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Background: The increase in serving sizes of energy-dense nutrient-poor discretionary foods over time, with attractively presented large servings and package sizes, has led to portion distortion and a new 'normal' for serving sizes. Little data exists on the variations of portion size norms of discretionary foods across settings. This study aimed to examine the differences in the range of normal portion sizes of commonly consumed foods between home and out-of-home settings (coffee shops, restaurants)., Methods: A repeated cross-sectional design was used, with nine selected discretionary foods and beverages included in a validated online image-series questionnaire. Participants completed the questionnaire at two time points to report their normal portion sizes in home and out-of-home settings. Quantile regression models were used to examine differences in the range of normal portion sizes (17th to 83rd percentile, representing the majority of the study population) between settings., Results: A final sample of 295 participants was included in the analysis (51% females, mean age 40 ± 14 years). The ranges of normal portion sizes did not differ by settings for all test foods except for sugar-sweetened beverages (SSB) tested in both containers and glassware. SSB showed smaller normal portion sizes at home compared to fast food restaurants (in a bottle/can and in a glass/cup; p < 0.001)., Conclusions: These findings suggest that the portion size norms of many discretionary foods are mostly consistent in home and out-of-home settings. As the typical serving sizes available to consumers in the out-of-home settings are large, it is essential to establish practical serving size guidelines directed at the food industry to increase the availability of smaller size options and empower consumers towards better portion control.

Objective: The high availability of energy-dense nutrient-poor discretionary foods in large serving and package sizes may have shifted portion size norms (described as a typical perception of how much people choose to eat from a given food at a single eating occasion) towards larger sizes. Few public health recommendations exist around appropriate discretionary food portion sizes. This qualitative study aimed to explore the underlying rationale of portion size norms of discretionary foods among Australian adults 18-65 years., Design: Four focus group sessions were conducted. Collected data were analysed using inductive thematic analysis., Setting: Focus groups were held online via Zoom between September and October 2023., Participants: Thirty-four participants were recruited in the study (mean age 38 years, 19 females)., Results: The key themes raised from inductive analysis were personal factors, eating context factors and food environment factors relevant to the portion size norms. A framework was established to illustrate the interaction across these themes during the conceptualisation of the norms. For serving size availability, consumers found that there were limited serving size choices when making portion size selections and lacked the knowledge and skills in portion control., Conclusions: These findings highlight the need to make positive changes to the current food environment and develop relevant public health guidelines around appropriate portion sizes to promote healthier portion size norms and enable better portion control.

There is a rising prevalence of non-communicable diseases (NCDs) in Papua New Guinea (PNG), adding to the disease burden from communicable infectious diseases and thus increasing the burden on the healthcare system in a low-resource setting. The aim of this review was to identify health and nutrition promotion programs conducted in PNG and the enablers and barriers to these programs. Four electronic databases and grey literature were searched. Two reviewers completed screening and data extraction. This review included 23 papers evaluating 22 health and nutrition promotion programs, which focused on the Ottawa Charter action areas of developing personal skills (12 programs), reorienting health services (12 programs) and strengthening community action (6 programs). Nineteen programs targeted communicable diseases; two addressed NCDs, and one addressed health services. Enablers of health promotion programs in PNG included community involvement, cultural appropriateness, strong leadership, and the use of mobile health technologies for the decentralisation of health services. Barriers included limited resources and funding and a lack of central leadership to drive ongoing implementation. There is an urgent need for health and nutrition promotion programs targeting NCDs and their modifiable risk factors, as well as longitudinal study designs for the evaluation of long-term impact and program sustainability.

While a large proportion of the population in Papua New Guinea (PNG) maintain a subsistence lifestyle, exposure to modernisation and industrialisation since European contact has influenced a transition towards Western diets. This review aimed to scope and summarise the published research on dietary intake among Pacific Islander adults in PNG. Four electronic databases and grey literature were searched. Two reviewers completed the screening and data extraction. Fourteen studies were included from the Highlands ( n = 7), Southern ( n = 5), Momase ( n = 1) and both the Highlands/Southern region ( n = 1). No studies were from the Islands region. The majority of the studies were published prior to the year 2000 ( n = 9). Geographical region and degree of urbanisation had an impact on dietary intake. Urban areas reported higher intakes of energy, protein and fat compared to rural areas. In the Southern region, a variety of foods, including sago, taro, kaukau, cooked banana, coconut and cassava contributed to energy intake, while kaukau was the main energy and protein source in the Highlands. The main foods contributing to protein in the Southern region were fresh fish, land animals and purchased animals. This review highlights an evidence gap regarding dietary intake research. Within the context of international initiatives, there is an urgent call for research aimed at understanding the social and cultural contextualisation of dietary behaviours in PNG.

With a shift towards plant-based diets for human and planetary health, monitoring the mineral content of staple crops is important to ensure population nutrient requirements can be met. This review aimed to explore changes in the iron content of unprocessed wheat and rice in Australia over time. A comprehensive systematic search of four electronic databases and the gray literature was conducted. A total of 25 papers published between 1930 and 2023 that measured the iron content of unprocessed wheat and rice were included. Triticum aestivum was the most common wheat type studied, including 26 cultivars; iron content ranged from 40 to 50 µg/g in the 1930s and 1970s and was more variable after this time due to the introduction of modern cultivars, with most values between 25 and 45 µg/g. The iron content of rice ( Oryza sativa ) was more consistent at 10-15 µg/g between the 1980s and 2020s. Variations over the years may be attributed to environmental, biological, and methodological factors but these were not well documented across all studies, limiting the interpretation of findings. As the number of individuals following plant-based diets continues to rise, the ongoing monitoring of the mineral content in commonly consumed plant-based foods is warranted.

Snacking outside main meals may contribute to the high intakes of discretionary foods (i.e., unhealthful foods) among young adults. This study assessed the snacking behaviours of Australian young adults including the contribution of snacking to energy and nutrient intakes, the main foods consumed, and portion sizes. A secondary analysis of the MYMeals study of adults aged 18-30 years who consumed at least one snack food during the recording period (n = 889) was conducted. All food consumed over 3 consecutive days was recorded using a purpose-designed smartphone app. Snack foods contributed 13.2% of energy, 23.4% of total sugars, and 16.2% of saturated fat. Females consumed more energy (13.8% vs. 12.2%, p = 0.007) and total sugars (25.8% vs. 20.8%, p = 0.009), from snacking than males. Fruit (20.2%), chocolate (9.9%), cake-type desserts (8.4%), sweet biscuits (6.1%), and ice-cream-type desserts (5.6%) were the most frequently consumed snacks by young adults. The median portion sizes for the top five snack foods consumed were fruit-106 g (IQR: 73), chocolate-26 g (IQR: 36), cake-95 g (IQR: 88), sweet biscuits-26 g (IQR: 29), and ice cream-75 g (IQR: 42). The current findings may inform population-wide strategies to encourage healthful snacks such as fruit, inform portion control by individuals, and persuade the food industry to reduce the serving size of discretionary snack foods such as cake.

Background: Perceived portion size norms (typical perception of how much of a given food individuals choose to eat at a single occasion) may have shifted towards larger sizes due to the ubiquity of large serving sizes. However, there is a lack of validated tools to assess such norms for energy-dense and nutrient-poor discretionary foods. This study aimed to develop and validate an online tool to examine the perceived portion size norms of discretionary foods., Methods: An online image-series tool of 15 commonly consumed discretionary foods was developed, with eight successive portion size options included for each food. Using a randomised-crossover design, adult consumers (18-65 years) completed the validation study in a laboratory session (April-May 2022) by reporting their perceived portion size norms for each food twice, once based on food images on a computer and another time based on equivalent real food portion size options at food stations in the laboratory. Agreement between methods for each test food was examined using cross-classification and intra-class correlation (ICC)., Results: A sample of 114 subjects were recruited (mean age 24.8 years). Cross-classification indicated >90% of selections were matched in the same or adjacent portion size option. ICC was 0.85 across all foods, demonstrating a good level of agreement., Conclusion: This novel online image-series tool developed to examine perceived portion size norms of discretionary foods showed good agreement with equivalent real food portion size options and may be valuable to investigate perceived portion size norms of common discretionary foods in future studies., (© 2023. The Author(s).)

Rationale & Objective: The development of new therapies for autosomal dominant polycystic kidney disease requires clinical trials to be conducted efficiently. In this study, the factors affecting the recruitment and retention of participants enrolled in a 3-year randomized controlled trial in autosomal dominant polycystic kidney disease were investigated., Study Design: Qualitative study., Setting & Participants: All participants (N=187) were invited to complete a 16-item questionnaire at the final study visit of the primary trial. Participants were recruited to complete a semistructured interview using purposeful sampling according to age, self-reported gender, and randomization group., Analytical Approach: Descriptive statistics were used for demographic data and questionnaires. The interview transcripts underwent inductive thematic coding., Results: One hundred and forty-six of the 187 randomized participants (79%) completed the post-trial questionnaire, and 31 of the 187 participants (21%) completed the interview. Most participants (94%) rated their global satisfaction with the trial as high (a score of 8 or more out of 10). Altruism, knowledge gain, and access to new treatments were the main motivators for recruitment. The main reasons for considering leaving the study were concerns about the risk of intervention and family or work issues. Strategies that favored retention included flexibility in attending different study sites, schedule flexibility, staff interactions, and practical support with parking and reminders. The main burden was time away from work with lost wages, and burden associated with magnetic resonance imaging scans and 24-hour urine output collections., Limitations: The study population was restricted to participants in a single nondrug clinical trial, and the results could be influenced by selection and possible social desirability bias., Conclusions: Participants reported high levels of satisfaction that occurred as a function of the trial meeting participants' expectations. Furthermore, retention was a balance between the perceived benefits and burden of participation. Consideration of these perspectives in the design of future clinical trials will improve their efficiency and conduct., Plain-Language Summary: Advances in the clinical practice of autosomal dominant polycystic kidney disease (ADPKD) require affected individuals to voluntarily participate in long-term multicenter randomized controlled trials (RCTs). In this qualitative post hoc study of a 3-year RCT of increased water intake in ADPKD, altruism, knowledge gain, and access to a nondrug treatment positively influenced the decision to volunteer. Ongoing participation was enabled by building flexibility into the study protocol and staff prioritizing a participant's needs during study visits. Although participants completed the required tests, most were considered burdensome. This study highlights the importance of incorporating protocol flexibility into trial design; the preference for interventions with a low risk of adverse effects; and the urgent requirement for robust surrogate noninvasive biomarkers to enable shorter RCTs in ADPKD., (© 2023 The Authors.)

Conventional dietary assessment methods are based predominately on Western models which lack Aboriginal and Torres Strait Islander knowledges, methodologies, and social and cultural contextualisation. This review considered dietary assessment methods used with Aboriginal and Torres Strait Islander populations and assessed their applicability. Four electronic databases and grey literature were searched with no time limit applied to the results. Screening, data extraction and quality appraisal were undertaken independently by two reviewers. Out of 22 studies, 20 were conducted in rural/remote settings, one in an urban setting, and one at the national population level. The most frequently used and applicable dietary assessment method involved store data. Weighed food records and food frequency questionnaires had low applicability. Modifications of conventional methods were commonly used to adapt to Indigenous practices, but few studies incorporated Indigenous research methodologies such as yarning. This highlights an opportunity for further investigation to validate the accuracy of methods that incorporate qualitative yarning-based approaches, or other Indigenous research methodologies, into quantitative data collection. The importance of developing validated dietary assessment methods that are appropriate for this population cannot be understated considering the high susceptibility to nutrition-related health conditions such as malnutrition, overweight or obesity, diabetes, and cardiovascular disease.

Objective: The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits., Methods: Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey., Results: Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L = -0.18, p &lt; 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake., Conclusions: These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Studies have shown that young adults follow less structured eating patterns compared with older cohorts. This may have implications for dietary assessment methods which rely on memory and structured meal patterns. Our aim was to describe the intra-individual variation of eating times in young adults aged 18−30 years. Participants (n = 41) wore an Autographer camera that captured first-person perspective images every 30 s for three consecutive days. All images were timestamped and those showing food consumption were used to extract data such as the timing of the first and last eating occasions (EOs), number of EOs per day, and length of eating window. Intra-individual variability was calculated from these data using composite phase deviation (CPD) and coefficient of variation (CV). The number of individuals with high or very high variability was 28 and 18 for timing of first and last EOs, respectively (CPD > 1.70), and 27 and 17 for number of EOs and eating window, respectively (CV > 20%). In this sample of young adults, the lack of regularity in eating patterns should be considered when selecting a dietary assessment method., Competing Interests: The authors declare that they have no conflicts of interest.

NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, ( n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

The study of food consumption, diet, and related concepts is motivated by diverse goals, including understanding why food consumption impacts our health, and why we eat the foods we do. These varied motivations can make it challenging to define and measure consumption, as it can be specified across nearly infinite dimensions-from micronutrients to carbon footprint to food preparation. This challenge is amplified by the dynamic nature of food consumption processes, with the underlying phenomena of interest often based on the nature of repeated interactions with food occurring over time. This complexity underscores a need to not only improve how we measure food consumption but is also a call to support theoreticians in better specifying what, how, and why food consumption occurs as part of processes, as a prerequisite step to rigorous measurement. The purpose of this Perspective article is to offer a framework, the consumption process framework, as a tool that researchers in a theoretician role can use to support these more robust definitions of consumption processes. In doing so, the framework invites theoreticians to be a bridge between practitioners who wish to measure various aspects of food consumption and methodologists who can develop measurement protocols and technologies that can support measurement when consumption processes are clearly defined. In the paper we justify the need for such a framework, introduce the consumption process framework, illustrate the framework via a use case, and discuss existing technologies that enable the use of this framework and, by extension, more rigorous study of consumption. This consumption process framework demonstrates how theoreticians could fundamentally shift how food consumption is defined and measured towards more rigorous study of what, how, and why food is eaten as part of dynamic processes and a deeper understanding of linkages between behavior, food, and health., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Portion sizes of many energy-dense and nutrient-poor foods and drinks have increased in the past decade, whereas our understanding of the pattern of changes in package sizes remains limited. This study aimed to determine changing trends in sales and package sizes of savoury snacks in Australia, the USA, Japan and Hong Kong, and to investigate industry perspectives for these changes. Sales data (units per capita) between 2006−2020 on savoury snacks were extracted from the Euromonitor International database. Industry perspectives on package size changes were extracted systematically from selected databases, company reports and related websites following the PRISMA-ScR guidelines. The findings showed that sales per capita of savoury snacks of all package sizes increased across all four countries/regions between 2006−2020. Although changes in the proportion of smaller (<100 g) versus larger (>100 g) package size sales in each country/region over time were modest, Japan and Hong Kong exhibited a consistently higher proportion of smaller package sales compared with Australia and the USA (83.3%, 64.4%, 44.3%, 20.2%, respectively). Industry perspectives showed that increasing consumer health consciousness, demands for convenience and portion control were the main contributors to decreasing package sizes of savoury snacks. Industry reports from 2020 showed an increase in larger package size sales due to consumer purchasing behaviour amidst the COVID-19 pandemic.

Low vitamin D status (serum 25-hydroxyvitamin D (25(OH)D) concentration < 50 nmol/L) is prevalent in Australia, ranging between 15% and 32% in the adolescent and adult populations. Vitamin D intakes are also low across the population and were recently estimated at 1.8−3.2 µg/day on average, assuming equal bioactivity of the D vitamers. In combination, these findings strongly suggest that data-driven nutrition policy is needed to increase vitamin D intake and improve status in the Australian population. Food fortification is a potential strategy. We used up-to-date vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2, and nationally representative food and supplement consumption data from the 2011−2013 Australian Health Survey, to model a fortification scenario of 0.8 µg/100 mL vitamin D for fluid dairy milks and alternatives. Under the modelled fortification scenario, the mean vitamin D intake increased by ~2 µg/day from baseline to 4.9 µg/day from food only (7.2 µg/day including supplements). Almost all individual intakes remained substantially below 10 µg/day, which is the Estimated Average Requirement in North America. In conclusion, this modelling showed that fortification of fluid milks/alternatives with vitamin D at the current permitted level would produce a meaningful increase in vitamin D intake, which could be of potential benefit to those with a low vitamin D status. However, this initial step would be insufficient to ensure that most of the population achieves the North American EAR for vitamin D intake. This approach could be included as an effective component of a more comprehensive strategy that includes vitamin D fortification of a range of foods.

As food intake patterns become less structured, different methods of dietary assessment may be required to capture frequently omitted snacks, smaller meals, and the time of day when they are consumed. Incorporating sensors that passively and objectively detect eating behavior may assist in capturing these eating occasions into dietary assessment methods. The aim of this study was to identify and collate sensor-based technologies that are feasible for dietitians to use to assist with performing dietary assessments in real-world practice settings. A scoping review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) framework. Studies were included if they were published between January 2016 and December 2021 and evaluated the performance of sensor-based devices for identifying and recording the time of food intake. Devices from included studies were further evaluated against a set of feasibility criteria to determine whether they could potentially be used to assist dietitians in conducting dietary assessments. The feasibility criteria were, in brief, consisting of an accuracy ≥80%; tested in settings where subjects were free to choose their own foods and activities; social acceptability and comfort; a long battery life; and a relatively rapid detection of an eating episode. Fifty-four studies describing 53 unique devices and 4 device combinations worn on the wrist ( n = 18), head ( n = 16), neck ( n = 9), and other locations ( n = 14) were included. Whilst none of the devices strictly met all feasibility criteria currently, continuous refinement and testing of device software and hardware are likely given the rapidly changing nature of this emerging field. The main reasons devices failed to meet the feasibility criteria were: an insufficient or lack of reporting on battery life (91%), the use of a limited number of foods and behaviors to evaluate device performance (63%), and the device being socially unacceptable or uncomfortable to wear for long durations (46%). Until sensor-based dietary assessment tools have been designed into more inconspicuous prototypes and are able to detect most food and beverage consumption throughout the day, their use will not be feasible for dietitians in practice settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Allman-Farinelli, Yang, Taylor, Gemming, Hekler and Rangan.)

Ready meals are typically a high sodium product and excessive sodium increases the risk for chronic disease. The study aimed to explore the association between sodium content, Health Star Rating (HSR) and the Healthy Food Partnership (HFP) sodium reduction target for ready meals. Median (IQR) sodium content in mg/100 g and mg/serving were determined overall and for each subcategory (ambient, chilled and frozen). Wilcoxon rank sum test was used to compare the sodium content between ready meals with and without HSR. The Jonckheere trend test was used to assess presence of trend in sodium content by HSR categories. In total, 631 ready meals were included and 311 (49%) met the HFP sodium target (<250 mg per 100 g). The percentage of products displaying the voluntary front-of-pack HSR was 52% and of these, 82% had a star rating ≥3.5. A lower median sodium content (mg/100 g) was consistently observed for products with HSR compared with products without HSR (all p’s < 0.05). Except for ambient ready meals, a trend was observed where the higher the HSR category, the lower the sodium content (p < 0.001). A higher proportion of the products with HSR ≥ 4 met the HFP sodium target for ready meals.

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated., Aim: To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery., Methods: A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations., Results: Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022)., Conclusions: Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.

Despite producing sufficient food for the global population, the growing prevalence of food insecurity in developed countries is cause for concern. The millions of metric tons of food wasted each year could be used instead to drastically lower rates of food insecurity and address food sustainability. In this scoping review, we aimed to identify barriers to and enablers of harnessing food waste across food sectors, including food retail, households, and food rescue organizations, to address food insecurity in a developed country, Australia. The findings demonstrate that research on and responsibility for harnessing food waste for food insecurity has predominantly fallen on ill-equipped food rescue organizations. Three primary policy advancements paramount to harnessing food waste to address food insecurity include (1) improving partnerships and subsidies to minimize transportation costs for redistributing imperfect or surplus food from farmers and retailers to those who with food insecurity; (2) enhancing existing partnerships and subsidies to stably involve more nutrition experts in food rescue organizations to improve the quality of foods being redistributed to those facing food insecurity; and (3) initiating interventions and campaigns that combine the following 5 characteristics: free to the participants; address food literacy; use multiple mass-media tools; are age tailored; and frame messages within personal values., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Postoperative feeding practices vary after pelvic exenteration surgery because of the lack of nutrition research in this specific surgical area. Postoperative ileus (POI) is common after pelvic exenteration surgery, and early enteral feeding is often avoided because of the lack of evidence and the belief that this may induce POI in this patient cohort. The aim of this study was to determine the effects of early enteral feeding after pelvic exenteration surgery on return of bowel movement and POI., Methods: A randomized controlled trial was conducted with patients undergoing pelvic exenteration surgery from November 2018 to June 2020. Forty participants received standard nutrition care (parenteral nutrition) and 47 participants received trophic enteral feeding (20 ml/h) via a nasogastric tube, in addition to standard care, until participants were upgraded to free fluids. Time to first bowel movement and rates of POI were the main outcome measures., Results: There was no significant difference between arms for time to first bowel movement; however, POI rates were significantly less in participants who were enterally fed (P = .036) in the per-protocol analysis. Regressions showed that the longer patients were restricted from an oral diet after surgery, the greater the time was to first bowel movement and the greater the postoperative complication rates (P < .0005)., Conclusions: Early enteral feeding can be commenced safely to improve gastrointestinal function after pelvic exenteration surgery., (© 2021 American Society for Parenteral and Enteral Nutrition.)

BACKGROUND: Arginine vasopressin promotes kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). Increased water intake reduces arginine vasopressin and urine osmolality and may slow kidney cyst growth. METHODS: In this randomized controlled 3-year clinical trial, we randomly assigned adults with ADPKD who had a height-corrected total kidney volume in Mayo imaging subclass categories 1B to 1E and an estimated glomerular filtration rate of 30 ml/min/1.73 m2 or greater to (1) water intake prescribed to reduce 24-hour urine osmolality to 270 mOsmol/kg or less or (2) ad libitum water intake irrespective of 24-hour urine osmolality. The primary end point was the percentage annualized rate of change in height-corrected total kidney volume. RESULTS: A total of 184 patients participated in either the ad libitum water intake group (n=92) or the prescribed water intake group (n=92). Over 3 years, there was no difference in the annualized rate of change in height-corrected total kidney volume between the ad libitum (7.8% per year; 95% confidence interval [CI], 6.6 to 9.0) and prescribed (6.8% per year; 95% CI, 5.8 to 7.7) water intake groups (mean difference, −0.97% per year; 95% CI, −2.37 to 0.44; P=0.18). The difference in mean 24-hour urine osmolality between the ad libitum and prescribed water intake groups was −91 mOsmol/kg (95% CI, −127 to −54 mOsmol/kg), with 52.3% of patients achieving adherence to the target 24-hour urine osmolality and no reduction in serum copeptin over 3 years. The frequency of adverse events was similar between groups. CONCLUSIONS: For patients with ADPKD, prescribed water intake was not associated with excess adverse events and achieved the target 24-hour urine osmolality for half of the patients but did not reduce copeptin or slow the growth of total kidney volume over 3 years compared with ad libitum water intake. (Funded by the National Health and Medical Research Council of Australia [grant GNT1138533], Danone Research, PKD Australia, the University of Sydney, and the Westmead Medical Research Foundation; Australian New Zealand Clinical Trials Registry number, ACTRN12614001216606).

Studies in UK and US have reported a temporal decline in the iron content of plant-based foods. Limited research on this topic has been conducted in Australia. The aim of this scoping review was to provide a comprehensive evaluation on the temporal change in iron content of Australian vegetables and legumes from 1900 onward. A systematic search of electronic databases, websites, backward reference searching, and Australian food composition tables was conducted. A total of 34 articles and six versions of Australian food composition databases published between 1930s to 2021, were included in this review. Overall, iron content of vegetables and legumes were assessed at limited time points and geographical origin, cultivars, sampling and analytical techniques varied across studies. The majority of vegetables had similar iron content between two or more timepoints but decreases of 30-50% were noted for sweet corn, red-skinned potatoes, cauliflower and green beans while increases of 150-300% were seen for Hass avocadoes, mushrooms and silverbeet. More pronounced reductions in iron content were observed for legumes, with higher and more variable values reported pre-2000 compared to recent years. Due to limited data and variations in sampling and analytical techniques, no definitive conclusions could be established. As plant-based diets are becoming more popular, consistent monitoring of the nutrient composition of staple plant-based foods is strongly recommended.

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

Introduction: Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake., Methods: This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946-2019) were included., Results: A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases., Conclusion: Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies., Prospero Registration Number: A pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809)., Competing Interests: Competing interests: GKR is chief investigator of an investigator-initiated grant from Danone Nutricia, but this project was conducted independently of this work. All other authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine the potential effect on Fe intake of 7-8 months old infants if pre-packaged baby foods (PBF) were used as the sole source of complementary foods., Design: Based on the 7-d recommended feeding plan for 7-8 months old infants in Hong Kong (moderate Fe-fortified rice cereal with home-cooked meals), twenty-four modelling scenarios were created which comprised of two milk use modes (breastmilk v. infant formula), three modes of rice cereal use (no-rice cereal; non-Fe-fortified rice cereal and Fe-fortified rice cereal) and four baby foods usage modes (home-cooked meals; low-Fe PBF only; high-Fe PBF only and mixed PBF). The PBF were randomly selected in each of the models and substituted the original meals/snacks. The average daily Fe intakes of the modelled meal plans were compared with the Chinese estimated average requirement (EAR) and recommended nutrient intake (RNI) for Fe., Setting: Modelling study., Participants: Not applicable., Results: In general, the infant-formula-based complementary feeding pattern (CFP) had higher average daily Fe intake when compared with breastmilk-based CFP. The Fe intakes of all scenarios under the breastmilk-based CFP were below the RNI and EAR, except for the fortified rice cereal meal plans with high-Fe or mixed PBF. For infant-formula-based CFP, the Fe intakes were close to or above the RNI regardless of types of PBF or rice cereal used., Conclusions: The inclusion of fortified rice cereal was important in maintaining adequate Fe intake for infants, especially for breast-fed infants. The replacement of home-cooked meals by low-Fe PBF could potentially put infants at risk of Fe deficiency.

Background: Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level., Methods: A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011-2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking., Results: Significant (P-trend ≤ 0.001) direct dose-response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m 2 ; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level., Conclusion: The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.

Objectives: The aim of this study was to investigate the role of breakfast consumption and breakfast size on daily energy, nutrient intakes, and diet quality., Methods: One-day 24-h recall data from the 2011 to 2012 National Nutrition and Physical Activity Survey (n = 9341, adults ≥ 19 y) were analyzed, and respondents were classified into breakfast consumers or skippers. Breakfast consumers were further classified into quartile of breakfast size (energy intake [EI] from breakfast × 100%/daily EI). Diet quality was assessed using the Healthy Eating Index for Australian Adults. General linear modeling was undertaken to compare groups, adjusting for potential confounders., Results: Overall, 85.9% of adults consumed breakfast, contributing a mean of 19.9 ± 10.9% of daily EI for consumers. Among breakfast consumers, obtaining a higher proportion of daily EI from breakfast was associated with lower daily intakes of energy, added sugars, saturated fat, and alcohol (%E); higher intakes of dietary fiber (%E) and most micronutrients (per 1000 kJ); and better Healthy Eating Index for Australian Adults scores (P trend < 0.0001). Additionally, those in the highest quartile of breakfast size (>25.5% EI) had higher diet quality scores (P < 0.001) but similar daily EI (P = 0.751) compared with breakfast skippers., Conclusions: These findings indicate that obtaining a higher proportion of daily EI from breakfast may result in more favorable dietary profiles and lower daily EI. Further research is needed to confirm this., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background/objectives: Diet is important in healthy ageing. Protein is essential for physical function, immunity, maintaining quality of life and ability to live independently., Subjects/methods: Protein intakes, sources and the protein content of meals and snacks among adults aged ≥65 years from the 1995 National Nutrition Survey (n = 1960) and the 2011/12 National Nutrition and Physical Activity Survey (n = 2103) were examined. Usual protein intakes were estimated using the National Cancer Institute method, and intakes and adequacy were compared between the two surveys., Results: Participants reported a higher total protein intake in 2011/12 than 1995 (81.0 vs. 73.4 g, p < 0.001). Mean protein intake per kg body weight (1995, 1.0 g/kg vs. 2011/12, 1.1 g/kg) and ability to meet the Australian (1995, 85% vs. 2011/12, 88%) and World Health Organisation (1995, 90% vs. 2011/12, 94%) protein requirements increased over time. Males >70 years or those with poor self-assessed health status were more likely to report inadequate protein intake compared with other respondents. Higher protein intake was associated with greater consumption of vegetables, fruit, dairy products, meat and alternatives and lower consumption of discretionary foods and alcohol. Participants obtained 17% of their protein intake from breakfast, 30% from lunch, 43% from dinner and 10% from snacks. Main protein sources included lean red meat, poultry and full cream milk., Conclusion: Specific dietary advice for older Australians, particularly older men and those with poor health, to promote healthy food choices with adequate protein content is needed for disease prevention and maintenance of quality of life.

Objective: The aim of this study was to validate self-reported anthropometric measurements and body mass index (BMI) classifications in a young adult population., Methods: Both self-reported and directly measured weight and height of 100 young adults 18 to 30 y of age were collected. Participants were measured at one of two university clinics by two research dietitians and within 2 wk self-reported their body weight and height via a questionnaire as part of a larger study. BMI was calculated and categorized according to the World Health Organization's cut-points for underweight, healthy weight, and overweight or obesity. The validity of measured against self-reported weight and height was examined using Pearson's correlation, Bland-Altman plots, and Cohen's kappa statistic., Results: Strong correlation was observed between measured and self-reported weight (r = 0.99; P < 0.001), height (r = 0.95; P < 0.001), and BMI (r = 0.94; P < 0.001). Bland-Altman plots indicated that the mean difference between self-reported and direct BMI measurements were small in the total sample (0.1 kg/m 2 ). The majority of values fell within the limits of agreement (2 SD), with random scatter plots and no systemic bias detected. The classification of BMI from self-reported and direct measurements showed that 88% were placed in the equivalent weight category with very good agreement Cohen's kappa (0.76; 95% confidence interval, 0.63-0.89; P < 0.001)., Conclusions: Good agreement was detected between self-reported and direct anthropometric measurements. The criticism of self-reported anthropometric measurements is unwarranted. The findings provide support for using self-reported height and weight data for research in Australian young adults when direct measurements are not feasible., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/objectives: Despite best practice guidelines, feeding methods after colorectal surgery vary due to the difficulties translating evidence into practice. The aim was to determine the effectiveness of diets delivered into the gastrointestinal tract (GIT) on gut motility following colorectal surgery., Subjects/methods: EMBASE, MEDLINE, CINAHL, Web of Science and PubMed were systematically searched. Randomised controlled trials investigating effectiveness of a diet on gut motility after colorectal surgeries were included. Outcomes included postoperative ileus, length of stay, mortality, nausea and vomiting., Results: A total of 756 potential studies were identified; of these, 10 trials reporting on 1237 unique patients were included. There is evidence that early feeding reduces time (days) to first flatus (mean difference (MD):-0.64; 95% CI:-0.84 to -0.44) and bowel movements (MD:-0.64; 95% CI:-1.01 to -0.26), when compared to traditional postoperative fasting. Introducing solids versus the progression of fluids to solids had no effect on time (days) to first flatus (MD:0.13; 95% CI:-1.99 to 1.74) or bowel movement (MD:0.20; 95% CI:-0.50 to 0.98). Complete nutrition compared to hypocaloric nutrition had no effect on time to first flatus (MD:-0.60; 95% CI:-1.66 to 0.46) or bowel movement (MD:-0.20; 95% CI:-1.59 to 1.19), whereas coffee and diet compared to water and diet significantly decreased time (days) to first bowel movement (MD:-0.60; 95% CI:-0.97 to -0.19) but had no effect on time to first flatus (MD:-0.20; 95% CI:-0.57 to 0.09)., Conclusions: Any form of early postoperative diet provided into the GIT early after colorectal surgery is likely to stimulate gut motility, resulting in earlier return of bowel function and shorter length of stay.

Objectives: Calcium is an essential nutrient required for peak bone mass growth during adolescence and into young adulthood. The aim of this study was to examine the calcium intake of Australian adolescents and young adults from both food sources and supplements; and the relationship between calcium intake and intake of food groups., Methods: Dietary data from 770 adolescents (14-18 y of age) and 774 young adults (19-25 y of age) from the 2011 to 12 National Nutrition and Physical Activity Survey were used. Analysis of covariances were conducted to identify associations between calcium intake and consumption of food groups., Results: For adolescents, 83% of males and 95% of females did not meet the Estimated Average Requirement (EAR); whereas for young adults, 69% of males and 83% of females failed to meet the EAR. Food sources contributing to calcium intake were similar across age groups and sex. The largest contributors included regular milk (15-24%), cheese (10-12%), refined low-fiber bread (10%), and low-fat milk (7-9%). For both age groups, the lowest consumers of calcium were the poorest consumers of dairy products and the highest consumers of discretionary food choices and alcoholic beverages. A higher consumption of calcium was associated with a higher intake of dairy products and lower intakes of meat and alternatives and all discretionary choices., Conclusions: Calcium intake among Australian adolescents and young adults remains below recommendations, particularly in females. A higher intake of calcium was associated with a better dietary pattern. Further investment in interventions is indicated., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To examine the eating occasion (EO) where most added sugars (AS) were consumed using a nationally representative dataset., Methods: Plausible dietary data from the Australian Health Survey respondents (n = 8202), collected by a multiple-pass 24-h recall, were analyzed. EO was self-reported during the recall. AS content of the foods reported was estimated using a previously published method. Proportion of daily AS consumed (%AS daily ) and the main food sources, at each EO, were calculated. Differences between children/adolescents and adults were tested by one-way ANOVA. Further stratification by age group and sex was performed., Results: The majority of the %AS daily came from non-main meal occasions (NMMOs; 48.3 %, 95 % CI 47.5-49.0 %), followed by breakfast/brunch (20.6 %, 95 % CI 20.1-21.1 %). Children and adolescents consumed more %AS daily during NMMOs compared with adults (52 vs. 47 %; p < 0.001), while girls/women consumed more %AS daily during NMMO compared with boys (54 vs. 49 %; p = 0.002) and men (50 vs. 45 %; p < 0.001). Sugar-sweetened beverages were the top contributors to AS at lunch, dinner and NMMOs, while sugar and sweet spreads were the top contributor at breakfast/brunch. Other top contributors at NMMOs included "other foods," ice cream and cakes and biscuits, pastries and batter-based products., Conclusion: Australians consumed nearly half of %AS daily during NMMOs, most of which came from high-sugar energy-dense nutrient-poor foods. While the common perception that most AS come from snacks holds true, our results suggest that main meals are also important intervention targets.

Background: The negative health effect of excessive intake of free sugars has been gaining increasing public awareness., Objective: This secondary analysis aimed to evaluate the impact of free-sugar intake on micronutrient dilution, and estimate a threshold level of free-sugar intake at which a decrease in micronutrient intake becomes evident, based on data from the Australian Health Survey 2011-2012., Design: Dietary data from adult respondents (weighted n = 6150) who had completed two 24-h recalls were analyzed. A published 10-step methodology was adopted and used to estimate the free-sugar intake of the respondents. Six modified cut-offs for percentage of energy of free sugars (%EFS) were created based on recommendations from the WHO and the Institute of Medicine to examine the association between %EFS on micronutrient intakes. Estimated marginal means and SEs were calculated using ANCOVA. Logistic regression was used to calculate the ORs of not meeting the nutrient reference values for Australia and New Zealand for each micronutrient with an increase in free-sugar intake. Analyses were adjusted for age, sex, socioeconomic status, country of birth, whether dieting, smoking status, and remoteness of living area., Results: Peak intake for most micronutrients was observed at %EFS between 5% and <15%. A significant reduction in most micronutrient intakes was observed at >25%EFS. At <5%EFS, some micronutrient intakes were reduced. Only small variations in micronutrient consumptions were observed when %EFS was between 5% and 25%. Core food intake decreased and discretionary food increased with an increase in free-sugar intake., Conclusion: A high free-sugar intake, particularly >25%EFS, was found to have a significant diluting effect on most nutrients. However, a free-sugar intake <5%EFS may increase the risk of undesirably low micronutrient consumption related to inadequate total energy intake. This secondary analysis was registered at anzctr.org.au as ACTRN12617000917336., (© 2018 American Society for Nutrition. All rights reserved.)

Background: It is hypothesized that the observed proliferation of energy-dense, nutrient-poor foods globally is an important contributing factor to the development of the obesity epidemic. However, evidence that the population's dietary energy density has increased is sparse. The World Cancer Research Fund recommends that dietary energy density be <1.25 kcal/g to prevent weight gain., Objective: The aim of this research was to determine whether the dietary energy density of the Australian population has changed between 1995 and 2012., Design: A secondary analysis of two cross-sectional Australian national nutrition surveys from 1995 and 2011/2012 was conducted., Participants/setting: Participants of the surveys included adults aged 18 years and older (1995 n=10,986 and 2011/2012 n=9,435) completing 24-hour dietary recalls, including a second recall for a subset of the population (10.4% in 1995 and 64.6% in 2011/2012)., Main Outcome Measures: Outcome measures included the change in dietary energy density (calculated as energy/weight of food [kcal/g] for food only) between surveys., Statistical Analysis: The National Cancer Institute method for "estimating ratios of two dietary components that are consumed nearly every day" was used to determine the usual distribution and the percentage of participants reporting energy density <1.25 kcal/g., Results: The mean (standard deviation) dietary energy density was 1.59 (0.26) kcal/g and 1.64 (0.32) kcal/g (P<0.0001) in 1995 and 2011/2012, respectively, with 13% and 5% (P<0.0001) of the population meeting dietary energy-density recommendations. For those aged 70 years and older, the percentage with energy density <1.25 kcal/g decreased from 22% to 6% (P<0.0001) for men and from 33% to 11% (P<0.0001) for women in 1995 and 2011/2012, respectively. Among those aged 18 to 29 years, 1% of men in both surveys (P=0.8) and 4% of women in 1995 and 2% in 2011/2012 (P=0.01) reported energy density <1.25 kcal/g., Conclusions: Dietary energy density has increased between the two surveys and few people consumed low energy-dense diets in line with recommendations. The change was largely due to increased energy density of older adult's diets, while young adults had high dietary energy density at both time points. These data suggest efforts now focus on the evaluation of the role of modifying energy density of the diet to reduce the risk of weight gain in adults., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to investigate the cross-sectional associations among sugar-sweetened beverage (SSB) consumption, its substitution with beverage alternatives, and obesity outcomes in an Australian population., Methods: We used data from 9341 adults ages ≥19 y from the 2011-2012 Australian National Nutrition and Physical Activity Survey. Multivariate linear regression with adjustment for covariates was used to examine the associations between SSB consumption and body mass index (BMI) and waist circumference (WC). Substitution modeling was used to simulate the effect of replacing SSB with water, coffee/tea, fruit juice, and milk., Results: SSB intake (100 g/d) was associated with higher BMI (β = 0.06 kg/m 2 ; P = 0.001) and WC (β = 0.19 cm; P < 0.001). A linear trend with BMI and WC also was seen when SSB intake was examined as categories of servings per day (P trend  ≤ 0.001). Replacing SSB with water, coffee/tea, or milk was inversely associated with BMI (β = -0.07 to -0.09 kg/m 2 ; P < 0.001) and WC (β = -0.25 to -0.28 cm; P < 0.001)., Conclusions: The results of the present study suggested that SSB intake is associated with obesity and that coffee/tea, water, and milk may be good alternatives for SSB. Further longitudinal and intervention studies are warranted to examine the effects of beverage substitution on obesity., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Tertiary education institutions have been linked with excessive weight in young adults. However, few data are available on the effect of foods from the university food environment on the diet quality of young adults. The aim of this study was to describe the association of a number of foods and beverages consumed at university food outlets with the diet quality of young adults., Methods: This was a cross-sectional survey in which the 103 university student participants, aged 19 to 24 y, contributed 5 d of dietary data. A purposely designed, validated smartphone application was used to collect the data. Diet quality was assessed by adherence to the 2013 dietary guidelines for food groups and nutrients, and the validated Healthy Eating Index for Australians (HEIFA-2013) was applied. Individual HEIFA-2013 scores were compared with the frequency of food purchase and consumption from university outlets to assess a dose-response effect of the food environment. Comparisons by tertiles of diet quality for body mass index, waist circumference, and takeaway food consumption (university and other) were computed using a one-way analysis of variance and post hoc Tukey test., Results: There was a statistically significant difference between the number of university foods and beverages consumed in 5 d and the HEIFA-2013 scores: More on-campus purchases resulted in a poor-quality diet (P = 0.001). As the HEIFA-2013 tertile scores increased, there was a significant decrease in the number of university campus and other takeaway foods consumed; body mass index and waist circumference showed a decrease in trend., Conclusions: Efforts to improve the diet quality of young adults attending university may benefit from approaches to improve the campus food environment., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Diet quality indices are used to assess dietary behavior and adherence to dietary guideline recommendations. The aim of this study was to develop, apply, and validate a Healthy Eating Index for Australian Adults (HEIFA-2013) based on the updated Dietary Guidelines for Australians 2013., Methods: The HEIFA-2013 used an 11-component system of 5 food groups, 4 nutrients, water intake, and a measure of dietary variety. The total possible index score was 100. The HEIFA-2013 was applied to weighed food record (WFR) and food frequency questionnaire (FFQ) data of a sample (n = 100) of young adults. The HEIFA-2013 was assessed using principal components analysis (PCA), Cronbach's coefficient, and correlation coefficient with nutrient intakes. Scores for HEIFA-2013 components were compared between methods using means, frequencies, 95% limits of agreement, Bland and Altman methods, and weighted kappa., Results: PCA indicated that multiple underlying dimensions compose the index, and Cronbach's coefficient α was 0.41. A higher HEIFA-2013 was associated with higher dietary quality, including a low intake of saturated fat and sodium and a high intake of selected vitamins and minerals. Low correlations with energy were observed. The mean HEIFA-2013 score ± standard error (SE) for the WFR was 53.84 ± 1 and for the FFQ was 54.82 ± 0.9. The total mean scores were 54.33 ± 0.1. Young adults had the lowest mean scores for sodium (2.9 ± 0.2), fat (3.0 ± 0.0), vegetables (4.7 ± 0.1), and grains (5.1 ± 0.1). The WFR and FFQ scored individual components differently, but at the group level the differences were not significant., Conclusions: The HEIFA-2013 will need to be catered for different diet collection methods. It is a useful index of overall diet quality and can be used to monitor changes in dietary intake of adults over time. The findings infer that even a highly educated affluent group of young adults fails to meet recommended dietary guidelines., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults., Objective: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method., Methods: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods., Results: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%)., Conclusions: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients.

Objective: The aim of this study was to examine the association between different types of beverage intake and substitution of sugar-sweetened beverages (SSBs) by water, milk, or 100% fruit juice in relation to 6-y change in body fatness., Methods: A cohort of 9-y-old children (N = 358) who participated in the Danish part of the European Youth Heart Study was followed for development of body fatness over 6 y. Multivariate linear regression was used to examine the associations between beverage intake at baseline and change in body fatness (body mass index z score [BMIz]), waist circumference (WC), and sum of four skinfolds (Σ4SF) over 6 y with adjustment for potential confounders. Substitution models were used to evaluate various beverages as alternatives to SSBs., Results: SSB intake at age 9 y, but not intake of other beverages, was directly associated with subsequent 6-y changes in BMIz (β = 0.05; P = 0.02) and Σ4SF (β = 0.86; P = 0.02). Daily substitution of 100 g water for 100 g SSB was inversely associated with changes in BMIz (β = -0.04; P = 0.02), WC (β =-0.29; P = 0.04), and Σ4SF (β = -0.91; P = 0.02) over 6 y. Daily substitution of 100 g milk for 100 g SSB was also inversely associated with changes in BMIz (β = -0.05; P = 0.02), WC (β = -0.33; P = 0.046), and Σ4SF (β = -0.79; P = 0.06). No effect was observed for substitution of SSB by 100% fruit juice., Conclusion: Our results suggest that SSB intake is associated with long-term changes in body fatness in children, and replacing SSBs with water or milk, but not 100% fruit juice, is inversely associated with body fatness development., (Copyright © 2015 Elsevier Inc. All rights reserved.)