Adolescence is characterised by a decrease in diet quality and higher intakes of energy-dense nutrient-poor foods at snacks. Snacking is almost universal and makes a significant contribution to total energy intake among adolescents(1). Evidence suggests adolescent dietary intake is influenced by individual and social and physical environmental factors(2). However, the relationships between adolescent snacking with individual and environmental factors remain largely unexplored. This study aimed to investigate the individual, social and physical environmental factors associated with snack characteristics in a nationally representative sample of adolescents in the US. This secondary analysis used 24-hour dietary recall data collected during 2011–2018 from the National Health and Nutrition Examination Survey (1,835 boys and 1,796 girls aged 12–19 years). Snacks were defined based on participant-identified eating occasions; along with where they were sourced from and location of consumption(3). The associations between snack energy density (ED; kJ/g) and food groups consumed at snacks (vegetables, fruits, refined grains, whole grains, protein foods, dairy, and snacks and sweets) with individual (age, race and ethnicity), social-environmental (socioeconomic position, food insecurity), and physical environmental (snacking location and source of snacks) factors were examined using a multilevel two-part (logistic and linear regression) models, stratified by sex. We found associations for snack ED and food groups consumed at snacks with the source of snacks. Snacks obtained from convenience stores, vending machines, and social sources (from someone else) were more energy dense than those from grocery stores. Additionally, adolescents had lower odds of consuming fruit at snacks obtained from convenience stores (OR (95% CI): Boys, 0.20 [0.12, 0.33]; Girls, 0.31 [0.16, 0.61]) and vending machines (OR (95% CI): Girls, 0.07 [0.01, 0.56]). There were also lower odds of consumption of dairy foods at snacks outside the home (OR (95% CI): Boys, 0.69 [0.55, 0.88]; Girls, 0.70 [0.53, 0.92]). Non-Hispanic black girls consumed significantly fewer dairy foods as snacks compared to non-Hispanic white girls (β (95% CI): −0.37 [−0.60, −0.14]). Few associations with snack ED and food groups were observed for individual and social-environmental factors; non-Hispanic black girls showed lower dairy consumption at snacks. Among US adolescents, snack ED and food groups consumed at snacks were associated with the source of snacks. However, few associations were found for socioeconomic position, food insecurity, and snack consumption location. These findings suggest that public health interventions targeting the sources of adolescent snacks may encourage healthier food choices. Further studies on adolescent snacking should explore other individual and social-environmental factors such as food preference and influence of peers and family, and these studies should examine a wider variety of consumption locations outside the home.

The aim was to assess food security on Stuart’s sixth expedition to the north (20 December 1861 to 10 December 1862), when he succeeded in crossing the continent from Adelaide to Van Diemen Gulf and returned without loss of life. Contemporary methods were applied to the evidence available for the expedition food supply in published reports(1). These included qualitative assessment of dietary food group diversity and food variety. These measures have been used as a proxy for the level of food security provided by the rations over the duration of the expedition. The food rations were also subjected to nutrient analysis and the results compared to recommended dietary intakes for explorers who had a high physical activity level. Observations of the edible wild flora and fauna observed along the route were collated and assessed. Weekly food ration packs were taken (7 lb flour, 2 lb meat-dried, 1 lb sugar, ¼ lb tea) and found to be very poor in both dietary diversity of food groups (excluding dairy, fruit, vegetable) and the variety of food items. The packs were low in energy, high in protein, low in riboflavin and probably other micronutrients. Vitamins A (retinol) and C were completely absent. The Naturalist on the expedition (FG Waterhouse) was the only man authorised to shoot (for the Adelaide Museum collection) and, after processing, the remaining tissues were added to the cooking pot, which increased food variety more than food group diversity. The men (10) were travelling rapidly with a large group of horses. The gathering of edible wild foods was intermittent, determined by their availability according to latitude and seasonal conditions. The men could not supplement their inadequate food rations by hunting and gathering enough edible foods. On one of his earlier and less successful expeditions (to achieve the same aim), Stuart wrote that he was aware that five pounds of flour per man per week was not enough, but he soon reduced (day 35) the weekly rations per man to 4 lb flour, 1 lb meat-dried, 1 lb sugar and ¼ lb tea. The men suffered from food insecurity and its health consequences for the entire duration of the expedition (day 356). They were perpetually hungry and became gaunt shadows of their former selves. Stuart himself suffered from night blindness (Vitamin A deficiency) and grievous scurvy (Vitamin C deficiency). Stuart achieved his aim to cross the continent against the great odds of food insecurity. He knew better but chose to ignore it, creating great danger for himself and his companions.

Women are the primary food providers within Cambodian families, however little is known about what influences their food choices. Despite recent economic improvements, Cambodia remains the second poorest country in south-east Asia(1). Twenty-two percent of Cambodian children have stunting and 16% are underweight(2). Cambodian women of reproductive age exhibit the double burden of malnutrition, with 44% having anaemia and 33% with overweight or obesity(2). Nearly half of Cambodian women do not achieve minimum dietary diversity, with diets consistently low in vitamin A, thiamine, calcium, zinc and iron(3). Strategies to improve Cambodian families’ dietary intake are therefore needed. Factors influencing food choice are complex and multidimensional(4), and no previous studies have explored how Cambodian women make food decisions. This study aimed to understand Cambodian women’s food-related decision-making for themselves and their families. This qualitative study applied a descriptive methodology consistent with the experiential paradigm. Four 90-minute focus groups were conducted in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged 18+ years with at least one child aged under five who have primary responsibility for food provision within their family. Focus groups were facilitated by an Australian researcher (JW), using an interpreter to translate between Khmer and English languages. Groups discussed perceptions about food related to health, prompted by ‘conversation cards’ depicting food sources and nutritional benefits of five key nutrients. Reflexive thematic analysis was used to analyse the focus group data(5). Three themes were identified: 1) food access impacts choice; 2) responsible nurturing food provision role; and 3) dichotomous perceptions of food. Access to food strongly influenced food choices made by Cambodian women. High cost and low availability prompted women to forage for easily accessible ingredients such as water plants, fish, crabs and fruit, or choose cheaper, lower-quality foods from the market. Cambodian women strived to fulfil their responsibility to provide healthy, nourishing meals for their family within their capabilities, prioritising their husband and children over themselves. Nutritional awareness included understanding that fruit and vegetables contained vitamins, and meat was a good source of iron. They perceived certain traditional Khmer soups as ideal healthy meals, providing adequate energy and strength for hard-working husbands and growing children, and preventing sickness. Cambodian women considered healthy food using a range of dichotomous factors beyond their nutritional value, including ‘wet or dry’ food, ‘helpful or harmful’ in relation to immediate body symptom responses to food, cultural food taboos and use of chemicals on fresh vegetables. These findings indicate the need for future nutrition interventions targeting Cambodian communities to address women’s perceptions about the health-related qualities of foods, and access to nutritious foods so that behaviour change strategies are practical, culturally appropriate and acceptable.

Delaying carbohydrate digestion and glucose absorption, via inhibition of gastrointestinal α-amylase, α-glucosidase and glucose transporter activities, is an effective strategy to alleviate postprandial hyperglycaemia, which is a major risk factor for the development of insulin resistance and metabolic diseases such as type 2 diabetes. Oral antihyperglycaemic agents (OHAs) can be used alone or in combination with other medications or insulin to manage diabetes. However, OHAs are associated with a risk of hypoglycaemic events and numerous side effects, especially gastrointestinal symptoms, and are contraindicated in patients with irritable bowel syndrome and/or kidney, liver or cardiac dysfunction(1). Hence, there is interest in food-based compounds, such as (poly)phenols, with similar but milder effects to reduce hyperglycaemia and risk of metabolic disease, and to manage diabetes. Our complete and highly sensitive in vitro protocol can measure human carbohydrate digestive enzyme activities(2) and glucose transport(3)accurately. The sugars in enzyme assays (both substrates and products) and transcellular glucose transport assays (including lactulose, which is added as a control for cell monolayer integrity) are quantified directly by specialised ion chromatography. We use commercially-available human α-amylases to assess starch hydrolysis and brush border α-glucosidases derived from differentiated human intestinal Caco-2/TC7 cells to assess disaccharide hydrolysis, while 2-deoxy-D-glucose transport is measured across Caco-2/TC7 cell monolayers cultured on transmembrane supports. Enzyme and glucose transporter activities are measured in the presence of various concentrations of phenolic compounds or phenol-rich extracts and compared to the controls using one-way ANOVA. The potency of potential inhibitors is evaluated by calculating the half-maximal inhibitory concentration (IC50). We have successfully used this protocol to screen for potential inhibition by dietary (poly)phenols and uncover specific mechanisms of action and structure-function relationships. For example, we confirmed that quercetagetin, a polyphenol in spinach, inhibits human salivary α-amylase by binding to both starch and the enzyme (p < 0.05 vs quercetagetin-free control; IC50 = 30.1 ± 2.1 μM), while also inhibiting human α-glucosidase activities. Anthocyanidins found in berries directly inhibit pancreatic α-amylase (p < 0.05 vs anthocyanidin-free control), especially peonidin (IC50 = 25.8 ± 1.9 μM) and petunidin (IC50 = 28.5 ± 0.8 μM), while polyphenols found in walnut inhibit both salivary and pancreatic α-amylases and intestinal glucose transport. Notably, we have identified several plant-derived inhibitors that may be useful in regulating postprandial glycaemia in vivo. Such mechanisms may partially explain why a diet that is high in fruits and vegetables results in lower metabolic disease risk. Dietary (poly)phenols offer the potential to manage insulin resistance by diet and adjunct therapies with lesser side effects than OHAs. Further, our accurate and reliable method will benefit researchers involved in the discovery and development of novel agents for the prevention and management of diabetes.

Multiple sclerosis (MS) is a neurodegenerative disease that affects approximately 2.8 million people worldwide. Among other risk factors, such as smoking and history of infectious mononucleosis, diet is emerging as a modifiable risk factor for MS. However, there is little evidence associating plant-based diets and MS risk. The few studies available investigated vegetarian diets and MS risk and found conflicting results: in one study, a vegetarian diet was associated with higher risk(1), the other with lower risk(2). The aim of this study was to investigate associations between plant-based indices and risk of MS. We used data from the UK Women’s Cohort Study, which followed adult women over 20 years (MS cases: n = 88, age = 47.9 years [SD 7.6]; controls n = 25,038, age = 52.1 years [SD 9.2]). We used three plant-based indices: i) plant-based index (PDI), ii) healthy plant-based index (hPDI) and iii) unhealthy plant-based index (uPDI)(3). These indices assign scores according to intakes of three food groups: ‘healthful plant-foods’ (e.g., fruits, vegetables), ‘unhealthful plant-foods’ (e.g., refined grains, sweets) and ‘animal foods’ (e.g., meat, fish). For the PDI, both the healthful and unhealthful plant-foods were positively scored from 1 to 5 according to increasing intakes. For the hPDI, healthful-plant foods were positively scored from 1 to 5 according to increasing intakes; unhealthful plant-based foods were scored in reverse. For the uPDI, unhealthful plant-based foods were scored positively, and the healthful plant-based foods were reverse-scored. Animal foods were reverse-scored for all three indices. MS incidence was ascertained from hospital records based on International Classification of Diseases (ICD-10) code G35. Adjusted (age, smoking, education, energy intake) multivariable cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of MS according to each dietary pattern separately (PDI, hPDI, uPDI) as well as each food group (healthful plant-foods, unhealthful plant-foods, animal foods). A higher PDI was associated with lower risk of MS (HR: 0.95, 95% CI: 0.92, 0.98, p = 0.001). However, the hPDI and the uPDI were not associated with MS risk. A higher intake of healthful (HR: 0.93, 95% CI: 0.88, 0.98, p = 0.004) and unhealthful (HR: 0.91, 95% CI: 0.85, 0.97, p = 0.008) plant-foods was associated with lower risk of MS, while animal foods were not associated with MS risk. These findings suggest that plant-based foods could be beneficial for people at high risk of MS, with no effect of animal products. However, these findings are from one country and for women only and may not necessarily be generalisable to other population groups. Future research investigating the association between plant-based diets and MS risk in other populations is warranted.

Between 2015 and 2017, East Arnhem Land recorded the highest rates of avoidable deaths in Australia.(1) In 2018, coronary heart disease emerged as the leading cause of avoidable death among First Nations people, with poor diet contributing to 50% of the total burden.(2) Yolŋŋu people in East Arnhem Land are aware of the health challenges and actively seek community-led support from organisations to create health-promoting food environments. The Arnhem Land Aboriginal Progress Corporation (ALPA), governed by a Yolŋu Board of directors, operate six grocery stores in East Arnhem Land. Through analysis of store sales data more than half of total sugar sales are attributed to table sugar. Despite the successful implementation of strong nutrition policies across their retail stores, which have significantly reduced the sale of sugary products like soft drinks, lollies, and cordial, there has been limited success with reducing purchasing of table sugar. Overall, free sugars from all sugar products purchased remains above the World Health Organization’s recommendations. To tackle this public health issue, the Heart Foundation, in collaboration with ALPA and Miwatj Health Aboriginal Corporation, have embarked on a project aimed at reducing table sugar consumption in East Arnhem Land. Consultations with community members and health professionals in Galiwin ‘ku and Milingimbi were held from July 15 to 19, 2024, to assist in the co-design of culturally relevant nutrition resources. Microsoft Teams was utilised for recording and transcription, and artificial intelligence software for thematic analysis. The consultations explored community perceptions of table sugar, its use, and its health impacts. It was identified that sugar consumption is deeply ingrained, particularly in tea drinking, where large quantities of sugar are consumed daily. The addictive nature of sugar was acknowledged, making it challenging to reduce intake. Thematic analysis revealed that while there is an awareness of sugar’s harmful effects, such as its links to heart disease and diabetes, challenges like food insecurity, addiction, and ingrained consumption habits persist. Community members preferred resources that are culturally sensitive, employ positive storytelling methods, and use both modern (Youtube, TikTok, Instagram and Facebook) and traditional (posters in stores and clinics) media. Suggested strategies included emphasising gradual reduction techniques and involving community to enhance the authenticity of resources. Draft resources will be further refined through a second round of community consultations in late October 2024, with final versions distributed by the end of the year and accessible on the Heart Foundation’s website. Success will be measured through ALPA store sales data on table sugar, website engagement, and social media metrics. This initiative seeks to promote sustainable behaviour change and improve health outcomes in East Arnhem Land.

In Australia and other high-income countries, communities are experiencing diet-related diseases due to social inequities and food systems that promote the production and consumption of unhealthy foods(1). Community food hubs have the potential to strengthen local food systems and improve access to healthy, affordable, culturally appropriate food by selling local food to local people(2). The primary aim of this rapid review was to identify short- and medium-term outcomes and long-term impacts associated with community food hubs. In January 2024, four databases and the grey literature were searched for relevant studies and reports published in English between 2013 and 2023. Empirical evaluations of food hubs in high-income countries that included a physical market selling healthy local food were eligible for inclusion. A narrative synthesis was conducted, and descriptive statistics were used to summarise outcomes and impacts under five categories: economic development and viability; ecological sustainability; access to and demand for healthy local food; personal and community wellbeing; and agency and re-localisation of power(3,4). A total of 16 studies/reports were included, reporting on 24 community food hubs (USA n = 16; Australia n = 7; Canada n = 1). Food hubs were often described as farmers’ markets (n = 9, 37% of food hubs), some of which offered financial incentives/subsidies to people living on low incomes. Some food hubs also sold food wholesale and/or provided nutrition education and community gardens. Across the 24 food hubs, a total of 83 short- and medium-term outcomes were assessed. No long-term impacts were evaluated. Outcomes were considered ‘positive’ if evaluation results reflected desirable changes. Overall, 86% of outcomes were positive (n = 71). Within the personal and community wellbeing category, 42 outcomes were assessed, and 83% (n = 35) were positive (e.g., increased fruit and vegetable consumption, increased community connection). Within the access to and demand for healthy local food category, 25 outcomes were assessed, and 96% (n = 24) were positive (e.g., increased access to and/or demand for affordable local produce). Outcomes under the remaining three categories were assessed less frequently. Within the economic development and viability category, 6 outcomes were assessed, and 50% (n = 3) were positive (e.g., access to new markets for food hub suppliers). Within the ecological sustainability category, 6 outcomes were assessed, and 100% (n = 6) were positive (e.g., reduction in food packaging and food waste). Within the agency and re-localisation of power category, 4 outcomes were assessed, and 75% (n = 3) were positive (e.g., integration of community members from low income and cultural minority groups into local food systems). Community food hubs can promote personal and community wellbeing, access to and demand for healthy local food, economic development and viability, ecological sustainability, and agency and re-localisation of power. Future research should focus on methods for evaluating long-term impacts under all five categories.

Nearly half of all Australians (42.9%) will experience a mental health disorder during their lifetime(1). Preliminary research suggests an association between dietary and tissue advanced glycation end-products (AGEs) and mental health conditions, such as depression(2,3). However, more research is needed to determine the extent to which poor mental health is linked with AGEs(4). This study examined whether dietary consumption of the AGE carboxymethyl-lysine (CML), tissue accumulation of AGEs, or levels of circulating glycated haemoglobin (HbA1c) were associated with depression or anxiety. Fifty adults participated in a cross-sectional study. Depression and anxiety were assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D) and Spielberger’s State-Trait Anxiety Inventory (STAI). Dietary CML intake was assessed from 3-day food records by matching food items to those in published, validated food AGE databases and adjusting for energy intake (CML/MJ). Tissue accumulation of AGEs was measured as skin autofluorescence (SAF) using an AGE Reader. HbA1c was measured in whole blood using a Capillary 3 HbA1c kit. Spearman’s rank correlations were performed to explore relationships between variables. Participants included 14 males and 36 females, aged (median (range)) 30.6 (18–72) years. Participants were predominantly healthy, with a BMI of 23.3 (18.5–31.1) kg/m2 and energy intake of 7889 (5452–12568) kJ/day. Depression scores were 8 (0–40) out of 60. State anxiety scores were 26 (20–53) and trait anxiety scores were 33.5 (20–66) out of 80, where higher scores indicated greater symptom severity. Daily intake of CML was 0.6 (0.2–1.9) mg/MJ/day. SAF was 1.8 (1.2–3.3) arbitrary units (AU), similar to previously reported normal reference values(5). Circulating HbA1c was 5.1% (4.4–6.2%), all within the healthy range(6). Spearman’s correlation tests indicated no significant associations between any of the independent variables (CML/MJ, SAF, HbA1c) and any of the dependent variables (CES-D, STAI) (all p > 0.05). In this population of predominantly of healthy individuals, there was no association between dietary CML intake, tissue AGE accumulation or circulating HbA1c and increased symptom severity for depression or anxiety. The next step of this research is to investigate metabolomic markers in this population and their association with depression and anxiety. In relatively healthy people, dietary metabolites may be more sensitive to uncover whether a relationship exists between AGEs and depression and anxiety.

The obesity prevalence among the Chinese population has increased more than three-fold over the last twenty years.(1) A cross-sectional study involving 15.8 million Chinese adults revealed that in 2023 one in every two Chinese adults was categorised as overweight or obese.(2) Chinese individuals face a higher health risk of developing chronic disease at comparable Body Mass Index levels to Caucasians.(3) Thus, it is urgent to address the increasing obesity prevalence in this population. People’ s perception towards obesity is likely to play an important role in influencing their weight management behaviour.(4) For Chinese people, the unique Confucianism ideology, collectivist society, and modern mass media information exposure may have a profound influence on how Chinese people develop their perceptions about weight issues. It is therefore valuable to understand Chinese people’s obesity-related perceptions as this may inform more culturally appropriate interventions for weight management. To the authors’ knowledge, this is the first bilingual systematic review which aimed to synthesise published literature exploring the perceptions of Chinese adults towards overweight and obesity. Four English databases and two Chinese databases (Medline, APA PsycINFO, Social Science Premium Collection, Scopus, Wanfang Chinese Journal Database, and Chinese Electronic Periodical Services) were searched from inception to 17 Jun 2023. Studies were included if they were published in English or Chinese, investigated perceptions towards overweight and obesity, and focused on Chinese adults living in or outside of Mainland China. All retrieved citations were screened by two reviewers independently. A narrative synthesis method was employed. Forty-eight studies (n = 20 in English, n = 21 in simplified Chinese, n = 7 in Traditional Chinese) were included, involving n= 73910 participants. Females were more often researched. Also, the overall sample consisted more younger and more highly educated people, with 22 studies including solely university students. The collective quality or risk of bias of the studies was suboptimal. Three overarching themes emerged from this review: (i) Chinese adults tend to misperceive their weight status, largely stemming from limited awareness of BMI and societal norms idealizing thinness, leading to high dissatisfaction with body weight and high motivation to pursue weight loss. Females perceived a stricter weight ideal than males; (ii) Despite a pronounced motivation for weight management, study participants lacked practical knowledge regarding sustainable strategies. Non-scientific weight-loss methods and unproductive perceptions were prevalent among this population; (iii) Chinese adults perceived dealing with obesity as a lonely journey, influenced by the pervasive negative societal attitude towards obesity and the prevailing mindset emphasizing personal responsibility for weight-related issues. This review provides a comprehensive profile of perceptions towards obesity among Chinese adults over the last two decades and discusses methodology implications and future research directions.

Human milk oligosaccharides (HMOs), which account for the third largest component of human milk, transit to the large intestine where they are fermented by gastrointestinal microbiota, or excreted unchanged(1). Recent advances in gene technology utilising microbial fermentation have allowed for the manufacture of human-identical milk oligosaccharides (HiMOs), which are chemically and structurally identical to the naturally occurring form. The HiMOs that have been manufactured are 2′-fucosyllactose (2′-FL), lacto-N-neotetraose, difucosyllactose, lacto-N-tetraose, 6′-sialyllactose and 3′-siallyllactose. The naturally occurring versions of these represent the most abundant in human milk, with 2′-FL identified in the greatest amounts(2). A pre-market assessment by Food Standards Australia New Zealand (FSANZ) of these substances is required prior to inclusion in infant formula products. The assessment aimed to examine the safety and health effects of the addition of HiMOs to infant formula in Australia and New Zealand in place of currently permitted non-human identical oligosaccharides. Multidisciplinary teams assessed applications (n = 7) to permit six HiMOs in infant formula. Specifically, the safety assessment included the genetically modified microbiological matter for production, the adverse effects of consumption, and any impacts on infant growth. The health effects assessment identified the benefit of HiMO consumption for infants. Risk analysis was used to assess in vitro, ex vivo, animal and human studies, and to consider relevant Ministerial Policy Guidelines. No public health and safety risks were identified for the addition of HiMOs to infant formula, including when the substances are added cumulatively at the requested amounts. No safety concerns were identified for the gene donors or microbial sources for any of the manufactured HiMOs. No adverse effects to recipients that consumed HiMOs were identified in both clinical and laboratory settings, with a no observed adverse effect level of 2′-FL observed at 7500 mg/kg. No difference in growth outcomes was observed between infants who consumed formula with or without HiMO supplementation (p < 0.05), with no clinical significance observed (±3 g/day). Two substantiated health benefits for HMOs were identified; the promotion of a bifidogenic effect (reported in n = 39 studies), and limiting infection by pathogens including Campylobacter jejuni (reported in n = 25 studies). The development of a microbiota profile closer to that of breastfed infants is supported by the inclusion of a wider range of HiMOs in infant formula products. Based on these results, FSANZ permits the voluntary addition of six HiMOs to infant formula to create products that better reflect the oligosaccharide profile of human milk to support the normal growth and development of infants. Assessments of applications to expand these permissions are ongoing. This suggests that based on innovation and economies of scale, HiMOs could one day replace the previously used non-digestible oligosaccharides in infant formula products.

Objective biomarkers of a healthy and typical Australian diet could enhance dietary assessment and provide insight into how adherence to, or deviations from, dietary guidelines impact health. This study aimed to identify and compare plasma and urinary metabolites in healthy Australian adults in response to a healthy and typical dietary pattern. This was an 8-week randomised, cross-over feeding trial(1). After a two-week run-in period, participants were randomly allocated to follow each diet for two weeks, with a minimum two-week washout period in between. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3). The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4). During each feeding phase, all food items were provided to ensure compliance. Both diets included different key indicator foods associated with known metabolites. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Blood samples following a ≥ 8-hour fast were collected by an accredited pathologist, and spot urine samples were self-collected by participants at the morning appointment. Metabolomics data was obtained using Ultra-high Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-MS/MS) through Metabolon Inc.’s (Morrisville, USA) Global Discovery Panel. Metabolite concentrations were log-transformed. Differential changes in metabolites between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. A total of 34 healthy Australian adults (age 38.4 ± 18.1 years, 53% females) completed all study measures. After adjusting for multiple comparisons, significant differences between TAD and HAD groups were observed for 257 plasma and 91 urine metabolites. Of these, 44 known metabolites consistently differed between dietary pattern groups in both biofluid types (plasma and urine). Several associations between specific food groups and metabolites were identified, including the externally validated metabolites associated with dark chocolate (theobromine), orange juice (proline betaine), and cruciferous vegetables (S-methylcysteine sulfoxide, S-methylcysteine). Consumption of dietary patterns aligned with Australian dietary guidelines had a measurable impact on the short-term human metabolome compared to a typical Australian dietary pattern. While some metabolites are established as biomarkers of specific foods, others may represent novel biomarkers requiring validation in future clinical trials and diverse populations. Further research should explore the relationship between these metabolites, the gut microbiome, and clinical outcomes. Additionally, studies are needed to assess the feasibility of using these biomarkers to evaluate diets in real-world settings.

Emerging research has highlighted a relationship between diet and genetics, suggesting that individuals may benefit more from personalised dietary recommendations based on their genetic risk for cardiovascular disease (CVD)(1,2). This current study aims to: (1) Measure knowledge of genetics among healthcare professionals (HCPs) working in CVD, (2) Identify HCPs’ attitudes to using genetic risk to tailor dietary interventions, and (3) Identify perceived barriers and enablers to implementing genetics to tailor dietary interventions. In a mixed-methods study, Australian HCPs (dietitians and AHPRA registered healthcare professionals) working with people with CVD were invited to complete an anonymous online survey (REDCap) and an optional interview. Recruitment occurred through social media and relevant professional organisations. Survey questions were underpinned by the theoretical domains framework(3) and data was synthesised descriptively. Semi-structured interviews were undertaken via Zoom. Interview responses were analysed using a thematic analysis approach using Braun & Clarke methodology(4). Survey responders (n = 63, 89% female, mean age 42 ± 14 years) were primarily dietitians (83%), with ≥ 10 years of experience (56%) and spent at least 20% of their time working with people with CVD (n = 55, 87%). Approximately half of respondents were aware that genetic testing for CVD exists (n = 36) and always assess family history of CVD (n = 31). Few respondents reported using genetic testing (n = 5, 8%) or felt confident interpreting and using genetic testing (n = 7, 11%) in practice. Respondents were interested in incorporating genetics into their practice to tailor dietary advice (n = 44, 70%). Primary barriers to using genetic testing included financial costs to patients and negative implications for some patients. Almost all respondents agreed genetic testing will allow for more targeted and personalised approaches for prevention and management of CVD (94%). From the interviews (n = 15, 87% female, 43 ± 17 years, 87% dietitian), three themes were identified: (1) ‘On the periphery of care’—HCPs are aware of the role of genetics in health and are interested in knowing more, but it is not yet part of usual practice; (2) ‘A piece of the puzzle’—using genetic testing could be a tool to help personalise, prioritise and motivate participants; and (3) ‘Whose role is it?’—There is uncertainty regarding HCP roles and knowing exactly whose role it is to educate patients. Healthcare professionals are interested in using genetics to tailor dietary advice for CVD, but potential implications for patients need to be considered. Upskilling is required to increase their knowledge and confidence in this area. Further clarity regarding HCP roles in patient education is needed before this can be implemented in practice.

Lactoferrin (LF), a sialylated iron-binding glycoprotein consisting of multiple sialic acid (Sia) residues attached to N-linked glycan chains, and studies have shown that both the iron and Sia are crucial for early neurodevelopment and cognition.(1) However, there is limited knowledge of the impacts of the iron saturation and sialylation in LF molecule on the early neurodevelopment and cognition. Objectives of the study were to explore the impacts and mechanisms of iron saturation and sialylation in LF molecule on early neurodevelopment and cognition. Maternal dietary intervention with native bovine LF (Native-LF), iron-free bovine LF (Apo-LF), or Sia-free bovine LF (Desia-LF) at a dose of 0.60 g/kg body weight per day was administered throughout the lactation period. Offspring pups were assessed for anxiety, learning, and memory through behavioral tests before being euthanized on postnatal day 63. Brain hippocampal tissue was then analyzed for polysialic acid (polySia), a marker of neurodevelopment and neuroplasticity.(1) The study protocol was approved by the Xiamen University Animal Ethics Committee (AE1640102). Our results showed that Apo-LF pups exhibited a 1.32-fold increase in total distance travelled in the arena compared to both Native-LF and Desia-LF groups, with the overall difference among the groups being statistically significant in the open field test (p = 0.008). Additionally, the frequency of central area entries in the Apo-LF group was 2.00-fold higher than in Desia-LF pups (p = 0.038) and 1.3-fold higher than in Native-LF pups, with a significant overall difference (p = 0.042). No significant differences in total distance travelled or central area entries were observed between Native-LF and Desia-LF groups (p > 0.05). These results suggest that Apo-LF pups demonstrated better anti-anxiety behaviors than both Native-LF and Desia-LF pups. In the Morris water maze test, Apo-LF pups spent significantly more time in the target quadrant compared to both Desia-LF (p = 0.019) and Native-LF pups (p = 0.0009), indicating enhanced short-term memory. Additionally, Apo-LF pups exhibited greater polySia-NCAM expression (1.2.95 ± 0.048) in the hippocampus, a marker associated with neuroplasticity and neurogenesis compared to both Native-LF and Desia-LF pups. We conclude that maternal supplementation with different types of lactoferrin during lactation supports improved learning and memory in offspring through distinct mechanisms, with sialylation playing a crucial role in neurocognitive development.

Maternal asthma increases the risk of adverse perinatal and respiratory outcomes in their infants(1); breastfeeding may mitigate the risk of respiratory outcomes, including wheeze(2,3). However, breastfeeding rates are lower in women with asthma(3) compared to general population data and no studies have examined early data on breastfeeding outcomes in this population. This study aimed to examine infant breastfeeding outcomes in the early postnatal period, including breastfeeding initiation, by maternal asthma exposure and whether any differences were due to adverse perinatal outcomes. Data were extracted from electronic obstetric records (e-Maternity) for pregnant women aged ≥ 18 years with singleton births who attended antenatal clinics in two local health districts in New South Wales, Australia, between 2018 and 2020. The association between breastfeeding outcomes and the exposure (maternal asthma) were estimated using multivariable logistic regression, adjusting for maternal confounders (body mass index, age, ethnicity, smoking, Socio-Economic Index for Areas). Secondly, selected perinatal outcomes were added individually to the models to examine if the effect of asthma on breastfeeding outcomes was mediated via these variable/s. Of 41,297 births, 4553 (11%) were to women with asthma. A lower proportion of the maternal asthma group intended to breastfeed compared to the no asthma group (87% vs 90%, p < 0.001); this was not significant in multivariable models, after adjusting for confounders (adjusted Odds Ratio [adjOR] 0.93, 95% Confidence Interval [CI] 0.84 to 1.03). Breastfeeding initiation was lower in the maternal asthma vs no asthma group (80 vs 84%, p < 0.001), as was infant breastfeeding at discharge from hospital (66% vs 71%, p < 0.001; mean length of stay 2.11 days vs 1.97 days) and at post-partum follow-up (56% vs 63%, p < 0.001). A higher proportion of the maternal asthma group had breastfeeding issues as an inpatient, compared to the no asthma group (44% vs 39%, p < 0.001). In multivariable models, maternal asthma was associated with 12% lower odds of breastfeeding initiation (adjOR 0.88, 95% CI 0.80 to 0.96); 11% and 9% lower odds, respectively, of the infant receiving breastmilk only at birth (adjOR 0.89, 95% CI 0.81 to 0.97) and at the postpartum follow-up (adjOR 0.91, 95% CI 0.83 to 0.99); and 12% higher odds of breastfeeding issues (adjOR 1.12, 95% CI 1.04 to 1.20). None of the potential mediators examined (low birthweight, preterm birth, caesarean section, neonatal intensive care unit admission) changed the effect size of asthma exposure by more than 10% on the OR scale for the selected outcomes (breastfeeding initiation, breastfeeding issues, breastfeeding at postpartum). In this population data analysis, maternal asthma increased the odds of poor breastfeeding outcomes in the immediate postpartum period, but these associations did not appear to be mediated via adverse birth outcomes.

Maternal diet during pregnancy influences the short- and long-term health of mothers and their offspring(1). Pregnant women from culturally and linguistically diverse (CALD) backgrounds potentially have challenges achieving a healthy diet due to language barriers, cultural differences and poor nutrition knowledge. Data from 2021 shows that ~7200 women who gave birth in Australia were of Chinese background(2), however, data on the dietary patterns and nutrition knowledge of pregnant women in Australia from CALD backgrounds are limited. This pilot, cross-sectional study aimed to: assess the food group, nutrient intakes and diet quality of pregnant/recently pregnant women in Australia with Chinese-speaking backgrounds, compare the intakes with national nutrition recommendations, and assess the nutrition knowledge of the women. Participants were recruited in partnership with Hunter New England Local Health District Multicultural and Refugee Health to complete an online survey, which was translated to simplified Chinese language. Eligible participants were pregnant women and women who had given birth in the previous 12-months, who were living in, but not born in Australia, who were ≥ 19 years, and primarily spoke a Chinese language. Dietary intake was assessed via the Australian Eating Survey, diet quality via the Australian Recommended Food Score (ARFS), and nutrition knowledge via a questionnaire adapted from the General Nutrition Knowledge Questionnaire. Food group serves, macronutrient, micronutrient and energy intake, and diet quality were reported as median (IQR) due to non-normal distributions. Intake of food group serves, macronutrients and micronutrients were compared with national nutrition recommendations. The mean (SD) nutrition knowledge score out of 23 was reported. Fifty participants (31.8 ± 4.3 years, mostly pregnant (66%), born in China (66%) with Mandarin as first language (62%)) reported median consumption of all five food groups below recommendations, with the poorest alignment for grain (4%) and dairy foods (4%). Median consumption of carbohydrate (46.5% EI), fat (34.5% EI) and protein (20.0% EI) met recommendations for pregnant women, but not saturated fat (12.5% EI) or dietary fibre (18.6 grams). The alignment of 16 micronutrients from food intake to recommendations was poor, particularly for iron (4%) and iodine (12%). The highest alignment to recommendations was for vitamin C (92%) and retinol (78%). The median (IQR) ARFS was 23 (18, 39) points out of 73, indicating poor overall diet quality. The mean (SD) nutrition knowledge score was 10.2 (2.9) out of 23. This sample of pregnant and recently pregnant women living in Australia with Chinese-speaking background reported suboptimal food group and nutrient intakes and overall diet quality that does not align with national nutrition recommendations. The low nutrition knowledge score suggests poor knowledge of pregnancy dietary recommendations. These findings warrant further investigation in larger samples of pregnant women from CALD backgrounds with regard to dietary intake and nutrition knowledge.

This paper investigates the association between potential serum biomarkers and diabetes status in older Australians by employing traditional and machine learning methods. Data from Sydney Memory and Ageing Study (MAS) were interrogated cross-sectionally in 801 participants aged 70–90 years (n = 801). Twenty-eight serum biomarkers and 6 other factors were investigated as potential indicators that may distinguish diabetes status. Diabetes status was categorised as No-Diabetes, Pre-diabetes, and Type 2 diabetes (T2D). Diabetes is defined as follows when using fasting plasma glucose: no diabetes/ normal: < 5.6 mmol/L; prediabetes: 5.6–6.9 mmol/L; and diabetes: ≥ 7 mmol/L(1). Variable selection was executed using two distinct regression methods (i) multinomial logistic regression with backward selection and (ii) machine learning using elasticNet regression. Multiple imputation was used to address missing data. Age and sex were included as a priori covariates in the multinomial regression model. Using a multinomial logistic regression, Malondialdehyde (MDA), Macrophage inhibiting cytokine 1 (MIC1), and vitamin E were associated with diabetes status. MDA was strongly associated with diabetes with relative risk ratio (RRR) of 4.78 (95% CI = 3.39, 6.75; p < 0.001) when comparing to no diabetes, surpassing usual markers insulin, triglycerides, and waist-to-hip (WHR). Diabetes was associated with lower vitamin E levels, compared to no diabetes, with an RRR of 0.54 (95% CI:0.38, 0.75; p < 0.001). Comparing diabetes to prediabetes, RRR for lower vitamin E levels was 0.71 (95% CI: 0.51, 0.98; p = 0.035). MIC1 distinguished between diabetes and prediabetes status (RRR: 1.84; 95% CI:1.41, 2.41; p < 0.001). Consistent with the traditional methods, machine learning also identified MDA as being associated with T2D, with an odds ratio (OR) of 1.9, followed hierarchically by insulin (OR = 1.23), WHR (OR = 1.22) and triglyceride (OR = 1.13). Higher serum Vitamin E were associated with a lower risk of being in diabetes category (OR = 0.84). MIC1, urate, IL1b, HDL, and carotene were identified by the machine learning model, but showed minimal association. These results suggest that the oxidative stress and inflammation markers distinguish the state of having T2D.

A growing number of Australians are experiencing challenges accessing and affording healthy food due to climate-related disasters, global supply chain disruptions, and rapid inflation that is affecting the cost of healthy food(1). There is limited understanding of how participation community-based food cooperatives can address these challenges and improve food security and dietary intake. This study investigated the motivations for joining and impact of participation in a community-based food cooperative called Box Divvy on self-reported food security status and intake of fruits and vegetables among a sample of Australian adults. A cross-sectional online survey was conducted among Box Divvy members, that measured sociodemographic characteristics, motivations for joining, self-reported fruit and vegetable intake (serves/week), and food insecurity status (USDA 6-item short form(2)) before and while using Box Divvy. Participants were classified as being food secure, or experiencing marginal, moderate, or severe food insecurity. Logistic regression assessed demographic predictors and self-reported change in food security status, and ANOVA examined changes in dietary intake before joining and while using Box Divvy. Of participants (n = 2764, 37% aged 35–44 years, 83% European ethnicity, 92% New South Wales residents), most joined Box Divvy to support local farmers (87.3%), and save money on healthy foods (70.6%). Around half of respondents (50.8%) reported experiencing food insecurity before joining Box Divvy (24.5% marginal, 18.4% moderate, 7.9% severe food insecurity). Univariate logistic regression identified age, household structure, and income as significant predictors of food insecurity (p < 0.001). Participants experiencing food insecurity reported significantly lower consumption of fruits and vegetables prior to joining Box Divvy compared to those who were food secure (p < 0.001). While using Box Divvy, 28.2% of participants reported experiencing food insecurity (16.6% marginal, 9.6% moderate, 2.1% severe food insecurity). The odds of food insecurity while using Box Divvy were 62% lower than before joining (OR: 0.38; 95% CI 0.34–0.43; p < 0.001). On average, participants reported their fruit intake increased by 2.5 ± 5.6 serves/week (p < 0.001), and vegetable intake increased by 3.3 ± 5.7 serves/week (p < 0.001). The mean increase was significantly greater among moderately food insecure (fruit mean difference 3.2 ± 6.5 serves/week; vegetable mean difference 3.9 ± 6.9 serves/week) and severely food insecure groups (fruit mean difference 4.4 ± 6.9 serves/week; vegetable mean difference 5.5 ± 7.7 serves/week; p < 0.001). Participation in Box Divvy significantly improved self-reported food security status and fruit and vegetable intake among a large sample of Australian adults. Notably, fruit and vegetable intake significantly increased among those experiencing moderate and severe food insecurity. This underscores the potential of community-based food cooperatives to improve food security and promote healthier eating habits among Australian adults, especially households experiencing food insecurity.

Malnutrition is a major contributor to poorer health outcomes and continues to be sub-optimally identified and managed(1). The collection and availability of healthcare data is growing rapidly, strategies to harness data for optimal care is evolving(2). A hospital nutrition informatics platform that presents food supply and intake data and categorises risk using energy and protein thresholds has shown potential for identifying malnutrition risk(3). This study aimed to determine the Nutrition Dashboard’s capability to predict malnutrition through analysis of multiple energy and protein thresholds. Data were extracted from medical files and food service records for 267 patients over a four-month period, in a 99-bed hospital. Energy (2500 to 8000 kJ) and protein (30 to 90 g) thresholds were applied for Nutrition Dashboard categorisation by supply and intake of food. Deficits in estimated requirements (105 kJ and 0.75 g/kg/day)(4) were also applied as a comparative screening method. The association between Nutrition Dashboard categories and Malnutrition Screening Tool (MST) score was explored using generalised estimating equations. A total of 267 patients and 1908 days of data were analysed. Patients at risk of malnutrition (MST ≥ 2) was 39.2%, of those patients at increased risk, 57% received a dietitian referral. The use of weight based estimated requirements for Nutrition Dashboard categorisation was not statistically significant predictor of MST ≥ 2. Application of energy (≤ 6000 kJ) and protein (≤ 65 g) thresholds for categorisation was significant (X2 = 9.50, df = 3, p = 0.023). When 5000 kJ and 55 g of protein were used for categorisation, patients were more likely to be at nutritional risk (MST ≥ 2) if they were within low supply (OR 2.11, p = 0.002) and low intake (OR 2.23, p < 0.001) categories. When age, length of stay and weight were added to the modelling as covariates, the upper intake and protein thresholds of 5500 kJ and 60 g protein for Nutrition Dashboard categories one (low supply; OR 1.64, p = 0.046) and two (low intake; OR 1.64, p = 0.041) remained statistically significant predictors of at-risk nutrition status as measured by MST ≥ 2. Age and LOS were not significant predictors of MST ≥ 2, a static weight measure was found to be a predictor of at-risk nutrition screening (OR 0.97, CI = 0.95–0.97, p < 0.001). Nutrition Dashboard supply and intake categories were associated with an increased risk of malnutrition when categorised using thresholds up to 6000 kJ and 65 g protein. The Nutrition Dashboard presents nutrition risk surveillance information directly to dietitians with high reliability in an easily accessed, interactive format. Technologies such as the Nutrition Dashboard present innovative opportunities for dietitians to utilise nutrition informatics to enhance and optimise nutrition care.

Traditional foods are increasingly being incorporated into modern diets. This is largely driven by consumers seeking alternative food sources that have superior nutritional and functional properties. Within Australia, Aboriginal and Torres Strait Islander peoples are looking to develop their traditional foods for commercial markets. However, supporting evidence to suggest these foods are safe for consumption within the wider general population is limited. At the 2022 NSA conference a keynote presentation titled ‘Decolonising food regulatory frameworks to facilitate First Peoples food sovereignty’ was presented. This presentation was followed by a manuscript titled ‘Decolonising food regulatory frameworks: Importance of recognising traditional culture when assessing dietary safety of traditional foods’, which was published in the conference proceedings journal(1). These pieces examined the current regulatory frameworks that are used to assess traditional foods and proposed a way forward that would allow Traditional Custodians to successfully develop their foods for modern markets. Building upon the previously highlighted works, this presentation will showcase best practice Indigenous engagement and collaboration principles in the development of traditionally used food products. To achieve this, we collaborated with a collective of Gamilaraay peoples who are looking to reignite their traditional grain practices and develop grain-based food products. To meet the current food safety regulatory requirements, we needed to understand how this grain would fit into modern diets, which included understanding the history of use, elucidating the nutritional and functional properties that can be attributed to the grain, and developing a safety dossier(2) so that the Traditional Custodians can confidently take their product to market. To aid the Traditional Custodians in performing their due diligence, we have systemically analysed the dietary safety of the selected native grain and compared it side-by-side with commonly consumed wheat in a range of in vitro bioassays and chemical analyses. From a food safety perspective, we show that the native grain is equivalent to commonly consumed wheat. The native grain has been shown to be no more toxic than wheat within our biological screening systems. Chemical analysis showed that the level of contaminants are below tolerable limits, and we were not able to identify any chemical classes of concern. Our initial findings support the history of safe use and suggest that the tested native grain species would be no less safe than commonly consumed wheat. This risk assessment and previously published nutritional study(3) provides an overall indication that the grain is nutritionally superior and viable for commercial development. The learnings from this project can direct the future risk assessment of traditional foods and therefore facilitate the safe market access of a broader range of traditionally used foods. Importantly, the methods presented are culturally safe and financially viable for the small businesses hoping to enter the market.

To achieve infectivity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, must first traverse the upper respiratory tract mucosal barrier. Once infection is established, the cascading complexities of the pathophysiology of COVID-19 makes intervention extremely difficult. Thus, enhancing the defensive properties of the mucosal linings of the upper respiratory tract may reduce infection by SARS-CoV-2 and indeed by other viruses such as influenza, which have been responsible for the two major pandemics of the last century. In this review we summarise potential opportunities for foods and nutrients to promote an adequate mucosal immune preparedness with an aim to assist protection against infection by SARS-CoV-2, to maximise the mucosal vaccination (IgA inducing) response to existing systemic vaccines, and to play a role as adjuvants to intranasal vaccines. We identify opportunities for vitamins A and D, zinc, probiotics, bovine colostrum and resistant starch to promote mucosal immunity and enhance the mucosal response to systemic vaccines, and for vitamin A to also improve the mucosal response to intranasal vaccination. It is possible that an entirely different virus may in the future, by way of convergent evolution, utilise a similar upper respiratory tract infection pathway. A greater research focus on mucosal lymphoid immune protection in partnership with nutrition would result in greater preparedness for such an event.