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

Hospital food service quality significantly impacts patient satisfaction with overall care(1) and can influence food intake, thereby increasing the risk of malnutrition(2). By contrast, meals tailored to patients’ needs result in lower complications and hospitalisation costs(3). With Australia’s ageing population and projected increases among racial and ethnic minority migrants, service delivery must adapt to promote equity and inclusion in the healthcare system. However, data is lacking on the lived experience, preferences, and acceptance of hospital food service and meal quality among older patients from culturally and linguistically diverse (CALD) backgrounds. This study aimed to bridge this gap by investigating the differences in hospital food services related to cultural and ethnic backgrounds. Semi-structured qualitative interviews were planned among 15 Australian-born and 15 CALD-background patients, aged 65 years or over, admitted to the Department of General Medicine at Flinders Medical Centre. Patients admitted with a highly contagious infectious disease (e.g., COVID-19), those referred for palliative care, receiving parenteral or enteral nutrition, or on nil-by-mouth orders were excluded. Translators were available to participants upon request. With participants’ consent, all interviews were audio recorded and transcribed verbatim. Transcripts were analysed thematically using Braun and Clarke’s six-phase process(4). Data was inductively coded with a phenomenological perspective to explore participants’ experiences with hospital food services. Similar codes were grouped together and further developed into themes through iterative discussions with the research team. The current analysis involved six participants from each group to present preliminary results. Among the 12 participants, the mean age was 82 years, ranging from 72–92 in the Australian-born group and 68–92 in the CALD group. Five primary themes emerged: (1) No Complaints—participants did not want to complain about their meals, preferring staff to focus on their healthcare. This attitude was compounded for CALD participants who lacked the language to voice complaints; (2) Food and Identity—CALD participants viewed themselves separately from Australian-born patients, with the lack of culturally familiar food contributing to a feeling of being the minority; (3) Acceptance—the food service was viewed in the context of the overall hospital system, with participants accepting that meals may not suit their preference; (4) Experiences of the Food Service—influenced by participant’s individual preferences for meal quality, menu options, and staff interactions; and (5) Nutrition and Health—All participants had a preference for smaller portions due to their perception of reduced nutritional needs, yet meals were also valued for enjoyment. These preliminary results indicate that hospital food services should offer culturally familiar options, improve patient-staff communication, and provide personalised, smaller portions to enhance patient experience. Addressing the enablers and barriers to meeting cultural and individual dietary needs in hospitals will promote equity, diversity, and inclusion in healthcare.

Iron deficiency is the most common nutritional deficiency globally. Premenopausal women are at particular risk due to increased requirements for iron associated with menstrual blood loss and pregnancy. To prevent iron deficiency, recommended intakes have been developed based on physiological requirements for absorbed iron and iron bioavailability. However, iron bioavailability is difficult to estimate as it depends on the composition of the diet and an individual’s absorptive efficiency. Several algorithms have been proposed to estimate iron bioavailability from diets based on the form of the iron and the presence of absorption modifiers. These algorithms can be complex and often underestimate bioavailability. Recently, a new approach was developed by Dainty et al.(1,2), which is based on calculated iron requirements, total dietary iron intakes, and the distribution of serum ferritin concentration values in the population. This model has been used by the European Food Safety Authority to set recommended iron intakes for adults(3). In contrast, the recommended iron intakes for Australian adults are based on iron bioavailability estimates from the US Institute of Medicine, which were primarily derived from 15 free living US adults(4). Therefore, the aim of this study was to predict dietary iron absorption in a representative sample of premenopausal Australian women using the model developed by Dainty et al.(1,2) Dietary iron intake and serum ferritin data from the 2011–13 Australian National Nutrition and Physical Activity Survey and National Health Measures Survey were analysed in 503 premenopausal women aged 18–49 years. Women were excluded if they were pregnant or lactating, had elevated C-reactive protein, consumed iron-containing supplements, or misreported energy intake. Dietary iron intake was assessed via two non-consecutive 24-hour recalls. Usual daily iron intake was determined by the Multiple Source Method. Dietary iron absorption was estimated using the predictive model developed by Dainty et al.(1,2) and the Institute of Medicine’s distribution of individual dietary iron requirements(4). Mean (SD) usual dietary iron intake was 10.4 (2.6) mg/d. The prevalence of serum ferritin < 15 μg/L was 14.1% (95% CI: 10.2%, 19.3%), and < 30 μg/L was 37.0% (95% CI: 31.8%, 42.5%). Predicted dietary iron absorption at serum ferritin concentrations of < 15 μg/L was 29.5%, and at serum ferritin concentrations of < 30 μg/L it was 19%. Our findings do not support the bioavailability assumption of 18% used to develop the Australian recommended iron intakes for premenopausal women based on the need to maintain serum ferritin concentrations of 15 μg/L. Our results may be useful in revising the recommended iron intakes for Australian premenopausal women.

Depression and dementia represent significant public health issues, affecting approximately 1 in 10 and 1 in 12 older Australians, respectively. While current pharmacological treatments are effective in relieving symptoms, they often entail undesirable adverse effects, including gastrointestinal issues and bradycardia(1,2). This highlights the need for primary preventative measures, including food- and nutrition-based approaches. Chronic brain inflammation is believed to interfere with the gut–brain axis(3). Consumption of fermented dairy products rich in beneficial gut microbes may attenuate this inflammation and offer protective health benefits. This study aimed to examine whether fermented dairy intake could mitigate the risk of incident depression and dementia. Utilising data from the Sydney Memory and Ageing Study I of 1037 participants 70–90 years, 816 participants (mean age: 76.7) were followed from 2005 until 2012 for incident depression, and 974 participants (mean age: 80.7) were followed up from 2005 until 2014 for incident dementia. Fermented dairy intake was assessed using the Dietary Questionnaire for Epidemiological Studies version 2 and categorised yoghurt and regular cheese into quartiles (Q) and low-fat cheese into consumers/non-consumers, with no consumption as the reference group. Depression diagnoses were assessed via self-reported physician-diagnosed history, medication use, service utilisation, and heavy alcohol use. Dementia diagnoses followed the criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Cox proportional hazards models examined the associations between fermented dairy intake and the risk of incident depression/dementia. Additionally, linear regression models were applied to assess for depressive symptoms score (measured by the Geriatric Depression Scale-15) and psychological distress score (measured by the Kessler Psychological Distress Scale-10). All models were adjusted for sociodemographic, lifestyle factors, and medical histories. Over a median follow-up of 3.9 and 5.8 years, 120 incident depression and 100 incident dementia cases occurred, respectively. Those who consumed high yoghurt (Q4: 145.8–437.4 g/day) and low-fat cheese (consumers: 0.4–103.1g/day) intakes were associated with a lower risk of incident depression, both compared to non-consumers (yoghurt: adj.HR: 0.38, 95% CI: 0.19–0.77; low-fat cheese: adj.HR: 0.50; 95% CI: 0.29–0.86). They were also associated with lower depressive symptom scores (yoghurt: adj.β = −0.46; 95% CI: −0.84, −0.07; low-fat cheese: adj.β = −0.42; 95% CI: −0.73, −0.11). However, those who consumed a higher intake of regular cheese (Q4: 14.7–86.1 g/day) had an elevated risk of incident depression (adj.HR: 1.88; 95% CI: 1.02, 3.47), and those in Q2 (0.1–7.2 g/day) had significantly higher depressive symptom scores (adj.β = 0.42; 95% CI: 0.05, 0.78). No significant findings were found for psychological distress scores or incident dementia. Our findings of a cohort of older Australians suggest that higher yoghurt and low-fat cheese intakes may reduce incident depression and depressive symptoms, while a higher intake of regular cheese may increase these risks.

In ultrarunning events, energy substrates are important due to the long duration of the event. However, anorexia that occurs during the event can pose a challenge to nutritional strategy(1). The risk of dehydration due to limited access to fluid is increased in trail running, but the association between dehydration and appetite loss due to reduced fluid intake is unclear. This study aims to clarify the relationship between exercise-induced appetite loss and dehydration during prolonged physical activity. The study included 47 healthy adults who provided prior consent and participated in a trail running race with a distance of 169 km and a cumulative elevation of 10,500 m. Dehydration status was ascertained by Urine Specific Gravity (USG), and fluctuations in hydration status were tracked through the race. Subjects with no missing data (n = 40) were classified into severely dehydrated (n = 33) if ≥ 1.030 or mildly dehydrated (n = 7) if < 1.030 based on USG at the finish line(2). Subjective evaluation of anorexia level and gastrointestinal condition was made in a post-race self-administered questionnaire, in which symptoms were rated on a 5-point scale for each race segment. In this questionnaire, participants were also asked to indicate the amount of food and water they consumed during the race. The parameters measured before the race, at the mid-race aid station, and at the finish line, as well as the responses provided in the questionnaire for each race segment, were analysed using a two-way ANOVA with factors for group and time. Multiple comparisons were performed to examine differences across time points and between groups. The mean USG at the finish line was 1.027 ± 0.002 in the mildly dehydrated group and 1.034 ± 0.003 in the severely dehydrated group, both showing a significant increase from before the race, with the severely dehydrated group being higher (p < 0.0001). Body weight decreased significantly in both groups by the finish line, with no difference. There was no significant difference in the rank between groups (p = 0.36). 57.9% of participants experienced appetite loss, but there was no difference in the frequency of appetite loss during the race between the group (p = 1.000, Fisher’s Exact Test), the severely dehydrated group exhibited increasing symptom levels as the race progressed. There was a tendency for the severely dehydrated group to have a higher frequency of nausea during the race (p = 0.095). Fluid intake was similar between groups, both in total and per hour. The results of this study suggested that dehydration and appetite loss are independent incidents and that appetite loss has not been a cause of dehydration. Dehydration in runners during 160km trail running races may have caused appetite loss by producing nausea(3).

In Australia, many adolescents are not meeting dietary guidelines, particularly for low-energy-dense foods such as vegetables(1). Adolescents’ diets also include high amounts of discretionary foods(1), which tend to be energy dense and nutrient poor. Decreasing dietary energy density could moderate energy intake(2) and improve overweight and obesity prevalence among adolescents. Communicating with adolescents about the energy in foods may be important for teaching them strategies to decrease their dietary energy density, but this requires careful consideration to ensure that key messages use language and concepts that are appropriate for adolescents. This study aimed to explore adolescents’ perceptions of food energy, understanding of food energy-related terminology and consideration of energy when making food and drink choices. The present study used face-to-face interviews with a structured schedule of open-ended and closed questions informed by previous research among adolescents as well as gaps in the literature. Some interview questions included prompts with visual cues (lists of food-related terms and factors previously associated with adolescent food choices) to encourage deeper discussion. Interviews were recorded, professionally transcribed and analysed using a six-phase thematic analysis. Thirty adolescents (mean age 14 years, range 12–17 years) from regional Victoria participated in interviews that lasted an average of 39 minutes (range 28–62 minutes). Most adolescents perceived energy in food as the fuel required to move the body or the ‘power’ stored in food. Adolescents identified that different foods contain varying amounts of energy, and they classified foods as high energy (‘good energy’) or low energy (‘bad energy’). Adolescents were more familiar with the term ‘calories’ than ‘kilojoules’ when asked about these words. Approximately half of adolescents described thinking about the energy in food in making food choices when prompted with the question ‘Do you ever think about energy when you’re choosing a food to eat?’, but most adolescents did not consider the energy in a drink as an influence on their drink choice when prompted with a similar question. In conclusion, this study, which was the first to explore adolescents’ perceptions of food energy and energy-related terminology in Australia, found some inconsistencies around adolescents’ understanding of food energy and that the metric system term ‘kilojoules’ was less familiar to adolescents than ‘calories’. Additionally, food energy may be an important inclusion in nutrition education, but the lower reported consideration of energy in drinks may have important implications for beverage consumption messages (e.g., around sugar-sweetened beverages). Practical implications of the results include that it may be helpful to use examples that distinguish between the energy we feel (e.g., our ‘energy levels’) and the energy in foods in nutrition education among adolescents. Additionally, nutrition education among adolescents may need to promote understanding of both kilojoules AND calories.

Due to the high prevalence and incidence of depression among young adults, identifying potential prevention strategies during young adulthood is of great public health importance. Indeed, dietary intake is an important determinant of mental health during this stage of the lifespan. Dietary polyphenols, present in plant and plant-derived foods, have been inversely associated with depression in older cohorts(1). However, the prospective association between polyphenol intake and depression remains unclear, particularly in young adults. As such, this study aimed to assess the prospective association between the intake of total polyphenols, polyphenol classes, and polyphenol subclasses and depressive symptoms in young adults. Data from the Raine Study Generation 2 participants at 20-, 22-, and 27-year follow-ups (n = 1,484; 52.7% female; age range: 18 to 28 years) were used. The exposure variable, polyphenol intake, was estimated from self-reported dietary intakes using the Phenol-Explorer Database. We categorised energy-adjusted polyphenol intake into quartiles. The primary outcome was self-reported depressive symptoms assessed via the 21-item Depression, Anxiety, and Stress Scale (DASS) averaged across the three timepoints. Linear mixed-effects models were used to assess the association between the polyphenol intake exposures and depressive symptoms. Sociodemographic characteristics and lifestyle- and health-related behaviours were adjusted for in multivariable models. Participants in the highest quartiles for flavonol and hydroxybenzoic acid intake had lower depressive symptoms across time than participants in the lowest quartiles [flavonols (Q4 vs Q1 model-adjusted mean difference: −1.42, 95% CI: −2.52, −0.31); hydroxybenzoic acids (Q4 vs Q1: −1.37, CI: −2.48, −0.26)]. We found little to no evidence of a prospective association between depressive symptoms and quartiles of total polyphenols, polyphenol classes, and other polyphenol subclasses. The results from the current study in combination with previous studies in the field suggest that the intake of some, but not all, polyphenol subclasses may be useful targets for novel prevention strategies for depression. However, further mechanistic studies in human populations, and prospective studies in young adults and across the lifespan are required.

The food environment plays an important role in nutrition-related health outcomes. The influence of market settings on overall diet quality may be substantial where individuals regularly attend any given market. Salamanca Market (Hobart, Tasmania), and Carriageworks Market (Sydney, New South Wales; NSW) are two popular Saturday markets, attended regularly by locals. Salamanca Market provides a diverse range of edible (~30% of stalls) and non-edible (~70% of stalls) goods with a non-exclusive focus on ‘Tasmania’s own’ products. Carriageworks ‘Farmers Market’ features primarily edible products (~90% of stalls), requiring products to be grown/made/produced by the stallholder in NSW or Australian Capital Territory(1). While benefiting from tourism, these two markets are strongly attended by locals(2), therefore making an important contribution to health of individuals as a food environment experienced frequently and repeatedly. This study examined changes in food/beverage stall offerings at these markets over a 10- to 13-year period, as a reflection on the potential changes in weekly markets and hence food environments experienced across Australia. Stallholder information for Salamanca (summer stallholders 2011–12 to 2023–24) and Carriageworks (2015–2024 inclusive) markets were obtained from the respective official websites and analysed for stall categorisation. Current range of available products and categorisations were confirmed through in-person audits in January 2024. Descriptive statistics were used to summarise the findings. Over the study period, Salamanca Market food and beverage offerings grew by 21% to comprise 31.7% (89/291) of all stalls in 2024. This was driven by an increase in stalls offering primarily ‘discretionary’ foods/beverages: Take Away Food increased by 58% to 38% and Confectionary nearly doubled to 11% of food/beverage stalls. Stalls selling alcohol as their primary product increased from 13% to 64% of all beverage stalls over this time; vendors selling primarily whisky/spirits grew from 1 stall in 2012–13 to 9 stalls in 2023–24. This occurred simultaneously with a reduction in ‘core’ foods availability: Fruit and Vegetable stalls dropped from 24% to 10% and Dairy halved to 3% of food/beverage stalls. However, self-titled ‘farmers market’ Carriageworks demonstrated relative stability in stall composition over 10 years. Notable changes included reduction in number of Meat/Fish/Poultry/Alternatives stalls by 50%, and an almost halving of Condiments stalls, however other stall types (Fruit/Vegetables; Dairy) have remained relatively unchanged in number and proportion; almost two thirds of stalls primarily sold ‘core’ foods. In summary, stall composition at a market prizing a diversity of offerings demonstrated a transition to a poorer food environment, whereas stall composition at a ‘farmers market’ demonstrated less change and a ‘healthier’ composition of food/beverage offerings over 10–13 years. The food environment offered at ‘farmers markets’ is likely to be superior for healthful food purchasing and positive impacts on nutrition-related outcomes, compared to mixed-business markets.

Higher-quality Australian diets are reported to taste more bitter(1), have healthier nutritional profiles and align more closely with the recommendations of the Australian Dietary Guidelines(2). Greater consumption of bitter foods may benefit health, but most research has focused on green leafy vegetables(3). However, there are other foods and beverages (F&Bs) that taste bitter and could increase the bitterness of diets if consumed in greater amounts(2). Yet, strategies to increase bitter F&B consumption and enhance the bitterness of diets remain largely underexplored. An online-based cross-sectional survey of Australian adults was conducted (in July and August 2023) to explore barriers, facilitators, and strategies associated with willingness to try or increase consumption of bitter F&Bs. Eight non-discretionary bitter F&Bs available in the Australian market (including coffee, tea, soda water, Brussels sprouts, rockets, grapefruit, walnuts, and eggplant) were selected. The design of survey questions was guided by conceptual models of food choice. Respondents were asked about their familiarity with and consumption habits of bitter F&Bs and their willingness to incorporate more bitter F&Bs into their diets. Respondents were grouped into those who had never tried bitter F&Bs, non-consumers or consumers, who were further categorised into low-, moderate- or high-consumers. This analysis focused on respondents with low bitter F&B consumption, non-consumers, and individuals who had never tried bitter F&Bs, as the potential to increase consumption was greatest. This study enrolled 879 respondents across Australia. Respondents had previously tried an average of six of the eight bitter F&Bs (median = 6). Most respondents (85.4%) were willing to increase their consumption of bitter F&Bs. While the bitter taste was consistently reported as the main barrier to greater consumption, the reported facilitators and strategies varied between consumer groups and the different F&Bs. More than half of the respondents (61.1%) had never tried bitter vegetables (i.e., Brussels sprouts and rockets). For this group, ‘nutrition education’ (selected by 34%) and ‘appealing presentation’ (selected by 25.9%) were the most commonly selected facilitator and preferred strategy, respectively. Non-consumers of other bitter foods in the survey reported ‘price’ (selected by 43.8%) and ‘convenience’ (selected by 16.5%) as the most important facilitator and strategy, respectively. While ‘food availability’ (selected by 39.3%) was the common facilitator among low-consumers of bitter beverages, ‘easier preparation’ and ‘altering the taste’ (selected by 19.9% and 17.3%) were the most preferred strategies. This study provides valuable insights into the acceptability of bitter F&Bs among Australian adults. These findings could help tailor dietary interventions to groups of individuals based on their consumption habits of particular bitter F&Bs to support increased consumption. Further research is needed to understand whether improving bitter F&B consumption increases the bitterness of diets overall and whether this is associated with improved health outcomes.

Short-term, immersive international placements are common and have been recognised for facilitating cultural learning, intercultural sensitivity, global-mindedness, and critical thinking. These outcomes are not guaranteed and the impact and inclusion of these experiences in an already comprehensive curriculum remain to be carefully evaluated. This study explores the impact of 4-week international placements on professional and personal development (short-term and enduring) of participating final-year undergraduate and postgraduate dietetic and undergraduate nutrition students. Recent nutrition and dietetic graduates (n = 8) of the program, implemented in underserved communities in the Philippines, Indonesia, and Vanuatu for four weeks during 2022–2021, were interviewed using semi-structured questions until saturation, followed by thematic analysis using a six-step process(1). Graduates were interviewed about their in-country experience and its impact on their professional practice, within 12–18 months of graduating. Findings were further analysed against the national competency standards for dietitians in Australia. Participants expressed significant cultural awareness (appreciation of the strength of other cultures, stronger communitarian values of hosts), greater critical and systems thinking (about socio-economic determinants of health, systems-level thinking) and deeper capacity for empathy and compassion (emotional quotient development). When viewed against the national competency standards, participants did not understand how international placements from developed to developing countries can perpetuate colonisation principles and global-mindedness was not identified as a strong theme. These findings suggest that immersive, international placements result in profound, transformational, and enduring learning that extends into participants’ professional life, especially respect for cultural safety and the development of systems thinking. There is an alignment with accrediting professional peak body competencies for cultural competency, professional practice and collaborative practice with findings suggesting areas for strengthening the nutrition and dietetic curriculum include enhancing learning outcomes of global-mindedness thinking and decolonisation principles.

Food insecurity has been associated with poorer dietary quality in Australian adults(1). Understanding the relationship between food insecurity and healthy lifestyle behaviours is crucial for developing effective personalised nutrition interventions. This study aimed to investigate differences in healthy lifestyle and food choice behaviours like food shopping, food preparation skills, and nutrition knowledge between food-secure and insecure adults. An online, cross-sectional survey using a convenience sample of Australian adults measured food insecurity using a single-item food insecurity screening tool(2). Healthy lifestyle and food choice behaviours were measured through the validated psycho-behavioural living and eating for health segments (LEHS) survey(3). Differences in survey responses between food-secure and food-insecure respondents were explored using Chi-square tests and t-tests. Among respondents (n = 148; 68% female; 92% tertiary educated; mean age 34.4 ± 10.9 years), 22% were classified as food insecure. According to the LEHS, food-secure participants are predominantly ‘Balanced All Rounders’ (n = 39; 33.6%) who try to live a balanced lifestyle and ‘Health Conscious’ (n = 36; 31.0%), who prioritise healthy eating. Food-insecure participants had a higher percentage identifying as ‘Lifestyle Mavens’ (n = 6; 18.8%) compared to the food-secure group (n = 4; 3.4%); who are passionate about healthy eating and use social media to follow active lifestyles. Both groups have similar proportions of ‘Aspirational Healthy Eaters’ (n = 32; 27.6% food-secure vs n = 8; 25.0% food insecure), who aspire to eat healthily but find it challenging, and ‘Contemplating Another Day’ (food insecure group n = 2; 6.3% compared to the food-secure group n = 5; 4.3%); who acknowledge the importance of healthy eating but do not prioritise it. Between group differences are statistically significant (p = 0.042). Regardless of food insecurity status, most respondents considered themselves highly skilled at various aspects of food preparation, food shopping and nutrition knowledge. A higher proportion of food-insecure individuals reported that people sought them out for healthy eating advice (43% vs 29%; p = 0.026). On average, food-insecure respondents reported being more knowledgeable about food budgeting (mean score difference on 5-point Likert scale = 0.5; p = 0.048) and buying cheaper cuts of meat to save money (mean score difference = 0.7; p < 0.001). However, food-insecure respondents reported being less able to keep basic pantry ingredients stocked for meal preparation (mean score difference = −0.6; p < 0.001). Unlike other Australian research(4), food insecurity in this convenience sample of Australian adults does not appear to be associated with a lack of food skills, and food-insecure people may be more health conscious, and better at food budgeting despite more limited resources. The LEHS survey may offer a valuable framework for tailoring personalised nutrition interventions in a manner that respects and supports the dignity of food-insecure individuals.

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.

Parents and teachers have expressed concerns about the adequacy of time allocated to eat lunch at primary schools in Australia(1). Short school lunch durations can result in negative outcomes such as insufficient food consumption, resulting in hunger and inadequate energy and nutrition(2). A recent study reported that students consumed less fruits and vegetables when given 10 minutes to eat compared to 20 minutes(3), leading to increased food waste. We aimed to explore parents’ perceptions regarding time-related aspects associated with school lunch including the sufficiency of time to eat school lunch, children requesting and parents providing quick-to-eat food, and the perception that healthy food takes longer time to eat. Additionally, we aimed to explore whether these time-related perceptions and children’s age are associated with how often children finish their lunches. An online survey was conducted in 2022 to explore Victorian parents’ perceptions regarding primary school lunches including the aspects mentioned above. Frequencies and percentages were calculated for all variables. Chi-square tests were used to explore the relationship between parents’ perceptions of time-related aspects and child’s age and how often children finish their lunches. Out of 359 parents, 29% reported that their child sometimes, rarely, or never finishes their lunches. When asked about reasons for this, 20% chose ‘not enough time is provided to finish lunch’ and 19% chose ‘my child is more interested in playing than eating during lunchtime’. About half of parents strongly agreed or agreed (SA/A) that the allocated time at their child’s school is not sufficient to eat school lunch (48%). Fifty percent of parents SA/A that their child asks them to pack easy-to-eat food and 60% SA/A that they provide such food for school lunches. However, the majority of parents (62%) strongly disagreed or disagreed (SD/D) that healthy foods take longer than less healthy food to eat during school lunchtime. More parents who SA/A with the statement ‘the allocated time at my child’s school is not sufficient to eat school lunch’ reported their child finishes lunch sometimes, rarely or never compared to parents who SD/D with this statement (36% vs 16%, Chi-sq = 11.372, p = 0.003). Parents’ perceptions regarding other time-related aspects were not associated with finishing lunches. More parents of children in prep to grade 2 compared to parents of children in grades 3 to 6 reported their child finishes their lunch sometimes, rarely or never (73% vs 49%, Chi-sq = 16.813, p < 0.001). The findings indicate that parents have concerns about the time allocated to eat lunch at primary schools. Increasing the time allocated to eating school lunches would help to ease these concerns and allow children, especially the younger primary school children, to eat comfortably and finish their lunches if they wish to do so.

Colorectal cancer is a prevalent global health issue. In Australia, it ranks as the third most common newly diagnosed cancer, with around 15,000 new cases annually(1). Despite treatment advances, high incidence and mortality rates highlight the need for effective prevention and new therapies. Polyphenols, abundant in plant-based foods, have shown promise in inhibiting cancer cell growth and inducing apoptosis, offering a dietary approach to reduce cancer risk and improve outcomes. Whole-grain cereals like sorghum are recognised sources of phenolic compounds and can scavenge free radicals(2). This study aimed to evaluate the role of sorghum-derived polyphenols in modulating the major cancer development pathways. Also, the impact of processing techniques (cooking and fermentation) on sorghum polyphenols and cancer was evaluated. Polyphenols were extracted from the raw, cooked, fermented, and fermented-cooked sorghum flour samples(3). The phenolic content was measured using benchtop chemical assays including the DPPH radical scavenging assay and the ferric-reducing ability of plasma assay. UHPLC analysis coupled with Online ABTS characterised the polyphenols present in these extracts and provided their antioxidant activities. Using these extracts, a resazurin red cytotoxicity assay was performed on HT-29 colorectal cancer cells to determine the optimal concentrations for the downstream experiments. HT-29 cells were incubated with the black sorghum phenolic extracts (500 ug/mL and 2000 ug/mL) for 12 and 24 hours. Following this, the gene expression of several cancer regulatory genes (APC, KRAS, TTN, GLUT-1, HIF-1a and HIF-1b) was evaluated by qPCR. Treatment of HT-29 cells with raw sorghum phenolic extracts significantly (p < 0.05) upregulated APC and TTN genes at 12 and 24-hour time points and the KRAS gene at 24-hour time points compared to the control. This indicates the impact of sorghum-derived polyphenols on genome mutation and instability in cancer development pathways. Also, treatment at 500 ug/mL significantly (p < 0.05) upregulated the expression of GLUT-1 suggesting the impact on dysregulated cellular metabolism cancer development pathway. Processed sorghum phenolic extracts also significantly regulated KRAS gene expression. Overall, the results from this study showed that sorghum polyphenols modulate the expression of key cancer development pathway-associated genes in HT-29 cells. The findings underscore the potential of dietary polyphenols in cancer prevention and highlight the need for further research to optimise their use and understand their mechanisms of action in vivo.

One in five Australian children are food insecure(1), and the majority are consuming inadequate vegetables and too many energy dense nutrient poor foods(2). A healthy school lunch program provided to all children will ensure fair and equitable access to essential nourishment during a school day that can improve academic achievement(3), attention, behaviour and concentration(4) and mental health and wellbeing(5). However, prior to implementing a school meal program, opinions and thoughts of key stakeholders, including teachers, should be explored. The aim of this study was to explore Victorian primary school teachers’ perceptions and opinions of current lunch practices and school provided lunch programs.An online survey of primary school teachers in Victoria was administrated via Qualtrics. Frequencies and percentages of responses were calculated and Chi Square tests were used to explore associations with demographic variables (gender, school type (government, independent, catholic, other)). A total of n = 322 Victorian primary school teachers completed the survey (95% female, 81% government schools). All year levels (Prep–grade 6) were represented. Thirty percent agreed and 45% were unsure whether there should be a school provided lunch program. Most teachers (91%) believed that the school provided lunches would allow children to eat healthy foods and 73% believed it would be convenient for parents. Perceived barriers included; cost for parents (81%), teachers do not want to serve food (75%) and time it would take to serve the food (70%). There was no difference between teachers in government and independent schools in preferences for a school lunch program or perceived potential benefits. However, more teachers from independent schools believed it would take too much time to serve food to all children (81%) compared to teachers from government schools (68%; Pearson’s Chi-Square test, p = 0.045). Additionally, more teachers from government schools thought that delivering a school provided lunch program may reduce teaching time, than teachers from independent schools (52% vs 37% respectively: Pearson’s Chi-square test, p = 0.041).While most teachers agreed school provided lunches would provide children an opportunity to eat healthy food for lunch and would be convenient for parents, less than a third agreed there should be a lunch program and many were unsure. Concerns included taking too much time to serve food and thinking they would need to serve the food themselves. This may be due to a lack of understanding of school provided lunch programs. Further research can investigate effective ways to mitigate some of the identified barriers when designing a school meal program.

Food security is a crucial issue for policymakers, practitioners, and researchers(1). Network analysis, which examines complex systems and relationships(2), can provide valuable insights into food security through the interactions of individuals and organisations. This study aimed to explore the Twitter network discussing food security in Australia, focusing on user connections and key influencers. Data was collected from 2019 to 2021 using the Twitter API and Python software(3). Eligible tweets were those sent by Australian users, in English, and containing at least one food security-related search term. From this data the interactions (re-tweets, replies and quote tweets) between users was extracted, including only users who interacted with another user from the dataset at least twice. Social network analysis was conducted using the software Gephi(4) where interactions (edges represented as lines) between users (nodes represented as circles) were visualised. Sentiment and topic analysis of the tweets were also used to explore what was being said and in what tone(3). The network comprised n = 2,172 Twitter users and 3,304 connections. However, 394 connections (11.9%) were self-interactions, contributing to a low network density of 0.001. The median number of users each user connected with (degree) was 1 (25th, 75th percentiles 1, 2), ranging from 1 to 346. The most common topic discussed by n = 589 users (27.1%) was global food production and the most common sentiment was positive (n = 1,228 users, 56.5%). High modularity (0.740/1) indicated the network could be divided into distinct communities that had dense connections within but not necessarily outside of their community. There were 353 communities, with 209 (59.2%) of these communities containing only one user. The largest ten communities represented 71.9% of the network, with the largest community (n = 530 users) focusing on Australian food insecurity and food banks, discussed from a political and refugee perspective with a generally negative tone. Betweenness centrality identified key influencers who connected various parts of the network. The top 20 influential users included seven non-profit organisations, seven academics, three advocacy groups, two political accounts, and one government account. Non-profit organisations often interacted with each other, while academics were mainly clustered in the same community. High-degree users, who had the most direct connections (≥ 35 connections), were predominantly non-profit organisations, with fewer academic and more political accounts than those with high betweenness centrality (≥ 12,000). Despite the overall low network density due to isolated users and relatively insular communities, some individuals exhibited extensive connections, highlighting their central role and potential influence in Twitter discussions. Future research could examine how these dynamics evolve and explore strategies to enhance connections, thereby enabling diverse social media users to better influence public discourse and ultimately policy on food security issues.

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.

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

Nutrition misinformation is pervasive on frequently accessed online sources such as social media and websites(1). Young adults in particular are at a higher risk of viewing or engaging with this content due to their higher Internet and social media usage(2). As such, this study aimed to understand the preferences, perceptions and use of online nutrition content in this age group. Young Australian adults (aged 18–25 years; n = 20) were individually interviewed via the video calling platform Zoom. Interviews ranged between 19 and 42 minutes. The interviewer followed a semi-structured format and questions were guided using a piloted template. Reflexive thematic analysis was conducted using NVivo. Quotes addressing the research questions were coded. Codes were grouped into themes and sub-themes and were summarised in a narrative format. Results showed that all but one participant used social media (n = 19) and Internet websites (n = 16) to view nutrition content. Content viewed or accessed from social media varied, whereas website content catered to the consumers’ goals and interests. While content from social media and was perceived as easy to use and accessible, perceived reliability varied. Short-form content, prevalent on online platforms, was considered less reliable, despite its engaging nature. This suggests that there exists a trade-off between the engagement and trust of nutrition content. Additionally, content containing sponsorships or product endorsements was less trusted. On the other hand, participants were more likely to trust content created by health professionals. The oversaturation of content also demotivated participants from evaluating the reliability of content. When asked about preferences, participants valued personalised content, mixed formats (i.e., short and long-form content), and evidence-based information such as statistics and references. They also preferred casual and entertaining content that incorporated modern and high audiovisual qualities (e.g., voiceovers). In conclusion, young Australian adults in the study recognise that unreliable nutrition content is not exclusive to certain platforms. The findings suggest that the accessibility and engagement of content and the ambiguity of professional ‘credentials’ may lead them to trust information that is potentially of low quality and accuracy, or alternatively, disregard high quality information. Findings also show that there needs to be a balance between engaging formats and presenting evidence-based information when designing nutrition content. Future research should explore how the factors influencing perceptions and preferences of online nutrition content in young Australian adults, as identified in this study, impact the usage of online nutrition content and dietary behaviours. Further consultation with this cohort can inform tailored interventions that aim to enhance young adults’ food and nutrition literacy and diet quality.

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