more research is required to better elucidate the role diets may have in preventing post-stroke cognitive impairment.

Current nutritional rating systems, like the health star rating, help consumers understand the nutritional value of food and were designed in an effort to combat obesity. However, these systems have limitations, especially for edible oils, which vary widely in composition(1). Coupled with the lack of standardisation in ranking edible oils, there has been advocacy for the introduction of different nutritional scores for edible oils. This study aims to develop a simple and easy-to-use nutritional scoring index based on the composition of extra virgin olive oil (EVOO). The composition includes all fatty acid parameters and total polyphenol content, measurable by nuclear magnetic resonance (NMR) spectroscopy, thereby avoiding the need for multiple analytical platforms. The development of an EVOO nutritional score involved: i) establishing a unique consensus dietary reference index (DRIs) for each component and evaluating their impact on human health(2,3); and ii) computing Scoring Reference Values (SRVs) for each component, expressed as grams of component per 100 g of EVOO, based on the assumptions of a daily energy intake of 2000 kcal, with a fat intake of 35% of total caloric intake(2,3), and considering EVOO as the only source of fat. A nutritional score (0–100) was developed based on saturated fat (SFA), trans-unsaturated fat, oleic, linoleic, alpha-linolenic acids, and polyphenols. Components with more substantial effects/evidence on human health were given greater weight in the scoring. The developed index was subsequently applied to evaluate 314 EVOOs that passed the International Olive Oil Council (IOC) quality criteria. These oils were sourced from Australia (n = 94), Greece (n = 54), Italy (n = 54), Spain (n = 69), and Tunisia (n = 43) and analysed using 400 MHz NMR spectroscopy. Nutritional scores for all samples showed a mean of 62.3 (range 13 to 94), with Australian EVOOs exhibiting the highest mean score of 65, followed by Spain, Tunisia, Italy, and Greece. EVOOs were differentiated by their SFA content and the balance between polyunsaturated (PUFA) and monounsaturated fatty acids (MUFA). MUFA and PUFA were typically inversely related, except for two Australian oils that achieved high levels of both. This novel scoring index for EVOOs, grounded in health-related compositional parameters, facilitates the differentiation of EVOOs based on their nutritional value. This enables consumers to make informed choices regarding their oil selection. Given the rising prevalence of obesity and its associated morbidity, this tool is particularly significant. Additionally, the implementation of this nutritional index encourages producers to produce oils with superior nutritional profiles.

Mood disorders such as depression and anxiety are increasing among individuals of all ages and can contribute significantly to decreased quality of life (QoL). The Mediterranean Diet (MedDiet) has been associated with improved mood state and QoL(1). However, few studies have determined the cost-effectiveness of delivering MedDiet interventions to address psychological wellbeing and QoL which is valuable as reducing the risk of non-communicable diseases through diet and lifestyle modification is a public health priority. We aimed first to determine the effect of a 6-month MedDiet intervention (MedLey) on QoL (SF-36V2), then to determine the cost of the intervention with the goal of completing a cost-effectiveness analysis. MedLey was a 6-month dietitian-led MedDiet randomised controlled trial in n = 152 Australian’s aged ≥ 65 years that led to significant improvements to markers of cardiovascular health. Intervention participants received intensive dietetic support while the equal-attention habitual diet group (HabDiet) were instructed to maintain their usual dietary pattern. Program costs were estimated including staff labour, food hampers and project development. Participants completed the SF-36V2 survey at three timepoints which generates 8 unweighted domain scores and a final ‘index score’ for use in economic evaluations and determination of quality-adjusted-life-years. Mean weighted index scores were generated using QualtiyMetrics software. Data were analysed using linear mixed effects models to determine a difference between groups in index score over time using a time*group interaction as a base model. A second model adjusting for age and gender was also analysed. MedLey program costs were estimated at $1,462 AUD per participant to deliver compared to control group participants $1,101—a differential of $361. Mean index scores at baseline and 6-months for the MedDiet and HabDiet group were 0.789, 0.824 and 0.818, 0.845, respectively. There were no statistically significant differences in index score from baseline to 6-months between or within groups for the base model. In a second model adjusting for age and gender, a within-group difference was identified in the control group between the 6 and 3-month timepoints (mean difference 0.040, p = 0.049). Though not statistically significant, the MedDiet group improved their index score from baseline to 6-months (mean difference 0.037, p = 0.141). The MedLey trial did not lead to statistically significantly improvements to QoL. Mean index scores of the MedDiet and HabDiet group at baseline were already considerably high leaving little room for improvement over a 6-month intervention period thus a robust cost-utility and economic evaluation could not be undertaken. A longer intervention period or follow up may have been needed to determine any protective effects of the MedDiet. RCTs should continue to investigate the relationship between a MedDiet and QoL and estimate program costs which could be used as community programs for mood disorder prevention.

Healthy eating patterns from sustainable food systems are crucial for population and planetary health(1). Primary schools are opportune settings for teaching children about food, nutrition and sustainability(2) (FNS), though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools. A cross-sectional online survey (open from August 2022–October 2023) with closed- and open-ended questions collected data about (i) teacher perceptions/attributes regarding FNS education (e.g., importance, understanding, knowledge/skills, training); (ii) FNS teaching practices (e.g., frequency, teaching approaches); and (iii) factors influencing FNS education (e.g., funding, policies). Statistical analyses were conducted using STATA. Descriptive statistics were generated for all categorical data. Chi-square tests and post hoc analyses using contingency tables and adjusted standardised residuals analysed associations between frequency of FNS education and teaching approaches (cross-curricular subject vs stand-alone subjects vs both) and presence of FNS-related policies, access to funding and teacher training. Statistical significance was set at p < 0.05. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14. Participants were 413 Australian primary school teachers recruited via social media, organisational mailing lists and departmental school listings. Most teachers reported it is extremely/very important to teach students about nutrition (83.8%), food skills (69.7%) and food sustainability (74.1%), and these topics were considered equally important to most mandatory curriculum subjects. FNS was generally taught only 1–2 times per term (29.9%) or 1–2 times per year (31.6%), and 44.1% of teachers taught this as both a stand-alone and cross-curriculum subject. Teachers reported high levels of understanding (89.3%/92.5%/78.7%) and knowledge/skills (70.5%/75.5%/62.5%) to teach students about food, nutrition and sustainability respectively. Less than a third were trained in food (22.8%), nutrition (29.5%) or sustainability (24.5%) education. Less than a third of teachers had access to funding for FNS activities (29.8%) or training (19.9%) or were from schools with policies about including FNS education in the curriculum (28.5%). There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability were more likely to teach this as both a stand-alone and cross-curricular subject (all p < 0.05). Within open-ended responses, teachers described personal factors (e.g., workload) that influenced their FNS teaching practices, as well as factors related to students’ families (e.g., family food practices), the curriculum (e.g., overcrowding) and the school environment (e.g., time, funding, training). Strengthening FNS education in the Australian primary school sector is an important next step for public health. Researchers and policy makers should explore opportunities for training, funding and policies to prioritise FNS within the curriculum.

There is growing interest in the role that dietary nitrate plays in cardiovascular health, with plant-sourced and animal-sourced nitrate showing potentially positive or negative effects. Inflammation is a key factor in the development and progression of atherosclerosis, a major contributor to cardiovascular disease (CVD). A recent review highlighted the potential of nitrate to modulate inflammatory processes.(1) However, research investigating the association between dietary nitrate intake from different sources (plant-sourced nitrate, nitrate-additive-permitted meat, and meat with naturally-occurring nitrate) and inflammation in humans is limited. This study aimed to investigate associations between source-dependent nitrate intake and inflammatory markers—namely lipoprotein-associated phospholipase A2 (Lp-PLA2) and high sensitivity C-reactive protein, (hs-CRP)—as well as traditional CVD risk factors. Among 100 non-smoking adults (mean age 49 ± 13 years, 31% male), cross-sectional associations between nitrate intakes from plant and animal sources (estimated from food frequency questionnaire data in combination with comprehensive food databases specifying food nitrate content)(2,3) and 1) Lp-PLA2 and hs-CRP measured in fasting plasma samples, and 2) blood lipid levels, blood pressure and waist circumference, were examined. Linear and logistic regression models were adjusted for sociodemographic, lifestyle and dietary confounders. Participants were classified as high-risk (either diagnosis of type 2 diabetes or two or more other CVD risk factors), or low-risk (normal health metrics and an absence of chronic disease). After adjusting for demographic and lifestyle confounders, a 1 standard deviation (SD) (95.73 mg/day) increment in plant-sourced nitrate intake was associated with a 0.191 SD lower LDL cholesterol (β = -0.191, 95% CI [-0.376, -0.004], p = 0.045; equivalent to -0.21 mmol/L), but not with any of the other outcomes. In contrast, intakes of naturally occurring animal-sourced nitrate were not associated with any of the outcomes. A 1 SD (0.32 mg/day) increment in nitrate intake from additive-permitted meat-sources was associated with a 0.192 SD higher waist circumference (β = 0.192, [0.005, 0.380], p = 0.042; equivalent to +1.29 cm) and a 0.208 SD lower HDL cholesterol (β = -0.208, [-0.362, -0.054], p = 0.009; equivalent to -0.10 mmol/L), but not with LDL cholesterol, triglycerides, blood pressure, Lp-PLA2, or CRP. No clear differences between CVD risk groups were observed. In conclusion, while no associations were found between naturally occurring animal-sourced nitrate and inflammatory markers or any CVD risk factors, nitrate from additive-permitted meat-sources were negatively associated with waist circumference and HDL cholesterol, whereas plant-sourced nitrate showed favourable associations with LDL cholesterol.

Systemic weight-bias may negatively influence nutrition recommendations and outcomes in the treatment of mental illness(1,2,3). However, weight loss is often considered a primary outcome in mental health care, despite the potential harm that may come from practising within a ‘weight-centric’ paradigm(4). Therefore, it is important to consider the impact of experiences of weight-based discrimination in mental health care, as well as investigate weight-neutral approaches in relation to mental and physical health and wellbeing. This study utilised a sequential explanatory study design. First, a systematic search was performed including observational studies of adult populations, with ≥ 1 mental or physical health outcome, and ≥ 1 validated measure of eating behaviour reflective of a weight-neutral approach. Outcomes were categorised into four domains (mental health, physical health, health promoting behaviours and other eating behaviours). Risk of bias was assessed using the Newcastle-Ottawa Scale. Next, a cross-sectional online survey was conducted among a community sample with self-reported diagnoses of depression or anxiety. Questions collected experiences of weight-stigma in mental health care, and validated measures such as the Depression and Anxiety Stress Scale (DASS-21), Stigmatizing Situations Inventory-Brief (SSI-B), and Weight Bias Internalization Scale (WBIS-M). Quantitative data were statistically analysed using Jamovi, while open-ended responses were thematically analysed using an inductive approach to reach consensus. In the systematic search, 8281 records were identified with 86 studies including 75 unique datasets, and 78 unique exposures including intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). Eating behaviours were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, diet quality, and higher fruit and vegetable intake. Among the 66 survey respondents (mean age 35.5 ± 11y), greater experienced weight bias (SSI-B) was significantly associated with greater depressive symptoms (r = 0.281, p < 0.05), and greater internalised weight-bias (WBIS-M) was significantly associated with greater depressive symptoms (r = 0.492, p < 0.001; β = 0.414, p = 0.001), anxiety symptoms (r = 0.437, p < 0.001; β = 0.390, p = 0.003), stress (r = 0.399, p < 0.01; β = 0.371, p = 0.006) and DASS-21 total score (r = 0.513, p < 0.001; β = 0.453, p < 0.001). Respondents reported experiences of weight-stigma that resulted in the mismanagement of mental health concerns, unsolicited diet and weight loss advice, and healthcare avoidance. Experiences of weight-stigma within mental health care have the potential to negatively impact mental health and nutrition-related recommendations. However, it must be considered that eating behaviours focused on health, not weight, are positively related to a range of mental and physical health outcomes. Therefore, it is vital healthcare professionals understand and assess their own biases related to weight, to reduce the impact of weight-bias on quality of care and consider weight-neutral approaches to better support mental health and wellbeing.

Chronic musculoskeletal pain (CMP) often disrupts daily activities, including dietary behaviours, which may lower overall diet quality(1). This study aimed to explore the extent to which participants with CMP perceived pain influences their eating behaviours and evaluate how diet quality is impacted during pain episodes. Twenty-five participants (72% women, 55 ± 16 years, 25.4 ± 4.6 kg/m2) were enrolled in a 2-week feasibility study, with scientific and exploratory outcomes reported(2). Clinic assessments captured pain sites, baseline pain intensity (0–100 mm Visual Analogue Scale, VAS), and thoughts and feelings evoked by pain (Pain Catastrophising Scale, PCS). Eating behaviours were assessed using the Dutch Emotional Eating Behaviours Questionnaire (DEBQ-E) and study-specific Food-Related Behaviours Questionnaire (FBQ). Participants completed 4-day weighed food records (WFR) and reported pain (via VAS) concurrently at each eating occasion. Daily pain intensity was obtained by averaging VAS at each eating occasion. Using a novel algorithm, diet quality was scored from WFR (FoodWorks, Xyris) data using the Dietary Guideline Index (DGI), generating total (0–120), core (0–70) and non-core scores (0–50) for each day’s intake, and averaged for the 4-days(3). Higher DGI scores reflect better diet quality. Spearman rho (rs) explored associations between baseline pain and diet outcomes. Linear mixed-effects (LME) models explored whether daily pain intensity (VAS) predicted fluctuations in diet quality (DGI scores). The FBQ responses were reported descriptively. Most participants (84%) reported multiple pain sites, with mild-moderate intensity (initial VAS, 40.8 ± 23.0) and poor diet quality (DGI total score 51.6 ± 18.0). Higher baseline pain intensity was associated with lower average DGI core food scores (rs −0.470, p = 0.018). Higher PCS scores correlated with lower average DGI total, and core food scores (rs −0.397, p = 0.049 and rs −0.442, p = 0.027), and higher DEBQ-E scores (rs 0.521, p = 0.008). However, when captured concurrently with dietary intake, LME models indicated that average daily pain intensity, which varied across the 4-days (VAS range: 0.8–85.0) did not significantly predict daily diet quality (DGI total, core, or non-core scores). Most participants disagreed that pain influenced their dietary behaviours (40–84% disagreement), with the highest agreements (31%) for choosing less healthy foods and snacking more frequently when in pain. This study suggests dietary behaviours are associated with CMP, with lower core food intake related to higher pain intensity, and emotional eating associated with pain catastrophising. The concurrent assessment of diet quality and pain intensity provided a novel approach to explore these relationships. However, although we observed fluctuations in pain intensity, these did not influence dietary intake and associated diet quality. This study highlights the importance of capturing diet quality and dietary behaviours in people with persistent pain.

Increased temporal variability in the gut microbiome is associated with intestinal conditions such as ulcerative colitis and Crohn’s disease, leading to the recently established concept of microbial volatility (1). Increased physiological stress has been shown to increase microbial volatility indicating that microbial volatility is susceptible to external interventions(1). Dietary fibre positively affects the gut microbiome, but it is unclear if it impacts microbial volatility. The gut microbiota influences hypertension, and high-fibre intake reduces blood pressure (BP)(2). However, not all individuals exhibit a response to these fibre-based dietary changes, and the reasons for this variability remain unclear. Similarly, it is unknown whether the degree of stability of the gut microbiota consortium could be a determining factor in individual responsiveness to dietary interventions. Here, we aimed to identify: i) whether gut microbiome volatility differs when dietary fibre vs placebo interventions, and ii) whether microbiome volatility discriminates between BP responders and non-responders to a high fibre intervention. Twenty treatment-naive participants with hypertension received either placebo or 40g per day of prebiotic acetylated and butyrylated high amylose maize starch (HAMSAB) supplementation for 3 weeks in a phase II randomised cross-over double-blind placebo-controlled trial(3). Blood pressure was monitored at baseline and each endpoint by 24-hour ambulatory BP monitoring, with those experiencing a reduction between timepoints of ≥ 2 mmHg classified as responders. Baseline stool samples were collected, and the V4 region of the 16S gene was sequenced. Taxonomy was assigned by reference to the SILVA database. Microbial volatility between timepoints (e.g., pre- and post-intervention) was calculated as the Euclidian distance of centred log-ratio transformed genera counts (Aitchison distance). No difference was observed in microbial volatility between individuals when they received the dietary fibre intervention or the placebo (21.5 ± 5.5 vs 20.5 ± 7.7, p = 0.51). There was no significant difference between microbial volatility on the dietary intervention between responders and non-responders (21.8 ± 4.9 vs 20.9 ± 7.2, p = 0.84). There was no association between the change in BP during intervention and microbial volatility during intervention (r2 = −0.09, p = 0.72). These data suggest that temporal volatility of the gut microbiota does not change with fibre intake or contribute to the BP response to dietary fibre intervention trials in people with hypertension.

Teacher food and nutrition (FN) practices influence their personal health and wellbeing outcomes, with implications for students. As educators, teachers role model FN practices to students and act as health promoters. Our team’s recent scoping review outlined the lack of standardised methods used to assess FN constructs in teachers, with limited validated and composite tools available that measure FN constructs, especially culinary factors, alongside measures of wellbeing(1). The importance of teacher FN education, to facilitate effective school health promotion, is highlighted by the World Health Organization and the United Nations Education Scientific and Cultural Organization. Therefore, understanding the scope of teacher FN practices in relation to teacher wellbeing is critical, yet limited evidence currently exists. This research aims to examine baseline data on teacher FN practices and potential FN predictors of teacher health and wellbeing from the Australian longitudinal teacher FN-related health and wellbeing study. The Teacher Food and Nutrition Questionnaire (TFNQ) consists of nine sub-scales and 21 single-item measures using pre-defined food, nutrition, and wellbeing constructs. This provides a composite evaluation tool to collate data on teacher FN practices for comparison with wellbeing outcomes, including stress and burnout. Descriptive statistics and Pearson correlation coefficient (r) were used to assess relationships between food, nutrition, and wellbeing constructs, and linear regression to determine slope of significant relationships using diet quality (i.e., the Fruit and Vegetable Variety index), wellbeing (i.e., burnout) and professional FN confidence as outcome variable(s) of interest. A total of n = 112 secondary teachers completed the baseline TFNQ (September 2023). Of these, the majority were female (87.5%), aged 31–45 years (52%), with 90% on full time contracts. Mean diet quality score was 92.0 (maximum score (MS) of 190), with sub-scale score for vegetable (63.2/122 MS) and fruit (28.9/68 MS) intake. Of the wellbeing measures, burnout (16.3/24 MS), stress (7.3/10 MS) and coping (6.2/10 MS) were measured alongside teacher food skills confidence (105.7/133 MS) and food agency (40.9/55 MS). Teacher FN confidence to role model healthy FN practices was moderately correlated to food agency r = −0.43 (p < 0.001), and personal subjective wellbeing ‘satisfied’ r = 0.41 (p < 0.001). A moderate correlation was observed between vegetable intake and food skills confidence r = 0.42 (p < 0.001), with a moderate negative correlation observed between food agency and teacher burnout r = −0.43 (p < 0.001). Overall, these baseline data confirm teacher diet quality is suboptimal, with teacher food agency and/or food skills confidence demonstrating moderate correlations with all three study outcomes of teacher wellbeing, diet quality and professional FN confidence. These data provide a snapshot of secondary teachers’ FN practices and wellbeing. Results inform development of professional development to support FN behaviours as a contributing factor for optimal teacher health and wellbeing.

Older adults are at an increased risk for both malnutrition and cognitive decline(1,2). However, the relationship between nutritional status and cognitive decline remains unclear, and was investigated in this study. This is a cross-sectional analysis of baseline data from the Capacity of Older Individuals after Nut Supplementation (COINS) study, a randomised controlled trial investigating the effect of peanut butter on functional capacity in older adults. Older adults aged 65 years and over, who were community-dwelling, generally healthy and at risk for falls (simplified fall risk screening score ≥ 2) were recruited as part of COINS study. Nutritional status was measured using the Mini Nutritional Assessment (MNA) tool (score range 0 to 30). An MNA score of ≥ 24 indicated normal nutrition status, while a MNA score of < 24 was indicative of at-risk for malnutrition. Cognitive performance was measured by the validated Montreal Cognitive Assessment MoCA (range 0 to 30), and Trail Making Tests-A and B (TMT-A, TMT-B) (as time taken to complete tasks) tools. The MoCA test further provided scores on visuospatial/executive function, naming, language, attention, abstraction, delayed recall, and orientation domains. Multivariable linear regression analysis was used to investigate the association between nutritional status and cognitive function, adjusted for age, sex and BMI. A total of 118 older adults with complete data were analysed (83% females, age (mean ± SD) = 74 ± 4 years; BMI = 27.5 ± 4.2 kg/m2), of which 93.2% (n = 110) were considered to have normal nutritional status, and the remaining 6.8% (n = 8) were deemed at risk of malnutrition. In terms of cognitive function status, 40.7% (n = 48) had normal cognitive function (MoCA score ≥ 26), 56.7% (n = 68) had mild cognitive impairment (MoCA score 18–25), and 1.7% (n = 2) had severe cognitive impairment (MoCA score 10–17). After adjusting for age, sex, and BMI, MNA score was positively associated with both overall MoCA scores (β (95% CI): 0.29 (0.04, 0.54), p = 0.024) and the visuospatial/executive function (β (95% CI): 0.16 (0.05, 0.28), p = 0.006), but not with other cognitive domains or TMT performance. In summary, our findings suggest that nutritional status assessed via MNA may be predictive of global cognitive function. Future studies are needed to determine if MNA could be a surrogate marker or risk factor for cognitive declines.

A relationship between characteristics of gut microbiota and obesity are now well-established(1). However, less well-understood is the extent to which these microbiological features change during periods of weight loss. This study aimed to investigate the relationship between gut microbiota and weight loss in adults (aged 25 to 65 years, BMI of 27.5 to 34.9 kg/m2) enrolled in a 9-month randomised controlled trial(2). Participants were randomised to consume an energy-restricted diet that was either almond-enriched (30–50 g/daily) or nut-free (carbohydrate-rich snack foods). Data were collected at baseline (BL, n = 108), 3 months (3M, weight loss, n = 87) and 9 months (9M, weight maintenance, n = 82) for body weight, diet composition (weighed food diaries) and faecal microbiota composition (16S rRNA V4 amplicon sequencing). Paired data were analysed using mixed-effects models adjusted for baseline BMI, age, sex, dietary fibre. As reported previously, significant weight loss occurred for both diet groups to an equal extent(3). Significant inverse relationships were observed at BL between BMI and both microbiota richness (number of unique bacterial taxa detected) (estimate = −6.56, 95% CI = −9.9 to −3.19, p = 0.0002) and diversity (Shannon’s index) (−0.06, −0.1 to −0.02, p < 0.001). The strongest relationship at BL involved members of the Christensenellaceae bacterial family, which negatively correlated with BMI (r = −0.26, p = 0.007), consistent with prior studies(3,4). Microbiota richness (8.79, −0.73 to 18.34, p = 0.024) and diversity (0.08, −0.01 to 0.18, p = 0.019) were significantly higher at 9M compared to BL but not at 3M (p > 0.05). Compared to BL, microbiota composition (the taxa detected and their relative abundance) was significantly at 3M (p < 0.001) and 9M (p = 0.007). Following weight loss at 3M, significant increases in the relative abundance of members of the Christensenellaceae and Ruminococcaceae families were observed (log2 fold change > 1, FDR p < 0.05). Positive associations between weight loss and an increase in the relative abundance of Christensenellaceae family was evident at 3M (0.001, 0.0002 to 0.002, p = 0.010), but did not remain significant at 9M. Additionally, weight loss at 3M (0.0002, 1.3 × 10-5 to 0.0005, p = 0.038) and at 9M (0.0002, 4.6 × 10-6 to 0.0005, p = 0.045) was positively associated with an increase in the relative abundance of Lachnospiraceae ND3007, a bacterial genus associated with improved diet quality(5). Our findings demonstrate that the abundance of specific bacterial populations within the gut microbiota change in a manner that is proportionate to weight loss resulting from an energy-restricted diet. The extent to which these microbes are simply markers of altered diet, or whether they contribute in a causal manner to weight loss, as suggested by emerging preclinical data(3), is yet unknown.

Asthma is a chronic inflammatory disease of the lungs, characterised by variable airflow limitation and symptoms including shortness of breath, wheezing, coughing and chest tightness(1). One in 9 Australians has asthma and 42% also have obesity(1). The risk of developing asthma doubles in people who have obesity(2). While obesity is associated with increased severity of asthma(3), people with obesity have more severe asthma symptoms, poorer lung function, reduced quality of life and an increased risk of an asthma exacerbation(3). Response to medication also tends to be impaired, therefore limiting the efficacy of pharmaceutical management(4). Obesity is associated with increased systemic inflammation and there is some evidence that this inflammation may extend to the airways of adults with asthma; with research suggesting obesity is associated with increased airway inflammation(5). The impact of weight management on airway and systemic inflammation in asthma is unclear. Weight loss has been shown to improve asthma and, as such, has been recommended in asthma management guidelines(1). However, the ideal approach to sustainable weight loss in people with asthma is unknown. The aim of this systematic review is to determine both the short- and long-term efficacy of different obesity management approaches in adults with obesity and asthma, by systematically reviewing the literature. Medline, Embase, CINAHL, Scopus, Web of Science, Current Contents and Cochrane Central Register of Controlled Trials were searched up to January 2024, for obesity management interventions that assessed changes in clinical asthma outcomes, body composition, inflammation, and/or metabolic parameters. Studies were grouped by intervention type (lifestyle modification, pharmacotherapy, and bariatric surgery) and follow-up duration (< 12 months and ≥ 12 months). Eighteen lifestyle interventions, two pharmacotherapy and 17 surgical studies were included in the systematic review and 15 in the meta-analysis. All (n = 18) lifestyle interventions reported short-term results (< 12 months) and two reported long-term results (≥ 12 months). For surgical interventions, five reported short-term outcomes and 94% (16/17) reported long-term outcomes. 69% (9/13) of the lifestyle interventions observed statistically significant improvement in asthma symptoms in the short-term. Only 2 studies report long-term results (≥ 12 months) with improvements maintained in 50% (1/2) of studies. All surgical interventions (8/8) observed statistically significant long-term (≥ 12 months) improvements in asthma symptoms at twelve months. Research suggests that lifestyle interventions to manage obesity improve asthma symptoms in the short-term; however, the long-term efficacy is less certain due to the small number of studies. Surgical interventions show improved asthma symptoms at 12 months. Additional research is required to better understand the optimal obesity management approach and duration for adults with comorbid obesity and asthma.

In Australia, Sports foods are increasingly being consumed by non-athletes, despite their intended purpose to supplement additional nutrient intake for high energy output by athletes(1,2). Recent evidence suggests that sports food are perceived as regular foods and are being used by non-athletes for purposes contrary to which they were designed(1,3). However, in contrast to lay-perceptions, this growing trend poses health risks, including nutrient overconsumption and unwanted health-related side effects such as caffeine overdose(4,5). Many consumers are also relying on the recommendation of sports food products through digital media sources and the use of misleading packaging information to choose products(1,6), although the factors influencing the use of these is unclear. Consumer sports food choice is complex, influenced by multiple social and ecological factors, therefore this study used an adapted Social-Ecological Model of sports food choice to examine the relevant factors that influence the perception of risks, regulations and on-pack attributes. The aim of this study was to explore non-athlete Australian sports food consumers’ perceptions of the risks associated with consumption, views about on-pack warnings and regulations in Australia and perceptions of packaging attributes displayed on these foods through a social ecological lens. This study also examined the suggestions to improve on-pack warnings and regulations of sports food products in Australia. Qualitative semi-structured online interviews were conducted with n = 15 non-athlete Australian adult sports food consumers. Reflexive thematic analysis was used to code responses using NVivo software. Participants had conflicting views on the risks associated with sports food consumption perceiving them to be high risk to others but of limited risk to themselves. Consumers trusted some packaging information more than others. That is, the Nutrition Information Panel and claims were seen as more credible than packaging colours and images. Digital media was the key source of recommendation for the selection of sports food products, particularly YouTube and podcasts. All participants in the study mentioned that warnings and regulations were too generic, not applicable to them and that government regulations lacked credibility and validity. Participants also suggested improvements for warning labels and regulatory measures such as providing more information, greater restriction on sale locations and on the ability for certain consumers to purchase these products. Consumption of sports foods by non-athletes is influenced by attitudes towards personal risks, the persuasive influence of digital media, and perceptions of the warnings and regulations as being inadequate. Findings highlight the need for stricter packaging and regulations that ensure marketing controls and provide safer sports food products for non-athletes to consume. Future research should track these perceptions over time to ensure that improvements to packaging clarity and regulatory measures impact consumer consumption of sports foods.

The number of people affected by at least one chronic disease is increasing worldwide, with poorer health-related quality of life (HRQOL) being a major consequence(1). HRQOL is an important measure for quantifying and evaluating the impacts of a disease or intervention on self-perceived wellbeing. Anti-inflammatory diets are consistently associated with improvements in disease-specific outcomes(2,3), but their effect on HRQOL is unclear. This systematic review and meta-analysis aimed to estimate the effectiveness of anti-inflammatory dietary interventions on HRQOL in adults with one or more chronic diseases. Five databases were searched from inception to May 2024 for randomised controlled trials evaluating the impact of an anti-inflammatory diet (e.g., Mediterranean, low-carbohydrate) on HRQOL. Screening, data extraction, and risk of bias assessment using the Cochrane Risk of Bias v2.0 tool were performed independently by two authors. Certainty of evidence was determined using the GRADE approach. Pooled effect sizes for HRQOL, separated into mental (MCS) physical (PCS) and general component scores (GCS) were calculated using random-effects meta-analyses and reported as standardised mean difference (SMD). Subgroup analyses and meta-regressions were performed to assess the influence of study-level characteristics on HRQOL outcomes. Twenty-three studies reporting HRQOL data for 2753 participants were included. The most common chronic diseases evaluated were type 2 diabetes (8 studies, 35%), musculoskeletal conditions (5 studies, 22%), and cardiovascular conditions (3 studies, 13%). Anti-inflammatory dietary interventions evaluated included the Mediterranean diet (14 studies, 61%), low-carbohydrate diets (8 studies, 35%), Dietary Approaches to Stop Hypertension (1 study, 4%) and low-sugar, low-yeast diet (1 study, 4%). Anti-inflammatory diets were associated with small improvements in PCS compared to usual care/non-anti-inflammatory dietary interventions such as national dietary guidelines and low-fat diets (SMD 0.22, 95% CI 0.06 to 0.38) but not MCS (SMD 0.10, 95% CI −0.02 to 0.23) or GCS (SMD 0.40, 95% CI −0.32 to 1.13). Assessment by study-level characteristics revealed that studies with a higher risk of bias reported a larger effect on PCS, and diet-only interventions (compared to multi-component interventions) had a greater effect on MCS. No study met the Cochrane criteria for low risk of bias, and certainty of evidence was low (PCS and MCS) to very low (GCS). This systematic review suggests that anti-inflammatory diets may lead to a small improvement in physical HRQOL, but not mental or general HRQOL. The low certainty of evidence calls for further high-quality RCTs with detailed descriptions of dietary interventions in individuals with one or more chronic diseases.

Management of mental health disorders often include nutritional therapy, and guidelines for monitoring require pathology tests. This includes but not limited to individuals with alcohol and other drugs (AOD) and weight-control issues in cases of metabolic syndrome (obesity, hypertension, dyslipidaemia, and diabetes), which involves cardiology or cardiovascular medicine management. The extent of compliance to evidence-based practice including laboratory tests(1), such as routine full blood count(2), as well as electrolytes and liver function tests are considerations in evaluation of nutritional management and monitoring. The primary objective of this review is to determine compliance to guidelines in case studies involving nutritional management. The secondary objective is evaluation of the pathology results in cases of cardiovascular disease management guidelines. This was a systematic literature review and meta-analysis, which were adopted in identifying and selecting the articles appraised. Search was unlimited in years of publication. Initial search engine was PubMed, for brevity. Appraisal tool was a simple objective questionnaire based on evidence-base practice in nutritional perspective of AOD management using a reference template. Additional grey literature search was done to provide nuance to the systematic review. Compliance to evidence-based practice was quantified by calculating the percentage of expected ‘yes’ responses. On pathology tests, the focus was predominantly on coagulation profile, haematology, lipid profile and liver function tests. Among the > 548,000 titles initially identified, only three were selected for the critical appraisal and three additional documents were selected from the grey literature search. All six articles appraised, showed 98% compliance to pathology guidelines. The laboratory evidence-based monitoring was implied in five, of which four were related to cardiology and four reports indicated or inferred laboratory monitoring of dyslipidaemia, only. None of the articles mentioned coagulation profile, haematology or liver function tests. This discourse advances that for almost 30-years, there has been knowledge of a strong link between nutritional management and cardiovascular disease management including in mental healthcare, which can be assessed with eWBV from pathology(3). There is excellent compliance to evidence-based practice in research reports involving nutritional management in mental health cases. However, laboratory evidence-based monitoring for cardiovascular medicine seems incomplete. In cognizance of cardiovascular disease management guidelines, this incompleteness may be a matter of discretion.

Eggs are a unique food that are high in cholesterol, but low in saturated fat. Egg consumption recommendations have fluctuated over time due to the belief that increased intake of dietary cholesterol raises plasma low density lipoprotein cholesterol (LDL-C) and therefore cardiovascular disease risk(1). Research suggests it is saturated fat, rather than dietary cholesterol, that is implicated in this association, yet controversy over egg consumption remains(1,2). This study aimed to evaluate the independent effects of dietary cholesterol (from eggs) and saturated fat intakes on LDL-C. Sixty-one adults with LDL-C less than 3.5 mmol/L (39 ± 2 years, BMI 25.8 ± 0.8 kg/m2) were enrolled in a randomised controlled counter-balanced, three-arm cross-over study(3). Participants consumed three isocaloric diets for five weeks each in randomised order: a high-cholesterol (600 mg)/low-saturated fat (6%) diet including two eggs per day (EGG) diet, a low-cholesterol (300 mg)/high-saturated fat (12%) without eggs (EGG-FREE) diet, and a control diet (CON) high in both cholesterol (600 mg) and saturated fat (12%) including one egg per week. Each diet phase included eight detailed daily meal plans with recipes, which were used on rotation for the five-week period. Throughout each dietary phase participants attended three diet review consults (via video conference or phone) and received individualised dietary advice from a dietitian. Dietary intake (5-day diaries analysed using Foodworks, Xyris Software, Australia), and lipid and lipoprotein levels were measured at study entry, and at the end of each diet phase. Treatment effects were analysed using linear mixed effects models. Results are reported as mean ± standard error. Forty-eight participants completed all three diets, with dietary analyses demonstrating target cholesterol and saturated fat intakes were generally met for each diet. Notably, saturated fat intake was 2% higher than target for all diets (CON and EGG 14%; EGG-FREE 8%). Compared to CON, plasma LDL-C concentration was significantly lower following the EGG diet (2.83 ± 0.08 mmol/L vs 2.68 ± 0.08 mmol/L, p = 0.02), but not the EGG-FREE diet (2.75 ± 0.08 mmol/L, p = 0.52). Across all three diets there was a significant within-individual relationship between dietary saturated fat intake and LDL-C concentration (β = 0.35, p = 0.002), but there was no significant relationship with dietary cholesterol intake (β = −0.006, p = 0.42). Our findings indicate that dietary saturated fat, not cholesterol, is responsible for elevating plasma LDL-C concentrations. Consuming two eggs per day within a low-saturated fat diet does not adversely affect plasma LDL-C.

Nutrition plays a key role in brain development in the first 1000–2000 days of life(1). Furthermore, fussy eating is broadly defined as the inconsistent rejection and acceptance of both familiar and unfamiliar foods(2). Fussy eating is reportedly found in 10–15% of 2–3-year-old children, although typically starts to decrease in prevalence by 4 years old(3). Despite this decrease in the general population, children with neurodevelopmental disabilities, such as autism spectrum disorder, can see a protracted continuation of fussy eating and reject approximately 30% more foods than typically developing children(4). Consequently, for some children with neurodevelopmental disabilities maintaining adequate nutritional intake can be a challenge. Key nutrients for optimal neurodevelopment include iron, omega-3, protein, zinc and folate(1), and underconsumption of these nutrients can lead to poorer developmental outcomes in some children(1). Limited empirical evidence has been published on fussy eating in children with neurodevelopmental disabilities and no studies has examined the effects of poor diet variety on their emotional regulation. This study aims to systematically review current evidence to determine the association between fussy eating, diet variety and experiences of emotional regulation in children with neurodevelopmental disability. The search strategy was designed with the use of database specific index phrasing and was modified and tested several times before the formal search day. The systematic literature review was conducted across Medline, Scopus, Embase, Cinahl and Google Scholar. Studies included were dated from 2014–2024 and must have included children with a diagnosed or suspected neurodevelopmental condition and be aged been 1 to 9 years. Articles were excluded if children were following diets restricted by caregivers such as vegetarianism or ketogenic diets. Studies which focused primarily on a psychological outcome were also excluded due to the scope of the research not being within a nutrition related field. All articles were stored in Endnote, with duplicates removed before screening. The search results yielded 500 articles, following screening 10 full text articles met all inclusion criteria. Following data extraction, results illustrated that children with neurodevelopmental disabilities and observed fussy eating behaviours can experience difficulties regulating emotions. Additionally, diet variety was found to be consisting primarily of processed grains and meats, with minimal wholegrain and vegetable intake. Further research is needed to understand the aetiology and causative pathways between fussy eating, diet variety and emotional regulation for children with neurodevelopmental disability to better inform potential dietary interventions in this population.

Immunoceuticals are natural products used to enhance immunity(1). Lactoferrin (Lf) is an immunoceutical supplement which has been shown to have immunomodulatory properties(2). The immuno-protective functions of Lf are of interest in older adults, as immune function declines with increasing age(3). This study examined the effects of oral Lf supplements on ex vivo immune cell responses to respiratory virus infection, circulating immune cell subsets, and systemic inflammation. Healthy adults (≥ 50 years old, n = 103) were randomised to High dose (600 mg/d) or Low dose (200 mg/d) Lf or placebo, in a 4-week, parallel, double-blinded trial. Ex vivo cytokine release of interferon (IFN)-α2, IFN-γ, interleukin (IL)-6 and tumour necrosis factor (TNF)-α) in isolated peripheral blood mononuclear cells (PBMCs) infected with rhinovirus A-16 (RV-16) and influenza A virus (H1N1), circulating immune cell subsets, and plasma IL-6, C-reactive protein (CRP) and TNF-α were assessed and analysed by multivariate regression models. Analysis included 102 participants at baseline, and 96 participants at follow up. High dose Lf decreased RV-16-induced IL-6 (p = 0.001 vs placebo), and increased RV-16-induced IFN-α2 (p = 0.041, vs low dose) in PBMCs. H1N1-induced IL-6 decreased following Low dose Lf and placebo (p = 0.009, p = 0.021 vs baseline), while High dose Lf increased H1N1-induced TNF-α (p = 0.023 vs low dose, p = 0.049 vs placebo) and decreased H1N1-induced IFN-γ (p = 0.032 vs baseline) in PBMCs. High dose Lf increased total T cells (p = 0.031), CD4+ T cells (p = 0.028) and BDCA-1 cells (p = 0.016), and decreased γδ T cells (p = 0.046) compared to placebo, while Low dose Lf reduced circulating neutrophils (p = 0.044), natural killer cells (p = 0.045), activated CD8+ T cells (p = 0.031), and γδ T cells (p = 0.031) compared to placebo. High dose Lf decreased plasma IL-6 and CRP compared to Low dose Lf (p = 0.004, p = 0.026), but not placebo. There was no difference between intervention groups in the number of adverse events. This 4-week trial in healthy, older adults showed both High and Low dose Lf interventions enhanced ex vivo immune cell responses to respiratory virus infection, with decreased pro-inflammatory cytokine and increased anti-viral cytokine release observed. Low dose Lf reduced the frequency of both pro-inflammatory and cytotoxic innate immune cells, while increased T-cell populations following High dose Lf indicate improved cellular adaptive immune responses which provide protection against infection, tumours and chronic disease. Effects on systemic inflammation were only seen following High dose Lf, suggesting higher doses of lactoferrin are required to address this outcome. Oral lactoferrin supplements are generally regarded as safe, and appear to have immunoceutical benefits in healthy, older adults.

With the food system estimated to be responsible for approximately one-third of greenhouse gas emissions(1) there is an urgent need to transition to healthy and more environmentally sustainable diets. Plant-based ‘milks’ are associated with lower greenhouse gas emissions than dairy milks(2) and many Australian consumers are making the substitution(3). The 2013 Australian Dietary Guidelines advise that plant-based ‘milks’ fortified with at least 100 mg of calcium per 100 ml (e.g., soy, rice or other cereal) can replace dairy milk in the diet(4). This study aimed to assess the likely population-wide nutritional implications of replacement of dairy milk with the main categories of plant ‘milks’ available in Australian supermarkets in November 2023. We used computer simulation modelling of data from the 2011–2 National Nutrition and Physical Activity Survey (n = 12,153 persons aged 2+ years)(5). Dairy milk (including from hot drinks) was replaced with each category of plant ‘milk’ and the likely impact on usual intake of key nutrients supplied by dairy milk was assessed across eight age groups (National Cancer Institute method). Mean usual protein intake was relatively unchanged when dairy milk was replaced by soy ‘milk’ but replacement by rice ‘milk’ led to reductions of 4–5% in older adults (71+ years), increasing the proportion of older men with an inadequate intake from 14% (95% margin of error 5.1) to 20% (8.1). Nine out of 11 categories of plant ‘milks’ were not fortified with riboflavin. Replacement of dairy milk with these products would likely reduce mean usual riboflavin intake by 11% in older adults, increasing the proportion with an inadequate usual intake from 20% (6.2, 5.8) to 30–31% (9.9, 6.3). Nine out of 11 plant milk categories were not fortified with vitamin B12, and replacement of dairy milk with these products would likely reduce usual intake by 10-49% depending on the population group, leading to the proportion of females aged at least 14 years with an inadequate usual intake of vitamin B12 to increase from between 5 (2.2) and 8% (4.0), depending on age, to between 11 (3.4) and 17% (5.4). All categories of plant milks were unfortified with iodine. As a result, replacement of dairy milk with plant ‘milks’ by females aged at least 14 years would likely reduce mean intake by 7–15% and increase the proportion with an inadequate intake from between 6 (4.2) and 12% (4.7), depending on age, to 15 (8.1) to 24% (6.0). In conclusion, replacement of dairy milk with most types of plant-based milk has the potential to adversely impact protein, riboflavin, vitamin B12 and iodine intakes by the Australian population. Advice about switching to plant-based milks needs to consider the population group concerned and a range of nutrients, not just calcium.