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Aims: To describe an Aboriginal cultural immersion delivered to dietetics students at a large university in Australia and assess its effectiveness as a method to teach Aboriginal history, culture, diet, and health in dietetics. Methods: Taking a strength‐based approach, Aboriginal processes of learning were privileged, with the cultural immersion being co‐designed with immersion educators, a First Nations researcher, and dietetics academic. The cultural immersion consisted of an opening ceremony and four stations of yarning, weaving, bush tucker, and artefacts/medicines. A mixed‐methods approach was used, with triangulation of data from pre‐ and postsurveys, station mapping, and focus group interviews. Quantitative and qualitative data were simultaneously analysed from participating first‐year Master of Nutrition and Dietetics students and then drawn together for an integrated understanding of the impact of the cultural immersion on student learnings. Results: Fifty‐three students completed pre‐ and postsurveys and 36 participated in focus groups. Through sharing lived experiences, learning through culture, and keeping sessions practical and Aboriginal leadership, each cultural immersion station utilised Aboriginal processes of learning that meaningfully engaged students with Aboriginal education content, appreciate holistic health and increased their general knowledge on Aboriginal history, culture, diet, and health (all p < 0.001). Conclusion: Cultural immersion is one teaching method to enhance student knowledges and can be a part of a programmatic and integrated approach that embeds Aboriginal content throughout the whole curriculum. It is necessary that institutions recognise the value of cultural immersions to student learnings and commit to providing ongoing support. [ABSTRACT FROM AUTHOR]

This paper examines whether the motivations and experiences of 'anti-diet' dietitians and psychologists represent a paradigm shift in healthcare. We conducted four 2-hour, discipline-specific focus groups with a total of 16 female participants residing in Australia. Our reflexive thematic analysis generated four themes that we consider to be stages of a weight-neutral paradigm shift: (1) a recognition of a mismatch between one's weight-centred training and one's lived experience of diet culture, which subsequently informs (2) gut feelings that influence their decision to reject the weight-centric paradigm, thereby leading to (3) exploring the anti-diet knowledge base and then subsequently (4) promoting or advocating for the weight neutral paradigm. Our findings represent a four-stage paradigm shift in action; emphasising the significance of lived experience in the weight-neutral turn, as well as differences in symbolic power between health professionals. Future research should focus on potential ruptures or conflicts within the weight-neutral paradigm itself, and look more deeply into the experiences of other health professionals who are critical of the weight-centred approach. [ABSTRACT FROM AUTHOR]

Aim: To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management. Method: A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open‐ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio‐ecological systems framework. Results: At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual‐level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM. Conclusion: Findings suggest a demand for more supportive, person‐centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a complex immune‐mediated disease with no currently known cure. There is growing evidence to support the role of diet in reducing some of the symptoms and disease progression in MS, and we previously developed and tested the feasibility of a digital nutrition education program for people with MS. Objective: The aim of this study was to explore factors that influenced engagement in the digital nutrition education program, including features influencing capability, opportunity and motivation to change their dietary behaviours. Methods: Semi‐structured interviews were conducted with people who had MS, and who completed some or all of the program until data saturation was reached. Interviews were analysed inductively using thematic analysis. Themes were deductively mapped against the COM‐B (Capability, Opportunity, Motivation, Behaviour) behaviour change model. Results: Sixteen interviews were conducted with participants who completed all (n = 10) or some of the program (n = 6). Four themes emerged: (1) acquiring and validating nutrition knowledge; (2) influence of time and social support; (3) getting in early to improve health and (4) accounting for food literacy experiences. Discussion: This is the first online nutrition program with suitable behavioural supports for people with MS. It highlights the importance of disease‐specific and evidence‐based nutrition education to support people with MS to make dietary changes. Acquiring nutrition knowledge, coupled with practical support mechanisms, such as recipe booklets and goal setting, emerged as crucial for facilitating engagement with the program. Conclusions: When designing education programs for people with MS and other neurological conditions, healthcare professionals and program designers should consider flexible delivery and building peer support to address the needs and challenges faced by participants. Patient or Public Contribution: Members of the MS Nutrition Research Program Stakeholder Reference Group, which includes people with MS and MS health professionals, provided input during the development of the nutrition education program and study design stages. [ABSTRACT FROM AUTHOR]

Background: Wearing complete denture in one or both arches can impact enjoyment of eating and affect quality of life compared with being dentate. Clinicians focus on issuing technically sound dentures but ignore the impact of wearing dentures on the eating‐related quality of life which affects the success of treatment. Objectives: The aim of this research was to qualitatively explore ERQoL in Australian adults wearing complete dentures using a validated questionnaire and through focus groups. Methods: Complete denture wearers (n = 44) were recruited from dental clinics and invited to complete the self‐administered Emotional and Social Issues Related to Eating questionnaire. Responses were categorised under the six questionnaire domains. A subsample of 20 participants who completed the questionnaire were invited to participate in focus groups to identify emerging themes. Results: Twenty‐three participants (52.3%) completed the questionnaire. Most participants expressed a decline in enjoyment of eating due to reduced ability to eat, longer chewing times and the need to frequently clean dentures while eating. Focus groups (n = 2 × 4 participants) indicated educational materials on eating with dentures would increase recognition of eating problems with dentures and reduce trial and error approaches to dealing with these. Conclusion: ERQoL is adversely affected by wearing complete dentures due to functional limitations, restricted food choices and adaptive eating behaviours. Patient support for eating well with a complete denture/s wearers is required. [ABSTRACT FROM AUTHOR]

Poison frogs are well known for their ability to sequester alkaloids from their diet of leaf-litter arthropods for use in defense against predators and pathogens. Australian frogs in the genus Pseudophryne (Myobatrachidae) represent an understudied lineage of poison frogs, with a unique ability to both sequester dietary alkaloids and synthesize pseudophrynamine alkaloids. Herein, we describe the alkaloid profiles and diet of six species of Pseudophryne (P. guentheri [Boulenger, 1882], P. occidentalis [Parker, 1940], P. semimarmorata [Lucas, 1892], P. dendyi [Lucas 1892], P. bibronii [Günther, 1859], and P. coriacea [Keferstein, 1868]) to gain a better understanding of how alkaloid defenses and diet are related within and among species. We characterized and quantified alkaloids using Gas Chromatography-Mass Spectrometry (GC-MS), and assessed diet by way of dissection and examination of stomach contents using light microscopy. We found that alkaloid profiles varied significantly among species, with pumiliotoxins (dietary-derived) and pseudophrynamines (biosynthesized) being the most abundant alkaloids. Pseudophryne bibronii and P. dendyi contained mostly dietary-derived alkaloids, whereas P. coriacea, P. guentheri, P. semimarmorata, and P. occidentalis possessed mostly biosynthesized alkaloids. The stomachs of all the studied species were largely empty, containing mostly soil and few partially digested insects. Our data suggest that frogs eat minimally during the breeding season. Therefore, a decrease in dietary alkaloids may be compensated by the biosynthesized pseudophrynamines, which could allow Australian poison frogs to remain defended from predators during this vulnerable time period. [ABSTRACT FROM AUTHOR]

Aims. To understand what domains of acculturation are experienced by Chinese immigrants with cardiovascular disease (CVD) in Australia and how these domains of acculturation influence their CVD self‐care behaviours. Design. A qualitative descriptive design. Methods. Individual phone interviews were conducted among Chinese immigrants with CVD in Sydney, recruited from Chinese Community associations and social media. Inductive and deductive thematic analysis was employed, guided by the Middle‐Range Theory of Self‐Care of Chronic Illness and the conceptual model of acculturation. Results. Twenty participants, mean age 69.9 years, were interviewed. The domains of acculturation in relation to CVD self‐care behaviours encompassed cultural practices, cultural values, healthcare system navigation, and new living environment. Retaining their Chinese culture and integrating into Australian culture regarding dietary practices, social networks, traditional values and family relationships served as both enablers and barriers of self‐care maintenance through factors such as heart‐healthy diets, physical activity, stress management and medication adherence. Many participants denied encountering difficulties to utilize primary care services, but language barriers deterred them from accessing acute services and heart‐health information from mainstream sources. Some preserved beliefs and practices in Traditional Chinese Medicine may complicate their self‐care maintenance (medication adherence) and self‐care management (responding to acute angina episodes). Conclusion. The influence of acculturation on CVD self‐care behaviours among Chinese immigrants is multifaceted and individualized. Clinicians and community health workers should assess patients' acculturation experiences to enable culturally sensitive practices. The lack of culturally and linguistically appropriate heart health information in the community should be addressed urgently to mitigate the cardiac health disparity. Collaboration with Chinese community associations offers an opportunity for co‐design and dissemination of information about Australian healthcare systems and heart health education to upskill CVD self‐care practices and mitigate the health inequities experienced by Chinese immigrants. [ABSTRACT FROM AUTHOR]

Purpose: This study examined maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors. Methods: Data of 473 Australian women from the Healthy Beginnings Trial were used. A food frequency questionnaire collected dietary intake in pregnancy and 1, 2 and 3.5 years postpartum. Diet quality scores were calculated using the 2013 Dietary Guideline Index (DGI-2013) and RESIDential Environments Guideline Index (RDGI). Group-based trajectory modelling identified diet quality trajectories from pregnancy to 3.5 years postpartum. Multivariable logistic regression investigated factors associated with maternal diet quality trajectories. Results: Two stable trajectories of low or high diet quality were identified for the DGI-2013 and RDGI. Women who smoked had higher odds of following the low versus the high DGI-2013 (OR 1.77; 95%CI 1.15, 2.75) and RDGI (OR 1.80; 95%CI 1.17, 2.78) trajectories, respectively. Women who attended university had lower odds of following the low versus the high DGI-2013 (OR 0.41; 95%CI 0.22, 0.76) and RDGI (OR 0.38; 95%CI 0.21, 0.70) trajectories, respectively. Women who were married had lower odds of following the low versus the high DGI-2013 trajectory (OR 0.39; 95%CI 0.17, 0.89), and women who were unemployed had higher odds of following the low versus the high RDGI trajectory (OR 1.78; 95%CI 1.13, 2.78). Maternal age, country of birth, household composition and pre-pregnancy body mass index were not associated with diet quality trajectories. Conclusion: Maternal diet quality trajectories remained stable from pregnancy to 3.5 years postpartum. Women who smoked, completed high school or less, were not married or were unemployed tended to follow low, stable diet quality trajectories. [ABSTRACT FROM AUTHOR]

Background: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three‐arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian‐led telehealth intervention at 3 months. Methods: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non‐core foods were reported. Results: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) −0.0 to 12.9], p = 0.049), non‐core foods (−6.4%/day [95% CI −12.9 to 0.0], p = 0.049), sweetened drinks (−1.7%/day [95% CI −2.9 to −0.4], p = 0.013), takeaway foods (−2.3%/day [95% CI −4.5 to −0.1], p = 0.045) and sodium (−478 mg/day [95% CI −765 to −191 mg], p = 0.001). Conclusions: A dietitian‐led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change. Highlights: A full range of dietary intake variables, eating behaviours, sleep quality and physical activity was evaluated.There was a significant negative relationship between change in diet quality and change food addiction (FA) symptoms at 3 months compared to baseline, indicating that, as FA symptoms decreased, diet quality increased.Participants allocated to the active intervention group reported statistically significant improvements in a range of dietary intake variables compared to the participants allocated to the passive intervention or control groups. [ABSTRACT FROM AUTHOR]

Background: Many young adults report poor diet quality. However, research evaluating whether young adult males and females differ in diet quality is limited. Additionally, although diet quality has a known inverse association with body mass index (BMI), it is unclear whether this association is observed in young adults and whether it varies by gender. The present study aimed to evaluate gender differences in diet quality in young adults, as well as the associations between diet quality and BMI. Methods: Data collected via the Healthy Eating Quiz (HEQ) in respondents aged 18–35 years between July 2019 and December 2021 were analysed, including demographics, and diet quality calculated using the Australian Recommended Food Score (ARFS). Differences in characteristics were analysed using a two‐sample t‐test, chi‐squared and one‐way analysis of covariance. Linear regressions were performed to estimate associations between diet quality and BMI. An interaction term was included in the model to test differences between genders. Results: The respondents (n = 28,969) were predominantly female (70.8%) with a mean ± SD age of 25.9 ± 5.0 years and BMI of 24.6 ± 5.2 kg/m2. The mean ± SD ARFS was significantly different between females and males (33.1 ± 8.6 vs. 31.4 ± 9.3 points out of 70; p < 0.001). Diet quality had a small, significant inverse association with BMI in both genders. The interaction effect between diet quality score and gender in predicting BMI was significant (p < 0.001), suggesting the impact of diet quality on BMI varies by gender, with lower diet quality more strongly associated with higher BMI in females compared to males. Conclusion: Interventions that target young adults are needed to improve diet quality and its potential contribution to BMI status. As a result of the small observed effect sizes, caution should be applied in interpreting these findings. Key points: Young male and female adults (18–35 years) demonstrate significantly different diet quality, with females scoring higher.Diet quality and body mass index (BMI) were inversely associated in both males and females, but the impact of diet quality on BMI varies by gender.Dietary interventions in young adults are needed to improve diet quality and the contribution to BMI status. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration: ACTRN12622000596707, Protocol version 1. [ABSTRACT FROM AUTHOR]

Parenting practices such as parental monitoring are known to positively impact dietary behaviours in offspring. However, links between adolescent‐perceived parental monitoring and dietary outcomes have rarely been examined and never in an Australian context. This study investigated whether adolescent‐perceived parental monitoring is associated with more fruit and vegetable, and less sugar‐sweetened beverages (SSB) and junk food consumption in Australian adolescents. Cross‐sectional data was collected as part of baseline measurement for a randomised controlled trial in 71 Australian schools in 2019. Self‐reported fruit, vegetable, SSB and junk food intake, perceived parental monitoring and sociodemographic factors were assessed. Each dietary variable was converted to "not at risk/at risk" based on dietary guidelines, binary logistic regressions examined associations between dietary intake variables and perceived parental monitoring while controlling for gender and socio‐economic status. The study was registered in ANZCTR clinical trials. The sample comprised 6053 adolescents (Mage = 12.7, SD = 0.5; 50.6% male‐identifying). The mean parental monitoring score was 20.1/24 (SD = 4.76) for males and 21.9/24 (SD = 3.37) for females. Compared to adolescents who perceived lower levels of parental monitoring, adolescents reporting higher parental monitoring had higher odds of insufficient fruit (OR = 1.03; 95% CI = 1.02–1.05) and excessive SSB (OR = 1.07; 95% CI = 1.06–1.09) intake, but lower odds of excessive junk food (OR = 0.96; 95% CI = 0.95–0.98) and insufficient vegetable (OR = 0.97, 95% CI = 0.96–0.99) intake. Adolescent dietary intake is associated with higher perceived parental monitoring; however, these associations for fruit and SSB differ to junk food and vegetable intake. This study may have implications for prevention interventions for parents, identifying how this modifiable parenting factor is related to adolescent diet has highlighted how complex the psychological and environmental factors contributing to dietary intake are. Key messages: Little research has been conducted on adolescent‐perceived parental monitoring, which is a factor contributing to overall parenting styles, and its relationship with adolescent's dietary intake. This study found that perceived parental monitoring is significantly associated with adolescent dietary intake, despite the increased autonomy and independence over food choices at this age.Our findings indicated that higher perceived parental monitoring is significantly associated with fruit, vegetable, sugar‐sweetened beverage and junk food intake in different ways, highlighting how complex the psychological and environmental factors contributing to dietary intake are.Further research is needed incorporating parents' own diet and different parenting practices from both an adolescent and parents' perspective to help better depict the most recommended style for the optimum diet during adolescence. [ABSTRACT FROM AUTHOR]

Feeding habits of herbivorous fishes play an important role in shaping the form and function of coastal marine ecosystems. Rabbitfishes (Siganidae) are important consumers of macroalgae on Indo‐West Pacific coral reefs. However, it is unclear how their diet varies among and within species at biogeographical scales, casting doubt on their precise functional roles across different regions. The present study assessed the inter‐ and intra‐specific diet variation of four rabbitfishes (Siganus trispilos, Siganus corallinus, Siganus virgatus and Siganus doliatus) factored by morphological relatedness among populations from Ningaloo Reef (western Australia), the Great Barrier Reef (GBR, eastern Australia) and the Yaeyama Islands (Okinawa Prefecture, Japan). Results showed that the region had a strong effect on diet, effectively reducing the expected effect of morphologic similitude. While intra‐specific differences were only significant when populations inhabited different regions; interspecific differences were not as predicted, with different morphotypes having similar diets when populations inhabited the same regions. Rabbitfishes consumed more corticated and filamentous macroalgae on the GBR, more foliose and membranous macroalgae at the Yaeyama Islands, and more leathery macroalgae at Ningaloo Reef. The findings indicate that rabbitfishes have high diet plasticity, and hence their functional role as mediators of competition between macroalgae and corals can change across biogeographic regions. Local context is therefore important when assessing the diet and functional role of herbivorous fishes. As climate change unfolds, shifts in the distribution, trophic behaviour and function of species are expected, making the study of trophic plasticity more important. [ABSTRACT FROM AUTHOR]

Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing chronic diseases; however, only one in 16 Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test the feasibility of modifying shopper purchasing behaviour to purchase more F&Vs using the Australian Dietary Guidelines 2&5 education message covering one‐half of the base of shopping trolleys. Placards giving the message that eating 2 fruits and 5 vegetables every day for good health were placed at the base of shopping trolleys as an educational nudge. Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting paper sales receipts to measure the weight (kg), total spending and F&V‐specific spending (Australian dollars) for intervention versus control trolleys for one Saturday. We also conducted a short intercept survey that was administered independently from the research study day on non‐trial shoppers. Shoppers who selected trolleys with the 2&5 education nudge placards (n = 101) purchased 1.66 kg less weight of F&Vs (Intervention: mean = 3.89 kg, SD = 3.40 kg, 95% CI = 3.21 kg, 4.56 kg, vs. Control: mean 5.55 kg, SD = 4.16 kg, 95% CI = 4.73 kg, 6.37 kg, p = 0.002) and spent less on F&Vs compared to shoppers in the control group (n = 102; Intervention: mean = $26.00, SD = $21.60, 95% CI = $21.78, $30.32 vs. Control: mean $36.00, SD = $27.00, 95% CI = $30.72, $42.36, p = 0.004). Intervention group shoppers also spent less in total spending between groups (Intervention: mean = $115.40, SD = $68.30, 95% CI = $101.95, $128.95 vs. Control: mean $151.30, SD = $79.40, 95% CI = $135.73, $166.93, p = 0.001). The 2&5 education nudge placard had the opposite effect as intended on shoppers' purchases to buy more F&Vs, although there may have been other differences between the intervention and the control groups since they were not randomised. Larger studies are required to elucidate and confirm these findings over the longer term. [ABSTRACT FROM AUTHOR]

Introduction: Gout management remains suboptimal despite safe and effective urate‐lowering therapy. Self‐monitoring of urate may improve gout management, however, the acceptability of urate self‐monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self‐monitoring in people with gout. Methods: Semistructured interviews were conducted with people taking urate‐lowering therapy (N = 30) in a 12‐month trial of urate self‐monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self‐management. Deidentified transcripts were analysed thematically. Results: Participants valued the ability to self‐monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self‐monitoring at home was easy, convenient and informed gout self‐management behaviours such as dietary modifications, hydration, exercise and medication routines. Many participants self‐monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases. Conclusion: Urate self‐monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self‐monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self‐monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines. Patient or Public Contribution: One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested. [ABSTRACT FROM AUTHOR]

Background: The UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT‐Australia Type 2 Diabetes Remission Service. Methods: All participants and HCPs delivering the service were invited to participate in semi‐structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT‐Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis. Results: Eight DiRECT‐Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT‐Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant‐HCP interactions and continuous support; (4) Acceptance and long‐term need for DiRECT‐Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT‐Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long‐term basis. Conclusions: Both participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT‐Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long‐term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission. [ABSTRACT FROM AUTHOR]

Objectives: Diet quality often changes as shift workers adjust to atypical work schedules, however, limited research exists examining the early effects of starting rotating shift work on diet and body composition. This study explored dietary behavior changes occurring in graduate paramedics during the first year of exposure to rotating shift work, and investigated dietary intake, diet quality and anthropometric changes over two years. Methods: Participants from a graduate paramedic cohort in Melbourne, Australia were approached after two years of shift work for study inclusion. Using a mixed method study approach, the qualitative component comprised individual in-depth interviews to explore perceived dietary behavior changes experienced over the first year of shift work. Interview transcripts were thematically analyzed and guided by the COM-B model (capability, opportunity, motivation, and behavior) and theoretical domains framework (TDF). Diet quality and dietary intake were quantitatively assessed by the Australian Eating SurveyTM at baseline, one year, and two years, along with body weight, waist circumference, and body mass index (BMI) to monitor changes. Results: Eighteen participants were included in the study. From the interviews, participants reported: 1. food choices are driven by wanting to fit in with coworker food habits, 2. food choices and mealtimes are unpredictable and 3. paramedics try to make healthy food choices but give in to less healthy options. While daily energy intake and diet quality scores did not differ in the first two years of shift work, daily energy from takeaway foods significantly increased (mean difference (MD): 2.96% EI; 95% CI: 0.44 − 5.48; p = 0.017) and increases in weight (MD: 2.96 kg; 95% CI: 0.89-5.04; p = 0.003), BMI (MD: 1.07 kg/m2; 95% CI: 0.26 – 1.87; p = 0.006) and waist circumference (MD: 5.07 cm; 95% CI: 1.25-8.89; p = 0.006) were also evident at two years. Conclusions: This study contributes new information on dietary changes and the current early trajectory of unintentional weight gain and takeaway reliance occurring within a graduate paramedic cohort over two years of shift work. To reduce the unintended metabolic consequences commonly observed with rotating shift schedules, workplaces could improve access to healthier food options and enable behavioral support/education to address nutrition-related health risks. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

Obesity can increase the risk of postoperative complications. Despite increased demand for patients living with obesity to lose weight prior to common surgical procedures, the impact of intentional weight loss on surgical outcomes is largely unknown. We aimed to conduct a pilot study to assess the feasibility of a full-scale randomised controlled trial (RCT) to examine the effect of preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic on surgical outcomes in gynaecology and general surgeries. Between August 2021 and January 2023, a convenience sample of adults living with obesity (BMI ≥ 30 kg/m2) awaiting gynaecology, laparoscopic cholecystectomy and ventral hernia repair procedures were randomised to dietitian-led VLCD (800–1000 kcal using meal replacements and allowed foods), or control (no dietary intervention), 2–12 weeks preoperatively. Primary outcome was feasibility (recruitment, adherence, safety, attendance, acceptability and quality of life (QoL)). Secondary outcomes were anthropometry and 30-d postoperative outcomes. Outcomes were analysed as intention-to-treat. Fifty-one participants were recruited (n 23 VLCD, n 28 control), mean 48 (sd 13) years, 86 % female, and mean BMI 35·8 (sd 4·6) kg/m2. Recruitment was disrupted by COVID-19, but other thresholds for feasibility were met for VLCD group: high adherence without unfavourable body composition change, high acceptability, improved pre/post QoL (22·1 ± 15 points, < 0·001), with greater reductions in weight (–5·5 kg VLCD v. −0·9 kg control, P < 0·05) waist circumference (–6·6 cm VLCD v. +0·6 control, P < 0·05) and fewer 30-d complications (n 4/21) than controls (n 8/22) (P > 0·05). The RCT study design was deemed feasible in a public hospital setting. The dietitian-led VLCD resulted in significant weight loss and waist circumference reduction compared with a control group, without unfavourable body composition change and improved QoL. [ABSTRACT FROM AUTHOR]

Issue Addressed: Supporting healthy behaviours (quality diet, physical activity, sleep) through home‐based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale‐up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research‐practice translation. Methods: Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi‐structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale‐up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale‐up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. Results: Individual‐level: Targeting multiple systems (primary, tertiary, community‐based care) and entry points (early, mid‐postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at‐risk women, was suggested. Provider‐level: Stakeholders identified strategies to enhance future roll‐out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems‐level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. Conclusions: For sustainable implementation and potential scalability of a home‐based multi‐behaviour postnatal intervention, multi‐level implementation and scale‐up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. So What?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future. [ABSTRACT FROM AUTHOR]

Aims: In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues. Methods: Two engagement events, in 2023, brought together experienced and mid‐ and early‐career nutrition professionals for co‐creation of implementation logic models. Results: One hundred and nine early and mid‐career professionals were involved. A revised model for the decadal plan pillars emerged from synthesis of all logic models. This new model integrated the precision and personalised nutrition pillar with nutrition mechanisms pillar. These combined pillars build towards the national data capability enabling platform and created new cross‐cutting themes for education and training. The need arose for greater focus on respectful engagement with Aboriginal and Torres Strait Islander communities and sustained effort to build cross‐disciplinary collaboration to realise the plan's societal determinants goals. A new alliance for nutrition science is proposed to become a unified advocacy voice and build trust in nutrition professionals. Conclusions: A programmatic approach provides a road map for implementing the decadal plan for the final 5 years. [ABSTRACT FROM AUTHOR]

Introduction: Evidence of associations between the Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score and gestational diabetes mellitus (GDM) in pregnant women is limited. This study examined changes in MDS and DASH and dietary patterns in Australian pregnant women between early and late pregnancy and their associations with GDM. Methods: The data from n = 284 participants were analysed. Diet quality indices and empirical dietary patterns were determined in early (15 ± 3 weeks gestation) and late pregnancy (35 ± 2 weeks gestation). Paired t‐tests were used to examine changes in scores for diet quality indices and dietary patterns from early to late pregnancy. Logistic regression analysis was used to examine associations between GDM, diet quality indices and dietary patterns. Results: Three major dietary patterns were identified at early pregnancy. The first and second dietary patterns included unhealthier and healthier food groups, respectively, and the third comprised mixed food groups. Although diet quality scores did not change over time, consumption of the first dietary pattern increased (p = 0.01), and consumption of the second dietary pattern decreased by late pregnancy in women without GDM (p < 0.001). Conclusion: No associations between DASH score, MDS and GDM were found; however an inverse association was observed between the first dietary pattern and GDM in late pregnancy (p = 0.023). Longitudinal studies are needed to examine diet quality and dietary patterns at early and late pregnancy to inform the development of tailored dietary advice for GDM. Key points: This study examined associations between diet quality and dietary patterns and gestational diabetes mellitus (GDM) in Australian pregnant women.No significant associations were found between the Mediterranean Diet Score and Dietary Approaches to Stop Hypertension score and GDM.There was an inverse link between the unhealthier dietary patterns and GDM. [ABSTRACT FROM AUTHOR]

There are few short, validated tools to assess young children's obesity‐related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice‐based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver‐reported short dietary questionnaire to rapidly assess obesity‐related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was developed using a rigorous process to determine content and structural validity. Three age‐appropriate versions were developed for (1) infants, aged 6–12 months, (2) toddlers, aged 1–2.9 years and (3) pre‐schoolers, aged 3–5 years. The questionnaire (7–15 items) measures dietary behaviours, including diet risk from non‐core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test–retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45–0.89, percentage agreement 68%–100%) and reliability (intraclass correlation coefficient: 0.61–0.99) for diet risk, diet quality and feeding practice items. The EPOCH‐DQ shows acceptable validity and reliability for screening of obesity‐related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH‐DQ allows for potential applications in various settings. Future testing of the EPOCH‐DQ should evaluate culturally and socio‐economically diverse populations and establish the predictive validity and sensitivity to detect change. Key messages: Accurate measurement of obesity‐related dietary behaviours is essential for the evaluation of early obesity prevention programmes and monitoring population trends.The 7–15 item Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was shown to have acceptable validity and reliability for assessing obesity‐related behaviours of children aged 6 months to 5 years of age.The short length and thus low participant burden of the EPOCH‐DQ allows for potential applications in various settings, including research, population health monitoring and use by health professionals.Future testing of the EPOCH‐DQ should include evaluation across culturally and socio‐economically diverse populations and determine the predictive validity and sensitivity to detect change of the EPOCH‐DQ. [ABSTRACT FROM AUTHOR]

Variety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake. This study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults. Secondary analyses of cross-sectional data from a validated, online survey that assesses participants' dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories. Participants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020. Variety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings. Descriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages. Participants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake). Variety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research. [ABSTRACT FROM AUTHOR]

Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. Methods: A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise–nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. Results: The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. Conclusions: This research revealed important factors affecting adherence to a self-managed exercise–nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between pro-inflammatory markers platelet-activating factor (PAF), lipoprotein-associated phospholipase A2 (Lp-PLA2), hsCRP, and intake of core food groups including fruit, cruciferous and other vegetables, grains, meat and poultry, fish and seafood, nuts and legumes, and dairy. Methods: A cross-sectional study was conducted. 100 adults (49 ± 13 years, 31% male) with variable cardiovascular disease risk were recruited. Data were collected in 2021 and 2022. Fasting PAF, Lp-PLA2 activity, hsCRP and usual dietary intake (via a validated food frequency questionnaire) were measured. Intake of foods were converted into serves and classified into food groups. Correlations and multiple regressions were performed with adjustment for confounders. Results: A one-serve increase in cruciferous vegetables per day was associated with 20–24% lower PAF levels. An increase of one serve per day of nuts and legumes was associated with 40% lower hsCRP levels. There were small correlations with PAF and Lp-PLA2 and cheese, however, these were not significant at the Bonferroni-adjusted P < 0.005 level. Conclusion: The lack of associations between PAF and Lp-PLA2 and other healthy foods may be due to confounding by COVID-19 infection and vaccination programs which prevents any firm conclusion on the relationship between PAF, Lp-PLA2 and food groups. Future research should aim to examine the relationship with these novel markers and healthy food groups in a non-pandemic setting. [ABSTRACT FROM AUTHOR]

This paper explores how those who adopt an 'anti-diet' stance use strategies to challenge weight-loss dieting norms. We used a qualitative survey to examine how a heterogenous collective of feminists, fat activists and health professionals (and those on the margins of these groups) define the source(s) of power underlying diet culture and discuss the strategies they use to challenge it. One hundred and eighteen people (Mage = 36.67, SD = 10.50) took part. Most were female (n = 112), heterosexual (69%), and residing in Australia (59%). A small proportion (13%) had a culturally and linguistically diverse (CALD) background. Thirty-seven per cent were health professionals, and over half identified as non-diet activists (52%). We generated three themes in our thematic analysis: 'Describing diet culture: Unpacking cultural and material forms of power,' 'Self-care as a political strategy: Refusals and ambivalence in the anti-diet community,' and 'Relational strategies: Challenging diet culture in work and everyday interactions.' Participants viewed diet culture as being reinforced through internalized multi-institutional patriarchal, Eurocentric and capitalist systems. They challenged cultural norms and institutions that reinforce diet culture by being critical of gender norms and rejecting consumerist dieting practices. We argue that the self-care and relational strategies used by participants across communities signify an awkward but unified 'anti-diet movement.' Future research should recruit a more culturally and ethnically diverse sample and examine the 'anti-diet' movement beyond the Global North context. [ABSTRACT FROM AUTHOR]

Objectives: Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons. Methods: This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII. Results: Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was −1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = −0.041 (−0.066, −0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001). Conclusion: Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community. [ABSTRACT FROM AUTHOR]

Background: The first 2000 days of life are a crucial and opportunistic time to promote positive dietary and physical activity behaviours that can continue throughout life. The bulk of research on the impact of parents promoting positive dietary and physical activity behaviours has been on mothers, with the impact of fathers rarely investigated. The aim of this study is to investigate fathers' perceived role, self-efficacy and support needs in promoting positive dietary and physical activity behaviours in early childhood. Methods: A sequential explanatory mixed methods study design consisted of a cross sectional survey of Australian fathers (n = 200) from a convenience sample, followed by semi-structured qualitative interviews (n = 21) with a purposeful sample of Australian fathers. Results: Quantitative survey data revealed that more than 90.0% of fathers agreed that it is important to role model healthy eating and participating in physical activity with their babies, toddlers and children. A majority of fathers were confident in getting their child to eat fruit/ vegetables (90%) and playing with their child (80%). When searching for information about nutrition and physical activity, the highest proportion of fathers nominated online sources (52%) as their preferred source in survey data. Qualitative interview data revealed that while fathers exhibited high self-efficacy in their abilities, this was susceptible to deterioration due to feelings of isolation, pressures of fatherhood, a lack of information and resources that are father specific, and difficulties navigating the different types of information/resources to find what is right for them. Conclusions: Although possessing self-efficacy, being committed and seeking knowledge, many fathers found that useful information was hard to find and understand. Appropriate resources are therefore required to support the specific needs of fathers to promote positive dietary and physical activity behaviours in their infants and young children. [ABSTRACT FROM AUTHOR]

• Baby spinach contributed most to Australian lutein and zeaxanthin (L/Z) intake. • Broccoli contributed highly to United Kingdom dietary L/Z intake. • Correlational statistics overestimated L/Z dietary screener tool validity. • Bland-Altman plot analysis is key to deducing dietary L/Z screener tool validity. • Validity of diet L/Z intake from prior research should be interpreted with caution. Habitual dietary intake measurement of carotenoids lutein and zeaxanthin (L/Z) has often been omitted or attempted with tools of unknown validity in past research. It was hypothesized that the dietary assessment tool, the L/Z screener, developed as part of this study, would be valid with agreement within 0.25 mg/day when compared against multiple 24-hour diet recalls in healthy Australian and United Kingdom adults. Two screeners with 91 food items were developed, 1 with a recall timeframe of a month and the other a week. Over 4 weeks, 56 Australian and 47 United Kingdom participants completed 4 weekly screeners, 2 monthly screeners, and eight 24-hour diet recalls. Validity was assessed through Bland-Altman plot analysis. L/Z intake measured by all tools was significantly correlated, with correlation coefficients from 0.58 to 0.83. Despite these correlations, the screeners were not valid, with poor Bland-Altman plot agreement when compared with the diet recalls. The Australian weekly screener performed best, demonstrating a mean difference of 0.51 mg/day and 95% limits of agreement between –1.46 mg/day and 2.49 mg/day of L/Z intake. Baby spinach, broccoli, and pumpkin provided the greatest proportion of L/Z intake. The low validity may be explained by high rates of misestimation or missed capture of moderate to high L/Z containing foods such as baby spinach. Prior research reliant on correlational statistics for L/Z tool validity should be interpreted with caution, and future screener development should prioritize accurate capture of high contribution foods. A 91-item L/Z diet screener was developed with 2 recall timeframes: a month or a week. Screener L/Z intake compared with 24-hour diet recalls by Bland-Altman plot analysis and correlational statistics in 103 adults resulted in significant correlations. However, agreement was poor (95% limits of agreement ≥0.25 mg/day) because of memory recall bias and missed capture; therefore, the screeners were deemed not valid. Abbreviations: AU, Australia; L/Z, lutein and zeaxanthin; UK, United Kingdom. Created with BioRender.com. [Display omitted] [ABSTRACT FROM AUTHOR]

Supporting health professionals' dietary behaviours is important to their own health and may influence the quality of care they provide. Understanding health professionals' perceptions on the experiences which have shaped their views on nutrition is important to inform interventions. A cross-sectional qualitative design utilised in depth interviews via telephone or videoconference. Health professionals with direct interaction with patients were recruited through the media channels of Australian national health professional associations. A semi-structured interview guide was used. Interview data analysis was conducted using thematic analysis. Twenty-two health professionals participated in the study including dietitians. Three themes emerged from the data: (1) Life experiences influence health professionals' feelings of self-efficacy in providing nutrition care. (2) Learning through observation and role modelling occurred continually and shaped health professionals' attitudes and beliefs on nutrition care. (3) Social interactions influenced self-efficacy through social persuasion and social pressure. The social environment played a role in both facilitating and/or hindering adoption of a dietary behaviour in their own lives. Health professionals perceive their personal dietary experiences strongly influence their self-efficacy to provide nutrition care. Strategies which enable health professionals to improve their diets could lead to improvements in nutrition care. Creating socially supportive environments in the workplace warrant investigation to support health professionals to eat well and provide nutrition care to patients. [ABSTRACT FROM AUTHOR]

Background: Very low‐calorie diet (VLCD) programs are readily available in Australia. However, there is a lack of real‐world evidence describing the characteristics related to positive outcomes. Aims: To examine the demographic, eating, self‐efficacy and program engagement characteristics of VLCD users in Australia, and the associations between user characteristics and program success, weight loss, quality of life (QOL) and health. Method: Cross‐sectional data from Australian adults: regular users (n = 189: VLCD user ≥4 days/week for >4 weeks) and intermittent users (n = 111, VLCD user <4 weeks and/or <4 days/week). Self‐reported data on demographics, VLCD program use, support, eating behavior, weight‐related QOL, mental health, physical health, self‐efficacy, and physical activity. Descriptive and inferential statistics were performed in R. Results: Compared to regular users, intermittent users reported lower percentage weight loss (15.1% ± SD 9.8 vs. 9.9% ± SD 6.8, relative to starting weight), fewer reported their VLCD program as very successful (44% vs. 35%), higher depressive symptom scores (8.7 ± SD 2.8 vs. 6.7 ± SD 5.1), and lower general self‐efficacy (23.9 ± SD 4.7 vs. 29.4 ± SD 5.7), nutrition self‐efficacy (11.9 ± SD 2.0 vs. 14.5 ± SD 3.1) and weight‐related QOL scores (60.9 ± SD 22.2 vs. 65.0 ± SD 11.8; p < 0.001 for all). In regular users, older age and longer program duration were associated with greater total weight loss, support, and program success (p < 0.001 for all). In intermittent users, program success was greater when dietitian support was used (odds ratio [OR] 6.50) and for those with higher BMIs (OR 1.08, p < 0.001 for all). In both groups, more frequent support was associated with better weight‐related QOL (p < 0.001). Conclusion: This study provides real‐world evidence that regular VLCD users had greater success and weight loss than intermittent program users. These findings may be used to tailor and improve the delivery of VLCD programs in Australia and other countries with retail access to VLCDs. [ABSTRACT FROM AUTHOR]

Appropriate dietary intake has been found to positively impact athletes' performance, body composition and recovery from exercise. Strategies to optimise dietary intake often involve targeting one or more of the many factors that are known to influence dietary intake. This review aims to investigate the types and effectiveness of interventions used to impact modifiable factors of dietary intake in athletes. MEDLINE, CINAHL, SPORTDiscus and Web of Science were searched from inception to May 2022 for intervention studies that measured dietary intake with a quantitative tool and explored at least one factor thought to influence the dietary intake of adult athletes. Study quality was assessed using the ADA Quality Criteria Checklist: Primary Research. Twenty-four studies were included. The most common interventions focused on nutrition education (n 10), macronutrient adjustment (n 7) and physical activity (n 5). The three most common factors thought to influence dietary intake addressed were nutrition knowledge (n 12), hunger and appetite (n 8), and body composition (n 4). Significant changes in dietary intake were found in sixteen studies, with nutrition education interventions returning significant results in the largest proportion of studies (n 8). Study quality within this review was mostly average (n 4 < 50 %, n 19 50–80 %, n 1 > 80 %). As studies included were published between 1992 and 2021, interventions and factors explored in older studies may require up-to-date research to investigate possible differences in results due to time-related confounders. [ABSTRACT FROM AUTHOR]

Despite evidence for favourable health outcomes associated with plant-based diets, a database containing the plant and animal content of all foods eaten is required to undertake a reliable assessment of plant-based diets within a population. This study aimed to expand an existing Australian food database to include the plant and animal content of all whole foods, beverages, multi-ingredient products and mixed dishes. Twenty-three plant- and animal-based food group classifications were first defined. The food servings per 100 g of each product were then systematically calculated using either a recipe-based approach, a food label-based approach, estimates based on similar products or online recipes. Overall, 4687 (83·5 %) foods and beverages were identified as plant or plant-containing products, and 3701 (65·9 %) were animal or animal-containing products. Results highlighted the versatility of plant and animal ingredients as they were found in various foods across many food categories, including savoury and sweet foods, as well as discretionary and core foods. For example, over 97 % of animal fat-containing foods were found in major food groups outside the AUSNUT 2011–2013 'fats and oils' group. Surprisingly, fruits, nuts and seeds were present in a greater percentage of discretionary products than in core foods and beverages. This article describes a systematic approach that is suitable for the development of other novel food databases. This database allows more accurate quantitative estimates of plant and animal intakes, which is significant for future epidemiological and clinical research aiming to investigate plant-based diets and their related health outcomes. [ABSTRACT FROM AUTHOR]

The consequences of biological invasions and habitat degradation for native biodiversity depend on how species cope with the individual and synergetic challenges these processes present. To assess the impact of anthropogenic land‐use on the food web architecture of an invaded community, we examine the diets of nine native and two highly invasive mammal species at different trophic levels, inhabiting different land‐uses across six biogeographic regions in Tasmania, Australia. We use two complementary methods, environmental DNA metabarcoding analysis (eDNA) of faeces and stable isotope analysis (SIA) of nitrogen (N) and carbon (C) in whole blood, to account for the high interindividual and temporal variability in the diets of multiple species simultaneously. eDNA showed regionalisation in the diet of smaller species, with land‐use further defining dietary taxa within each region. SIA revealed that bioregion and land‐use influence the δ13C values of all carnivore species and omnivores, whereas the δ15N values of these species are influenced only by land‐use and not bioregion. Including multiple species showed that native rats are changing their diet in response to the presence of invasive rats, an impact that would have otherwise been attributed to land‐use. Our findings demonstrate that human activities and invasive species are moulding the diets of invaded communities, raising questions about the potential impacts that dietary modifications will have on the life‐history traits and the evolutionary consequences these modifications might have on the survival of native species. This highlights the urgency of including human activities in ecological studies and the importance of targeting multispecies assemblages to gain a better understanding of synergetic impacts on native biodiversity. [ABSTRACT FROM AUTHOR]

It is clear that the societal role of meat is being challenged with ideological and simplified logic without substantiation from robust data-driven science. With this background, the international summit titled 'The societal role of meat – what the science says' was held in Dublin, Ireland, during October 2022, to provide evidence-based evaluations and the Dublin Declaration was signed by over 1000 scientists. In this paper, we provide a synopsis of the summit and then give context for evaluating the societal role of meat in Australia. The key themes of the summit were the essential roles of meat in (1) diet and health, (2) a sustainable environment and (3) society, economics and culture. Evidence clearly showed the role of meat as a nutrient-dense source of high-quality protein and micronutrients that can be safely consumed by humans. Further, the complementary role of livestock in agricultural systems was highlighted with both plant- and animal-based agriculture reliant on each other to maximise the efficient production of food. Thus, from both an Australian and world perspective, very little food considered to be human-edible is fed to livestock. The role of livestock in rural societies across the world was emphasised to underpin regional and national economies, with particular importance in those countries with developing economies to facilitate growing wealth to 'step out' of poverty and provide gender equality. Meat production, particularly from ruminants, is a critical part of Australian primary production and it is concluded that the Dublin Declaration is highly relevant to Australia. Finally, concern regarding future funding and organisation of research and extension is discussed. There is a need to continue funding highly collaborative programs that bring a broad range of disciplines together, in conjunction with undergraduate and postgraduate teaching to underpin the social license to operate for meat and livestock production. The societal role of meat is being challenged with ideological and simplified logic without substantiation from robust data driven science. The international summit titled 'The societal role of meat – what the science says' was held to provide evidence-based evaluations and the Dublin Declaration. A synopsis of the summit is described and the societal role of meat in Australia is evaluated under the themes of meat for (1) diet and health, (2) a sustainable environment and (3) society, economics and culture. [ABSTRACT FROM AUTHOR]

The challenge to reduce crude protein (CP) contents of wheat-based broiler diets is both justified and formidable because the performance of broiler chickens offered reduced-CP, wheat-based diets is usually compromised. Moreover, broiler chickens offered wheat-based diets do not accommodate CP reductions as well as do those offered maize-based diets; this appears to stem from the higher protein concentrations and more rapid starch digestion rates of wheat. The higher protein concentrations of wheat than maize result in elevated inclusion levels of non-bound (synthetic, crystalline) amino acids (NBAA). This may be an impediment, because non-bound and protein-bound amino acids are not bioequivalent and intestinal uptakes of NBAA are more rapid than their protein-bound counterparts. This leads to post-enteral amino acid imbalances and the deamination of surplus amino acids, which generates ammonia (NH3). Because NH3 is inherently detrimental, it must be detoxified and eliminated as uric acid, which attracts metabolic costs. Moreover, inadequate NH3 detoxification may seriously compromise broiler growth performance. Also, consideration is given to some intrinsic wheat factors, including soluble non-starch polysaccharides, amylase–trypsin inhibitors and gluten, that may hold relevance. Several strategies are proposed that may enhance the performance of birds offered reduced-CP, wheat-based diets, including capping dietary starch:protein ratios, blending wheat with sorghum, whole-grain feeding in association with phytase, dietary inclusions of L-carnitine and the use of protected or slow-release amino acids. In future research, it should prove instructive to compare different wheats with a wide range of protein contents that, importantly, have been fully characterised for relevant parameters, to ascertain the most appropriate properties. The successful development and adoption of reduced-CP, wheat-based diets would be an enormous advantage for the Australian chicken-meat industry as it would diminish the huge dependence on imported, expensive soybean meal. The successful reduction of protein contents in wheat-based diets holds a number of advantages for chicken-meat production in Australia, including a decreased dependence on imported soybean meal and extends to enhanced bird welfare, flock health and environmental conditions. The relatively high protein concentrations and rapid digestion rates of wheat starch may be impeding their adoption. Several strategies are proposed that could expedite the practical acceptance of reduced crude-protein, wheat-based diets. [ABSTRACT FROM AUTHOR]

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n  = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing. [ABSTRACT FROM AUTHOR]

Aims. This study aimed to identify the quantity and range of protein, fat, and carbohydrate consumed in meals and snacks in children with Type 1 diabetes (T1D), and to explore associations between the variability in fat and protein intakes with the glycemic outcomes. Methods. This was a cross-sectional dietary study of children 6–18 years attending pediatric diabetes service in Australia. Three-day weighed food records were analyzed for the macronutrient intake. Impacts of dietary intake on glycemic outcomes were explored. Results. Forty-eight children (63% male) aged 11.7 ± 2.9 (mean ± SD) with HbA1c 6.7 ± 1.1% (mmol/mol), BMI Z-score 0.51 ± 0.83, and daily insulin dose 0.99 units/kg completed 3-day weighed food records. Mean intakes at breakfast were 47-g carbohydrate, 15-g protein, and 12-g fat. Lunch: 49-g carbohydrate, 19-g protein, and 19-g fat. Dinner: 57-g carbohydrate, 33-g protein, and 26-g fat. Fifty-five percent (n = 80) of the dinner meals met criteria for a high-fat, high-protein (HFHP) meal. In a subset (n = 16) of participants, exploratory analysis indicated a trend of reduced %TIR (58%) in the 8 hr following HFHP dinner, compared to %TIR (74%) following non-HFHP dinner (p = 0.05). Seventy-eight percent of the participants aged 12–18 years intake at dinner varied by more than 20-g fat or more than 25-g protein. There was no association between the variability in fat and protein intake at dinner with HbA1c. Saturated fat contributed to 14.7% (±3.0) of participants energy intake. Conclusions. Children with T1D frequently consume quantities of fat and protein at dinner that have been shown to cause delayed postprandial hyperglycemia. HFHP dinners were associated with the reduced %TIR over 8 hr, presenting an opportunity for insulin-dose adjustments. Future research that explores the meal dietary variability with postprandial glycemia in this population is needed. Excessive intake of the saturated fat highlights the need for dietary interventions to reduce CVD risk. This trial is registered with ACTRN12622000002785. [ABSTRACT FROM AUTHOR]

Threatened species throughout the world are in decline due to various causes. In some cases, predators of conservation or cultural value are causing the decline of threatened prey, presenting a conservation conundrum for managers. We surveyed marine turtle nests on K'gari (formally known as Fraser Island), Australia, to investigate dingo predation of green and loggerhead turtle nests, where each of these species is of conservation value. Our monitoring revealed that 84% of nests were predated by dingoes. Only 16% of nests were not consumed by dingoes, and only 5.7% of nests were confirmed to have successfully hatched. Up to 94% of nests were consumed in some areas, and predation rates were similar across different dingo packs. Information on the available numbers of nests and dingoes in the area indicated that turtle nests alone are sufficient to support extant dingoes over the summer. These results indicate that marine turtle eggs represent a previously unquantified but important food source for dingoes on K'gari, and that turtle nests at this rookery site are under serious threat from dingoes. This research should highlight the importance of prioritising the protection of turtle nests from dingoes or risk losing the entire rookery forever in the near future. [ABSTRACT FROM AUTHOR]

Purpose: To assess any effects of a state-wide sodium reduction intervention on sodium intake, sources of dietary sodium and discretionary salt use at a population level. Methods: Data (24-h urinary sodium excretion, self-report survey, a 24-h dietary recall) were collected cross-sectionally at baseline (2016/2017) and follow-up (2020) from adults in Victoria, Australia. Intervention activities included consumer awareness advertising campaign, public debate generation via mass media, strengthening existing policy initiatives and supporting food innovation with industry. Results: There were 339 participants at baseline and 211 at follow-up, with 144 and 90 of participants completing a 24-h dietary recall, respectively. There was no difference in adjusted 24-h urinary sodium excretion between baseline and follow-up (134 vs 131 mmol/24 h; p = 0.260). There were no differences in the percentage of participants adding salt during cooking (63% vs 68%; p = 0.244), adding salt at the table (34% vs 37%; p = 0.400) or regularly taking action to control salt/sodium intake (22% vs 21%; p = 0.793). There were large differences in the quantity of dietary sodium sourced from retail stores (57% vs 77%, p < 0.001), and less sodium was sourced from foods at fresh food markets (13% vs 2%; p ≤ 0.001) at follow-up. No large differences were apparent for foods with different levels of processing or for food groups. Conclusion: There was no clear population-level effect of the 4-year multi-component Victorian Salt Reduction Intervention on sodium intake with Victorian adults continuing to consume sodium above recommended levels. The findings indicate that more intensive and sustained efforts aiming at the retail and food industry with national level support are likely to be required to achieve a measurable improvement in sodium intake at a state level. [ABSTRACT FROM AUTHOR]

Background: Maternal dietary choline has a central role in foetal brain development and may be associated with later cognitive function. However, many countries are reporting lower than recommended intake of choline during pregnancy. Methods: Dietary choline was estimated using food frequency questionnaires in pregnant women participating in population-derived birth cohort, the Barwon Infant Study (BIS). Dietary choline is reported as the sum of all choline-containing moieties. Serum total choline-containing compounds (choline-c), phosphatidylcholine and sphingomyelin were measured using nuclear magnetic resonance metabolomics in the third trimester. The main form of analysis was multivariable linear regression. Results: The mean daily dietary choline during pregnancy was 372 (standard deviation (SD) 104) mg/day. A total of 236 women (23%) had adequate choline intake (440 mg/day) based on the Australian and New Zealand guidelines, and 27 women (2.6%) took supplemental choline (≥ 50 mg/dose) daily during pregnancy. The mean serum choline-c in pregnant women was 3.27 (SD 0.44) mmol/l. Ingested choline and serum choline-c were not correlated (R2) = − 0.005, p = 0.880. Maternal age, maternal weight gain in pregnancy, and a pregnancy with more than one infant were associated with higher serum choline-c, whereas gestational diabetes and environmental tobacco smoke during preconception and pregnancy were associated with lower serum choline-c. Nutrients or dietary patterns were not associated with variation in serum choline-c. Conclusion: In this cohort, approximately one-quarter of women met daily choline recommendations during pregnancy. Future studies are needed to understand the potential impact of low dietary choline intake during pregnancy on infant cognition and metabolic intermediaries. [ABSTRACT FROM AUTHOR]

This study investigates how engagement with social media leads women to adopt diet and exercise practices. We base our analysis on qualitative research, including surveys and in-depth interviews, with thirty (30) Australian women aged 18-35 years between April and August 2021. Our findings reveal how healthism discourse on social media, namely Facebook, Instagram and TikTok, underpin the adoption of diet and exercise practices by enhancing experiences of digital intimacy, repeat messages and personal testimonials from other women, and supporting new routines during COVID-19 lockdowns. This article contributes to health marketing literature by providing critical knowledge about women's experiences that prompt and shape complex ideologies of health that are often masked through diet and exercise practices on social media. [ABSTRACT FROM AUTHOR]

Shifts in zooplankton communities due to changing ocean climate can affect foraging patterns among planktivorous seabirds. To better understand seabird response to environmental change in Bass Strait, southeast Australia, we investigated the prey species and 16 elements in prey and feathers of the planktivorous White-faced Storm Petrel Pelagodroma marina. The krill Nyctiphanes australis was the most abundant prey species, followed by several species of post-larval fish; otherwise, the species appeared to be a generalist feeder. Element concentrations of feathers were not significantly influenced by dietary composition. Likewise, element concentrations did not significantly differ between major prey species, confirming that the nutritional profile of these species is likely linked to their seawater environment. Given that Whitefaced Storm Petrels in Bass Strait substantially rely on a narrow range of prey species, this may increase their vulnerability to events that change their availability. As coastal krill is highly sensitive to sea surface temperatures (SST), the increases in SST predicted under climate change scenarios may alter the timing and abundance of krill swarms, which in turn may affect planktivores, including White-faced Storm Petrels. [ABSTRACT FROM AUTHOR]

Purpose: People living with severe mental illness (PLWSMI) experience disproportionately high rates of morbidity and mortality compared with the general population. Sydney Local Health District (SLHD) introduced the Living Well, Living Longer integrated care program in 2013 to address this inequity. This paper reports on the impact of the COVID-19 pandemic on the provision of physical health interventions to community mental health consumers in SLHD. Design/methodology/approach: Rates of COVID-19 vaccinations were collated. Routinely collected service data were reviewed for changes in rates of metabolic monitoring, mental health shared care, physical health checks, cardiometabolic health clinic assessments and diet and exercise interventions. Findings: 91.9% of consumers received at least two COVID-19 vaccinations and 61.3% received a booster. However, there was a 37.3% reduction in rates of metabolic monitoring, 20.1% reduction in Mental Health Shared Care agreements, 60.6% reduction in physical health checks with general practitioners, 65.4% reduction in cardiometabolic clinic assessments and 19.8% reduction of diet and exercise interventions. Practical implications: The impact of the pandemic may lead to an exacerbation of poorly managed comorbid disease and increased premature mortality in people living with severe mental illness. Service providers should consider the local impact of the pandemic on the provision of physical health interventions and ensure steps are taken to address any deficits. Originality/value: There is a paucity of published analysis regarding the impact of the pandemic on the provision of physical health interventions to people living with severe mental illness. [ABSTRACT FROM AUTHOR]

The West Indian drywood termite, Cryptotermes brevis (Walker) (Blattodea: Kalotermitidae), is a well-known invasive pest of timber, responsible for substantial damage, control, and prevention costs across many countries. Although it has likely been present in Australia since the 1940s, Queensland remains the only state in which the termite is confirmed as established, though detections have occurred elsewhere. The Queensland state government has spent millions of dollars since the 1960s to manage the termite, but with the cessation of this program in 2021, the risk of its spread within Queensland, and to other states, is likely to increase. As such, further research into the biology of C. brevis is needed to help understand and combat this pest. In particular, there are knowledge gaps about which Australian timbers are susceptible to C. brevis infestation, and the mechanisms underlying their ability to access nutrients available in dry wood. Here, I describe my research assessing the susceptibility of different timbers to C. brevis feeding to identify the most vulnerable host species in Australia. Meta-barcoding investigations of the gut microbiome, including changes that occur when feeding on different timber species, will examine the adaptive ability of endosymbionts within this system to different food sources. Finally, chemical analysis of frass will investigate how the termites modify the wood during digestion to extract nutrients, aiding in an understanding of how wood species affect feeding ability and digestion. All of these results will help us formulate better strategies for managing this invasive pest. [ABSTRACT FROM AUTHOR]

Subjective well‐being is associated with many positive health outcomes. However, little is known about whether these favourable outcomes translate into a reduction in the number of doctor visits. Using large‐scale panel data from Australia, we find that individuals with high life satisfaction need fewer visits to their family doctor or general practitioner. We also present evidence on the pathways underlying this relationship, showing it is significantly explained by a person's diet. These findings remain after correcting for sample selection bias using Heckman's approach as well as controlling for various confounding factors. [ABSTRACT FROM AUTHOR]

Purpose: Bariatric surgery works, in part, by surgically changing signals of hunger and satiety to achieve weight loss. Not all patients experience optimal outcomes. One potential explanation is that post-surgery dieting may subvert the ability to identify physiological cues of hunger and fullness. Dieting behaviours (e.g. restriction/cognitive restraint) are correlated with disordered eating, and disordered eating implicated in poor outcomes. This study examines the experience of dieting after bariatric surgery. Method: Seventeen adult participants who had undertaken bariatric surgery and residing in Australia participated in semi-structured interviews. Surgeries occurred in 2021 (n = 8), 2020 (n = 4), 2019 (n = 2), and one participant each had surgery in 2014, 2009, and 2004. Thematic analysis elicited themes related to post-operative dieting. Results: All participants reported chronic pre-surgery dieting. Lifestyle change was the overarching post-surgical theme comprising (i) flexibility (e.g. allowing food, intuitive eating), and (ii) control, comprising surgery control (e.g. set portions, surgery instilled control) and dieting control (e.g. discipline, restriction/restraint). Descriptions of lifestyle change often mirrored pre-surgery descriptions of dieting. Conclusion: Post-surgery lifestyle change appears to encompass a tension between flexible/adaptive approaches to eating and the need to maintain control. Control may emerge as practices that mirror pre-surgery dieting with the potential to interfere with adaptive eating behaviours or promote disordered eating. Dieting behaviours may be a precursor to the development of disordered eating. Health care practitioners should regularly assess dieting behaviour post-surgery to enable early intervention where warranted. Future research should consider how post-surgery re-emerging dieting may be identified and measured to aid in intervention. [ABSTRACT FROM AUTHOR]