One-fifth of the 101 million stroke survivors worldwide experience another stroke within the following five years. Research indicates that lifestyle risk factors account for 90% of stroke (similar to recurrent stroke) risk, and improving diet quality is a promising strategy(1). Synthesised research suggests that adopting a Mediterranean-style diet(2) with reduced sodium intake(3) can enhance cardiovascular health, which may be beneficial for secondary stroke prevention. Our previous ENAbLE trial, a co-designed telehealth diet and exercise intervention, demonstrated improvements in diet quality among stroke survivors. However, post-stroke effects (such as fatigue, hemiplegia, memory issues, aphasia, and dysphasia) along with poor culinary nutrition skills, limit the full adoption of the Mediterranean-style diet. Culinary nutrition combines cooking skills and nutrition knowledge to help individuals create nutritious and fulfilling meals. A recent scoping review revealed only two culinary nutrition programs designed for stroke survivors, with none co-designed specifically for Australian survivors. This research aims to co-design a Mediterranean-style diet based culinary nutrition program to enhance post-stroke nutrition. Using an Integrated Knowledge Translation model(4), three lived experience research partners and six clinical researchers engaged in the co-design process. Preliminary interviews with stakeholders highlighted gaps in current stroke care. We conducted two focus groups with potential end-users, including six stroke survivors and seven clinicians. Data were analysed thematically, and prototypes were developed iteratively with end-users. Consumers (lived experience research partners and end-users) identified a significant gap in practice during the early post-discharge period, emphasising the need for self-paced remote culinary nutrition resources. They identified several facilitators (e.g., simple recipes, easy translation of nutrition knowledge, aphasia-friendly design) and barriers (e.g., fatigue, muscle weakness, cooking for one or for a household) in meal preparation. Consumers noted that while recipe books reduce the cognitive load of meal preparation, no stroke-specific resources are currently available. As a result, we developed a co-designed recipe book titled Cook Well After Stroke, incorporating feedback from end-users. This book features Mediterranean-style diet recipes for both single-serving and household/batch cooking. It is designed with plain English, requiring minimal ingredients, equipment, and cooking skills. Recipes are highly adaptable to common Australian ingredients, encouraging users to repeat the recipes with available resources. It includes nutrition principles to create balanced meals, increase protein and vegetable intake, and reduce sodium consumption. Each section includes hints and hacks tailored to post-stroke effects, providing strategies for one-handed cooking, softer diet textures, and energy conservation. The recipe book will be integrated into a co-designed online cooking program, which will be trialled with stroke survivors.

Optimal infant feeding practices in the first 2000 days of life offer protection against chronic diseases in later life(1). A study focusing on Indian-born mothers in Australia found that while they generally followed health-promoting infant feeding practices such as prolonged breastfeeding and delayed introduction of solids, they also displayed sub-optimal practices such as early introduction of water, fruit juice, cows’ milk, and formula(2), suggesting nonadherence to the Australian Infant Feeding guidelines(3), potentially increasing the risk of overweight/obesity or chronic disease in later life. Therefore, this study explored cultural beliefs, knowledge, attitudes and perceptions of Indian-born mothers living in Australia that may influence these practices. Thirteen Indian-born mothers (n = 13) with a child aged between 1.5–5 years born in Australia were purposively sampled from participants of an Australia-wide online survey involving Indian-born mothers. Purposive sampling was based on a mix of variables such as length of stay in Australia, language spoken at home, and education. These mothers took part in semi-structured interviews over Zoom. Zoom transcripts were analysed using a reflexive thematic approach to generate themes with NVivo. All mothers were married, and 85% were aged between 35 and 39 years. All mothers had lived in Australia for at least five years, with 54% for at least ten years. Most mothers (54%) had postgraduate qualifications and an annual household income of more than $156,000 (39%). Most mothers were Hindu (92%), and the main language spoken at home was Marathi (38%). Most fathers belonged to Indian ethnicity (85%). Themes relating to infant feeding and infant growth were identified.1) Cultural beliefs about breastfeeding positively influenced breastfeeding initiation and duration; 2) Maternal beliefs and attitudes negatively influenced formula feeding practices; 3) Acculturation positively influenced exposure to cows’ milk, honey, and pre-lacteal feeds; 4) Maternal knowledge about feeding guidelines and cultural beliefs positively influenced solid introduction and types of solids introduced; 5) ‘Tiny baby’ perception of mothers often influenced by health care professionals, negatively influenced infant feeding practices; 6) Reliance on mothers and mothers-in-law for feeding advice due to cultural disconnect between infant feeding guidelines and; 7) Lack of support after hospital discharge negatively influenced breastfeeding journey. In conclusion, Indian immigrant mothers in this study expressed their need to have culturally tailored support and consistent advice from healthcare professionals during the solid introduction and better support structures after hospital discharge to enable their optimal breastfeeding journey.

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.

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.

Genome-wide association studies (GWAS) of food preferences(1) and intake(2) have identified hundreds of loci, most previously linked to health conditions. This suggests these loci may reflect participants’ health status, leaving unclear their direct influences on eating behaviour. Given that taste and olfactory perception play a crucial role in food preferences and choices(3), this study aims to: i) investigate the influence of genetic variants within taste and olfactory receptor genes on food preferences and ii) use these variants to investigate the potential causal influence of food preferences on health. We assess the associations across 1214 nonsynonymous variants (minor allele frequency ≥ 0.01) within 425 non-pseudo taste and olfactory receptor genes and 140 food-liking traits in the UK Biobank (n = 162006 unrelated Europeans; mean age = 57). Food likings were measured on a 9-point scale, with 1 being ‘Extremely dislike’ and 9 being ‘Extremely like’. We identify 700 associations (FDR-corrected p < 0.05), of which 88 are also associated with their corresponding food intake traits in the UK Biobank. We replicate 84 associations in the younger Avalon Longitudinal Study of Parents and Children (ALSPAC; n = 2802 unrelated Europeans; mean age = 25), including OR2T6 rs6587467 for onion liking (p = 5.4 × 10-41 in UK Biobank, p = 2.9 × 10-4 in ALSPAC), whereas others cannot be replicated (e.g., OR4K17 rs8005245 for garlic liking, p-value = 1.9 × 10-69 in UK Biobank, p = 0.66 in ALSPAC). These variants account for greater phenotypic variances in food-liking traits in the ALSPAC than in the UK Biobank (e.g., 0.54% and 0.25% for garlic liking in ALSPAC and UK Biobank, respectively), suggesting genetically determined sensory perception has larger impacts on food preferences in young adulthood. Lastly, we use an epidemiological technique, Mendelian randomisation(4), to assess the potential causal influence of food preferences on health outcomes using food-liking-associated variants and summary results from large-scale GWAS. Taking likings for onions and bananas as an example, our results show that both are causally associated with lower systolic blood pressure (onions: beta = −1.257, p = 0.001; bananas: beta = −3.166, p = 0.005; unit = mmHg/liking score). While liking for onions decreases the risk of type 2 diabetes (odds ratio [OR, 95% confidence interval] = 0.856 [0.781, 0.939]), liking for bananas increases it (OR = 1.289 [1.051, 1.579]). We found no evidence for causal associations with coronary artery diseases (onions: OR = 0.995 [0.879, 1.126]; bananas: OR = 0.982 [0.742, 1.299]). This study furthers current knowledge of direct genetic influences on food preferences, which helps understand individual differences in eating behaviour and has implications for personalised nutrition. Results from causal modelling provide complementary evidence for previous observational studies and could be used to guide future trials.

In adults, a diet low in sodium and high in potassium helps reduce blood pressure and risk of cardiovascular disease(1). Whether this same relationship exists among children is less clear. There is some evidence to indicate that reducing sodium intake is favourable for maintaining healthy blood pressure levels across childhood(2). However, it is not clear how sodium intake during childhood influences blood pressure and whether sex or body mass index moderates any effects. The effects of potassium intake and the sodium-to-potassium ratio on children’s blood pressure have been generally inconsistent(3). It is important to understand the relationship between sodium and potassium on childhood blood pressure as elevated blood pressure across childhood increases the risk of future hypertension and target organ damage(4). Few studies in children have utilised the 24-hour urinary electrolyte excretion, an objective measure, of sodium intake. Therefore, this study examined the relationship between 24-hour urinary sodium, potassium and sodium-to-potassium molar ratio and blood pressure among Australian schoolchildren aged 4–12 years; and if these associations were moderated by body weight or sex. Data from 793 children who participated in the Salt and Other Nutrient Intakes in Children study were included in this analysis. Children recruited from primary schools (n = 61) located across the state of Victoria provided one 24-hour urine collection, and anthropometric and blood pressure measurements. Blood pressure z-scores standardised for age, sex and height were calculated. Multiple linear regression analysis, with adjustment for covariates (age, sex, socioeconomic position and weight category), was conducted. Body weight (underweight/healthy weight, overweight and obese) and sex subgroup analyses, including interaction terms were completed. Mean (SD) sodium excretion was 2386 (1046) (SD) mg/d and 72% of children exceeded the recommended upper level for sodium intake. Mean (SD) potassium excretion was 1796 (675) mg/d and the sodium-to-potassium molar ratio was 2.4 (1.1). Eighteen percent of children had elevated blood pressure. Overall, there were no associations between 24-hour sodium or potassium excretion and blood pressure in adjusted regression models. However, there was a significant positive association between sodium excretion and systolic blood pressure z-score in children with obesity (b-coefficient 0.70 [95% CI 0.05, 1.33], p = 0.04, n = 23) and among girls (b-coefficient 0.09 [95% CI 0.01, 0.17], p = 0.02, n = 365). We found a positive association between 24-hr urinary excretion and SBP in girls and children living with obesity, providing further support to the hypothesis that body weight is a moderator of this relationship through heightened salt sensitivity. Public health interventions aiming to reduce elevated blood pressure during childhood are likely to be most effective by reducing sodium intake in conjunction with promoting healthy weight.

Approximately half of Australian universities offer a degree in nutrition, nutrition science, human nutrition or nutrition combined with another discipline. In the absence of any formal accreditation requirements, the design of nutrition undergraduate courses is guided by national nutrition science competencies(1). Degrees might also include specialisations such as in public health, food industry or animal nutrition, and a range of special interest topics included to enhance the graduate skillset for the workforce. This diversity in degrees develops graduates with broad and transferrable skills, thought to be desirable to industry employers. In an earlier study by the authors(2), it was identified that graduates placed high value on nutrition science theory and practical content, but there was an expressed desire for more work-integrated-learning opportunities and professional skill development for work in private practice. To triangulate the perspectives of students and graduates, there is a need for universities to understand how nutrition graduates are received by employers. This paper will present preliminary findings from the Working in Nutrition Employer (WIN-E) study. The aims of this study were to build on findings from the WIN-G study(2) and explore the perceptions of nutrition graduate employers in Australia regarding aspects of the graduate skillset that were highly valued, and identify training gaps. After being tested for face validity, the purpose-built WIN-E survey was delivered online via Qualtrics between June–December 2022. The survey included a mix of 32 closed- and open-ended questions about employer characteristics, additional education, employment and professional experience, and employers perceived graduate preparedness for the workforce. An interim analysis revealed that 110 participants had given informed consent; of these, 41 completed 75% of the questions, with 32 having relevance to nutrition graduate employment, and were included in the current analyses. Most respondents were female (n = 25, 78%) aged 25–34 years (n = 13, 52%). Respondents predominantly identified as working in education (n = 8), research (n = 5) or in ‘other settings’ (n = 5) such as community aged care, digital media/coaching, food preparation, agriculture or homelessness project work. To a lesser extent domains in retail/hospitality (n = 4), food industry (n = 3), public health/not for profit (n = 2), clinical (n = 2) and sport and fitness (n = 1) were represented. Fifteen (47%) employers felt nutrition graduates had all, or some of the expected skills and attributes at time of employment. More development of skills in written health translation (n = 2), data analysis (n = 1), working collaboratively in health systems (e.g., aged care) (n = 2), marketing (n = 1), and understanding transferable skillsets with the motivation for ongoing professional development were also valued (n = 2). Further data analysis will provide more context around the roles and responsibilities employers typically assign to nutrition graduates, highlighting potential training gaps and opportunities for universities to better prepare graduates for the workforce.

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.

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction that affects 3.5% of Australians and is characterised by abdominal pain and altered bowel motions(1). The low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet (LFD) is a three-phase process (Phase 1 FODMAP restriction, Phase 2 FODMAP reintroduction, and Phase 3 FODMAP personalisation) efficacious for IBS symptom management(2). However, data on the nutritional adequacy post-phase 1 is lacking. This study aimed to evaluate the nutritional adequacy across the three phases of the LFD in adults with IBS. Adults meeting the Rome IV criteria were recruited for a 25-week longitudinal trial. Participants underwent dietetic consultation at week 0 for phase 1 FODMAP restriction (weeks 1–5), phase 2 FODMAP reintroduction (weeks 6–13) and phase 3 FODMAP personalisation (weeks 14–25). Nutrient intake was assessed using a food frequency questionnaire to determine the average daily intake(3) collected at weeks 1, 5, 13, and 25. Participant nutrient intake was compared to the age and gender-specific Australian Recommended Dietary Intake at each time point. A least squares means analysis using the post hoc Tukey Framer test for significance was used to determine significant changes in nutrient intake at a population level between phases of the LFD. Nutrient data was available for n = 88 at week 1 (mean age 34.9 ± 12 years, 88% female), n = 78 at week 5, n = 50 at week 13 and n = 40 at week 25. There were no nutrients for which participants met 100% of the requirements between weeks 1–13. At week 25, vitamin C was the only nutrient for which participants met 100% of the requirements. There was no significant increase in nutrient intake during FODMAP reintroduction (week 13 to 25). At week 25, compared to week 1, there was a significant reduction in energy (10146 to 7721 kj, p = 0.0001), protein (112 to 90 g, p = 0.0149), carbohydrates (275 to 195 g, p < 0.0001), fat (99 to 76 g, p = 0.003), dietary fibre (38 to 25 g, p < 0.0001), sodium (2364 to 1834 mg, p = 0.0031), magnesium (435 to 318 mg, p < 0.0001), calcium (1180 to 909 mg, p = 0.0168), iron (14 to 11 mg, p = 0.0001) and folate (576 to 404 μg, p < 0.0001). The nutrient intake of participants following the LFD worsened across the three phases of the LFD. These results signify the importance of monitoring nutrient targets in conjunction with managing symptoms of IBS. Further research is needed to determine the long-term consequences of poor nutrient intake from the LFD.

Diet is a key modifiable factor for improving suboptimal lipoprotein profiles and reducing cardiovascular disease (CVD) risk(1). Dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) or the Mediterranean Diet, with varying macronutrient components, have shown positive effects on total cholesterol and low-density lipoproteins (LDL)(2). However, limited research exists on the impact of different healthy diets on lipoprotein subclass profiles, which are increasingly known to influence CVD risk. This study aims to compare the nuclear magnetic resonance (NMR)-measured 112 lipoprotein profiles across three healthy dietary patterns: a carbohydrate-rich diet (CARB), similar to the DASH diet; a protein-rich diet (PROT); and an unsaturated fat-rich diet (USFA), similar to the Mediterranean diet. Lipoprotein parameters were generated using the Bruker IVDr Lipoprotein Subclass Analysis (B.I.LISA) method(3). The lipoprotein subclasses included different molecular components of very low-density lipoprotein (VLDL, 0.950–1.006 kg/L), low-density lipoprotein (LDL, density 1.09–1.63 kg/L), intermediate-density lipoprotein (IDL, density 1.006–1.019 kg/L), and high-density lipoprotein (HDL, density 1.063–1.210 kg/L). The LDL subfraction was further divided into six density classes, and the HDL subfractions were divided into four different density classes. Plasma samples from a randomised cross-over intervention study involving 156 individuals who completed more than two dietary patterns were included for the NMR analysis (registered at www.clinicaltrials.gov as NCT00051350 and NCT03369535). The Friedman’s test with post-hoc analysis, corrected for multiple testing, showed that all healthy dietary patterns led to a reduction in overall lipoprotein subclasses known to be associated with atherogenic risk. This reduction included large and medium-sized LDL subclasses, all intermediate-density IDL subclasses, as well as total plasma cholesterol, triglycerides, apolipoprotein-B100, apo-B100/apo-A1 ratio, and LDL-cholesterol (p < 0.05). Additional variations in lipoprotein subclasses specific to each diet were also observed. The PROT diet showed a decrease in small-sized and dense LDL, large to medium VLDL subclasses, and large-sized HDL subclasses. Conversely, the CARB diet exhibited an increase in smaller-sized and denser LDL, along with a decrease in large-sized HDL and an increase in smaller-sized HDL subclasses. The USFA diet led to decreases in LDL and overall VLDL subclasses, while increasing LDL and HDL subclasses (p < 0.05). The impact of different healthy diets with differential effects on lipoproteins suggests the possibility of targeting the cholesterol status of individuals to optimise lipoprotein profiles and thereby reduce CVD risk. Preliminary exploratory analyses based on linear mixed-effect models coupled with a latent profile analysis, adjusted for cholesterol status, showed that individual lipoprotein responses to specific diets varied. Inter-individual variations in lipoprotein responses to healthy diets were evident. A small proportion of individuals only responded to specific diets, suggesting potential of personalised nutrition based on individual lipoprotein profiles. These observed variations highlight the complexity of individual responses to dietary interventions.

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.

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.

Iron and zinc deficiencies are prevalent globally and have been found to co-exist within populations(1). Previous work from our laboratory found dual iron and zinc deficiency alters iron absorption compared with iron deficiency alone (unpublished). Iron deficient (FeD), zinc deficient (ZnD), dual iron and zinc deficient (FeZnD) and healthy Caco-2 cells demonstrated different rates of cell media acidification, indicative of altered cell metabolism. The aim of this study was to understand changes to energy substrate consumption and intracellular concentrations under individual and dual deficient conditions. Iron, zinc and dual iron and zinc deficiencies were induced in Caco-2 cells by Chelex-100 removal of minerals from FBS in the growth media and repleting all but the target mineral. Cell media was changed every second day for the first 9 days post seeding, then every day until day 14 due to increased rate of media acidification particularly in iron deficient cells. Glucose (Megazyme, GOPOD), lactate (Megazyme, K-LATE) and protein (Thermo Scientific, SKU# 23225) contents were analysed using commercial kits. Creatine and phosphocreatine were analysed by HPLC. ANOVA was used for statistical analyses using Tukey’s test for post-hoc analyses with a significance of p < 0.05. FeZnD cells had significantly higher intracellular glucose (p = 0.000), and lower lactate (p = 0.000) concentrations compared to healthy control cells. Intracellular glucose and lactate concentrations in cells were also significantly different to that in FeD and ZnD (p < 0.05) cells. Iron deficient and zinc deficient cells were not different to healthy cells (control) for either intracellular glucose (p(FeD) = 0.354, p(ZnD) = 0.996) or lactate (p(FeD) = 0.251, p(ZnD) = 1.000) concentrations. Iron deficient cells did not show a difference in glucose media loss compared to healthy (p = 0.715) cells, whereas zinc deficient (p = 0.000) and dual iron and zinc deficient (p = 0.000) cells had significantly lower glucose loss than healthy cells. Zinc deficiency and dual iron and zinc deficiency resulted in a significant reduction in total intracellular creatine (phosphocreatine + creatine) compared to control cells (p = 0.000). In contrast, zinc deficiency and dual iron and zinc deficiency resulted in a significant increase in phosphocreatine compared to control or iron deficient cells (p < 0.05). Changes to glucose, lactate and phosphocreatine found in this study indicate that dual iron and zinc deficient cells do not mirror changes in individual deficiency. How changes in energy substrates affect nutrient absorption is uncertain from this present work. Further research is required to improve understanding with the view to translate findings into effective treatment and prevention of micronutrient deficiencies.

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).

Approximately 25% of the global workforce engages in night shift work(1), characterised by non-standard hours outside the conventional 6:00am to 6:00pm window. This irregular wakefulness and pattern of mealtimes disrupt circadian rhythms, which are essential for regulating physiological and behavioural functions, including digestion, nutrient absorption, motility, gut microbiome, and hormone secretion(2). Despite some evidence suggesting a link between shift work and increased gastrointestinal (GI) issues(3), comprehensive data on the prevalence and impact of GI disorders among night shift workers remains limited. This cross-sectional study aimed to assess the prevalence of functional GI disorders (e.g., irritable bowel syndrome, functional dyspepsia), their impact on well-being, and contributing factors among night shift workers across various industries. Participants were adults based in Australia or the United Kingdom, and were currently employed in regular night shift work. Participants with previously diagnosed GI disease (e.g., malignancy, inflammatory bowel disease), previous surgery of the GI tract, or were pregnant/lactating were excluded. An online survey was administered via REDCap, utilising validated tools to assess the self-reported presence and severity of upper and lower GI symptoms, quality of life, psychological symptoms, and dietary habits. A total of 392 participants completed the survey (median age 48 (16) years; 52% from Australia, 48% from UK). Results revealed that 21.27% of participants met the Rome IV diagnostic criteria for irritable bowel syndrome, 30.36% for functional dyspepsia, and 24.49% for both disorders. Rotating shift workers reported an increased symptom severity when working night shifts compared to fixed night shift workers (p = 0.003). Of concern, 16.33% of participants considered quitting their job due to the impact of their GI symptoms. Quality of life was reduced in the participants meeting criteria for gut disorders compared to those who did not, with these participants reporting food avoidance, negative body image, and ongoing concerns about their general health (all p < 0.001). For the participants meeting gut disorder diagnostic criteria, they also reported elevated scores on the depression anxiety stress scale (p = 0.001) and GI-specific anxiety (p < 0.001), characterised by constant worry about abdominal sensations and discomfort. 81% of the participants who met criteria for GI disorder diagnosis self-managed their symptoms through dietary modifications, such as the low FODMAP diet or the use of supplements including probiotics and peppermint oil. In conclusion, night shift workers experience substantially higher rates of irritable bowel syndrome and functional dyspepsia than those reported in the general population (4.1% and 7.2% respectively, worldwide)(4). This study underscores the substantial burden of GI disorders among night shift workers, and highlights the need for further research to understand underlying mechanisms and develop effective symptom management strategies.

Approximately 15% of Australia’s workforce are shift workers, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease.(1,2,3) While current guidelines for obesity management prioritise diet-induced weight loss as a treatment option, there are limited weight-loss studies involving night shift workers and no current exploration of the factors associated with engagement in weight-loss interventions. The Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study was a randomised controlled trial that compared three, 24-week weight-loss interventions: continuous energy restriction (CER), and 500-calorie intermittent fasting (IF) for 2-days per week; either during the day (IF:2D), or the night shift (IF:2N). This current study provided a convergent, mixed methods, experimental design to: 1) explore the relationship between participant characteristics, dietary intervention group and time to drop out for the SWIFt study (quantitative); and 2) understand why some participants are more likely to drop out of the intervention (qualitative). Participant characteristics included age, gender, ethnicity, occupation, shift schedule, number of night shifts per four weeks, number of years in shift work, weight at baseline, weight change at four weeks, and quality of life at baseline. A Cox regression model was used to specify time to drop out from the intervention as the dependent variable and purposive selection was used to determine predictors for the model. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries every two weeks were collected from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis.(4) A total of 250 participants were randomised to the study between October 2019 and February 2022. Two participants were excluded from analysis due to retrospective ineligibility. Twenty-nine percent (n = 71) of participants dropped out of the study over the 24-week intervention. Greater weight at baseline, fewer years working shift work, lower weight change at four weeks, and women compared to men were associated with a significant increased rate of drop out from the study (p < 0.05). Forty-seven interviews from 33 participants were conducted and 18 participants completed audio diaries. Lack of time, fatigue and emotional eating were barriers more frequently reported by women. Participants with a higher weight at baseline more frequently reported fatigue and emotional eating barriers, and limited guidance on non-fasting days as a barrier for the IF interventions. This study provides important considerations for refining shift-worker weight-loss interventions for future implementation in order to increase engagement and mitigate the adverse health risks experienced by this essential workforce.

Diabetes-related foot ulcers (DFU) are common, with 56,000 Australia presenting with DFUs every year(1). Optimal nutrition is critical in wound healing, however, in DFU there is limited data available on nutritional status and healing outcomes. Therefore, the aim is to summarise the work leading to the development of a co-designed intervention for individuals with DFU and determine the dietary intake of individuals with DFU. Three separate studies were conducted: (1) qualitative interviews within individuals with DFU, (2) qualitative interviews with health care professionals working with people with DFU, and (3) comparison of current dietary intakes of individuals with DFU against international guidelines. To explore the individual with DFU perspective, a qualitative study using a reflexive thematic approach of conversational style interviews was undertaken. A targeted heterogenous sample with active or recent history of DFU, were recruited from a high-risk foot service in New South Wales, Australia. To gain an understanding of the perspectives of Australian health professionals involved in the care of individuals with DFU regarding nutrition assessment and management, semi-structured interviews were conducted nation-wide. To compare dietary intake, descriptive analysis was conducted. Dietary intake was collected using the Australian Eating Survey food frequency questionnaire and used to generate nutrient intake data. Nineteen interviews with individuals with DFU identified negative experiences with dietitians, seeing them as judgemental. Dietary misconceptions were common, with many having an unhealthy perception of food and no participants previously given personalised dietary advice for wound healing. However, it was evident that participants were willing to do anything to improve their wound healing, including a dietary intervention. Participants expressed a strong preference for personalised, face-to-face dietary advice. A total of 19 health professionals participated in interviews. Major barriers to implementation of nutrition assessment and management were identified: inadequate time, lack of knowledge and lack of clinical guidance. Facilitators included: professional development, a standardised clinical pathway and screening tool, and a resource addressing wound healing and diabetes management. One hundred and fifteen participants with DFU were included in the dietary analysis. Most individuals with DFU did not meet current consensus guidelines for optimal dietary intake for wound healing. Inadequate intake of protein, vitamin A, vitamin C, vitamin E and zinc was identified 46%, 45%, 26%, 86%, and 37% of participants, respectively. This body of work highlighted that individuals with DFU are interested in receiving personalised medical nutrition therapy, however they are not currently meeting higher wound healing nutrient requirements. Furthermore, health care professionals are not confident in supporting these individuals. These findings suggest that co-designing interventions for individuals with DFU needs to utilise co-design of the patient and clinician perspective to increase acceptability of the nutrition intervention.

Indirect calorimetry (IC) is regarded as the benchmark for measuring resting energy expenditure (REE)(1) but validity and reliability in adults with overweight or obesity have not been systematically appraised(2). The aim of our research was to evaluate the diagnostic accuracy of IC for REE in adults with overweight or obesity. A rapid systematic review was conducted. PubMed and Web of Science were searched to December 2023. Eligible studies measured REE by IC in adults with overweight or obesity (BMI ≥ 25 kg/m2 or mean BMI > 30 kg/m2) reporting validity and/or reliability. Studies were selected using Covidence and critically appraised using the CASP diagnostic study checklist. From n = 4022 records, n = 21 studies utilising n = 13 different IC devices were included (n = 10 reported concurrent validity, n = 7 reported predictive validity, n = 7 reported reliability). A hand-held IC had poor validity and inconsistent reliability (n = 6 studies). Standard desktop-based ICs (n = 9 devices) were examined by across n = 18 studies; most demonstrated high validity, predictive ability, and good to excellent reliability. An IC accelerometer showed weak validity (n = 1 study); a body composition-based IC showed strong validity (n = 1 study); and a whole-room IC demonstrated excellent reliability (n = 1 study). Standard desktop-based IC demonstrated the most consistent validity, predictive ability, and reliability for REE in adults with overweight or obesity. Hand-held IC may have limited validity and reliability. Accelerometer, body composition-based, and whole-room IC devices require further evaluation. Inconsistent findings are attributed to differing methodologies and reference standards. Further research is needed to examine the diagnostic accuracy of IC in adults with overweight and obesity.

There has been a proliferation of ultra-processed foods (UPF) in the food environment since the 1980s which have newly been linked to growing number of non-communicable diseases (NCD) including cardiovascular disease, cancers, type 2 diabetes, fatty liver disease, depression, frailty, and hypertension(1). There is intense debate surrounding whether the mechanism for the negative effect on health of consumption of UPF is their nutrition composition or processing(1). There is growing evidence that macronutrient ratios are important for chronic disease risk, predict longevity and may adversely affect micronutrient intakes(2). Intake of macronutrients from ultra-processed sources may lead to macronutrient imbalances and higher energy intakes(3) while being deficient in micronutrients, making it difficult to achieve energy balance and meet micronutrient requirements. Using nationally representative nutrition surveillance data on the Australian population, the National Nutrition and Physical Activity Survey, in this paper we employ the Geometric Framework for Nutrition(2) to examine the multidimensional dietary composition of UPF. Diet was assessed for adults (n = 9.341) with two 24-hour recalls. Diets were classified by degree of processing according the NOVA classification system and classified as ultra-processed diets (UPD, > 60% energy from UPF), moderate or low in UPF i.e., minimally processed diets (MPD, < 20% energy from UPF). Outcomes included the nutrient rich food index (NRF 9.3 index)(4), the Nutri-Score(5), and macronutrient and micronutrient intakes. Micronutrients were plotted over macronutrient ratios for MPD and UPD to determine whether micronutrient intakes could be met within the acceptable macronutrient distribution ranges (AMDR). Scheffe’s polynomials were fitted to the data for total energy intake, macronutrient intake and micronutrient intake. Vitamin and mineral intakes were higher for MPD compared to UPD (p < 0.001). Overall nutrient density decreased and the NRF 9.3 scores were 399.2 for MPD and 297.7 for UPD (p < 0.001). For the Nutri-Score, MPD diets scored A (highest quality) and UPD scored C (moderate quality). Poor scores were due to higher energy density, saturated fat, added sugar and sodium increased with UPD, while protein, dietary fibre and micronutrient density and fruit, vegetable, nut and legume ratios decreased. Diets met the estimated average requirement (EAR) for all micronutrients within AMDR for MPD but not for UPD. Regardless of processing, in almost all nutritional indicators of health, diets high in UPF were unsatisfactory relative to nutritional recommendations. We conclude that compositional factors alone point to the mechanisms through which ultra-processed dietary patterns could lead to poor health, in the full understanding that processing likely has additional effects over and above composition that exacerbates the problem.

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.