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AIMS To evaluate the nutrition knowledge of elite Australian athletes, and to obtain feedback from sports dietitians on the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaires' (PEAKS-NQ) suitability. METHODS Sports dietitians from the National Institute Network across Australia recruited athletes to complete the online, 50-item PEAKS-NQ which contained two sections (General Nutrition and Sports Nutrition). Sports dietitians provided feedback on the PEAKS-NQ using a 14-item questionnaire (with two open-ended items). The main outcome measures were nutrition knowledge score and tool suitability (usefulness, acceptability and feasibility) scores. For knowledge scores, independent t-tests, ANOVA and Chi-square tests were used to evaluate differences between groups. Suitability was evaluated using descriptive statistics. RESULTS Twelve sports dietitians from the National Institute Network in Australia recruited a convenience sample of 240 athletes (21.3 ± 4.3 years, 63.5% female, 63.3% competed internationally). Athletes scored 70.7 ± 10.5%, with better general vs sports nutrition knowledge. Females had higher overall scores (P

Background Donor selection is an important factor influencing the engraftment and efficacy of fecal microbiota transplantation (FMT) for complex conditions associated with microbial dysbiosis. However, the degree, variation, and stability of strain engraftment have not yet been assessed in the context of multiple donors. Methods We conducted a double-blinded randomized control trial of FMT in 87 adolescents with obesity. Participants were randomized to receive multi-donor FMT (capsules containing the fecal microbiota of four sex-matched lean donors) or placebo (saline capsules). Following a bowel cleanse, participants ingested a total of 28 capsules over two consecutive days. Capsules from individual donors and participant stool samples collected at baseline, 6, 12, and 26 weeks post-treatment were analyzed by shotgun metagenomic sequencing allowing us to track bacterial strain engraftment and its functional implications on recipients’ gut microbiomes. Results Multi-donor FMT sustainably altered the structure and the function of the gut microbiome. In what was effectively a microbiome competition experiment, we discovered that two donor microbiomes (one female, one male) dominated strain engraftment and were characterized by high microbial diversity and a high Prevotella to Bacteroides (P/B) ratio. Engrafted strains led to enterotype-level shifts in community composition and provided genes that altered the metabolic potential of the community. Despite our attempts to standardize FMT dose and origin, FMT recipients varied widely in their engraftment of donor strains. Conclusion Our study provides evidence for the existence of FMT super-donors whose microbiomes are highly effective at engrafting in the recipient gut. Dominant engrafting male and female donor microbiomes harbored diverse microbial species and genes and were characterized by a high P/B ratio. Yet, the high variability of strain engraftment among FMT recipients suggests the host environment also plays a critical role in mediating FMT receptivity. Trial registration The Gut Bugs trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001351505). Trial protocol The trial protocol is available at https://bmjopen.bmj.com/content/9/4/e026174.

Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.

While athletes’ nutrient intakes have been widely reported, few studies have assessed the diet quality of athletes. This is the first study to evaluate the diet quality of athletes using the purpose-built Athlete Diet Index (ADI). A convenience sample of 165 elite athletes from Australian sporting institutions completed the ADI online, with subsequent automated results provided to their respective accredited sports dietitians (ASDs). At the completion of athlete participation, ASDs (n = 12) responded to a range of survey items using a Likert scale (i.e., 1 = strongly agree to 5 = strongly disagree) to determine the suitability of the ADI in practice. Differences in ADI scores for demographics and sport-specific variables were investigated using independent t-tests, analysis of variance (ANOVA) and Bonferroni multiple comparisons. Spearman’s rank correlation was used to assess the association between total scores and demographics. The mean total ADI score was 91.4 ± 12.2 (range 53–117, out of a possible 125). While there was no difference in total scores based on demographics or sport-specific variables, team sport athletes scored higher than individual sport athletes (92.7 vs. 88.5, P &lt, 0.05). Athletes training fewer hours (i.e., 0–11 h/week) scored higher on Dietary Habits sub-scores compared with athletes training more hours (&gt, 12 h/week, P &lt, 0.05), suggesting that athletes who train longer may be at risk of a compromised dietary pattern or less than optimal nutrition practices that support training. Most (75%) ASDs surveyed strongly agreed with the perceived utility of the ADI for screening athletes and identifying areas for nutrition support, confirming its suitability for use in practice.

Dietary intake is an important predictor of health and disease outcomes. This cross-sectional study evaluated the relative validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) for assessing energy and nutrient intake in older adults. Dietary data were collected 2018–2019 in Auckland, New Zealand from a convenience sample of community-dwelling adults (65–74 years, n = 294, 37% male) using a 109-item self-administered FFQ at baseline (FFQ1) and four weeks later to assess reproducibility. FFQ1 was compared to a four-day food record to determine relative validity. Agreement between dietary assessment tools was assessed for both raw and energy-adjusted nutrient intakes using paired t-tests, correlation coefficients, weighted kappa statistic, Bland–Altman plots, and linear regression analysis. Energy adjustments moderately improved the relative validity and reproducibility for most nutrients. For energy and energy-adjusted nutrient intakes, the mean correlation coefficients were 0.38 (validity) and 0.65 (reproducibility); the mean weighted kappa statistics were 0.27 (validity) and 0.51 (reproducibility). A significant slope of bias was present in 54% (validity) and 25% (reproducibility) of Bland–Altman plots. The Researching Eating, Activity, and Cognitive Health (REACH) FFQ has acceptable relative validity and good reproducibility for ranking nutrient intakes in older New Zealand adults, but is less suitable for assessing absolute nutrient intakes.

Food-based diet indices provide a practical, rapid, and inexpensive way of evaluating dietary intake. Rather than nutrients, diet indices assess the intake of whole foods and dietary patterns, and compare these with nutrition guidelines. An athlete-specific diet index would offer an efficient and practical way to assess the quality of athletes’ diets, guide nutrition interventions, and focus sport nutrition support. This study describes the development and validation of an Athlete Diet Index (ADI). Item development was informed by a review of existing diet indices, relevant literature, and in-depth focus groups with 20 sports nutritionists (median of 11 years’ professional experience) from four elite athlete sporting institutes. Focus group data were analyzed (NVivo 11 Pro; QSR International Pty. Ltd., 2017, Melbourne, Australia), and key themes were identified to guide the development of athlete-relevant items. A modified Delphi survey in a subgroup of sports nutritionists (n = 9) supported item content validation. Pilot testing with athletes (n = 15) subsequently informed face validity. The final ADI (n = 68 items) was categorized into three sections. Section A (n = 45 items) evaluated usual intake, special diets or intolerances, dietary habits, and culinary skills. Section B (n = 15 items) assessed training load, nutrition supporting training, and sports supplement use. Section C (n = 8 items) captured the demographic details, sporting type, and caliber. All of the athletes reported the ADI as easy (40%) or very easy (60% of participants) to use and rated the tool as relevant (37%) or very relevant (63% of participants) to athletes. Further evaluation of the ADI, including the development of a scoring matrix and validation compared with established dietary methodology, is warranted.

Decreases in Fe status have been reported in military women during initial training periods of 8–10 weeks. The present study aimed to characterise Fe status and associations with physical performance in female New Zealand Army recruits during a 16-week basic combat training (BCT) course. Fe status indicators – Hb, serum ferritin (sFer), soluble transferrin receptor (sTfR), transferrin saturation (TS) and erythrocyte distribution width (RDW) – were assessed at the beginning (baseline) and end of BCT in seventy-six volunteers without Fe-deficiency non-anaemia (sFer 10 mg/l at baseline or end. A timed 2·4 km run followed by maximum press-ups were performed at baseline and midpoint (week 8) to assess physical performance. Changes in Fe status were investigated using paired t tests and associations between Fe status and physical performance evaluated using Pearson correlation coefficients. sFer (56·6 (sd 33·7) v. 38·4 (sd 23·8) µg/l) and TS (38·8 (sd 13·9) v. 34·4 (sd 11·5) %) decreased (PP=0·014, respectively), while sTfR (1·21 (sd 0·27) v. 1·39 (sd 0·35) mg/l) and RDW (12·8 (sd 0·6) v. 13·2 (sd 0·7) %) increased (Psd 7·5) v. 142·9 (sd 7·9) g/l) increased (P=0·009) during BCT. At end, sTfR was positively (r 0·29, P=0·012) and TS inversely associated (r –0·32, P=0·005) with midpoint run time. There were no significant correlations between Fe status and press-ups. Storage and functional Fe parameters indicated a decline in Fe status in female recruits during BCT. Correlations between tissue-Fe indicators and run times suggest impaired aerobic fitness. Optimal Fe status appears paramount for enabling success in female recruits during military training.

Irritability and hyperactivity are common in children with Autism Spectrum Disorder (ASD). Because pharmacological treatments may have adverse effects, and despite limited evidence, caregivers/parents often use dietary supplements such as vitamin D and omega-3 fatty acids to address these behavioural symptoms. As a secondary objective of the VIDOMA (Vitamin D and Omega-3 in ASD) trial, we evaluated the efficacy of vitamin D, omega-3 long chain polyunsaturated fatty acid [omega-3 LCPUFA; docosahexaenoic acid (DHA)], or both on irritability and hyperactivity. New Zealand children with ASD (aged 2.5-8 years) participated in a 12-month randomized, double-blind, placebo-controlled trial of vitamin D (2000 IU/day, VID), omega-3 LCPUFA (722 mg/day DHA, OM), or both (2000 IU/day vitamin D + 722 mg/day DHA, VIDOM). The primary outcomes were the Aberrant Behaviour Checklist (ABC) domains of irritability and hyperactivity. Biomarkers (serum 25-hydroxyvitamin D [25(OH)D] and omega-3 index) and primary outcomes were measured at baseline and 12-months. Out of 111 children who completed baseline data collection, 66% completed the study (VID = 19, OM = 23, VIDOM = 15, placebo = 16). After 12 months, children receiving OM (-5.0 ± 5.0, P = 0.001) and VID (-4.0±4.9, P = 0.01) had greater reduction in irritability than placebo (0.8±6.1). Compared to placebo, children on VID also had greater reduction in hyperactivity (-5.2±6.3 vs. -0.8±5.6, P = 0.047). Serum 25(OH)D concentration (nmol/L, mean±SD) increased by 27±14 in VID and by 36±17 in VIDOM groups (P 0.0001), and omega-3 index (%, median (25th, 75th percentiles)) by 4.4 (3.3, 5.9) in OM and by 4.0 (2.0, 6.0) in VIDOM groups (P 0.0001), indicating a good compliance rate. The results indicate that vitamin D and omega-3 LCPUFA reduced irritability symptoms in children with ASD. Vitamin D also reduced hyperactivity symptoms in these children.

Background Child growth stunting remains a challenge in sub-Saharan Africa, where 34% of children under 5 years are stunted, and causing detrimental impact at individual and societal levels. Identifying risk factors to stunting is key to developing proper interventions. This study aimed at identifying risk factors of stunting in Rwanda. Methods We used data from the Rwanda Demographic and Health Survey (DHS) 2014–2015. Association between children’s characteristics and stunting was assessed using logistic regression analysis. Results A total of 3594 under 5 years were included; where 51% of them were boys. The prevalence of stunting was 38% (95% CI: 35.92–39.52) for all children. In adjusted analysis, the following factors were significant: boys (OR 1.51; 95% CI 1.25–1.82), children ages 6–23 months (OR 4.91; 95% CI 3.16–7.62) and children ages 24–59 months (OR 6.34; 95% CI 4.07–9.89) compared to ages 0–6 months, low birth weight (OR 2.12; 95% CI 1.39–3.23), low maternal height (OR 3.27; 95% CI 1.89–5.64), primary education for mothers (OR 1.71; 95% CI 1.25–2.34), illiterate mothers (OR 2.00; 95% CI 1.37–2.92), history of not taking deworming medicine during pregnancy (OR 1.29; 95%CI 1.09–1.53), poorest households (OR 1.45; 95% CI 1.12–1.86; and OR 1.82; 95%CI 1.45–2.29 respectively). Conclusion Family-level factors are major drivers of children’s growth stunting in Rwanda. Interventions to improve the nutrition of pregnant and lactating women so as to prevent low birth weight babies, reduce poverty, promote girls’ education and intervene early in cases of malnutrition are needed.

We evaluated the efficacy of vitamin D (VID), omega-3 long chain polyunsaturated fatty acids (omega-3 LCPUFA, OM), or both (VIDOM) on core symptoms of ASD. New Zealand children with ASD (n = 73; aged 2.5–8.0 years) received daily 2000 IU vitamin D3, 722 mg docosahexaenoic acid, both, or placebo. Outcome measures were Social Responsiveness Scale (SRS) and Sensory Processing Measure (SPM). Of 42 outcome measures comparisons (interventions vs. placebo), two showed greater improvements (P = 0.03, OM and VIDOM for SRS-social awareness) and four showed trends for greater improvements (P

The global population is ageing. Evidence show dietary patterns may be associated with cognitive status in older adults. This cross-sectional study investigated associations between dietary patterns and cognitive function in older adults in New Zealand.The REACH study (Researching Eating, Activity, and Cognitive Health) included 371 participants (65-74 years, 36% male) living independently in Auckland, New Zealand. Valid and reproducible dietary patterns were derived, using principal component analysis, from dietary data collected by a 109-item validated food frequency questionnaire. Six cognitive domains (global cognition, attention and vigilance, executive function, episodic memory, working memory, and spatial memory) were tested using COMPASS (Computerised Mental Performance Assessment System). Associations between dietary patterns and cognitive scores, adjusted for age, sex, education, physical activity, energy, and Apolipoprotein E-ε4 status were analysed using multiple linear regression analysis.Three dietary patterns explained 18% of dietary intake variation-'Mediterranean style' (comprising: salad vegetables, leafy cruciferous vegetables, other vegetables, avocados and olives, alliums, nuts and seeds, white fish and shellfish, oily fish, and berries); 'Western' (comprising: processed meats, sauces and condiments, cakes, biscuits and puddings, meat pies and chips, and processed fish); and 'Prudent' (comprising: dried legumes, soy-based foods, fresh and frozen legumes, whole grains, and carrots). No associations between any cognitive domain and dietary pattern scores were observed. Global cognitive function was associated with being younger and having a university education.In this cohort of community-dwelling, older adults in New Zealand, current dietary patterns were not associated with cognitive function.

Infants born preterm, low birthweight or with other perinatal complications require frequent and accurate growth monitoring for optimal nutrition and growth. We implemented an mHealth tool to improve growth monitoring and nutritional status assessment of high risk infants. We conducted a pre–post quasi‐experimental study with a concurrent control group among infants enrolled in paediatric development clinics in two rural Rwandan districts. During the pre‐intervention period (August 2017–January 2018), all clinics used standard paper‐based World Health Organization (WHO) growth charts. During the intervention period (August 2018–January 2019), Kirehe district adopted an mHealth tool for child growth monitoring and nutritional status assessment. Data on length/height; weight; length/height‐for‐age (L/HFA), weight‐for‐length/height (WFL/H) and weight‐for‐age (WFA) z‐scores; and interval growth were tracked at each visit. We conducted a ‘difference‐in‐difference’ analysis to assess whether the mHealth tool was associated with greater improvements in completion and accuracy of nutritional assessments and nutritional status at 2 and 6 months of age. We observed 3529 visits. mHealth intervention clinics showed significantly greater improvements on completeness for corrected age (endline: 65% vs. 55%; p = 0.036), L/HFA (endline: 82% vs. 57%; p ≤ 0.001), WFA (endline: 93% vs. 67%; p ≤ 0.001) and WFL/H (endline: 90% vs. 59%; p ≤ 0.001) z‐scores compared with control sites. Accuracy of growth monitoring did not improve. Prevalence of stunting, underweight and inadequate interval growth at 6‐months corrected age decreased significantly more in the intervention clinics than in control clinics. Results suggest that integrating mHealth nutrition interventions is feasible and can improve child nutrition outcomes. Improved tool design may better promote accuracy.

Background Aging is associated with decreases in muscle strength and simultaneous changes in body composition, including decreases in muscle mass, muscle quality and increases in adiposity. Methods Adults (n = 369; 236 females) aged 65–74 years living independently were recruited from the cross-sectional Researching Eating Activity and Cognitive Health (REACH) study. Body fat percentage and appendicular skeletal muscle mass (ASM) (sum of lean mass in the arms and legs) were assessed using Dual-energy X-ray Absorptiometry (Hologic, QDR Discovery A). The ASM index was calculated by ASM (kilograms) divided by height (meters) squared. Isometric grip strength was measured using a hand grip strength dynamometer (JAMAR HAND). Results Linear regression analyses revealed that muscle strength was positively associated with the ASM index (R2 = 0.431, p < 0.001). When exploring associations between muscle strength and muscle mass according to obesity classifications (obesity ≥30% males; ≥40% females), muscle mass was a significant predictor of muscle strength in non-obese participants. However, in participants with obesity, muscle mass was no longer a significant predictor of muscle strength. Conclusions Body fat percentage should be considered when measuring associations between muscle mass and muscle strength in older adults.

The incidence of pre-diabetes and type 2 diabetes mellitus (T2DM) is increasing in children. Early identification of pre-diabetes is an important first step in preventing the progression to T2DM. The aim was to investigate the association of selected factors with pre-diabetes in children.This data were from a subset of the 685 children recruited for the Children's Bone Study, a cross-sectional study of children aged 8-11 years in Auckland, New Zealand. Glycated haemoglobin (HbA1c) was measured from a finger-prick blood test. Children were classified as normoglycaemic (HbA1c≤39mmol/mol) and pre-diabetic (HbA1c39mmol/mol). Anthropometry included weight, height, waist circumference (WC) and percentage body fat (%BF) measured using bioelectrical impedance analysis. Information about age, gender, ethnicity and physical activity was collected by questionnaires.HbA1c was measured in 451 children (10.4±0.6years, 45% male). Pre-diabetes was present in 71 (16%) children and was greatest in South Asian (n=13, 30%), Pacific Island (n=29, 27%) and Māori (n=10, 18%) children, compared with European children (n=10, 6.0%) (P0.001). South Asian and Pacific Island ethnicity, high WC, high %BF and low physical activity were associated with pre-diabetes.Factors associated with pre-diabetes in children were ethnicity, anthropometric measures and physical-activity levels. The prevalence of pre-diabetes in children of South Asian and Pacific Island ethnicities suggests the need for appropriate and timely identification and intervention to halt the progression to T2DM.

Background The benefit of reducing sugar-sweetened beverage (SSB) consumption is widely accepted, but updated and in-depth data on New Zealand (NZ) children’s SSB consumption is lacking. The aims of this study were to describe beverage consumption, focusing on SSBs in primary school age children living in Auckland; to examine the association of selected socio-demographic, home, community and school factors and children’s beverage knowledge/attitudes with regards to beverage consumption; to explore the relationship between SSBs consumption and adiposity in children. Methods A cross-sectional, Auckland-wide survey of 578 school age children (8-12 years) was conducted using questionnaires to collect data on beverage consumption, beverage knowledge/attitudes, and selected socio-demographic and home, community, school factors. Body fat percentage (BF%) was assessed using bioelectrical impedance (BIA). Results Ninety-six percent of children consumed ≥1 serving of SSBs a week; with ≥5 servings reported by 62% of children. Of all SSBs assessed, consumption of ≥1 serving of sugar sweetened milk-based beverages (85%, mainly milk drinks made from powder) was most prevalent, followed by fruit juice (46%) and sugar-containing carbonated drinks (39%, mainly soft/fizzy drinks). Among unsweetened beverages, plain water was reported to be consumed Conclusions The consumption of SSBs is prevalent in NZ school age children, with higher consumption rates observed among those from socially disadvantaged areas. This high consumption is associated with higher BF% in females. Multi-contextual interventions to decrease SSBs should target children, and their families/environment, particularly those from socially disadvantaged areas.

Background Little is known about father's involvement in the care of children born with perinatal risk factors. This study aimed to understand father's involvement in the care of children born preterm, low birth weight (LBW) and/or with hypoxic ischemic encephalopathy (HIE) in rural Rwanda and assess child and home environment factors associated with father involvement. Methods A cross-sectional study of children born preterm, LBW or with HIE who were discharged from Kirehe District Hospital neonatal unit from May 2015 to April 2016 and those enrolled in a neonatal unit follow-up programme from May 2016 to November 2017. Interviews were conducted when the children were ages 24-47 months in the child's home. Primary caregivers reported on father involvement in parenting, home environment, child disability, and child development outcomes. Children's nutritional status were directly measured. Only children whose fathers were living in the home were included in the sample. Bivariate analyses were conducted using Fisher's exact test and Wilcoxon Rank Sum test. Results A total of 236 children aged 24-47 months were included in this study, 66.4% were born preterm or LBW with a mean age of 33.3 months. 73.5% of children were at risk of disability and 77.7% had potential delay in overall child development. 15.5% of fathers reported engaging in four or more activities with their child in the last 3 days. Factors associated with father involvement included smaller household size (p = 0.004), mother engaged in decision-making (p = 0.027), being on-track in developmental milestones for problem solving (p = 0.042) and mother's involvement in learning activities (p = 0.043); the number of activities a father engaged in was significantly associated with the child's overall development (p = 0.032). Conclusion We found that father involvement in activities to support learning was low amongst children born preterm/LBW and/or with HIE. Programme interventions should encourage fathers to engage with their children given the benefits for children's development.

Dietary patterns analyse combinations of foods eaten. This cross-sectional study identified dietary patterns and their nutrients. Associations between dietary patterns and socio-demographic and lifestyle factors were examined in older New Zealand adults. Dietary data (109-item food frequency questionnaire) from the Researching Eating, Activity and Cognitive Health (REACH) study (n = 367, 36% male, mean age = 70 years) were collapsed into 57 food groups. Using principal component analysis, three dietary patterns explained 18% of the variation in diet. Dietary pattern associations with sex, age, employment, living situation, education, deprivation score, physical activity, alcohol, and smoking, along with energy-adjusted nutrient intakes, were investigated using regression analysis. Higher &lsquo, Mediterranean&rsquo, dietary pattern scores were associated with being female, higher physical activity, and higher education (p &lt, 0.001, R2 = 0.07). Higher &lsquo, Western&rsquo, pattern scores were associated with being male, higher alcohol intake, living with others, and secondary education (p &lt, 0.001, R2 = 0.16). Higher &lsquo, prudent&rsquo, pattern scores were associated with higher physical activity and lower alcohol intake (p &lt, 0.001, R2 = 0.15). There were positive associations between beta-carotene equivalents, vitamin E, and folate and &lsquo, dietary pattern scores (p &lt, 0.0001, R2 &ge, 0.26), energy intake and &lsquo, scores (p &lt, 0.0001, R2 = 0.43), and fibre and carbohydrate and &lsquo, 0.25). Socio-demographic and lifestyle factors were associated with dietary patterns. Understanding relationships between these characteristics and dietary patterns can assist in health promotion.

Reliable and valid assessment of sports nutrition knowledge can inform athlete nutrition education to address knowledge gaps. This study aimed to test the reliability and validity of an electronically administered sports nutrition knowledge tool – Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire (PEAKS-NQ). A 94-item PEAKS-NQ was piloted to 149 developmental athletes (DA) in New Zealand, with a subset invited to complete the PEAKS-NQ again to assess reliability. Reliability was evaluated using sign test, intraclass correlation and Cronbach’s α. Accredited sports dietitians (ASD; n 255) completed the PEAKS-NQ to establish construct validity via known-groups methodology and provided relevance scores to determine the scale content validity index (S-CVI). Rasch analysis was conducted to identify potentially problematic items and test reliability. Score differences between DA and ASD were analysed using independent t or non-parametric tests. DA (n 88) were 17·8 (sd 1·4) years, 61·4 % female and mostly in high school (94·3 %). ASD (n 45) were 37·8 (sd 7·6) years, 82·2 % female, with >5 years of dietetic experience (59·1 %). ASD scored higher than DA in all sections and overall (91·5 (sd 3·4) v. 67·1 (sd 10·5) %) (P < 0·001). There were no differences between retests (n 18; P = 0·14). Cronbach’s α was 0·86. S-CVI indicated good content validity (0·88). Rasch analysis resulted in a fifty-item PEAKS-NQ with high item (0·91) and person (0·92) reliability. The PEAKS-NQ is reliable and valid for assessing sports nutrition knowledge which could assist practitioners effectively tailor and evaluate nutrition education.

Optimising nutrition intake is a key component for supporting athletic performance and supporting adaption to training. Athletes often use micronutrient supplements in order to correct vitamin and mineral deficiencies, improve immune function, enhance recovery and or to optimise their performance. The aim of this review was to investigate the recent literature regarding micronutrients (specifically iron, vitamin C, vitamin E, vitamin D, calcium) and their effects on physical performance. Over the past ten years, several studies have investigated the impacts of these micronutrients on aspects of athletic performance, and several reviews have aimed to provide an overview of current use and effectiveness. Currently the balance of the literature suggests that micronutrient supplementation in well-nourished athletes does not enhance physical performance. Excessive intake of dietary supplements may impair the body's physiological responses to exercise that supports adaptation to training stress. In some cases, micronutrient supplementation is warranted, for example, with a diagnosed deficiency, when energy intake is compromised, or when training and competing at altitude, however these micronutrients should be prescribed by a medical professional. Athletes are encouraged to obtain adequate micronutrients from a wellbalanced and varied dietary intake.

With rising childcare enrollments, caregivers have a unique opportunity to promote children&rsquo, s nutrition education and healthy eating. Accurately identifying nutrition knowledge gaps amongst caregivers is necessary for professional development planning. Our aim was to design an early childhood education and care (ECEC) teacher nutrition knowledge questionnaire that satisfies psychometric criteria of validity and reliability. Items were based on the New Zealand Ministry of Health dietary guidelines, literature and expert advice. University students in their final year of a Bachelor of Science (BSc) in Human Nutrition (n = 40), and students with no nutrition background (n = 51) completed the questionnaire to assess construct validity, 35 BSc nutrition students completed the questionnaire two weeks later to assess reliability. The Mann-Whitney-U test and a median-split table assessed construct validity, Pearson&rsquo, s product-moment correlation assessed test-retest reliability. Nutrition students achieved higher total and subcategory scores (p &lt, 0.01). All nutrition students scored above the median of the combined group, 82% of non-nutrition students scored below the median. In testing reliability, first and second administration median scores for total and subcategories were significantly correlated (r = 0.43&ndash, 0.78, p &lt, 0.01). The questionnaire achieved construct validity and test-retest reliability and measured ECEC teachers&rsquo, nutrition knowledge for preschoolers.

Children born preterm, low birth weight (LBW) or with other perinatal risk factors are at high‐risk of malnutrition. Regular growth monitoring and early intervention are essential to promote optimal feeding and growth; however, monitoring growth in preterm infants can be complex. This study evaluated growth monitoring of infants under 6 months enrolled in Paediatric Development Clinics (PDCs) in rural Rwanda. We reviewed electronic medical records (EMR) of infants enrolled in PDCs before age 2 months with their first visit between January 2015 and December 2016 and followed them until age 6 months. Nurse classification of anthropometric measures and nutritional status were extracted from the EMR. Interval growth and length‐for‐age, weight‐for‐length, and weight‐for‐age z‐scores were calculated using World Health Organization anthropometry software as a ‘gold standard’ comparison to nurse classifications. Two hundred and ninety‐four patients enrolled and had 2,033 visits during the study period. Referral reasons included prematurity/LBW (73.8%) and hypoxic ischemic encephalopathy (28.2%). Nurses assessed interval growth at 58.7% of visits, length‐for‐age at 66.4%, weight‐for‐length at 65.6% and weight‐for‐age at 66.4%. Nurses and gold standard assessment agreed on interval growth at 53.3% of visits and length‐for‐age at 63.7%, weight‐for‐length at 78.2% and weight‐for‐age at 66.3%. At 6 months, 46.5% were stunted, 19.9% were wasted and 44.2% were underweight. There were significant challenges to optimizing growth and growth monitoring among high‐risk infants served by PDCs, including incomplete and inaccurate assessments. Developing tools for clinician decision support in assessing growth and providing specialized nutritional counselling are essential to supporting optimal outcomes in this population.

Background: The role of vitamin D and omega-3 long chain polyunsaturated fatty acids (omega-3 LCPUFA) in improving core symptoms of autism spectrum disorder (ASD) in children has been investigated by a few randomised controlled trials and the results are mixed and inconclusive. The response to treatment with these nutrients is heterogenous and may be influenced by inflammatory state. As an exploratory analysis, we investigated whether inflammatory state would modulate the effect of these nutrients on core symptoms of ASD. Methods: Seventy-three New Zealand children with ASD (2.5&ndash, 8.0 years) completed a 12-month randomised, double-blind, placebo-controlled trial of vitamin D (VID, 2000 IU/day), omega-3 LCPUFA, (OM, 722 mg/day docosahexaenoic acid), or both (VIDOM). Non-fasting baseline plasma interleukin-1&beta, (IL-1&beta, ) was available for 67 children (VID = 15, OM = 21, VIDOM = 15, placebo = 16). Children were categorised as having undetectable/normal IL-1&beta, (&lt, 3.2 pg/ml, n=15) or elevated IL-1&beta, (&ge, 3.2 pg/mL, n = 52). The Social Responsiveness Scale (SRS) questionnaire was used to assess core symptoms of ASD (baseline, 12-month). Mixed model repeated measure analyses (including all children or only children with elevated IL-1&beta, ) were used. Results: We found evidence for an interaction between baseline IL-1&beta, and treatment response for SRS-total, SRS-social communicative functioning, SRS-awareness and SRS-communication (all Pinteraction &lt, 0.10). When all children were included in the analysis, two outcome comparisons (treatments vs. placebo) showed greater improvements: VID, no effect (all P &gt, 0.10), OM and VIDOM (P = 0.01) for SRS-awareness. When only children with elevated IL-1&beta, were included, five outcomes showed greater improvements: OM (P = 0.01) for SRS-total, OM (P = 0.03) for SRS-social communicative functioning, VID (P = 0.01), OM (P = 0.003) and VIDOM (P = 0.01) for SRS-awareness. Conclusion: Inflammatory state may have modulated responses to vitamin D and omega-3 LCPUFA intervention in children with ASD, suggesting children with elevated inflammation may benefit more from daily vitamin D and omega-3 LCPUFA supplementation.

Metabolic diseases are increasing among adolescents with obesity. Although the reported prevalence of metabolic syndrome is approximately 30% worldwide, its prevalence is largely unknown among New Zealand adolescents. Therefore, we assessed the health of adolescents with obesity (BMI ≥ 30 kg/m2) enrolled in a randomised clinical trial (Gut Bugs Trial), to identify the prevalence of undiagnosed comorbidities. Assessments included anthropometry, 24-h ambulatory blood pressure monitoring, and insulin sensitivity. We report on baseline data (pre-randomisation) on 87 participants (14–18 years; 59% females), with mean BMI 36.9 ± 5.3 kg/m2 (BMI SDS 3.33 ± 0.79). Approximately 40% of participants had undiagnosed metabolic syndrome, which was twice as common among males. Half (53%) had pre-diabetes and 92% a reduction in insulin sensitivity. Moreover, 31% had pre-hypertension/hypertension, 69% dyslipidaemia, and 25% abnormal liver function. Participants with class III obesity had a greater risk of metabolic syndrome than those with classes I/II [relative risk 1.99 (95% CI 1.19, 3.34)]. Risks for pre-hypertension/hypertension and inflammation were also greater among those with class III obesity. We identified a high prevalence of undiagnosed comorbidities among adolescents with obesity in New Zealand. As adolescent obesity tracks into adulthood, early interventions are needed to prevent progression to overt cardiometabolic diseases.

IntroductionMaternal obesity during pregnancy is associated with adverse changes in body composition and metabolism in the offspring. We hypothesise that supplementation during pregnancy of overweight and obese women may help prevent the development of greater adiposity and metabolic dysfunction in children. Previous clinical trials investigating fish oil supplementation in pregnancy on metabolic outcomes and body composition of the children have not focused on the pregnancies of overweight or obese women.Methods and analysisA double-blind randomised controlled trial of fish oil (providing 3 g/day of n-3 polyunsaturated fatty acids) versus an equal volume of olive oil (control) taken daily from recruitment until birth, and in breastfeeding mothers, further continued for 3 months post partum. Eligible women will have a singleton pregnancy at 12–20 weeks’ gestation and be aged 18–40 years with body mass index ≥25 kg/m2 at baseline. We aim to recruit a minimum of 128 participants to be randomised 1:1. Clinical assessments will be performed at baseline and 30 weeks of pregnancy, including anthropometric measurements, fasting metabolic markers, measures of anxiety, physical activity, quality of life and dietary intake. Subsequent assessments will be performed when the infant is 2 weeks, 3 months and 12 months of age for anthropometry, body composition (dual-energy X-ray absorptiometry (DXA)) and blood sampling. The primary outcome of the study is a between-group difference in infant percentage body fatness, assessed by DXA, at 2 weeks of age. Secondary outcomes will include differences in anthropometric measures at each time point, percentage body fat at 3 and 12 months and homeostatic model assessment of insulin resistance at 3 months. Statistical analysis will be carried out on the principle of intention to treat.Ethics and disseminationThis trial was approved by the Northern A Health and Disabilities Ethics Committee, New Zealand Ministry of Health (17/NTA/154). Results will be published in a peer-reviewed journal.Trial registration numberACTRN12617001078347p; Pre-results.

Key Points Question Will fecal microbiome transfer (FMT) lead to weight loss among adolescents with obesity? Findings In this randomized clinical trial of 87 adolescents with obesity, FMT alone did not lead to weight loss at 6 weeks. FMT alone was associated with a reduction in android-to-gynoid-fat ratio sustained for at least 26 weeks, particularly in female adolescents; changes in the overall gut microbiome composition; and a resolution of metabolic syndrome by 26 weeks in participants who had this undiagnosed condition at baseline. Meaning FMT alone is not an effective treatment for weight loss but may reduce visceral adiposity and improve health., This randomized, double-masked, placebo-controlled clinical trial of 87 adolescents assesses the effect of fecal microbiome transfer on weight loss. Follow-up examination was conducted for the primary outcome at 6 weeks with intention-to-treat analyses, and was measured by body mass index standard deviation score., Importance Treatment of pediatric obesity is challenging. Preclinical studies in mice indicated that weight and metabolism can be altered by gut microbiome manipulation. Objective To assess efficacy of fecal microbiome transfer (FMT) to treat adolescent obesity and improve metabolism. Design, Setting, and Participants This randomized, double-masked, placebo-controlled trial (October 2017-March 2019) with a 26-week follow-up was conducted among adolescents aged 14 to 18 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or more in Auckland, New Zealand. A total of 87 individuals took part—565 individuals responded to advertisements, 328 were ineligible, and 150 declined participation. Clinical data were analyzed from September 2019 to May 2020. Interventions Single course of oral encapsulated fecal microbiome from 4 healthy lean donors of the same sex or saline placebo. Main Outcomes and Measures Primary outcome was BMI standard deviation score at 6 weeks using intention-to-treat analysis. Secondary outcomes included body composition, cardiometabolic parameters, well-being, and gut microbiome composition. Results Eighty-seven participants (59% female adolescents, mean [SD] age 17.2 [1.4] years) were randomized 1:1, in groups stratified by sex, to FMT (42 participants) or placebo (45 participants). There was no effect of FMT on BMI standard deviation score at 6 weeks (adjusted mean difference [aMD] −0.026; 95% CI −0.074, 0.022). Reductions in android-to-gynoid-fat ratio in the FMT vs placebo group were observed at 6, 12, and 26 weeks, with aMDs of −0.021 (95% CI, −0.041 to −0.001), −0.023 (95% CI, −0.043 to −0.003), and −0.029 (95% CI, −0.049 to −0.008), respectively. There were no observed effects on insulin sensitivity, liver function, lipid profile, inflammatory markers, blood pressure, total body fat percentage, gut health, and health-related quality of life. Gut microbiome profiling revealed a shift in community composition among the FMT group, maintained up to 12 weeks. In post-hoc exploratory analyses among participants with metabolic syndrome at baseline, FMT led to greater resolution of this condition (18 to 4) compared with placebo (13 to 10) by 26 weeks (adjusted odds ratio, 0.06; 95% CI, 0.01-0.45; P = .007). There were no serious adverse events recorded throughout the trial. Conclusions and Relevance In this randomized clinical trial of adolescents with obesite, there was no effect of FMT on weight loss in adolescents with obesity, although a reduction in abdominal adiposity was observed. Post-hoc analyses indicated a resolution of undiagnosed metabolic syndrome with FMT among those with this condition. Further trials are needed to confirm these results and identify organisms and mechanisms responsible for mediating the observed benefits. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001351505

Aim In New Zealand, there are few adequate food frequency questionnaires for assessing dietary intake. This study aimed to develop and assess the relative validity of a multi-nutrient, culturally appropriate, semi-quantitative food frequency questionnaire for use in young adult New Zealand women (the New Zealand Women's Food Frequency Questionnaire (NZWFFQ)). Methods Women (n = 110) aged 16-45 years of Māori, Pacific or European ethnicity completed a NZWFFQ assessing dietary intake over the previous month, and a 4-day weighed food record. Relative validity was evaluated by comparing nutrient intakes from the NZWFFQ with the food record using Spearman's rank correlation coefficients, cross-classification, the weighted kappa statistic and Bland-Altman analysis. Results Nutrient intake was higher from the NZWFFQ compared with the food record for all nutrients (range: 1%-64% difference) except alcohol (-16% difference). Energy-adjusted correlations ranged from 0.23 to 0.67 (average 0.48). Correct classification into same and adjacent quartiles was over 70% for all nutrients except folate and vitamin D. Gross misclassification into opposite quartiles ranged from 1% (monounsaturated fat, magnesium, calcium) to 10% (iron). The weighted kappa showed poor agreement for vitamin D and folate, fair agreement for most nutrients, and moderate agreement for fibre, vitamin E, magnesium, calcium and phosphorus. Conclusions The NZWFFQ overestimated intake of nearly all nutrients. While not suitable for assessing absolute intake, the NZWFFQ is suitable for ranking individuals based on nutrient intake demonstrating reasonable relative validity for this purpose.

Background: As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay. Objectives: We aim to describe the differences in development in rural Rwandan children at 24–36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development. Methods: We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05. Findings: In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37–3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay. Conclusion: Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.

Dietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet-disease relationships.This study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults.A subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns.Dietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand.Daily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand.Agreement of dietary pattern loadings were assessed using Tucker's congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κThree similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P0.001).The REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.

OBJECTIVES We sought to develop and evaluate the relative validity of a dietary diversity questionnaire (DDQ) that reflects food-group diversity, food variety, and micronutrient adequacy among New Zealand women. METHODS A cross-sectional study included New Zealand women (Auckland based; ages 16-45 y, n = 101), completing a 7-d DDQ and 4-d weighed food record (reference method). The relative validity of the DDQ was evaluated by correlating nutritious and discretionary dietary diversity scores (DDSs; number of food groups) and food-variety scores (number of foods), calculated from both methods. The dietary mean adequacy ratio (MAR; micronutrient intakes relative to estimated average requirements) was calculated from the weighed food record and correlated to dietary diversity and food-variety scores from the DDQ to assess construct validity. Cross-tabulation was used to explore dietary diversity measures versus adequacy ratios. Significance was set at P < 0.05. RESULTS The median (interquartile range) DDSs (maximum 25) from the DDQ-23 (21-23)-and the weighed food record-18 (17-19)-were significantly correlated (rs = 0.33, P < 0.001), as were the food-variety scores (maximum 237)-respectively, 75 (61-87) and 45 (37-52) (rs = 0.22, P < 0.03). A mean (± SD) MAR of 0.94 ± 0.04 suggested a near-adequate diet, but one-third of foods consumed were from discretionary sources. Nutritious DDS was significantly correlated with MAR for micronutrients (rs = 0.20, P ≤ 0.05). An inverse trend was observed between discretionary DDS and MAR. CONCLUSIONS The DDQ is a quick, low-burden tool for describing nutritious and discretionary dietary diversity reflecting micronutrient adequacy in high-income settings. It requires further validation across different time frames, population groups, and settings.

To investigate associations between dietary patterns, socio-demographic factors and anthropometric measurements in adult New Zealanders. Dietary patterns were identified using factor analysis in adults 15 years plus (n = 4657) using 24-h diet recall data from the 2008/09 New Zealand Adult Nutrition Survey. Multivariate regression was used to investigate associations between dietary patterns and age, gender and ethnicity. After controlling for demographic factors, associations between dietary patterns and food insecurity, deprivation, education, and smoking were investigated. Associations between dietary patterns and body mass index and waist circumference were examined adjusting for demographic factors, smoking and energy intake. Two dietary patterns were identified. ‘Healthy’ was characterised by breakfast cereal, low fat milk, soy and rice milk, soup and stock, yoghurt, bananas, apples, other fruit and tea, and low intakes of pies and pastries, potato chips, white bread, takeaway foods, soft drinks, beer and wine. ‘Traditional’ was characterised by beef, starchy vegetables, green vegetables, carrots, tomatoes, savoury sauces, regular milk, cream, sugar, tea and coffee, and was low in takeaway foods. The ‘healthy’ pattern was positively associated with age, female gender, New Zealand European or other ethnicity, and a secondary school qualification, and inversely associated with smoking, food insecurity, area deprivation, BMI and waist circumference. The ‘traditional’ pattern was positively associated with age, male gender, smoking, food insecurity and inversely associated with a secondary school qualification. A ‘Healthy’ dietary pattern was associated with higher socio-economic status and reduced adiposity, while the ‘traditional’ pattern was associated with lower socio-economic status.

To investigate vitamin D status and its determinants in school-aged children living in Auckland, New Zealand.Healthy children (n=507) aged 8-11 years were recruited from six primary schools to include a range of ethnicities and sociodemographic characteristics. Finger-prick blood spots were collected and analysed for capillary 25-hydroxyvitamin D (25(OH)D). Weight and percentage of body fat (%BF) were measured using the InBody 230 (Biospace Co. Ltd., Seoul, Korea). Information related to ethnicity, skin colour, physical activity and sun exposure were sought from parents through a questionnaire.Mean±standard deviation (SD) 25(OH)D concentration were 64±21 nmol/L, with 31% of the population presenting with 25(OH)D≥75nmol/L, 41% 50-75nmol/L and 28%50nmol/L. Capillary 25(OH)D was significantly higher in New Zealand European compared to all other ethnic groups (75±20nmol/L, P0.001). As expected, children with dark/brown skin colour had lower 25(OH)D levels compared to other skin colour categories (51±18nmol/L, P0.001). Using multiple logistic regression analysis, determinants of 25(OH)D were %BF and ethnicity.Approximately one-third of this population had 25(OH)D50nmol/L. Determinants of a 25(OH)D50nmol/L included %BF and ethnicity. Wintertime serum 25(OH)D was highly variable. There are some children at high risk of 25(OH)D50nmol/L for whom supplementation may be considered.

Dietary assessment in infants is challenging but necessary to understand the relationship between nutrition and growth and development. Currently no simple, validated methods exist to assess nutrient intake in New Zealand (NZ) infants. Therefore, this study aimed to assess the relative validity and reproducibility of a Complementary Food Frequency Questionnaire (CFFQ) to determine nutrient intakes of NZ infants. Ninety‐five parent–infant pairs (infant age 10 ± 1 months) completed the CFFQ twice (CFFQ‐1 and CFFQ‐2), 4 weeks apart (to assess reproducibility). A 4‐day weighed food record (4dWFR) was collected between CFFQ administrations (to assess validity). Validity and reproducibility were assessed for intakes of energy and 18 nutrients using Bland–Altman analysis, Pearson's correlation coefficients, cross‐classification, and weighted Kappa (κ). The CFFQ showed acceptable validity: Nutrients from the CFFQ were comparable with the 4dWFR (bias, 9–28%), correlation between methods ranged from r = .18 (saturated fat) to r = .81 (iron; mean r = .52), 54% (mean) of participants were correctly classified (range 39% to 67%), and 7.1% (mean) misclassified into opposite tertiles (range 2.1% to 14.7%). There was acceptable agreement between the CFFQ and 4dWFR (κ = 0.20–0.60). The CFFQ showed good reproducibility: Correlations ranged from r = .34 (folate) to r = .80 (zinc); for 16 nutrients, >50% of participants were correctly classified, and for all nutrients, 0.20). The CFFQ has acceptable relative validity and good reproducibility for assessing nutrient intake in NZ infants aged 9–12 months, making it a useful tool for use in future research.

Background - Loss of cognitive function is a significant issue as the world’s population ages. Preserving cognitive function maintains independence in older adults bringing major societal and financial benefits. Lifestyle factors such as diet are modifiable risk factors, which may help preserve cognitive function.\ud \ud Most nutrition research aimed at preserving cognitive function and metabolic health has focussed on individual nutrients and foods, not allowing for food combinations and interactions. A dietary pattern approach considers the entire diet including its complexity. Previous research investigating dietary patterns and cognitive function has not always considered relevant covariates such as physical activity and the Apolipoprotein E genotype, which are known to have associations with cognitive function.\ud \ud The aim of the REACH (Researching Eating, Activity and Cognitive Health) study is to investigate associations between dietary patterns, cognitive function and metabolic syndrome, accounting for a range of covariates.\ud \ud Methods - This cross-sectional study design will recruit older, community-living adults (65–74 years) from Auckland, New Zealand. Dietary data will be collected via a 109-item food frequency questionnaire validated using a 4-day food record. Cognitive function will be assessed using the Montreal Cognitive Assessment (paper based) and the Computerised Mental Performance Assessment System (COMPASS) - a testing suite covering six domains. Additional data will include genetic (Apolipoprotein E ε4) and biochemical markers (fasting glucose, HbA1c, lipids profile), anthropometric measurements (weight, height, waist and hip circumference, body composition using dual X-ray absorptiometry), blood pressure, physical activity (International Physical Activity Questionnaire – short form) and health and demographics (questionnaire).\ud \ud Dietary patterns will be derived by principal component analysis. Associations between cognitive function and dietary patterns will be examined using multiple regression analysis. Covariates and interaction factors will include age, education, socio-economic status, physical activity, Apolipoprotein E ε4 genotype, family history of dementia or cognitive impairment, and lifestyle factors. Differences between participants with and without metabolic syndrome will also be examined.\ud \ud Discussion - This study will bring new knowledge regarding associations between dietary patterns and cognitive function and metabolic health in older adults living in New Zealand. This is important for developing nutrition related recommendations to help older adults maintain cognitive function.

IntroductionAnimal studies showed that germ-free mice inoculated with normal mouse gut bacteria developed obesity, insulin resistance and higher triglyceride levels, despite similar food intake. In humans, an association has been found between obesity and gut microbiome dysbiosis. However, gut microbiome transfer has not been evaluated for the treatment of human obesity. We will examine the effectiveness of gut microbiome transfer using encapsulated material for the treatment of obesity in adolescents.Methods and analysisA two-arm, double-blind, placebo-controlled, randomised clinical trial of a single course of gut microbiome transfer will be conducted in 80 obese [body mass index (BMI) ≥30 kg/m2] adolescents (males and females, aged 14–18 years) in Auckland, New Zealand. Healthy lean donors (males and females, aged 18–28 years) will provide fresh stool samples from which bacteria will be isolated and double encapsulated. Participants (recipients) will be randomised at 1:1 to control (placebo) or treatment (gut microbiome transfer), stratified by sex. Recipients will receive 28 capsules over two consecutive mornings (~14 mL of frozen microbial suspension or saline). Clinical assessments will be performed at baseline, 6, 12 and 26 weeks, and will include: anthropometry, blood pressure, fasting metabolic markers, dietary intake, physical activity levels and health-related quality of life. Insulin sensitivity (Matsuda index), gut microbiota population structure characterised by 16S rRNA amplicon sequencing and body composition (using dual-energy X-ray absorptiometry) will be assessed at baseline, 6, 12 and 26 weeks. 24-hour ambulatory blood pressure monitoring will be performed at baseline and at 6 weeks. The primary outcome is BMI SD scores (SDS) at 6 weeks, with BMI SDS at 12 and 26 weeks as secondary outcomes. Other secondary outcomes include insulin sensitivity, adiposity (total body fat percentage) and gut microbial composition at 6, 12 and 26 weeks. Statistical analysis will be performed on the principle of intention to treat.Ethics and disseminationEthics approval was provided by the Northern A Health and Disability Ethics Committee (Ministry of Health, New Zealand; 16/NTA/172). The trial results will be published in peer-reviewed journals and presented at international conferences.Trial registration numberACTRN12615001351505; Pre-results.

This study aimed to examine the validity and reliability of the Dietary Index for a Child's Eating (DICE) in children living in New Zealand (NZ). Caregivers of healthy children aged 2–8 years completed a 4‐day estimated food record (4DFR) for their child and completed the DICE online on two separate occasions, 8 weeks apart. Relative validity was assessed by comparing the DICE and 4DFR total score and component subscores using the Wilcoxon test, Spearman rank correlation coefficients, cross‐classification, and weighted kappa (ĸ) statistic. For evaluating construct validity, the DICE total score was compared with energy and nutrient intake from the 4DFR using linear contrast analysis. Intraclass correlation coefficients (Cronbach's α) and Bland–Altman plots were used to assess the reliability of DICE. From a possible score of 100, the mean ± standard deviation of DICE was 78.2 ± 11.5 and from the 4DFR, was 73.8 ± 10.8, with a positive correlation (r = 0.72; p

Factures are common during childhood. There are limited data available regarding relationships between bone fracture history and calcium intake, sugar sweetened beverages (SSBs) intake, vitamin D status, physical activity (PA), ethnicity, and body composition in New Zealand (NZ) children. Identifying groups of NZ children at risk of fracture and associated predictors may help to improve bone quality during childhood and decrease the risk of fractures throughout life. The aim of this study was to investigate fracture history and associated risk factors in New Zealand children. Children aged 8-12 years were recruited. Capillary blood spots collected from a finger prick were as analyzed for 25(OH)D concentrations. Bioelectrical impedance analysis (InBody720, Seoul, Korea) was used to measure body fat percentage (%BF). Information about fracture history, siblings' history of fractures, family osteoporosis history, PA, ethnicity, and intake of calcium containing foods, and SSBs was collected using questionnaires. Children (n = 647, 354 girls), mean ± SD age 9.8 ± 0.7 years were recruited from six Auckland primary schools. NZ European (n = 252) (NZE) and South Asian (n = 68) children reported the lowest (20.2 %) and highest (44.1 %) fracture incidence, respectively. NZE compared to South Asian children, had higher 25(OH)D concentrations (74.6 ± 19.8 vs. 48.4 ± 19.3 nmol/L, P < 0.001), higher total calcium intake (764.0 ± 394.4 vs. 592.7 ± 266.3 mg/d, P < 0.018), and lower %BF (19.5 ± 6.6 vs. 23.4 ± 8.4, P < 0.003). Māori children had the next highest fracture rate (32.5 %). This group had adequate 25(OH)D (64.2 ± 18.9 nmol/L), but high %BF (23.9 %) and most participated in vigorous PA. After stratifying by sex, binary logistic regression analysis revealed the main determinants of fracture history for boys were high %BF, low 25(OH)D, low calcium intake, high SSBs consumption, siblings' fracture history, family osteoporosis history, and being South Asian; and in girls, high SSBs consumption, siblings' fracture history, and family osteoporosis history. We found South Asian ethnicity was a significant risk factor for boys. Some children were at high risk of vitamin D deficiency and for whom supplementation may be necessary in winter. Good nutrition (especially good sources of calcium and reducing SSBs intakes) should be recommended to children during growth and development to reduce their risk of fractures.

The aim of this study was to compare food fussiness, weight, serious choking, and early feeding characteristics in babies following Baby-Led Weaning (BLW) and babies following traditional spoon-feeding (TSF) at 6–7 months of age. The First Foods New Zealand Internet Survey recruited 876 New Zealand caregivers of children aged 6–36 months through social media. Information was collected on food fussiness, infant weight, choking, infant feeding practices, and demographics. Based on infant feeding at 6–7 months of age, participants were described as: TSF (mostly or all adult spoonfed), partial BLW (half adult spoonfed, half self-fed), or full BLW (mostly or all self-fed). A total of 628 (72%), 93 (11%), and 155 (18%) infants followed TSF, partial BLW, and full BLW respectively. Compared to infants following TSF, infants following full BLW had significantly lower food fussiness scores at 6–36 months (difference, 95% CI: −0.37,-0.51 to −0.24). Infants following BLW had been exclusively breastfed for longer (P = 0.019), and at 6–7 months had 1.96 times the odds of consuming red meat, but 0.10 times the odds of consuming iron-fortified infant cereal. Only 21% of BLW participants had received advice from a health professional. In conclusion, many New Zealand parents are following BLW. Benefits associated with BLW included less food fussiness. Although BLW infants were more likely to eat red meat, they were less likely to eat iron-fortified infant cereal. These results suggest the need for studies with biochemical measurement of nutritional status, standardized measurement of weight, and rigorous assessment of diet in infants following BLW.

In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death. Here, we share our experience developing and piloting an inpatient malnutrition checklist (MLNC) for children 6 to 59 months and associated scoring system to coordinate care delivery, improve team documentation, strengthen WHO malnutrition protocol adherence and facilitate quality improvement in a district hospital in rural Rwanda. MLNC was developed after careful review of the 2009 Rwandan National Nutrition Protocol and 2013 WHO malnutrition guidelines. Critical steps were harmonized, extracted and designed into an initial MLNC with input from pediatric ward nurses, doctors, a locally based pediatrician and a registered dietitian. A scoring system was developed to facilitate quality improvement. Using the standard Plan-Do-Study-Act cycle, MLNC was modified and progress assessed on a monthly to bimonthly basis. Significant modifications occurred in the first 6 months of piloting including incorporation of treatment reminders and formatting improvements, as well as initiation of the MLNC from the emergency department. The MLNC is the first checklist to be developed that unifies WHO 10 steps of treatment of inpatient SAM with local standards. Anecdotally, MLNC was observed to identify gaps in key malnutrition care, promote protocol adherence and facilitate quality improvement. Data gathering on the MLNC local facility impact is underway. Collaborative international efforts are needed to create an inpatient malnutrition checklist for wider use to improve quality and reduce unnecessary, facility-based child mortality.

To investigate dietary intakes and food sources of polyunsaturated fatty acids in New Zealand pregnant women.Women (n=596) 16 years plus in trimester three of pregnancy completed an online food frequency questionnaire validated for omega-3 and omega-6 polyunsaturated fatty acids.Estimated median [25th, 75th percentile] intakes of omega-3 polyunsaturated fatty acids were: 1,300 [790, 2,120] mg/d alpha-linolenic acid (adequate intake 1,000mg/d); 220 [120, 520] mg/d total long chain omega-3 polyunsaturated fatty acids (adequate intake 115mg/d); and 110 [50, 250] mg/d docosahexaenoic acid (recommended 200mg/d). Only 30.9% of participants consumed more than 200mg/d docosahexaenoic acid. Participants taking omega-3 supplements (19.6%) were 16.5 times more likely to meet recommendations for docosahexaenoic acid. Fish and seafood were the main contributors to docosahexaenoic acid (84.8%) intakes, yet only 21.7% of women consumed fish at least twice per week. Intakes of omega-6 polyunsaturated fatty acids were 11,580 [8,840, 15,760] mg/d linoleic acid (adequate intake 10,000mg/d) and 90 [60, 110] mg/d arachidonic acid (upper limit 800mg/d).Most participants did not meet recommended intakes for docosahexaenoic acid, which may be partly due to low intakes of fish, seafood and omega-3 supplements.

This study investigated dietary patterns and nondietary determinants of suboptimal iron status (serum ferritin < 20 μg/L) in 375 premenopausal women. Using multiple logistic regression analysis, determinants were blood donation in the past year [OR: 6.00 (95% CI: 2.81, 12.82);P<0.001], being Asian [OR: 4.84 (95% CI: 2.29, 10.20);P<0.001], previous iron deficiency [OR: 2.19 (95% CI: 1.16, 4.13);P=0.016], a “milk and yoghurt” dietary pattern [one SD higher score, OR: 1.44 (95% CI: 1.08, 1.93);P=0.012], and longer duration of menstruation [days, OR: 1.38 (95% CI: 1.12, 1.68);P=0.002]. A one SD change in the factor score above the mean for a “meat and vegetable” dietary pattern reduced the odds of suboptimal iron status by 79.0% [OR: 0.21 (95% CI: 0.08, 0.50);P=0.001] in women with children. Blood donation, Asian ethnicity, and previous iron deficiency were the strongest predictors, substantially increasing the odds of suboptimal iron status. Following a “milk and yoghurt” dietary pattern and a longer duration of menstruation moderately increased the odds of suboptimal iron status, while a “meat and vegetable” dietary pattern reduced the odds of suboptimal iron status in women with children.

Anecdotally, it is suggested that Pacific Island women have good bone mineral density (BMD) compared to other ethnicities; however, little evidence for this or for associated factors exists. This study aimed to explore associations between predictors of bone mineral density (BMD, g/cm²), in pre-menopausal Pacific Island women. Healthy pre-menopausal Pacific Island women (age 16-45 years) were recruited as part of the larger EXPLORE Study. Total body BMD and body composition were assessed using Dual X-ray Absorptiometry and air-displacement plethysmography (n = 83). A food frequency questionnaire (n = 56) and current bone-specific physical activity questionnaire (n = 59) were completed. Variables expected to be associated with BMD were applied to a hierarchical multiple regression analysis. Due to missing data, physical activity and dietary intake factors were considered only in simple correlations. Mean BMD was 1.1 ± 0.08 g/cm². Bone-free, fat-free lean mass (LMO, 52.4 ± 6.9 kg) and age were positively associated with BMD, and percent body fat (38.4 ± 7.6) was inversely associated with BMD, explaining 37.7% of total variance. Lean mass was the strongest predictor of BMD, while many established contributors to bone health (calcium, physical activity, protein, and vitamin C) were not associated with BMD in this population, partly due to difficulty retrieving dietary data. This highlights the importance of physical activity and protein intake during any weight loss interventions to in order to minimise the loss of muscle mass, whilst maximizing loss of adipose tissue.

Obesity is a leading cause of morbidity and mortality, yet is preventable. This study aimed to investigate associations between body mass index, body fat percentage and obesity-related eating behaviors. Women (n = 116; 18–44 years) were measured for height, weight and body fat using air displacement plethysmography (BodPod). Women completed the validated Three Factor Eating Questionnaire to assess their eating behaviors using Restraint, Disinhibition and Hunger eating factor categories and sub-categories. The eating behavior data were analyzed for associations with body mass index and body fat percentage, and comparisons across body mass index and body fat percentage categories (< vs. ≥25 kg/m2; < vs. ≥30%, respectively). Women had a mean (standard deviation) body mass index of 23.4 (3.5) kg/m2, and body fat percentage of 30.5 (7.6)%. Disinhibition was positively associated with both body mass index (p < 0.001) and body fat percentage (p < 0.001). Emotional Disinhibition was positively associated with body fat percentage (p < 0.028). Women with low Restraint and high Disinhibition had significantly higher body mass index and body fat percentage than women with high Restraint and low Disinhibition. Disinhibition seems likely to be an important contributor to obesity. Tailored intervention strategies focused on counteracting Disinhibition should be a key target area for managing weight/fat gain.

To investigate associations between dietary patterns and suboptimal iron status in premenopausal women living in Auckland, New Zealand.Premenopausal women (n = 375; 18-44 years) were included in this cross-sectional analysis. Suboptimal iron status was defined as serum ferritin20 μg/L. Participants completed a 144-item iron food frequency questionnaire (FeFFQ) and a questionnaire on dietary practices to assess dietary intake over the past month. Factor analysis was used to determine dietary patterns from the FeFFQ. Logistic regression was used to determine associations between these dietary patterns and iron status.Seven dietary patterns were identified: refined carbohydrate and fat; Asian; healthy snacks; meat and vegetable; high tea and coffee; bread and crackers; and milk and yoghurt. Logistic regression suggested that following a "meat and vegetable" dietary pattern reduced the risk of suboptimal iron status by 41 % (95 % CI: 18, 58 %; P = 0.002) and following a "milk and yoghurt" pattern increased the risk of suboptimal iron status by 50 % (95 % CI: 15, 96 %; P = 0.003).These results suggest that dietary patterns characterized by either a low intake of meat and vegetables or a high intake of milk and yoghurt are associated with an increased risk of suboptimal iron status. Dietary pattern analysis is a novel and potentially powerful tool for investigating the relationship between diet and iron status.

Using food frequency data to identify dietary patterns is a newly emerging approach to assessing the relationship between dietary intake and iron status. Food frequency questionnaires should be assessed for validity and reproducibility before use.We aimed to investigate the relative validity and reproducibility of an iron food frequency questionnaire (FeFFQ) specifically designed to identify iron-related dietary patterns.Participants completed the FeFFQ at baseline (FeFFQ1) and 1 month later (FeFFQ2) to assess reproducibility. A 4-day weighed diet record (4DDR) was completed between these assessments to determine validity. Foods appearing in the 4DDR were classified into the same 144 food groupings as the FeFFQ. Factor analysis was used to determine dietary patterns from FeFFQ1, FeFFQ2, and the 4DDR.A convenience sample of women (n=115) aged 18 to 44 years living in Auckland, New Zealand, during 2009.Agreement between diet pattern scores was compared using correlation coefficients, Bland-Altman analysis, cross-classification, and the weighted κ statistic.A "healthy" and a "sandwich and drinks" dietary pattern were identified from all three dietary assessments. Correlation coefficients between FeFFQ1 and the 4DDR diet pattern scores (validity) were 0.34 for the healthy, and 0.62 for the sandwich and drinks pattern (both Ps0.001). Correlation coefficients between the two FeFFQs (reproducibility) were 0.76 for both the healthy and sandwich and drinks pattern (P0.001). The FeFFQ1 correctly classified50% of participants into the correct tertile and10% into the opposite tertile for both the healthy and sandwich and drinks diet pattern scores when compared with the 4DDR and FeFFQ2.The FeFFQ appears to be a reproducible and relatively valid method for identifying dietary patterns, and could be used to investigate the relationship between dietary patterns and iron status.

To determine the relationship between iron depletion and self-perceived health, well-being, and fatigue in a female university student population living in New Zealand.A total of 233 women aged 18-44 years studying at Massey University, Auckland, were included in this cross-sectional analysis. Serum ferritin (SF), hemoglobin (Hb), and C-reactive protein (CRP) were analyzed from a venipuncture blood sample. Participants completed the SF-36v2 General Health Survey (SF-36) and the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) questionnaire, and anthropometric measurements (height and weight) and data on demographics, lifestyle, and medical history were obtained. Characteristics of iron-sufficient (SF ≥ 20 μg/L, Hb ≥ 120 g/L) and iron-depleted (SF20 μg/L, Hb ≥ 120 g/L) participants were compared, and multiple regression analyses were carried out to determine predictors of health, well-being, and fatigue using a p value of0.01 to indicate statistical significance because multiple comparisons were being made.There were no significant differences in self-perceived health and well-being determined using the SF-36 questionnaire between women who were iron sufficient and women who were iron depleted. Although MFSI-SF physical fatigue was significantly lower in those with iron depletion (p = 0.008), it was not predicted by current iron status in a multivariate model controlling for factors expected to be associated with iron status and fatigue (p = 0.037). However, smoking, a history of suboptimal iron status, and having a current medical condition were significant (negative) predictors of MFSI-SF physical fatigue, explaining 22.5% of the variance (p0.001). There were no significant differences in the other measures of fatigue determined using the MFSI-SF between women who were iron sufficient and those who were iron depleted.Women with iron depletion did not differ significantly from women who were iron sufficient with regard to self-perceived health, well-being, or fatigue. Future studies investigating fatigue should control for previous diagnosis of suboptimal iron status, smoking, and presence of a medical condition.

Perception of fat taste, aroma, and texture are proposed to influence food preferences, thus shaping dietary intake and eating behaviour and consequently long-term health. In this study, we investigated associations between fatty acid taste, olfaction, mouthfeel of fat, dietary intake, eating behaviour, and body mass index (BMI). Fifty women attended three sessions to assess oleic acid taste and olfaction thresholds, the olfactory threshold for n-butanol and subjective mouthfeel ratings of custard samples. Dietary intake and eating behaviour were evaluated using a Food Frequency and Three-Factor Eating Questionnaire, respectively. Binomial regression analysis was used to model fat taste and olfaction data. Taste and olfactory detection for oleic acid were positively correlated (r = 0.325; p < 0.02). Oleic acid taste hypersensitive women had significantly increased n-butanol olfactory sensitivity (p < 0.03). The eating behaviour disinhibition and BMI were higher in women who were hyposensitive to oleic acid taste (p < 0.05). Dietary intake of nuts, nut spreads, and seeds were significantly correlated with high olfactory sensitivity to oleic acid (p < 0.01). These findings demonstrate a clear link between fatty acid taste sensitivity and olfaction and suggest that fat taste perception is associated with specific characteristics of eating behaviour and body composition.

Ballet dancing is a multifaceted activity requiring muscular power, strength, endurance, flexibility, and agility; necessitating demanding training schedules. Furthermore dancers may be under aesthetic pressure to maintain a lean physique, and adolescent dancers require extra nutrients for growth and development. This cross-sectional study investigated the nutritional status of 47 female adolescent ballet dancers (13–18 years) living in Auckland, New Zealand. Participants who danced at least 1 hr per day 5 days per week completed a 4-day estimated food record, anthropometric measurements (Dual-energy X-ray Absorptiometry) and hematological analysis (iron and vitamin D). Mean BMI was 19.7 ± 2.4kg/m2 and percentage body fat, 23.5 ± 4.1%. The majority (89.4%) of dancers had a healthy weight (5th-85th percentile) using BMI-for-age growth charts. Food records showed a mean energy intake of 8097.3 ± 2155.6kJ/day (48.9% carbohydrate, 16.9% protein, 33.8% fat, 14.0% saturated fat). Mean carbohydrate and protein intakes were 4.8 ± 1.4 and 1.6 ± 0.5g/kg/day respectively. Over half (54.8%) of dancers consumed less than 5g carbohydrate/kg/day, and 10 (23.8%) less than 1.2 g protein/kg/day. Over 60% consumed less than the estimated average requirement for calcium, folate, magnesium and selenium. Thirteen (28.3%) dancers had suboptimal iron status (serum ferritin (SF)

Examining dietary patterns provides an alternative approach to investigating dietary behaviors related to excess adiposity. The study aim was to investigate dietary patterns and body composition profiles of New Zealand European (NZE) women, participating in the women’s EXPLORE (Examining the Predictors Linking Obesity Related Elements) study. Post-menarche, pre-menopausal NZE women (16–45 years) (n = 231) completed a validated 220-item, self-administrated, semi-quantitative food frequency questionnaire. Body mass index (BMI) was calculated using measured height (cm) and weight (kg); body fat percentage (BF%) was measured using air displacement plethysmography (BodPod). Dietary patterns were identified using principal component factor analysis. Associations between dietary patterns, age, BMI and BF% were investigated. Four dietary patterns were identified: snacking; energy-dense meat; fruit and vegetable; healthy, which explained 6.9%, 6.8%, 5.6% and 4.8% of food intake variation, respectively. Age (p = 0.012) and BMI (p = 0.016) were positively associated with the “energy-dense meat” pattern. BF% (p = 0.016) was positively associated with the “energy-dense meat” pattern after adjusting for energy intake. The women following the identified dietary patterns had carbohydrate intakes below and saturated fat intakes above recommended guidelines. Dietary patterns in NZE women explain only some variations in body composition. Further research should examine other potential factors including physical activity and socioeconomic status.

Low vitamin D status in early development has been hypothesised as an environmental risk factor for Autism Spectrum Disorder (ASD), given the concurrent increase in the prevalence of these two conditions, and the association of vitamin D with many ASD-associated medical conditions. Identification of vitamin D-ASD factors may provide indications for primary and secondary prevention interventions. We systematically reviewed the literature for studies on vitamin D-ASD relationship, including potential mechanistic pathways. We identified seven specific areas, including: latitude, season of conception/birth, maternal migration/ethnicity, vitamin D status of mothers and ASD patients, and vitamin D intervention to prevent and treat ASD. Due to differences in the methodological procedures and inconsistent results, drawing conclusions from the first three areas is difficult. Using a more direct measure of vitamin D status--that is, serum 25(OH)D level during pregnancy or childhood--we found growing evidence for a relationship between vitamin D and ASD. These findings are supported by convincing evidence from experimental studies investigating the mechanistic pathways. However, with few primary and secondary prevention intervention trials, this relationship cannot be determined, unless randomised placebo-controlled trials of vitamin D as a preventive or disease-modifying measure in ASD patients are available.

Ascorbic acid, and more recently, the carotenoids lutein and zeaxanthin have been shown to enhance Fe absorption. However, it is not clear whether Fe status improves when foods high in ascorbic acid and carotenoids are consumed with Fe-fortified meals. The present study aimed to investigate whether consuming highv.low ascorbic acid-, lutein- and zeaxanthin-rich fruit (gold kiwifruitv.banana) with Fe-fortified breakfast cereal and milk improved Fe status in women with low Fe stores. Healthy women aged 18–44 years (n89) with low Fe stores (serum ferritin ≤ 25 μg/l and Hb ≥ 115 g/l) were randomly stratified to receive Fe-fortified breakfast cereal (16 mg Fe as ferrous sulfate), milk and either two gold kiwifruit or one banana (164 mgv.not detectable ascorbic acid; 526v.22·90 μg lutein and zeaxanthin, respectively) at breakfast every day for 16 weeks. Biomarkers of Fe status and dietary intake were assessed at baseline and end in the final sample (n69). Median serum ferritin increased significantly in the kiwifruit group (n33) compared with the banana group (n36), with 10·0 (25th, 75th percentiles 3·0, 17·5)v.1·0 (25th, 75th percentiles − 2·8, 6·5) μg/l (P v.0·0 (25th, 75th percentiles − 0·3, 0·4) mg/l (P = 0·001). Consumption of an Fe-fortified breakfast cereal with kiwifruit compared with banana improved Fe status. Addition of an ascorbic acid-, lutein- and zeaxanthin-rich fruit to a breakfast cereal fortified with ferrous sulfate is a feasible approach to improve Fe status in women with low Fe stores.