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Aim: Evaluation of asthma control is the first step in the management of pediatric patient symptoms. The aim of this study was to a) validate the accuracy of the Greek version of the Asthma Control Questionnaire (ACQ) in quantifying asthma status in Greek pediatric patients; b) compare the 6-item with the 7-item ACQ; and c) explore the discriminatory power of the ACQ in relation to medication use. Methods: Cross-sectional analysis of pulmonary data from 64 primary school children with mild asthma (51% boys). At baseline and 6 months, pulmonary function was recorded using spirometry and asthma control using the Greek version of the ACQ. Validity was assessed using Cronbach’s alpha. Results: Cronbach’s alpha showed good internal consistency for both the 7-item and 6-item ACQ (alpha = 0.67, 0.74 respectively). No differences in scores were observed in the presence/or absence of medication therapy. Conclusions: The findings of this study showed good precision and internal consistency of the 6-item ACQ in measuring recent asthma control in Greek children of the mild-asthma phenotype, independent of forced expiratory volume in 1 second (FEV1) and medication use. This suggests that the 6-item questionnaire alone is potentially a robust tool in assessing asthma symptom control in children when pulmonary function tests (PFTs) are not feasible.

Non-alcoholic fatty liver disease (NAFLD) is predominantly managed by lifestyle intervention, in the absence of effective pharmacotherapies. Mediterranean diet (MedDiet) is the recommended diet, albeit with limited evidence.To compare an ad libitum MedDiet to low-fat diet (LFD) in patients with NAFLD for reducing intrahepatic lipids (IHL) by proton magnetic resonance spectroscopy (In this parallel multicentre RCT, subjects were randomised (1:1) to MedDiet or LFD for 12 weeks.Forty-two participants (25 females [60%], mean age 52.3 ± 12.6 years) were included, 23 randomised to LFD and 19 to MedDiet.; 39 completed the study. Following 12 weeks, there were no between-group differences. IHL improved significantly within the LFD group (-17% [log scale]; p = .02) but not within the MedDiet group (-8%, p = .069). HOMA-IR reduced in the LFD group (6.5 ± 5.6 to 5.5 ± 5.5, p .01) but not in the MedDiet group (4.4 ± 3.2 to 3.9 ± 2.3, p = .07). No differences were found for LSM (MedDiet 7.8 ± 4.0 to 7.6 ± 5.2, p = .429; LFD 11.8 ± 14.3 to 10.8 ± 10.2 p = .99). Visceral fat reduced significantly in both groups; LFD (-76% [log scale], p = .0005), MedDiet (-61%, p = .0005).There were no between-group differences for hepatic and metabolic outcomes when comparing MedDiet to LFD. LFD improved IHL and insulin resistance. Significant improvements in visceral fat were seen within both groups. This study highlights provision of dietary interventions in free-living adults with NAFLD is challenging.

Background: Whether older immigrant populations from the Mediterranean region, continue to follow the MD long after they immigrated is not known. Aim: Compare adherence to the MD and successful aging levels between Greeks living in Greece (GG) and Greeks living abroad (GA). Methods: Anthropometrical, clinical, psychological, sociodemographic, dietary and lifestyle parameters were assessed in a cross-sectional manner in a sample of 252 GG and 252 GA. Mediterranean Diet Score (MedDietScore range 0-55) was used to assess adherence to the MD. Successful aging was evaluated with the validated successful aging index (SAI range 0-10). Results: GA presented higher adherence to MD (p 0.05). MedDietScore was positively associated with SAI among both groups after adjusting for possible confounders (0.041 ± 0.014, p = 0.003 GG and 0.153 ± 0.035, p

Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression. Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis. Results: n = 152 eligible adults aged 18–65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = −2.10, P = 0.04) and red meat/chicken (t = −2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = −2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = −0.298, P = 0.01), nuts (r = −0.264, P = 0.01), and vegetable diversity (r = −0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression. Refereed/Peer-reviewed

Background: A Mediterranean diet (MD) appears to be beneficial in non‐ alcoholic fatty liver disease (NAFLD) patients in Mediterranean countries; however, the acceptability of a MD in non‐Mediterranean populations has not been thoroughly explored. The present study aimed to explore the acceptability through understanding the barriers and enablers of the MD and low‐fat diet (LFD) interventions as perceived by participating Australian adults from multicultural backgrounds with NAFLD. Methods: Semi‐structured telephone interviews were performed with 23 NAFLD trial participants at the end of a 12‐week dietary intervention in a multicentre, parallel, randomised clinical trial. Data were analysed using thematic analysis. Results: Participants reported that they enjoyed taking part in the MD and LFD interventions and perceived that they had positive health benefits from their participation. Compared with the LFD, the MD group placed greater emphasis on enjoyment and intention to maintain dietary changes. Novelty, convenience and the ability to swap food/meals were key enablers for the successful implementation for both of the dietary interventions. Flavour and enjoyment of food, expressed more prominently by MD intervention participants, were fundamental components of the diets with regard to reported adherence and intention to maintain dietary change. Conclusions: Participants randomised to the MD reported greater acceptability of the diet than those randomised to the LFD, predominantly related to perceived novelty and palatability of the diet.

Purpose Olive oil polyphenols have been associated with cardiovascular health benefits. This study examined the antioxidant and anti-inflammatory effect of extra-virgin high polyphenol olive oil (HPOO) vs. low polyphenol olive oil (LPOO) in healthy Australian adults. Methods In a double-blind cross-over trial, 50 participants (aged 38.5 ± 13.9 years, 66% females) were randomized to consume 60 mL/day of HPOO (320 mg/kg polyphenols) or LPOO (86 mg/kg polyphenols) for three weeks. Following a 2-week wash-out period, participants crossed-over to the alternate treatment. Plasma oxidized low-density lipoprotein (ox-LDL), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP) and anthropometrics were measured at baseline and follow-up. Results Fourty-three participants completed the study. Although there were no significant differences between treatments in the total sample, plasma ox-LDL decreased by 6.5 mU/mL (95%CI - 12.4 to - 0.5) and TAC increased by 0.03 mM (95% CI 0.006-0.05) only in the HPOO arm. Stratified analyses were also performed by cardiovascular disease risk status defined by abdominal obesity (WC > 94 cm in males, > 80 cm in females) or inflammation (hs-CRP > 1 mg/L). In the subgroup with abdominal obesity, ox-LDL decreased by 13.5 mU/mL (95% CI - 23.5 to - 3.6) and TAC increased by 0.04 mM (95% CI 0.006-0.07) only after HPOO consumption. In the subgroup with inflammation, hs-CRP decreased by 1.9 mg/L (95% CI - 3.7 to -0.1) only in the HPOO arm. Conclusions Although there were no significant differences between treatments, the changes observed after HPOO consumption demonstrate the antioxidant and anti-inflammatory effect of this oil, which is more pronounced in adults with high cardiometabolic risk (Clinical Trial Registration: ACTRN12618000706279).

Olive oil (OO) polyphenols have been shown to improve HDL anti-atherogenic function, thus demonstrating beneficial effects against cardiovascular risk factors. The aim of the present study was to investigate the effect of extra virgin high polyphenol olive oil (HPOO) v. low polyphenol olive oil (LPOO) on the capacity of HDL to promote cholesterol efflux in healthy adults. In a double-blind, randomised cross-over trial, fifty participants (aged 38·5 (sd 13·9) years, 66 % females) were supplemented with a daily dose (60 ml) of HPOO (320 mg/kg polyphenols) or LPOO (86 mg/kg polyphenols) for 3 weeks. Following a 2-week washout period, participants crossed over to the alternate treatment. Serum HDL-cholesterol efflux capacity, circulating lipids (i.e. total cholesterol, TAG, HDL, LDL) and anthropometrics were measured at baseline and follow-up. No significant between-group differences were observed. Furthermore, no significant changes in HDL-cholesterol efflux were found within either the LPOO and HPOO treatment arms; mean changes were 0·54 % (95 % CI (0·29, 1·37)) and 0·10 % (95 % CI (0·74, 0·94)), respectively. Serum HDL increased significantly after LPOO and HPOO intake by 0·13 mmol/l (95 % CI (0·04, 0·22)) and 0·10 mmol/l (95 % CI (0·02, 0·19)), respectively. A small but significant increase in LDL of 0·14 mmol/l (95 % CI (0·001, 0·28)) was observed following the HPOO intervention. Our results suggest that additional research is warranted to further understand the effect of OO with different phenolic content on mechanisms of cholesterol efflux via different pathways in multi-ethnic populations with diverse diets.

Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide and the majority are preventable with a healthy diet and lifestyle, but controversy remains as to the best approach. Greater adherence to a traditional Mediterranean diet has consistently been associated with lower morbidity and mortality from cardiovascular disease, diabetes and many cancers, and lower all-cause mortality. Despite the well known benefits on chronic disease risk there remains some scepticism as to the effects of this dietary pattern across populations outside the Mediterranean and the mechanisms of action of this traditional plant-based dietary pattern.This narrative review aims to summarize the latest evidence on the health protective effects of a traditional Mediterranean diet on chronic noncommunicable diseases, specifically focussing on the anti-inflammatory effects of this highly published dietary pattern.Recent high-quality evidence now supports a Mediterranean diet in secondary prevention of cardiovascular disease with impacts on atherosclerosis progression, likely through reduction of systemic inflammation and irrespective of changes in cholesterol or weight. The Mediterranean diet has a low Dietary Inflammatory Index illustrating its anti-inflammatory potential. This dietary pattern beneficially modulates the gut microbiota and immune system, including emerging evidence for efficacy against severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019). Emerging evidence shows clinicians are not routinely recommending a Mediterranean diet despite well known evidence due to barriers such as lack of training, patient materials and concerns about potential patient adherence.The physiological mechanisms of action of this healthy diet pattern are becoming better understood to be multisystem and involving the gut. Larger controlled trials investigating mechanistic effects in broader non-Mediterranean populations are warranted. Although reflected in therapeutic guidelines for chronic disease management worldwide there are individual, clinical practice and health system barriers to its implementation that need a multisectoral approach to address.

Objective:To examine the associations between the level of adherence to the Mediterranean diet (MedDiet) with obesity, insulin resistance (IR), metabolic syndrome (MetS) and its components in schoolchildren.Design:The Healthy Growth Study was a large epidemiological cross-sectional study.Setting:School children who were enrolled in primary schools in four counties covering the northern, southern, western and central part of Greece were invited to participate.Participants:The study was conducted with a representative sample of 9–13-year-old schoolchildren (n 1972) with complete data. This study applied the KIDMed score to determine ‘poor’ (≤3), ‘medium’ (4-7) and ‘high’ (≥8) adherence of children to the MedDiet. The research hypothesis was examined using multivariate logistic regression models, controlling for potential confounders.Results:The percentage of children with ‘poor’, ‘medium’ and ‘high’ adherence to the MedDiet was 64·8 %, 34·2 % and 1 %, respectively. Furthermore, the prevalence of obesity, IR and MetS was 11·6 %, 28·8 % and 3·4 %, respectively. Logistic regression analyses revealed that ‘poor’ adherence to the MedDiet was associated with an increased likelihood for central obesity (OR 1·31; 95 % CI 1·01, 1·73), hypertriglyceridaemia (OR 2·80; 95 % CI 1·05, 7·46) and IR (OR 1·31; 95 % CI 1·05, 1·64), even after adjusting for several potential confounders.Conclusions:The present study showed that approximately two-thirds of the examined sample of schoolchildren in Greece have ‘poor’ adherence to the MedDiet, which also increases the likelihood for central obesity, hypertriglyceridaemia and IR. Prospective studies are needed to confirm whether these are cause–effect associations.

Background Commercial growing up milks (GUMs) targeted at children from 12 to 36 months of age are a rapidly growing industry, particularly across the Asia Pacific. Methods The present study assessed the frequency of use and socio‐demographic and child associations of commercial GUM feeding in children, aged between 12 and 36 months, in capital cities in four Asia Pacific countries. Mothers of children aged between 12 and 36 months were surveyed, assessing GUM feeding frequency in the past month. A market research company database was used to survey across Asia Pacific urban cities, including Bangkok Thailand, Jakarta Indonesia, Singapore and Australian Capital Cities (ACC). Results More than 1000 women (n = 1051) were surveyed (Bangkok, n = 263; Jakarta, n = 275; ACC, n = 252; Singapore, n = 261). The mean (SD) age of mothers was 32.4 (5.3) years and that of children was 23.6 (6.7) months. In total, 62.7% of the children were fed GUMs more than once per week with significant country variance. In comparison with ACC, Asian countries were significantly more likely to feed GUMs ≥once per week: Bangkok [odds ratio (OR) = 5.7, 95% confidence interval (CI) = 3.8–8.6]; Jakarta (OR = 3.5, 95% CI = 2.3–5.5); and Singapore (OR = 7.4, 95% CI = 4.9‐11.1). Associations of GUM feeding included: maternal tertiary education; mothers younger than 30 years; working full time; and feeding of commercial infant formula under 12 months. Conclusions This is the first published study to explore commercial GUM feeding in and between countries. The incidence of GUM feeding, in contrast to international recommendations, signals the need for further research into the drivers for GUM feeding and its contribution to the diet.

Purpose: To investigate whether BMI modifies pulmonary function across vitamin D tertiles in pediatric asthma patients of the mild-asthma phenotype. Methods: This cross-sectional study compared lung function variability as assessed by spirometry among 35 normo-weight and 26 overweight/obese Greek schoolchildren with mild-asthma attending an urban children’s asthma clinic. Nitric oxide associated with airway inflammation was measured from exhaled breath (FeNO). Serum 25(OH)D levels ≥ 30 ng/mL were defined as ‘sufficient’, 20-30 ng/mL ‘insufficient’ and < 20 ng/mL ‘deficient’. Linear regression was used to investigate associations among vitamin D, pulmonary function tests, and BMI category. Results: Almost all children were D-insufficient (< 30 ng/mL) which did not differ by BMI status. Stratification by BMI category showed positive associations between D (continuous), % FVC (β = 0.49, 95%CI: 0.05, 0.94; Padj = 0.031) and % FEV1 (β = 0.48, 95%CI: -0.01, 0.95; Padj = 0.047) in the normo-weight only, adjusted for age, sex, regular exercise and medication. Furthermore, FEV1 was 10% higher in the normo-weight D-sufficient group compared to those D-deficient (β = 10.43, 95%CI: 0.54, 20.32; Padj = 0.040). No associations were observed for the overweight/obese group or FeNO. Conclusion: BMI modified associations of vitamin D on airway mechanics in children of the mild-asthma phenotype. Serum 25(OH)D concentrations ≥ 30 ng/mL were associated with higher ventilation in central airways of normo-weight asthmatic children.

Asthma in children is the most prevalent allergic disease worldwide that has become a major public health priority. The objective of this study was to examine the relationship between baseline serum vitamin D status, spirometry, and fractional exhaled nitric oxide levels (FeNO) in 64 Greek children with 'mild asthma' aged 5 to 12 years (51.6% male) in a dietary intervention study. We hypothesized that baseline serum vitamin D levels modify the beneficial response of fatty fish intake on pulmonary function in asthmatic children following a Mediterranean diet. The intervention group consumed 2 fatty fish meals/week (≥150 g cooked filleted fish/meal) as part of the Mediterranean diet for six months, and the control group consumed their usual diet. Baseline serum 25(OH)D was determined using enzyme-linked immunoassay and defined as sufficient levels of 25(OH)D ≥25 ng/mL. Only 36% of children were graded as sufficient in 25(OH)D levels on entry into the study with a higher proportion of girls insufficient than boys (61% vs 39% respectively). Participants with sufficient levels of serum 25(OH)D at baseline, consuming the intervention diet increased FEV1/FVC by 4.89 units (β = 4.89; 95%CI: 1.19-8.61; p = 0.013) and FEF25-75% by 12.83 units (β = 12.83; 95%CI: 4.27-21.40; p = 0.006) compared to controls. No significant differences in pulmonary function or FeNO were observed for those with insufficient levels of 25(OH) D in the intervention or control groups. In conclusion, sufficient serum vitamin D levels enhanced ventilatory function in response to a dietary intervention in asthmatic children.

Previous clinical studies have suggested that high polyphenol extra virgin olive oil (EVOO) provides a superior cardioprotective effect compared to low polyphenol olive oil. However, further studies are required to replicate these results in non-Mediterranean populations. To investigate the effect of high polyphenol EVOO versus low polyphenol olive oil with known polyphenol composition on markers of cardiovascular disease risk in a healthy non-Mediterranean cohort. In a double-blind randomised cross-over trial, the present study will examine the effect of high polyphenol EVOO versus low polyphenol olive oil in 50 healthy participants. Each intervention phase will be 3 weeks long with a 2-week washout period between each phase. Outcomes to be assessed include HDL cholesterol efflux, oxidised LDL, blood lipids, C-reactive protein, arterial stiffness, blood pressure and cognitive function. Dietary intake, physical activity levels and anthropometry will also be collected. Because of the rigorous trial design, novel and clinically relevant outcomes, the use of a well-characterised EVOO, and, in contrast to the current literature, the non-Mediterranean study population, the present study will provide a significant contribution to the understanding of the clinical importance of polyphenol intake in the Australian sociocultural context.

There is limited understanding of how plasma fatty acid levels affect pulmonary function in pediatric years. It has been speculated that polyunsaturated fatty acids influence asthma via anti or pro-inflammatory mechanisms. Metabolomics presents a new and promising resource for identifying molecular processes involved in asthma pathology. We investigated the relationship of plasma fatty acid metabolites as biomarkers of the ‘mild-asthma’ phenotype and lung function including airway inflammation in children. This cross-sectional study involved 64 children (5–12 years, 33 male) with mild-asthma phenotype attending an outpatient pediatric clinic in Athens, Greece. Clinical examination included spirometry (FVC, FEV1, FEV1/FVC, PEF, FEF25–75%) and Fractional exhaled Nitric Oxide (FeNO). Targeted metabolomic profiling was used to quantify plasma fatty acid composition. Associations between lipids and pulmonary function indices were investigated applying linear regression. Targeted GC-MS identified 25 unique plasma fatty acids in mild-asthmatic children. Linear regression revealed significant associations between linoleic, oleic, erucic, cis-11-eicosenoic, arachidic acids and FEV1, FVC, FEV1/FVC, PEF, FEF25–75% and FeNO in the overweight/obese group, adjusting for age and sex; and in the normo-weight between stearic and arachidic acids versus FEV1 and FEV1/FVC respectively. No associations were observed for arachidonic, α-linolenic, EPA and DHA. Metabolomics is a novel science that is useful to discover metabolic signatures specific to disease. Evaluation of fatty acid status could assist clinicians in decision-making about a dietary modification that can be used for personalized nutrition therapies to achieve better asthma control, optimum lung function, and therapeutic response in children.

Background and Aims Substantial scientific evidence supports the effectiveness of a Mediterranean diet (MedDiet) in managing type 2 diabetes mellitus (T2DM). Potential benefits of time restricted feeding (TRF) in T2DM are unknown. The MedDietFast trial aims to investigate the efficacy of a MedDiet with or without TRF compared to standard care diet in managing T2DM. Methods and Results 120 adults aged 20 -75 with a body mass index (BMI) of 20-35 kg/m2 and T2DM will be randomised in a 3-arm parallel design to follow an ad libitum MedDiet with or without 12-hours TRF or the standard Australian Dietary Guidelines (ADG) for 24 weeks. All groups will receive dietary counselling fortnightly for 12 weeks and monthly thereafter. The primary outcome is changes in HbA1c from baseline to 12 and 24 weeks. Secondary outcomes include fasting blood glucose, insulin, blood lipids, weight loss, insulin resistance index (HOMA), Glucagon-like peptide 1 (GLP-1) and high-sensitivity C- reactive protein (hs-CRP). Data on medical history, anthropometry, wellbeing, MedDiet adherence and satiety will be measured at a private clinic via self-report questionnaires at baseline, 6, 12 and 24 weeks. Additionally, specimens (blood, urine and stool) will be collected at all time points for future omics analysis. Conclusion The MedDietFast trial will examine the feasibility and effectiveness of a MedDiet with/without TRF in T2DM patients. Potential synergistic effects of a MedDiet with TRF will be evaluated. Future studies will generate microbiomic and metabolomic data for translation of findings into simple and effective management plans for T2DM patients. Trial registration Australia and New Zealand Clinical Trials Register, ACTRN12619000246189

Comparing lifestyle and successful aging between Greeks living in Greece (GG) and Greeks living abroad (GA) using a multidimensional model of successful aging including both biomedical and non-medical components.Anthropometric, clinical, psychological, socio-demographic, dietary and lifestyle parameters were assessed in a random sample of 252 GG and 252 GA. Successful aging was evaluated using the validated successful aging index (SAI range 0-10).GA had better financial and educational status and scored higher in all social activity parameters (p's 0.05). GA were more likely to be physically active (p 0.001), had higher adherence to the Mediterranean diet (p 0.001) and were less likely to be smoking (p = 0.008). Depression was more evident among GG compared to GA (p 0.001). GA was aging significantly more successfully than GG (p 0.001). Men irrespective of location were aging significantly more successfully than women (p 0.05).Place of residence and personal choices significantly affect the level of healthy aging among people with similar genetic backgrounds.

Background Increased intestinal permeability (IP) is associated with sepsis in the intensive care unit (ICU). This study aimed to pilot a sensitive multisugar test to measure IP in the nonfasted state. Methods Critically ill, mechanically ventilated adults were recruited from 2 ICUs in Australia. Measurements were completed within 3 days of admission using a multisugar test measuring gastroduodenal (sucrose recovery), small-bowel (lactulose-rhamnose [L-R] and lactulose-mannitol [L-M] ratios), and whole-gut permeability (sucralose-erythritol ratio) in 24-hour urine samples. Urinary sugar concentrations were compared at baseline and after sugar ingestion, and IP sugar recoveries and ratios were explored in relation to known confounders, including renal function. Results Twenty-one critically ill patients (12 males; median, 57 years) participated. Group median concentrations of all sugars were higher following sugar administration; however, sucrose and mannitol increases were not statistically significant. Within individual patients, sucrose and mannitol concentrations were higher in baseline than after sugar ingestion in 9 (43%) and 4 (19%) patients, respectively. Patients with impaired (n = 9) vs normal (n = 12) renal function had a higher L-R ratio (median, 0.130 vs 0.047; P = .003), lower rhamnose recovery (median, 15% vs 24%; P = .007), and no difference in lactulose recovery. Conclusion Small-bowel and whole-gut permeability measurements are possible to complete in the nonfasted state, whereas gastroduodenal permeability could not be measured reliably. For small-bowel IP measurements, the L-R ratio is preferred over the L-M ratio. Alterations in renal function may reduce the reliability of the multisugar IP test, warranting further exploration.

Metabolomics is a powerful tool of omics that permits the simultaneous identification of metabolic perturbations in several autoimmune and chronic diseases. Several parameters can affect a metabolic profile, from the population characteristics to the selection of the analytical method. In the current chapter, we summarize the main analytical methods and results of the metabolic profiling of fatty and organic acids performed in human metabolomic studies for asthma, COPD, psoriasis and Hashimoto's thyroiditis. We discuss the most significant metabolic alterations associated with these diseases, after comparison of either a single patient's group with healthy controls or several patient's subgroups of different disease severity and phenotype with healthy controls or of a patient's group before and after treatment. Finally, we present critical metabolic patterns that are associated with each disease and their potency for the unraveling of disease pathogenesis, prediction, diagnosis, patient stratification and treatment selection.

Olive oil polyphenols have been associated with cardiovascular health benefits. This study examined the antioxidant and anti-inflammatory effect of extra-virgin high polyphenol olive oil (HPOO) vs. low polyphenol olive oil (LPOO) in healthy Australian adults.In a double-blind cross-over trial, 50 participants (aged 38.5 ± 13.9 years, 66% females) were randomized to consume 60 mL/day of HPOO (320 mg/kg polyphenols) or LPOO (86 mg/kg polyphenols) for three weeks. Following a 2-week wash-out period, participants crossed-over to the alternate treatment. Plasma oxidized low-density lipoprotein (ox-LDL), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP) and anthropometrics were measured at baseline and follow-up.Fourty-three participants completed the study. Although there were no significant differences between treatments in the total sample, plasma ox-LDL decreased by 6.5 mU/mL (95%CI - 12.4 to - 0.5) and TAC increased by 0.03 mM (95% CI 0.006-0.05) only in the HPOO arm. Stratified analyses were also performed by cardiovascular disease risk status defined by abdominal obesity (WC 94 cm in males, 80 cm in females) or inflammation (hs-CRP 1 mg/L). In the subgroup with abdominal obesity, ox-LDL decreased by 13.5 mU/mL (95% CI - 23.5 to - 3.6) and TAC increased by 0.04 mM (95% CI 0.006-0.07) only after HPOO consumption. In the subgroup with inflammation, hs-CRP decreased by 1.9 mg/L (95% CI - 3.7 to -0.1) only in the HPOO arm.Although there were no significant differences between treatments, the changes observed after HPOO consumption demonstrate the antioxidant and anti-inflammatory effect of this oil, which is more pronounced in adults with high cardiometabolic risk (Clinical Trial Registration: ACTRN12618000706279).

The benefits of a Mediterranean Diet (MedDiet) in the management of diabetes have been reported, but the contribution of polyphenol-rich citrus fruit has not been studied widely. Here, we report the sub-study findings of a previously conducted MedDiet intervention clinical trial in patients with type 2 diabetes mellitus (T2DM), where we aimed to measure the diet intervention effects on plasma citrus bioflavonoids levels and biomarkers of inflammation and oxidative stress. We analysed plasma samples from 19 (of original 27) participants with T2DM who were randomly assigned to consume the MedDiet intervention or their usual diet for 12 weeks and then crossed over to the alternate diet. Compared with baseline, MedDiet significantly increased levels of the citrus bioflavonoids naringin, hesperitin and hesperidin (by 60%, 58% and 39%, respectively, p &lt, 0.05) and reduced plasma levels of the pro-inflammatory cytokine IL-6 (by 49%, p = 0.016). Oxidative stress marker 8-hydroxy-2′-deoxyguanosine (8-OHdG) decreased by 32.4% (p = 0.128). Usual diet did not induce these beneficial changes. The reduced inflammatory profile of T2DM participants may, in part, be attributed to the anti-inflammatory actions of citrus bioflavonoids. Together with indications of improved oxidative stress, these findings add to the scientific evidence base for beneficial consumption of citrus fruit in the MedDiet pattern.

Metabolomics is a powerful tool of omics that permits the simultaneous identification of metabolic perturbations in several autoimmune and chronic diseases. Several parameters can affect a metabolic profile, from the population characteristics to the selection of the analytical method. In the current chapter, we summarize the main analytical methods and results of the metabolic profiling of fatty and organic acids performed in human metabolomic studies for asthma, COPD, psoriasis and Hashimoto's thyroiditis. We discuss the most significant metabolic alterations associated with these diseases, after comparison of either a single patient's group with healthy controls or several patient's subgroups of different disease severity and phenotype with healthy controls or of a patient's group before and after treatment. Finally, we present critical metabolic patterns that are associated with each disease and their potency for the unraveling of disease pathogenesis, prediction, diagnosis, patient stratification and treatment selection.

The aim of this study was to explore the relationship between plasma folate status and measures of airway disease (as reflected by spirometry) in children with asthma on a traditional Mediterranean diet. We hypothesized that folate deficiency is associated with lung function impairment in this group of children.This cross-sectional study included 64 children with mild asthma (52% boys, mean age 8 ± 2 y) residing in Athens, Greece. Clinical assessments included spirometry and fractional exhaled nitric oxide (FeNO). Plasma 5-methyltetrahydrofolate (5-MTHF) was analyzed using high performance-liquid chromatography assay and examined in participants using quartiles (Q1-Q4).Of the 64 children, 45.3% were folate deficient (5-MTHF10 nmol/L). A positive relationship was observed between 5-MTHF and forced vital capacity (FVC; β = 0.79, 95% confidence interval (CI), 0.14-1.44; adjusted P = 0.019), forced expiratory volume in 1s (FEVThe findings of this study highlighted the potential negative effects of folate deficiency on pulmonary function in girls with asthma, the importance of monitoring folate status in children with asthma, and early prevention strategies.

The concept of Entrustable Professional Activities, recently pioneered in medical education, has emerged to support the implementation of competency-based education. Although competency-based frameworks are widely used in healthcare professional education to develop outcomes-based curricula, assessment of student competency in professional placement settings remains challenging. The novel concept of Entrustable Professional Activities together with established methods of competency assessment, namely e-portfolios and self-assessment, was implemented in the "[La Trobe University Dietetic program in 2015-2016. This study aimed to appraise the e-portfolio and evaluate the use of Entrustable Professional Activities to assess competence. A mixed-methods evaluation, using qualitative and quantitative surveys with follow-up structured consultations, was conducted with final year dietetics students and their supervisors. Dietetics students were comfortable with Entrustable Professional Activities and competency-based assessment, whereas supervisors preferred Entrustable Professional Activity based assessment. All stakeholders valued student self-assessment and the ongoing use of structured e-portfolios to develop and document competency. The use of structured e-portfolios, student self-assessment, and the emerging concept of Entrustable Professional Activities are useful tools to support dietetics student education in professional placement settings.

There is limited understanding of how plasma fatty acid levels affect pulmonary function in pediatric years. It has been speculated that polyunsaturated fatty acids influence asthma via anti or pro-inflammatory mechanisms. Metabolomics presents a new and promising resource for identifying molecular processes involved in asthma pathology.We investigated the relationship of plasma fatty acid metabolites as biomarkers of the 'mild-asthma' phenotype and lung function including airway inflammation in children.This cross-sectional study involved 64 children (5-12 years, 33 male) with mild-asthma phenotype attending an outpatient pediatric clinic in Athens, Greece. Clinical examination included spirometry (FVC, FEVTargeted GC-MS identified 25 unique plasma fatty acids in mild-asthmatic children. Linear regression revealed significant associations between linoleic, oleic, erucic, cis-11-eicosenoic, arachidic acids and FEVMetabolomics is a novel science that is useful to discover metabolic signatures specific to disease. Evaluation of fatty acid status could assist clinicians in decision-making about a dietary modification that can be used for personalized nutrition therapies to achieve better asthma control, optimum lung function, and therapeutic response in children.

This chapter defines the term ‘food habits’ and describe aspects of Australian and New Zealand food habits. It describes the immigration patterns in both Australia and New Zealand. The chapter outlines the characteristics of key culinary influences in Australia and New Zealand and their respective culinary practices. It describes food restrictions and food-related rituals associated with religious beliefs. The Japanese tend to consume simple meals at breakfast and lunch followed by a more substantial evening meal. Thai cuisine has influenced Australian cuisine partly through Australian travellers bringing home a desire for Thai food. Turkish migrants first came to Australia in significant numbers following the assisted passage agreement in 1967. Refugees from the Vietnam War reached Australia and New Zealand, many by boat, towards the end of the war, and this formed the greatest increase seen in the number of Vietnamese people settling in both countries.

Objective:(i) Describe the development of a multipurpose Cardio-Med survey tool (CMST) comprising a semi-quantitative FFQ designed to measure dietary intake in multicultural patients with or at high risk of CVD and (ii) report pilot evaluation of test–retest reliability and validity of the FFQ in measuring energy and nutrient intakes.Design:The CMST was developed to identify CVD risk factors and assess diet quality over 1 year using an FFQ. Design of the ninety-three-item FFQ involved developing food portion photographs, and a list of foods appropriate for the Australian multicultural population allowing the capture of adherence to a Mediterranean diet pattern. The FFQ was administered twice, 2 weeks apart to assess test–retest reliability, whilst validity was assessed by comparison of the FFQ with a 3-d food record (3DFR).Setting:The Northern Hospital and St Vincent’s Hospital, Melbourne, Australia.Participants:Thirty-eight participants aged 34–81 years with CVD or at high risk.Results:Test–retest reliability of the FFQ was good: intraclass correlation coefficient (ICC) ranged from 0·52 (Na) to 0·88 (alcohol) (mean 0·79), with energy and 70 % of measured nutrients being above 0·75. Validity was moderate: ICC ranged from 0·08 (Na) to 0·94 (alcohol) (mean 0·59), with energy and 85 % of measured nutrients being above 0·5. Bland–Altman plots demonstrated good levels of agreement between the FFQ and 3DFR for carbohydrates, protein, alcohol, vitamin D and Na.Conclusions:The CMST FFQ demonstrated good test–retest reliability and moderate validity for measuring dietary energy and nutrients in a multicultural Australian cardiology population.

BACKGROUND: Childhood asthma is the most common respiratory disorder worldwide, being associated with increased morbidity and a decreased quality of life. Omega‐3 fatty acids have anti‐inflammatory and immunomodulating properties; however, their efficacy in asthma is controversial. The present study aimed to examine the efficacy of a Mediterranean diet supplemented with a high omega‐3 ‘fatty’ fish intake in Greek asthmatic children. METHODS: A single‐centred, 6‐month, parallel randomised controlled trial compared the consumption of a Mediterranean diet supplemented with two meals of 150 g of cooked fatty fish weekly (intervention) with the usual diet (control) with respect to pulmonary function in children (aged 5–12 years) with mild asthma. Pulmonary function was assessed using spirometry and bronchial inflammation by fractional exhaled nitric oxide analysis. RESULTS: Sixty‐four children (52% male, 48% female) successfully completed the trial. Fatty fish intake increased in the intervention group from 17 g day⁻¹ at baseline to 46 g day⁻¹ at 6 months (P

Background: Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management. Method: An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy. Results: The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident. Conclusion: The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.

Diabetic macular edema (DME) is a common cause of visual impairment. Current treatments for DME include laser photocoagulation, corticosteroids and Vascular Endothelial Growth Factor (VEGF) antagonists, which are administered via intravitreal injection. The purpose of this systematic review is to explore the experiences and perceptions of patients undergoing laser, corticosteroid implants and intravitreal injection treatment for DME and the impact on Quality of Life (QoL). A systematic search of the Embase, Medline, PsycINFO and Cinahl electronic databases was conducted to identify all studies with an unlimited date range, published in the English language, full text and incorporating human participants. Hand searching identified two articles. Following the application of the Critical Appraisal Skills Programme (CASP) Quantitative and Qualitative Research Checklist 21 articles were selected for inclusion, as they were deemed pertinent for the purpose of this review. Limited studies have examined DME patients' experiences and perceptions of treatment and QoL. The outcomes of these studies lack agreement on the effectiveness of treatment, treatment preferences and impact of QoL in patients with DME. Future research which enhances current knowledge will therefore serve to improve treatment outcomes and QoL in these patients.

Context: The aim of this systematic review was to evaluate clinical trial data regarding the effect of resveratrol supplementation on cognitive performance and mood in populations that are healthy and in the clinical setting. Data Sources: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review of randomized controlled trials was conducted. Data Extraction: A meta-analysis was also conducted to determine treatment effect on the following cognitive domains and mental processes: processing speed, number facility, memory, and mood. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Quality of the body of evidence was assessed by evidence for each outcome related to cognitive function for which data was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: Ten studies were included. Three studies found resveratrol supplementation significantly improved some measures of cognitive performance, 2 reported mixed findings, and 5 found no effect. When data were pooled, resveratrol supplementation had a significant effect on delayed recognition (standardized mean difference [SMD], 0.39; 95% confidence interval [CI], 0.08-0.70; I-2 = 0%; P = 0.01; n = 3 studies; n = 166 participants) and negative mood (SMD,-0.18; 95% CI, -0.31 to -0.05; I-2 = 0%; P = 0.006; n = 3 studies; n = 163 participants). Included studies generally had low risk of bias and were of moderate or high quality. Conclusions: The results of this review indicate that resveratrol supplementation might improve select measures of cognitive performance; however, the current literature is inconsistent and limited.

The health benefits of a Mediterranean diet are thought to be mediated via its anti-inflammatory effects; however, the anti-inflammatory effect of this diet is unclear in patients who have already developed coronary heart disease (CHD). This systematic review and meta-analysis assessed the effect of Mediterranean-type diets on cytokines and adipokines in patients with CHD. An electronic search of the literature was conducted up to October 2016 using PubMed, Scopus, Web of Science, and Cochrane Library. Eleven of the 435 articles identified met eligibility criteria. Four observational studies reported significant inverse associations between Mediterranean-type diet scores and inflammatory cytokines. Five clinical trials (4 in non-Mediterranean countries) demonstrated nonsignificant reductions, and 2 trials conducted in Spain demonstrated significant reductions in C-reactive protein with a Mediterranean-type diet. Random effects meta-analysis of 4 controlled trials detected a nonsignificant difference in final mean value of C-reactive protein with Mediterranean-type diet vs low-fat diet. Despite promising findings from observational studies, this review demonstrated mostly nonsignificant effects of Mediterranean-type diet interventions on inflammatory cytokines and no effect in comparison to low-fat diets in controlled trials conducted primarily in Mediterranean populations. Therefore, randomized controlled trials of a traditional Mediterranean diet in non-Mediterranean populations and with multiple inflammatory biomarkers are needed in the high-risk CHD patient group.

AIM Health professionals seeking employment in foreign countries are commonly required to undertake competency assessment in order to practice. The present study aims to outline the development and validation of a written examination for Dietetic Skills Recognition (DSR), to assess the knowledge, skills, capabilities and professional judgement of overseas-educated dietitians against the competency standards applied to dietetic graduates in Australia. METHODS The present study reviews the design, rationale, validation and outcomes of a multiple choice question (MCQ) written examination for overseas-educated dietitians based on 5 years of administration. The validity of the exam is evaluated using Messick's validity framework, which focuses on five potential sources of validity evidence-content, internal structure, relationships with other variables, response process and consequences. The reference point for the exam pass mark or "cutscore" is the minimum standard required for safe practice. RESULTS In total, 114 candidates have completed the MCQ examination at least once, with an overall pass rate of 52% on the first attempt. Pass rates are higher from countries where dietetic education more closely reflects the Australian model. While the pass rate for each exam tends to vary with each cohort, the cutscore has remained relatively stable over eight administrations. CONCLUSIONS The findings provide important data supporting the validity of the MCQ exam. A more complete evaluation of the validity of the exam must be sought within the context of the whole DSR program of assessment. The DSR written component may serve as a model for use of the MCQ format for dietetic and other professional credentialing organisations.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. In the absence of effective pharmacotherapies, clinical guidelines focus primarily on weight loss to treat this condition. Established consensus, evidence-based, and clinical dietary recommendations for NAFLD are currently lacking. The aim of this paper is to provide evidence-based practical dietary recommendations for the prevention and management of NAFLD in adults. A literature review focusing on established principles for the development of clinical practice recommendations was employed using the following criteria: based on substantial evidence, ensures risk minimization, is flexible for an individual patient approach, and is open to further modification as evidence emerges. The Practice-based Evidence in Nutrition classification system was used to grade these principles. Five key dietary recommendations were developed: 1) follow traditional dietary patterns, such as the Mediterranean diet; 2) limit excess fructose consumption and avoid processed foods and beverages with added fructose; 3) PUFAs, especially long-chain omega-3 rich foods and MUFAs, should replace SFAs in the diet; 4) replace processed food, fast food, commercial bakery goods, and sweets with unprocessed foods high in fiber, including whole grains, vegetables, fruits, legumes, nuts, and seeds; and 5) avoid excess alcohol consumption. Improving diet quality may reduce the incidence and progression of NAFLD and associated risk factors. Many of the benefits are likely to result from the collective effect of dietary patterns. High-quality research-in particular, randomized clinical trials assessing dietary interventions that focus on liver-specific endpoints-are needed as a priority.

Aim To describe the study protocol of the MEDiterranean ISlands-Australia (MEDIS-Australia) Study modelled on the MEDIS Study conducted in Greece. The present study aims to explore adherence to the traditional Mediterranean diet pattern, determine enablers and barriers to adherence, explore the definition of Greek cuisine, and associations between adherence to the diet pattern and risk factors for cardiovascular disease (CVD) and metabolic syndrome in older Greek Australians originally from Greek islands and Cyprus. Now long-term immigrants, with at least 50 years in Australia, characteristics and risk factor profiles of older Greek islander-born Australians will be compared and contrasted to their counterparts living on Greek islands to evaluate the influence of migration on adherence. Methods The present study is an observational study of cross-sectional design using a modified lifestyle and semi-quantitative food frequency questionnaire to capture sociodemographic, health, psychosocial and dietary characteristics, including cuisine, of 150 older Greek islander-born Australians. Anthropometric measures and medical history will be collected. Participants will be aged over 65 years, live independently, are originally from a Greek island and are free from CVD. Results Data collection is underway. Conclusions Characteristics and behaviours associated with adherence, if identified, could be evaluated in future studies. For example, exploration of enablers or barriers to adherence to a Mediterranean dietary pattern in an Australian population.

This article explores why some Greek immigrants to Australia continue to adhere to a traditional Mediterranean diet whereas others have adopted eating behaviors characteristic of a less healthy “Australian” diet. Twelve qualitative interviews were conducted and comparisons made between individuals consuming more (n = 6) and less traditional diets (n = 6). The level of adherence to the diet was previously assessed by a diet score in a separate quantitative study (MEDIS-Australia) from which the subset of 12 participants for the present study was recruited. Analysis revealed that maintenance of a strong ethnic identity offers a pathway through which individuals retain dietary practices of their homeland.

To evaluate the relationship between retinal vascular caliber and kidney function in a cohort of Australian children and adolescents with type 1 diabetes.This was a cross-sectional study of 483 children and adolescents with type 1 diabetes, aged 7-18 years. An audit of medical files of participants who attended the Royal Children's Hospital, Melbourne, between January 2009 and March 2014 was performed. Albumin to creatinine ratio (ACR) was acquired through spot urine samples and microalbuminuria was classified as ACR3.5 mg/mmol in females and2.5 mg/mmol in males. Retinal vascular caliber was measured using a standardized protocol and later summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE).CRAE was significantly narrower in participants with microalbuminuria compared to those with normo-albuminuria in crude analysis (mean ± standard deviation 159.07 ± 9.90µm vs 164.49 ± 12.45 µm; p = 0.006). After adjustment for key confounders and known or potential mediators of microalbuminuria (age, sex, ethnicity, hemoglobin A1c, systolic blood pressure, total cholesterol, body mass index, duration of diabetes and CRVE) the association between narrower CRAE and microalbuminuria was attenuated and was no longer significant (95% confidence interval 0.94-1.02, p = 0.222). No significant associations between CRVE or arteriole-to-venule ratio and microalbuminuria were observed in univariate or multivariate models.After adjustment for potential confounding variables, retinal vascular caliber was not significantly associated with microalbuminuria in this sample of children and adolescents with type 1 diabetes. Future prospective longitudinal research is warranted to further evaluate these findings.

In this study,we explored the effect of adiposity as measured by BMI on lung function in 72 asthmatic school children (5–12 years) using baseline data from the Mediterranean diet enriched with fatty fish intervention study. Bronchial function was assessed using spirometry and fractional exhaled nitric oxide (FeNO). BMI categories were classified as normal and overweight/obese based on International Obesity Task Force cut-offs. Weak correlations were observed between BMI and FVC (p = 0.013) and FEV1 (p = 0.026). Median FeNO was lower in the overweight/obese as compared to normal weight group (p = 0.027). Linear regression showed an increment in FEF25–75% in the overweight/obese group as compared to normal weight after controlling for confounders namely age, height, sex, regular physical activity, medication and KIDMED score (p = 0.043; β = 11.65 units, 95% CI 0.36–22.94), although with no effect on FeNO. In conclusion, the findings of this study suggest that excess body weight could impact pulmonary dynamics in childhood asthma.

Summary Background & aims The Mediterranean diet (MedDiet) is recognised to reduce risk of coronary heart disease (CHD), in part, via its anti-inflammatory and antioxidant properties, which may be mediated via effects on body fat distribution. Diet efficacy via these mechanisms is however unclear in patients with diagnosed CHD. This study aimed to determine: (1) the effect of ad libitum MedDiet versus low-fat diet intervention on adiposity, anti-inflammatory marker adiponectin, oxidative stress marker malondialdehyde (MDA) and traditional CVD risk markers, and (2) whether improvement in MedDiet adherence score in the pooled cohort was associated with these risk markers, in a pilot cohort of Australian patients post coronary event. Methods Participants (62 ± 9 years, 83% male) were randomised to 6-month ad libitum MedDiet (n = 34) or low-fat diet (n = 31). Pre- and post-intervention, dietary adherence, anthropometry, body composition (Dual-energy X-ray Absorptiometry) and venepuncture measures were conducted. Results The MedDiet group reduced subcutaneous adipose tissue (SAT) area compared to the low-fat diet group (12.5 cm2 more, p = 0.04) but not visceral adipose tissue or other body composition measures. In the pooled cohort, participants with greatest improvement in MedDiet adherence score had significantly lower waist circumference (−2.81 cm, p = 0.01) and SAT area (−27.1 cm2, p = 0.04) compared to participants with no improvement in score at 6-months. There were no changes in adiponectin, MDA or other risk markers in the MedDiet compared to low-fat diet group, and no differences in 6-month levels between categories of improvement in MedDiet score (p > 0.05). Within the MedDiet group only, the proportion of participants taking beta-blocker medication reduced from baseline to 6-months (71% vs. 56%, p-trend = 0.007). Conclusions Adherence to 6-month ad libitum MedDiet reduced subcutaneous fat and waist circumference which discounts the misconception that this healthy but high fat diet leads to body fat gain. The effect of MedDiet on body fat distribution and consequent anti-inflammatory and antioxidant effects, as well as need for medications, in patients with CHD warrants exploration in larger studies. Clinically significant effects on these markers may require adjunct exercise and/or caloric restriction. Trial registration ACTRN12616000156482.

Objectives To determine the proportion of Residential Aged Care Facilities (RACFs) in Australia who use a nutrition screening tool on residents to identify those at risk of malnutrition, and to review practice following identification of residents as being at high risk of malnutrition. Design Multi-center, cross sectional observational study. Setting: Residential Aged Care Facilities. Participants The Director of Nursing at each site was contacted by telephone and asked questions relating to current nutrition screening practices at their residential aged care facility. Measurements Data was collected from a stratified sample of 229 residential aged care facilities in each state and territory in Australia. Results 82% of RACFs (n = 188) use a nutrition screening tool on residents to identify those at risk of malnutrition, however only 52% of RACFs (n = 119) used a screening tool which is validated in the residential aged care setting. There was a significant association between facilities using a nutrition screening tool and the staff members being trained to conduct nutrition screening (p < 0.001). Facilities that employed a dietitian were more likely to use a validated nutrition screening tool (p < 0.005). The most frequently used nutrition screening tool was the ‘Mini Nutritional Assessment–Short Form (MNA-SF)’, which was used by 32% (n = 60) of the RACFs, followed by the ‘Malnutrition Universal Screening Tool (MUST)’ (15%, n = 29). Conclusion We found that the majority of RACFs in Australia use a nutrition screening tool, however many of these RACFs use a tool which has not been validated in the RACF setting. This study highlights the need for greater dietetic advocacy in using validated nutrition screening tools to ensure malnutrition is identified.

Introduction: Reports on the development of professional identity and socialisation in the healthcare professions are mainly from medicine and nursing, although the body of work from other health professions is increasing. This scoping review investigates what is known about the development of professional identity by students from nine allied health professions and what they experience when developing a professional identity. Methods: Reviewers independently searched five databases: CINAHL Plus, Informit, Ovid Medline, Proquest and Scopus, using either terms from text mining six key articles known to the authors or from the keywords: allied health occupation, student, professional identity, professional socialisation, professionalisation and professional role. Results: Ninety-six articles met inclusion criteria from 3 662 records. Over half the articles were published after 2010 and reported studies using qualitative methods with small numbers of participants. Study participants were mainly from the United States of America, the United Kingdom and Australia, and their professions were social work, occupational therapy and physiotherapy. There was no consensus for terminology of professional identity, and related terms were used interchangeably. Theoretical frameworks varied, with situated learning theory and application of standards or frameworks to meet accreditation or professional organisation requirements being most common. Students reported that early introduction to their profession was beneficial to developing a professional identity. Conclusions: While interest in the development of professional identity has increased, findings indicate that further research, including longitudinal studies, would deepen our understanding of the process of socialisation at different stages and similarities between the professions. This is needed for curriculum development, graduate employability strategies and in order to best prepare students for their future practice.

Background and aim The aim of the present review is to examine evidence from published studies on the effectiveness of six or more months of low carbohydrate, macrobiotic, vegan, vegetarian, Mediterranean and intermittent fasting (IF) diets compared to low fat diets on diabetes control and management. Methods and results In accordance with PRISMA guidelines, Cochrane CENTRAL, PubMed and Scopus databases were systematically searched for relevant studies. Twenty randomised controlled trials (RCTs) > 6 months that investigated the effectiveness of various dietary patterns on type 2 diabetes mellitus (T2DM) were included. Risk of bias was assessed using the Cochrane tool. There were no significant differences in glycemic control, weight and lipids for the majority of low carbohydrate diets (LCDs) compared to low fat diets (LFDs). Four out of fifteen LCD interventions showed better glycemic control while weight loss was greater in one study. The Mediterranean dietary pattern demonstrated greater reduction in body weight and HbA1c levels and delayed requirement for diabetes medications. The vegan and macrobiotic diet demonstrated improved glycemic control, while the vegetarian diet showed greater body weight reduction and insulin sensitivity. Conclusions Although more long-term intervention trials are required, mounting evidence supports the view that vegan, vegetarian and Mediterranean dietary patterns should be implemented in public health strategies, in order to better control glycemic markers in individuals with T2DM.

Objective: It is unclear whether the cardioprotective Mediterranean diet (MedDiet) can be adhered to in non-Mediterranean populations. The aim of this study was to report preliminary results on adherence to a 6-mo ad libitum MedDiet intervention in multiethnic Australian patients with coronary heart disease, including maintenance at 12 mo. Methods: Participants (62 ± 9 y of age, 83% men) were randomized to the MedDiet (n = 34) or a low-fat diet (n = 31). Dietitian-led appointments occurred at 0, 3, and 6 mo with a follow-up phone review at 12 mo. Dietary intake was assessed via 7-d food diaries analyzed in FoodWorks8, and MedDiet adherence was measured by a validated 14-item questionnaire. Results: In the pooled cohort, the MedDiet adherence score was low at baseline (5.2 ± 2.1 of 14), with only 6.2% achieving a high score (≥9). MedDiet participants significantly improved the MedDiet adherence score compared with low-fat diet participants after 6 mo (+4.8 ± 2.7 versus +1.2 ± 2 points, respectively; P < 0.001). MedDiet participants significantly increased intake of olive oil, nuts, tomato, yogurt, legumes, and seafood and decreased intake of processed meats and added sugars compared with low-fat diet participants (P < 0.05). Maintenance of the MedDiet at 12 mo was high with 78% of MedDiet participants maintaining an adherence score ≥9; however, mean adherence score decreased by 1 ± 1.9 point (P = 0.01) between 6 and 12 mo. Conclusions: The MedDiet intervention in this pilot trial of Australian patients with coronary heart disease was well adhered to, improved diet quality, and could therefore provide a feasible alternative to a low-fat diet. Notably, improvement in adherence to the MedDiet was achieved through dietitian-led intervention and cross-cultural translation of dietary principles.

The polyphenol fraction of extra-virgin olive oil may be partly responsible for its cardioprotective effects. The aim of this systematic review and meta-analysis was to evaluate the effect of high versus low polyphenol olive oil on cardiovascular disease (CVD) risk factors in clinical trials. In accordance with PRISMA guidelines, CINAHL, PubMed, Embase and Cochrane databases were systematically searched for relevant studies. Randomized controlled trials that investigated markers of CVD risk (e.g. outcomes related to cholesterol, inflammation, oxidative stress) were included. Risk of bias was assessed using the Jadad scale. A meta-analysis was conducted using clinical trial data with available CVD risk outcomes. Twenty-six studies were included. Compared to low polyphenol olive oil, high polyphenol olive oil significantly improved measures of malondialdehyde (MD: −0.07µmol/L [95%CI: −0.12, −0.02µmol/L]; I2: 88%; p = 0.004), oxidized LDL (SMD: −0.44 [95%CI: −0.78, −0.10µmol/L]; I2: 41%; P = 0.01), total cholesterol (MD 4.5 mg/dL [95%CI: −6.54, −2.39 mg/dL]; p

Substantial evidence supports the effect of the Mediterranean Diet (MD) for managing chronic diseases, although trials have been primarily conducted in Mediterranean populations. The efficacy and feasibility of the Mediterranean dietary pattern for the management of chronic diseases has not been extensively evaluated in non-Mediterranean settings. This paper aims to describe the development of a MD model that complies with principles of the traditional MD applied in a multiethnic context. Optimal macronutrient and food-based composition was defined, and a two-week menu was devised incorporating traditional ingredients with evidence based on improvements in chronic disease management. Strategies were developed for the implementation of the diet model in a multiethnic population. Consistent with the principles of a traditional MD, the MD model was plant-based and high in dietary fat, predominantly monounsaturated fatty acids from extra virgin olive oil. Fruits, vegetables and wholegrains were a mainstay, and moderate amounts of nuts and seeds, fish, dairy and red wine were recommended. The diet encompassed key features of the MD including cuisine, biodiversity and sustainability. The MD model preserved traditional dietary components likely to elicit health benefits for individuals with chronic diseases, even with the adaptation to an Australian multiethnic population.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease globally, with increased rates in high-risk populations, including type 2 diabetes and obesity. The condition increases the risk of end-stage liver disease, hepatocellular carcinoma and all-cause mortality. NAFLD is asymptomatic and often remains undiagnosed as routine screening in high-risk groups is not practised. AIMS The aim of this study was to determine the rates and characteristics of NAFLD patients attending liver clinics at two Melbourne metropolitan hospitals. METHODS Liver clinics were prospectively screened for 10 consecutive months and participants with a diagnosis of NAFLD were further evaluated using pathology and imaging results obtained from medical records. RESULTS Of the 2050 patients screened, 148 (7%) had NAFLD predominantly diagnosed using ultrasound (81%). NAFLD patients were obese (mean body mass index 30.7 ± 5.9 kg/m2 ), insulin resistant (median HOMA 4.2 (3.2) mmol/L) and had elevated liver enzymes (ALT median, males 47.0 (34.3), females 36.0 (28.0) U/L), and 18% of patients had liver stiffness measuring >12 kPa, suggesting a moderate probability of cirrhosis. Patients with liver stiffness measuring ≥9.6 kPa had significantly higher: glucose (median 5.5 (1.2) vs 6.2 (5.3) mmol/L, P = 0.007), aspartate aminotransferase levels (median 25.5 (26.0) vs 41.0 (62.0) u/L, P = 0.0005) and HOMA (3.1 (3.0) vs 5.4 (5.5) mmol/L, P = 0.040). CONCLUSIONS NAFLD constituted a minority of liver clinic patients, most of who were obese, insulin resistant and hypertensive, and many had an elevated liver stiffness measurement. NAFLD poses added adverse health outcomes to high-risk patients, and therefore, early detection is warranted.