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BACKGROUND: Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women. METHODS: We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the

Abstract Objective: This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices. Setting: Urban local government authorities. Design: Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP) that targeted at least one healthy and sustainable diet-related practice. Grey literature was then searched to retrieve associated policy documentation. Data from both sources were charted against the MUFPP’s monitoring framework to analyse the policy actions included in each overarching policy. Results: From 2624 screened peer-reviewed studies, 27 met inclusion criteria and cited 36 relevant policies amongst signatory cities to the MUFPP. Most were from high income countries (n 29; 81 %), considered health (n 31; 86 %), equity (n 29; 81 %) and the broader food system beyond dietary consumption (n 34; 94 %). Of the 66 policy actions described, the most common involved food procurement within public facilities (n 16; 44 %) and establishing guidelines for school-feeding programs (n 12; 33 %). Conclusions: This review has demonstrated that urban local government authorities are implementing policies that consi

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Introduction: Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiac arrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiac arrest rhythm was shockable or non-shockable. Methods: Return of spontaneous circulation (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiac arrest trials were combined and meta-analysed. Results: The initial rhythm was known for 3929 (98.2%) in the placebo arm and 3919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable cardiac rhythms (1002/3003 (33.4%) versus 222/3005 (7.4%), adjusted OR: 6.5, (95% CI 5.6–7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95%CI: 1.9–2.9)). The adjusted odds ratio for survival at discharge for non-shockable rhythms was 2.5 (1.3, 4.8) and 1.3 (0.9, 1.8) for shockable rhythms (P value for interaction 0.065) and 1.8 (0.8–4.1) and 1.1 (0.8–1.6) respectively for neurological outcome at discharge (P value for interaction 0.295). Meta-analysis found similar results. Conclusion: Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced. ISRCTN73485024.

Copyright © 2018 Massachusetts Medical Society. BACKGROUND Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebocontrolled trial to determine whether the use of epinephrine is safe and effective in such patients. METHODS In a randomized, double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine (4015 patients) or saline placebo (3999 patients), along with standard care. The primary outcome was the rate of survival at 30 days. Secondary outcomes included the rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score of 3 or less on the modified Rankin scale (which ranges from 0 [no symptoms] to 6 [death]). RESULTS At 30 days, 130 patients (3.2%) in the epinephrine group and 94 (2.4%) in the placebo group were alive (unadjusted odds ratio for survival, 1.39; 95% confidence interval [CI], 1.06 to 1.82; P = 0.02). There was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4007 patients [2.2%] vs. 74 of 3994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (39 of 126 patients [31.0%] vs. 16 of 90 patients [17.8%]). CONCLUSIONS In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine grou

Reducing salt intake is a cost-effective public health intervention to reduce the global burden of non-communicable disease (NCDs). Ultra-processed foods contribute ~80% of dietary salt in high income countries, and are becoming prominent in low-middle income countries. Instant noodle consumption is particularly high in the Asia Pacific region. The aim of this study was to compare the sodium content of instant noodles sold worldwide to identify potential for reformulation. Analysis was undertaken for 765 instant noodle products from 10 countries using packaged food composition databases of ultra-processed foods compiled by the Global Food Monitoring Group (GFMG) and national shop survey data. Sodium levels were high and variable, within and between countries. Instant noodles in China had the highest mean sodium content (1944 mg/100 g, range: 397-3678/100 g) compared to New Zealand (798 mg/100 g, range: 249-2380 mg/100 g). Average pack size ranged from 57 g (Costa Rica) to 98 g (China). The average packet contributed 35% to 95% of the World Health Organization recommended daily salt intake of <5 g. Forty-one percent of products met the Pacific Island (PICs) regional sodium targets, 37% met the South Africa 2016 targets, and 62% met the UK 2017 targets. This study emphasises a need for stronger regulation and closer monitoring to drive rigorous reformulation of salt in ultra-processed foods.

Background & aims In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa. Methods & results Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18–49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age. Conclusion These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted

Background & aims In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa. Methods & results Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18–49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age. Conclusion These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose-timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve (12) older (65y+) and 12 younger (18-45y) adults participated in an acute crossover study. Participants received, randomly, either a 1x300ml or 3x100ml plum juice over 3h on two different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0h and 6h on each study day. BP and urinary anthocyanin/metabolite excretion profiles were measured over 24h. Area under the Curve for BP was calculated (0-6h). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for SBP, DBP, Mean Arterial Pressure and Heart Rate (p-values=0.035, 0.028, 0.017 and 0.006 respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites were detected in urine with no significant differences between age groups or dose-timing. High anthocyanin plum juice significantly reduced blood pressure but dose-timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Background Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes. Methods A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching. Results Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible. Conclusions The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

Background Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes. Methods A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching. Results Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible. Conclusions The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

Background Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes. Methods A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching. Results Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible. Conclusions The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

The development of central fatigue is prominent follow- ing exercise-induced hyperthermia, but the contribution of supraspinal fatigue is not well understood. Seven endurance-trained cyclists (mean ± SD peak O 2 uptake, 62.0 ± 5.6 mL/kg/min) completed two high-intensity constant-load cycling trials (296 ± 34 W) to the limit of tolerance in a hot (34 °C, 20% relative humidity) and, on a separate occasion, for the same duration, a control con- dition (18 °C, 20% relative humidity). Core body tem- perature (T c ) was measured throughout. Before and immediately after each trial, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation were obtained from the knee extensors to assess neuromuscular and corticospinal function, respec- tively. Exercise time was 11.4 ± 2.6 min. Peak T c was higher in the hot compared with control (38.36 ± 0.43 °C vs 37.86 ± 0.36 °C; P = 0.035). Post-exercise reductions in maximal voluntary contraction force (13 ± 9% vs 9 ± 5%), potentiated twitch force (16 ± 12% vs 21 ± 13%) and voluntary activation (9 ± 7% vs 7 ± 7%) were similar in hot and control trials, respectively. However, cortical voluntary activation declined more in the hot compared with the control (8 ± 3% vs 3 ± 2%; P = 0.001). Exercise- induced hyperthermia elicits significant central fatigue of which a large portion can be attributed to supraspinal fatigue. These data indicate that performance decrements in the heat might initially originate in the brain

The development of central fatigue is prominent follow- ing exercise-induced hyperthermia, but the contribution of supraspinal fatigue is not well understood. Seven endurance-trained cyclists (mean ± SD peak O 2 uptake, 62.0 ± 5.6 mL/kg/min) completed two high-intensity constant-load cycling trials (296 ± 34 W) to the limit of tolerance in a hot (34 °C, 20% relative humidity) and, on a separate occasion, for the same duration, a control con- dition (18 °C, 20% relative humidity). Core body tem- perature (T c ) was measured throughout. Before and immediately after each trial, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation were obtained from the knee extensors to assess neuromuscular and corticospinal function, respec- tively. Exercise time was 11.4 ± 2.6 min. Peak T c was higher in the hot compared with control (38.36 ± 0.43 °C vs 37.86 ± 0.36 °C; P = 0.035). Post-exercise reductions in maximal voluntary contraction force (13 ± 9% vs 9 ± 5%), potentiated twitch force (16 ± 12% vs 21 ± 13%) and voluntary activation (9 ± 7% vs 7 ± 7%) were similar in hot and control trials, respectively. However, cortical voluntary activation declined more in the hot compared with the control (8 ± 3% vs 3 ± 2%; P = 0.001). Exercise- induced hyperthermia elicits significant central fatigue of which a large portion can be attributed to supraspinal fatigue. These data indicate that performance decrements in the heat might initially originate in the brain

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.

of a poster that presented at 20th International Congress of Nutrition, Granada, Spain, September 15-20, 2013.

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa.

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa

of poster that presented at 20th International Congress of Nutrition, Granada, September 2013.

of oral presentation that presented at ICCAS 2013: International Conference on Culinary Arts and Sciences VIII.

of poster that presented at the 20th International Congress of Nutrition: Granada, Spain, September 15-20, 2013.

of poster that presented at the 20th International Congress of Nutrition: Granada, Spain, September 15-20, 2013.

of poster that presented at 20th International Congress of Nutrition, Granada, September 2013.

of a poster that presented at 20th International Congress of Nutrition, Granada, Spain, September 15-20, 2013.

presented at the 35th ESPEN Congress, 31 August 2013 - 03 September 2013, Leipzig, Germany

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than 65 years of age were hypertensive in 2008. Multilevel and multisectorial strategies are required to lower salt intake at population level, including the legislation of food supply, clearer labelling and signposting of food packaging, and improved consumer education on behavioural change regarding salt usage practices. A comprehensive national strategy that focuses on salt reduction is needed to reduce national blood pressure levels in the future. Legislating the levels of salt in processed food is only one part of this national strategy. All health professionals and educators should also provide appropriate nutritional recommendations that will educate, motivate and enable consumers to change their nutritional behaviour to reduce salt intake to less than 5 g per day, as recommended. The aim of this review is to revise the current food-based dietary guideline for salt, the implementation of which would contribute to lowering population salt intake, and blood pressure and cardiovascular disease, in South Africa.

of oral presentation that presented at ICCAS 2013: International Conference on Culinary Arts and Sciences VIII.

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

presented at the Annual Scientific Meeting of the Nutrition Society of Australia, 27-30 November 2012, Wollongong, Australia

Objectives Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia. Participants A convenience sample of 12 MOW clients. Intervention Participants received snacks five times a week, in addition to their usual MOW order, for four weeks. Measurements Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients’ homes were digitally recorded, transcribed verbatim, and themes identified. Results Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477)/day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as ‘malnourished’ or ‘at risk of malnutrition’ decreased from 17% to 8%, and 67% to 25%, respectively (P Conclusion Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

Background/Objectives: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. Subjects/Methods: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. Results: At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P

presented at the Annual Scientific Meeting of the Nutrition Society of Australia, 27-30 November 2012, Wollongong, Australia

Objectives Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia. Participants A convenience sample of 12 MOW clients. Intervention Participants received snacks five times a week, in addition to their usual MOW order, for four weeks. Measurements Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients’ homes were digitally recorded, transcribed verbatim, and themes identified. Results Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477)/day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as ‘malnourished’ or ‘at risk of malnutrition’ decreased from 17% to 8%, and 67% to 25%, respectively (P Conclusion Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

BACKGROUND AND AIMS: Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease. METHODS AND RESULTS: One-hundred and fifty overweight men and women were randomized into a 3month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with 10% polyunsaturated fatty acids (LF-PUFA); (3) low calorie (LF-LC) (-2MJ); (4) low calorie with 10% PUFA (LF-PUFA-LC). Primary outcomes were changes in body weight and body fat and secondary outcomes were changes in fasting levels of leptin, insulin, glucose, lipids and erythrocyte fatty acids. Changes in dietary intake were assessed using 3day food records. One-hundred and twenty-two participants entered the study and 95 completed the study. All groups lost weight and body fat (P<0.0001 time effect for both), but the LC groups lost more weight (P=0.026 for diet effect). All groups reduced total cholesterol levels (P<0.0001 time effect and P=0.017 intervention effect), but the LC and PUFA groups were better at reducing triacylglycerol levels (P=0.056 diet effect). HDL increased with LF-LC and LF-PUFA but not with LF-PUFA-LC (0.042 diet effect). The LF and LF-LC groups reported greater dietary fat reductions than the two PUFA groups (P=0.043). CONCLUSION: Energy restriction has the most potent effect on weight loss and lipids, but fat modification is also beneficial when energy restriction is more modest.

To validate a revision of the Mini Nutritional Assessment short-form (MNAA (R)-SF) against the full MNA, a standard tool for nutritional evaluation. A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.