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High prevalence of obesity and non-communicable diseases is a global public health problem, in which the quality of food environments is thought to play an important role. Current scientific evidence is not consistent regarding the impact of food environments on diet. The relationship between local food environments and diet quality was assessed across 10 Australian suburbs, using Australian-based indices devised to measure the two parameters. Data of dietary habits from the participants was gathered using a short questionnaire. The suburbs' Food Environment Score (higher being healthier) was associated with higher consumption of fruit (χ² (40, 230) = 58.8, p = 0.04), and vegetables (χ² (40, 230) = 81.3, p = 0.03). The Food Environment Score identified a significant positive correlation with four of the diet scores: individual total diet score (r s = 0.30, p < 0.01), fruit and vegetable score (r s = 0.43, p < 0.01), sugary drink score (r s = 0.13, p < 0.05), and discretionary food score (r s = 0.15, p < 0.05). Moreover, the suburbs' RFEI (Retail Food Environment Index, higher being unhealthier) showed a significant association with higher consumption of salty snacks (χ² (24, 230) = 43.9, p = 0.04). Food environments dominated by food outlets considered as 'healthier' were associated with healthier population food intakes, as indicated by a higher consumption of fruit, vegetables, and water, as well as a lower consumption of junk food, salty snacks, and sugary drinks. This association suggests that healthier diet quality is associated with healthier food environments in regional Australia., Competing Interests: The authors declare no conflict of interest.

Objective: To update the estimate of mean salt intake for the Australian population made by the Australian Health Survey (AHS)., Design: A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of salt intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily salt intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples., Setting: Lithgow, New South Wales, Australia., Subjects: Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll., Results: Mean (95 % CI) salt intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of salt intake for Lithgow adults based upon the 24 h urine collections was 9·0 (8·6, 9·4) g/d. When the age- and sex-specific estimates of salt intake obtained from the 24 h urine collections in the Lithgow sample were weighted using Australian census data, estimated salt intake for the Australian population was 9·0 (8·6, 9·5) g/d. Further adjustment for non-urinary Na excretion made the best estimate of daily salt intake for both Lithgow and Australia about 9·9 g/d., Conclusions: The dietary recall method used by the AHS likely substantially underestimated mean population salt consumption in Australia.

Essentials The pathophysiology of type 2M von Willebrand disease (VWD) is poorly understood. Sequence variations in type 2M VWD subjects were characterized. A high degree of clinical and laboratory variability exists within type 2M VWD variants. Some type 2M variants may share features of type 2A VWD., Summary: Background von Willebrand factor (VWF) is a multimeric coagulation factor that tethers platelets to injured subendothelium. Type 2M von Willebrand disease (VWD) is characterized by a qualitative defect in VWF with preserved multimer distribution. Objectives Through the Zimmerman Program for the Molecular and Clinical Biology for VWD, five VWF sequence variations were studied in subjects diagnosed with type 2M VWD. Methods Bleeding phenotype was assessed using the ISTH bleeding assessment tool. Full-length VWF gene sequencing was performed for each subject. Each variant was placed into a recombinant VWF vector using site-directed mutagenesis and expressed in HEK293T cells as homozygous or heterozygous VWF. Variant expression, collagen binding and platelet GPIbα binding were studied through ELISA assays. Multimer analysis was performed by gel electrophoresis. Results Bleeding scores were elevated for all subjects except for the p.P1162L and p.R1374C variants. Although all had reduced VWF ristocetin cofactor activity/VWF antigen ratios on plasma testing, recombinant VWF did not show a classic type 2M phenotype for any of the five variants. Homozygous expression of variants p.D1283Y, p.R1349C, p.R1374C and p.I1453N was consistent with type 2A VWD, although all had normal expression as heterozygous recombinant VWF. Variant p.P1162L had normal VWF expression and function, consistent with the lack of bleeding symptoms. Conclusions Although originally classified as type 2M VWD, these homozygous recombinant VWF variants do not fulfill complete 2M VWD diagnostic criteria. A better classification schema and improved testing for putative type 2M variants is needed in order to effectively diagnose and treat affected patients., (© 2017 International Society on Thrombosis and Haemostasis.)

Consuming a healthy diet forms an important component of diabetes management; however, adhering to a healthy diet is challenging. Dietary behaviour is often guided by socio-cultural, environmental and emotional factors, and not necessarily by physical and nutritional needs. This study explored Nepalese patients' perceptions of the impact of diet, diet management requirement for diabetes and how Nepalese food culture in particular influenced diet management. Interviews were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu; and data was thematically analysed. Diet was recognized as a cause of, and a key treatment modality, in diabetes. Besides doctors, participants in Nepal received a large amount of dietary information from the community. Dietary changes formed a major component of lifestyle modifications adopted after diagnosis, and mostly consisted of removal of foods with added sugar and foods with high total sugar content from the diet, and a reduction in overall quantity of foods consumed. Perceived dietary restriction requirements created social and emotional discomfort to patients. Most participants perceived the Nepalese food culture as a barrier to effective diet management. Meals high in carbohydrates, limited food choices, and food preparation methods were identified as barriers, particularly in Nepal. In Australia, participants reported greater availability and easier access to appropriate food, and healthier cooking options. The socio-cultural aspects of food behaviour, mainly, food practices during social events were identified as significant barriers. Although diet was acknowledged as an important component of diabetes care, and most adopted changes in their diet post-diagnosis, effective and sustained changes were difficult to achieve. Future public health campaigns and education strategies should focus on improving diet knowledge, awareness of food options for diabetes, and effective dietary management., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim: To obtain expert consensus to develop and evaluate a rating system on the relative healthiness of Australian suburbs' food outlet types., Methods: Twenty-four food outlet types and 10 local suburbs were identified from previous mapping studies and based on a scan of suburbs across one large Australian geographical region. Initial food outlet 'scores' for relative healthiness were proposed based on available literature, classified into five categories, from 'most' to 'least' healthy. In round 1 of a modified Delphi survey, participants, Australian public health and nutrition experts, were given each outlet type's definition and the proposed scores and invited to modify the scores based on their perceived 'healthiness'. In round 2, participants were able to revise or adjust their scores., Results: Median scores for food outlet types from both rounds highly correlated with the originally proposed scores (two-tailed Pearson's correlation coefficient 0.97 and 0.96, respectively, P = 0.01), and scores from round 1 highly correlated with those from round 2 (Pearson's coefficient 0.998, P = 0.01). Round 2 scores were used to calculate suburbs' overall food environment score, healthiness score, unhealthiness score and a ratio of unhealthiness to healthiness scores. There was strong positive correlation between suburbs' ratio of unhealthiness to healthiness scores and a previously recognised scoring ratio, Retail Food Environment Index (Spearman's rho 0.847, P < 0.01)., Conclusions: The study generated experts' consensus about relative healthiness of food outlet types found in Australian neighbourhoods. Proposed scores can be used to assess and compare healthiness of community food environments and to explore their associations with area characteristics, population's diet and health outcomes., (© 2016 Dietitians Association of Australia.)

Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories - for example, among 347 non-alcoholic beverages (e.g. soft drinks), the median for serving size was 250 (interquartile range (IQR) 250, 355) ml (range 100-750 ml). Declared serving size for unique products that are available in multiple package sizes also showed high variation, particularly for chocolate-based confectionery, with median percentage difference between minimum and maximum serving size of 183 (IQR 150) %. Categories with a high proportion of products that exceeded the 600 kJ ADG standard serve included cakes and muffins, pastries and desserts (≥74 % for each). High variability in declared serving size may confound interpretation and understanding of consumers interested in standardising and controlling their portion selection. Future research is needed to assess if and how standardising declared serving size might affect consumer behaviour.

Background: Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs., Methods: A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected., Results: Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (-0.80, 95 % confidence interval -1.2 to -0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their salt intake by using spices (5 % vs. 28 %; p < 0.001) and avoiding eating out (21 % vs. 34 %; p < 0.001). However, the proportions that checked food labels (30 % vs. 25 %; p = 0.02) fell, as did the numbers avoiding processed foods (44 % vs. 35 %; p = 0.006). Twenty-six percent reported using salt substitute at the end of the intervention period and 90 % had heard about the program. Findings were robust to multivariable adjustment., Conclusions: Implementation of this multi-faceted community-based program was associated with a ~10 % reduction in salt consumption in an Australian regional town. These findings highlight the potential of well-designed health promotion programs to compliment other population-based strategies to bring about much-needed reductions in salt consumption., Clinical Trial Registration: NCT02105727 .

The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.

Background and Aims: The published literature shows that nut consumption has a favorable impact on health. We aimed to assess the association between nut consumption and risk of 15-year total mortality, and mortality from cardiovascular disease (CVD) (including ischemic heart disease, IHD, and stroke), and cancer., Methods and Results: Prospective analyses involved 2893 participants aged ≥49 years at baseline. Dietary data were collected by using a semi-quantitative food-frequency questionnaire, and nut intakes were calculated. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Over 15 years, 1044 participants had died, of these 430 had died from stroke and another 430 had died from IHD. Participants in the second tertile of nut consumption versus those in the first tertile of intake had reduced risk of total mortality: multivariable-adjusted HR 0.76 (95% CI 0.65-0.89). Participants in the second tertile compared to those in the first tertile had 24% and 23% reduced risk of 15-year CVD and IHD mortality, respectively. Associations were more marked in women compared to men. Women in the second versus first tertile of nut consumption had 27%, 39%, 34% and 49% reduced risk of death from all causes (n = 489), CVD (n = 258), IHD (n = 188) and stroke mortality (n = 101), respectively., Conclusions: Nut consumption was independently associated with a decreased risk of overall and vascular-disease mortality, particularly in women., (Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Purpose: To assess the associations between dietary intake of polyunsaturated fatty acids (PUFAs) and diabetic retinopathy (DR)., Methods: This was a cross-sectional study of 379 patients (median age: 66.0 years) with diabetes attending a diabetes eye clinic. Daily fatty acid intake was assessed by using a validated Food Frequency Questionnaire and adjusted for energy intake. Diabetic retinopathy was graded from fundus photographs as no DR, nonproliferative DR, or proliferative DR. Patients were categorized as "well-controlled diabetes" (n = 123) and "poorly controlled diabetes" (n = 256), defined as glycated hemoglobin (HbA1c) level < 7.0% or ≥ 7.0%, respectively., Results: There were no associations between any fatty acid intake and DR. However, among patients with well-controlled diabetes, increasing daily intake of PUFAs was associated with a reduced likelihood of the presence (odds ratio [OR]: 0.18; 95% confidence interval [CI]: 0.06-0.59) and severity of DR after adjusting for age, sex, HbA1c, mean arterial blood pressure, and duration of diabetes. Moreover, an increased saturated fatty acid (SFA) intake was associated with increased likelihood of the presence (OR: 2.37; 95% CI: 1.15-4.88) and severity of DR. No association was found among those with poorly controlled diabetes., Conclusions: Increasing PUFA intake was associated with a reduced likelihood of the presence and severity of DR in well-controlled diabetes, whereas increasing SFA intake was associated with an increased likelihood of the presence and severity of DR. Further studies to confirm this observation are warranted to elucidate the underlying mechanisms and potential role of dietary PUFA and SFA intake in the management of DR.

Background/objectives: The effect of added sugar on health is a topical area of research. However, there is currently no analytical or other method to easily distinguish between added sugars and naturally occurring sugars in foods. This study aimed to develop a systematic methodology to estimate added sugar values on the basis of analytical data and ingredients of foods., Subjects/methods: A 10-step, stepwise protocol was developed, starting with objective measures (six steps) and followed by more subjective estimation (four steps) if insufficient objective data are available. The method developed was applied to an Australian food composition database (AUSNUT2007) as an example., Results: Out of the 3874 foods available in AUSNUT2007, 2977 foods (77%) were assigned an estimated value on the basis of objective measures (steps 1-6), and 897 (23%) were assigned a subjectively estimated value (steps 7-10). Repeatability analysis showed good repeatability for estimated values in this method., Conclusions: We propose that this method can be considered as a standardised approach for the estimation of added sugar content of foods to improve cross-study comparison.

We investigated the cross-sectional association between parental history of hypertension and dietary intakes among early adolescent schoolchildren. A total of 1845 participants aged 12 years had complete data on diet and parental medical history, and thus they were included in the final analyses. Dietary data were assessed from validated semi-quantitative food-frequency questionnaires. Parents completed questionnaires about their medical conditions. Cases where the biological mother and/or father had hypertension were classified as positive parental history of hypertension. After multivariable adjustment, participants with positive versus negative parental history of hypertension had 33% greater likelihood of consuming soft drinks ⩾1 per week. Boys with a parental history versus boys without a parental history of hypertension consumed more energy-dense, nutrient-poor foods: 379.4 g per day and 318.0 g per day, respectively, P=0.02. Girls with a positive versus a negative parental history consumed more vegetables: 164.1 versus 142.6 g per day, P=0.01. Significant associations were not observed between those with and those without a positive parental history in mean dietary intakes of carbohydrates, fats, sugars and sodium. Children with a positive parental history of hypertension were 67% more likely to simultaneously engage in three unhealthy lifestyle behaviors (excessive recreational screen viewing, high consumption of snacks and and high consumption of soft drinks). Parental hypertension was associated with unhealthy dietary behaviors among offspring, including higher consumption of soft drinks and energy-dense, nutrient-poor foods.

Background and Aims: The relationship between dairy food consumption and dietary calcium intake, and vascular risk factors during adolescence remains unclear. We aimed to prospectively assess whether dairy food consumption (milk, cheese, yoghurt) is associated with blood pressure (BP) and retinal microvascular signs among adolescents., Methods and Results: As many as 2353 and 1216 participants aged 12 and 17, respectively, were examined. Longitudinal analyses involved 888 subjects with complete baseline and follow-up data. Dairy consumption was assessed from validated semi-quantitative food frequency questionnaires. BP information was collected and retinal vessel caliber was quantified from digital photographs using computer software. In girls, after multivariable adjustment, each serve/day increase in total dairy intake was concurrently associated with 1.04 (p = 0.03) and 1.10 mm Hg (p = 0.02) decreases in mean diastolic and arterial BP, respectively. Also in girls, each serve/day increase in cheese intake over 5 years was concurrently related to 7.18 (p = 0.001), 5.28 (p = 0.002) and 5.79 mm Hg (p = 0.001) decrease in mean systolic, diastolic and arterial BP, respectively. Among girls, each 100 mg/day increase in dietary calcium intake was associated with a concurrent 0.5 (p = 0.01) and 0.3 mm Hg (p = 0.02) decrease in mean systolic and arterial BP, respectively. Cross-sectionally, adolescents in the highest versus lowest tertile of yoghurt intake had ∼ 1.3 μm wider retinal arterioles (p = 0.05) and ∼ 2.0 μm narrower venules (p = 0.04)., Conclusions: Consumption of dairy products, particularly cheese, could have a beneficial effect on BP, particularly among girls., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Purpose: To assess whether adherence to dietary guidelines at baseline is associated with the incidence of visual impairment among older persons after 10 years., Design: A population-based cohort of 3654 participants of the Blue Mountains Eye Study were examined at baseline and were reexamined after 5 and 10 years., Methods: The incidence of visual impairment was defined as best-corrected visual acuity (VA)<20/40 at follow-up in 1 or both eyes. Dietary information was obtained at baseline using a validated food frequency questionnaire (FFQ). Total Diet Score (TDS) was calculated based on the Australian diet quality index. TDS includes components of diet quality; poor dietary habits; and energy balance. Discrete logistic regression models with time-dependant outcome variables were used to calculate hazard risk ratios (HR) and 95% confidence intervals (CI) associated with incidence of visual impairment for each unit/quartile increase in TDS, adjusting for potential confounders., Results: Of the 3654 baseline participants, 1963 had up to 10 years follow-up with completed FFQs. With each unit increase in TDS, the risk of visual impairment decreased (HR 0.94, 95% CI 0.88-1.00). The risk of developing visual impairment was lower among persons in the highest compared to the lowest TDS quartile (HR 0.71, 95% CI 0.47-1.05). This association was significant among persons aged 65+ years (HR 0.63, 95% CI 0.38-0.98) but not those aged <65 years (HR 0.95, 95% CI 0.46-1.97)., Conclusions: Compliance to dietary guidelines was associated with a decreased long-term risk of visual impairment in this sample of Australians aged 65+ years., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Initiatives promoting the reduction of high-salt food consumption by consumers need to be partly based on current levels of salt knowledge in the population. However, to date there is no validated salt knowledge questionnaire that could be used to assess population knowledge about dietary salt (i.e. salt knowledge). Therefore, the aim of the present study was to develop and validate a salt knowledge questionnaire., Design: A cross-sectional study was conducted on an online web survey platform using convenience, snowball sampling. The survey questionnaire was evaluated for content and face validity before being administered to the respondents., Setting: Online survey., Subjects: A total of forty-one nutrition experts, thirty-two nutrition students and thirty-six lay people participated in the study., Results: Item analyses were performed to evaluate the psychometric properties of the test items. Twenty-five items were retained to form the final set of questions. The total scores of the experts were higher than those of the students and lay people (P < 0·05). The total salt knowledge score showed significant correlations with use of salt at the table (ρ = -0·197, P < 0·05) and inspection of the salt content in food products when shopping (ρ = 0·400; P < 0·01)., Conclusions: The questionnaire demonstrated sufficient evidence of construct validity and internal consistencies between the items. It is likely to be a useful tool for the evaluation and measurement of levels of salt knowledge in the general population.

Background: Excess dietary salt is a leading risk for health. Multiple health, government, industry and community organisations have identified the need to reduce consumption of dietary salt. This project seeks to implement and evaluate a community-based salt reduction intervention., Methods: The study comprises a baseline assessment followed by a targeted intervention and then an evaluation of efficacy. The study location is Lithgow, a regional town in New South Wales, Australia. The salt reduction intervention is based upon the Communication for Behavioural Impact framework which utilises an integrated communication model to enact community advocacy and impact by providing tools that enable the translation of knowledge into behavioural change. The duration of the intervention will be between 6 and 12 months. The primary evaluation will be through measurement of 24-hr urinary sodium excretion in independent population samples aged>20 years, drawn before and after the intervention period. The study is designed to detect a difference in mean sodium excretion of 0.7 grams per day or greater with 80% power and p=0.05., Discussion: This study will provide a robust evaluation of the effectiveness of a community-based intervention seeking to reduce dietary salt intake using the Communication for Behavioural Impact framework. The results will provide important new evidence to inform the design and implementation of current and future salt reduction policies in Australia. The results will also have important international implications because, following the recent World Health Organization recommendations for the control of non-communicable diseases, many countries are now seeking to achieve a reduction in average population salt consumption., Trial Registration: ClinicalTrials.gov, NCT02105727.

Aim: Salt reduction efforts usually have a strong focus on consumer education. Understanding the association between salt consumption levels and knowledge, attitudes and behaviours towards salt should provide insight into the likely effectiveness of education-based programs., Methods: A single 24-hour urine sample and a questionnaire describing knowledge, attitudes and behaviours was obtained from 306 randomly selected participants and 113 volunteers from a regional town in Australia., Results: Mean age of all participants was 55 years (range 20-88), 55% were women and mean 24-hour urinary salt excretion was 8.8(3.6) g/d. There was no difference in salt excretion between the randomly selected and volunteer sample. Virtually all participants (95%) identified that a diet high in salt can cause serious health problems with the majority of participants (81%) linking a high salt diet to raised blood pressure. There was no difference in salt excretion between those who did 8.7(2.1) g/d and did not 7.5(3.3) g/d identify that a diet high in salt causes high blood pressure (p=0.1). Nor was there a difference between individuals who believed they consumed "too much" 8.9(3.3) g/d "just the right amount" 8.4(2.6) g/d or "too little salt" 9.1(3.7) g/d (p=0.2). Likewise, individuals who indicated that lowering their salt intake was important 8.5(2.9) g/d vs. not important 8.8(2.4) g/d did not have different consumption levels (p=0.4)., Conclusion: The absence of a clear association between knowledge, attitudes and behaviours towards salt and actual salt consumption suggests that interventions focused on knowledge, attitudes and behaviours alone may be of limited efficacy.

Background: Inadequate nutrient intake and physical inactivity may have adverse health consequences. The present study aimed to describe young female students' dietary intake, food choices and physical activity (PA) patterns, and also to determine the influence of dietary avoidance of meat and poultry on nutrient intake., Methods: A cross-sectional study of female university students was conducted. Questionnaires were used to measure dietary intakes, food habits and PA. Anthropometric measurements of participants included height, weight and calculated body mass index (BMI)., Results: There were 308 participants with a mean (SD) age of 22.9 (3.9) years and a BMI of 21.5 (2.8) kg m(-2) ; 78% were in the BMI range 18.5-24.9 kg m(-2) . Of those who responded to the PA questionnaire (n = 218), 53% reported activity ≥150 min per week, with walking being the largest contributor. Completed food frequency questionnaires were returned by 256 participants. National recommendations for servings of cereals, vegetables, meat, fish and energy-dense 'extra foods' were not met by the majority of participants. Avoidance of animal foods was reported in 23% of women, and resulted in lower intakes of omega-3 fatty acids, vitamin B12 , selenium and zinc (P < 0.05) compared to non-avoidance. Iron intake from animal sources decreased significantly (P < 0.05) with the increase in meat and poultry avoidance., Conclusions: Female students had a healthy weight and reported adequate physical activity. However, in comparison to meat and poultry consumers, the avoidance of these foods was associated with a lower intake of some micronutrients. A sustained low intake of micronutrients may lead to adverse health effects in the longer-term, such as compromised immune function and iron deficiency anaemia., (© 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.)

Background: Mortality risk for people with chronic kidney disease is substantially greater than that for the general population, increasing to a 7-fold greater risk for those on dialysis therapy. Higher body mass index, generally due to higher energy intake, appears protective for people on dialysis therapy, but the relationship between energy intake and survival in those with reduced kidney function is unknown., Study Design: Prospective cohort study with a median follow-up of 14.5 (IQR, 11.2-15.2) years., Setting & Participants: Blue Mountains Area, west of Sydney, Australia. Participants in the general community enrolled in the Blue Mountains Eye Study (n = 2,664) who underwent a detailed interview, food frequency questionnaire, and physical examination including body weight, height, blood pressure, and laboratory tests., Predictors: Relative energy intake, food components (carbohydrates, total sugars, fat, protein, and water), and estimated glomerular filtration rate (eGFR). Relative energy intake was dichotomized at 100%, and eGFR, at 60 mL/min/1.73 m(2)., Outcomes: All-cause and cardiovascular mortality., Measurements: All-cause and cardiovascular mortality using unadjusted and adjusted Cox proportional regression models., Results: 949 people died during follow-up, 318 of cardiovascular events. In people with eGFR<60 mL/min/1.73 m(2) (n = 852), there was an increased risk of all-cause mortality (HR, 1.48; P = 0.03), but no increased risk of cardiovascular mortality (HR, 1.59; P = 0.1) among those with higher relative energy intake compared with those with lower relative energy intake. Increasing intake of carbohydrates (HR per 100g/d, 1.50; P = 0.04) and total sugars (HR per 100g/d, 1.62; P = 0.03) was associated significantly with increased risk of cardiovascular mortality., Limitations: Under-reporting of energy intake, baseline laboratory and food intake values only, white population., Conclusions: Increasing relative energy intake was associated with increased all-cause mortality in patients with eGFR<60 mL/min/1.73 m(2). This effect may be mediated by increasing total sugars intake on subsequent cardiovascular events., (Copyright © 2014 National Kidney Foundation, Inc. All rights reserved.)

Objectives: Published literature shows that individual nutrients could influence the risk of developing vision and hearing loss. There is, however, a lack of population-based data on the relationship between overall patterns of food intake and the presence of concurrent vision and hearing impairment. We aimed to assess the associations between diet quality with the prevalence and 5-year incidence of dual sensory impairment (DSI)., Design: Cross-sectional and 5-year longitudinal analyses., Setting: Blue Mountains, Sydney, Australia., Participants: 2443 participants aged ≥50 from baseline were examined and followed over 5 years., Measurements: Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet score (TDS). Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear)., Results: After adjusting for age, sex, education, noise exposure, current smoking, and type 2 diabetes, participants in the lowest compared to the highest quintile of TDS had a 2-fold increased likelihood of having prevalent DSI, odds ratio, OR, 2.62 (95% confidence intervals, CI, 1.08-6.36), P-trend=0.04. Significant associations were not observed between TDS and the prevalence of having a single sensory impairment (vision or hearing loss). Baseline TDS was not significantly associated with the 5-year incidence of DSI. Adherence to dietary guidelines was associated with a reduced likelihood of having DSI in cross-sectional, but not in longitudinal analyses., Conclusions: Further studies with adequate power are warranted to assess the prospective relationship between diet quality and DSI.

Background and Aims: Higher consumption of dairy products and calcium is likely to play a role in maintaining optimal vascular health. In this study, we aimed to explore the associations between consumption of total-, regular- and low-fat dairy foods, and total calcium intake with retinal vascular caliber., Methods and Results: 2813 Blue Mountains Eye Study participants aged 50+ years had dietary data collected using a semi-quantitative food frequency questionnaire, and serves of dairy consumption were calculated. Fundus photographs were taken and retinal vascular caliber measured using computer-assisted techniques and summarized. After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, serum glucose, white cell count, history of diagnosed hypertension, stroke and coronary heart disease, plus retinal arteriolar caliber, participants in the lowest quintile of total dairy consumption compared to those in the remaining highest 4 quintiles had significantly wider retinal venular caliber, 227.2 versus 224.7 μm, respectively (multivariable-adjusted p = 0.002). Also, subjects in the lowest quintile of low-fat dairy product consumption versus those in the remaining quintiles of low-fat dairy intake had wider retinal venules (∼ 1.7 μm, p = 0.03) and narrower retinal arterioles (∼ 1.4 μm, p = 0.04). Participants in the lowest quintile versus highest quintile of total dietary calcium intake had ∼ 2.3 μm wider retinal venules (multivariable-adjusted p-trend = 0.02)., Conclusions: A significant association was observed between lower intake of dairy products or calcium and adverse retinal vascular signs. We cannot discount the possibility of confounding from unmeasured risk factors; hence, further studies are warranted to confirm these findings., (Copyright © 2013. Published by Elsevier B.V.)

Objective: The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results., Setting: Lithgow, New South Wales, Australia., Participants: We randomly selected 2152 adults and obtained usable 24 h urine samples from 306 (response rate 16%). Specimens were also collected from a further 113 volunteers. Estimated salt consumption and the costs for each strategy were compared., Results: The characteristics of the 'random' and 'volunteer' samples were moderately different in mean age 58 (SD 14.6 vs 49(17.7) years, respectively; p<0.001) as well as self-reported alcohol use, tobacco use, history of hypertension and prescription drug use (all p<0.04). Overall crude mean 24 h urinary salt excretion was 8.9(3.6) g/day in the random sample vs 8.5(3.3) g/day for the volunteers (p=0.42). Corresponding age-adjusted and sex-adjusted estimates were 9.2(3.3) and 8.8(3.4) g/day (p=0.29). Estimates for men 10.3(3.8) vs 9.6(3.3) g/day; (p=0.26) and women 7.6(3) vs 7.9(3.2) g/day; (p=0.43) were also similar for the two samples, as was salt excretion across age groups (p=0.72). The cost of obtaining each 24 h urine sample was two times greater for the random compared to volunteer samples ($A62 vs $A31)., Conclusions: The estimated salt consumption derived from the two samples was comparable and was not substantively different to estimates obtained from other surveys. In countries where salt is pervasive and cannot easily be avoided, estimates of consumption obtained from volunteer samples may be valid and less costly.

Objective: With ongoing national concern about food security, the aim of the study was to estimate the prevalence of food insecurity and to identify associated characteristics in a cohort of older Australians., Design, Setting and Participants: The Blue Mountains Eye Study is a cohort study of community living participants aged 49 + years. The 12-item food security survey was completed by 3068 participants in the cross sectional study which comprised 2335 survivors from baseline and the recruitment of an additional 1174 eligible residents., Main Outcome Measures: Prevalence of self reported food insecurity was calculated and multivariate logistic regression provided odds ratios with 95% confidence intervals to determine risk factors., Results: Overall prevalence of food insecurity was 13%. Women (15.7%) compared with men (9.4%) and younger participants, aged <70 years (15.7%) than older participants, ≥70 years (8.4%), were significantly more likely to report being food insecure. Characteristics for reporting food insecurity included participants living in rented accommodation (OR 4.10, 95% CI: 2.83, 5.89) and those living on a pension only (OR 1.90, 95%CI: 1.30, 2.78)., Conclusions: A relatively high level of food insecurity among this representative population of older Australians should be an issue of concern for policy makers and health and welfare service providers. Addressing food insecurity should be a priority of integrated national food and nutrition policies and this should in turn inform health and welfare service provision to this vulnerable population.

Background and Aims: Studies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults., Methods and Results: 1952 participants aged ≥50 years at baseline were examined between 1992-1994 and 2002-2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min⁻¹·1.73 m⁻². Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻², [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41-0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74-0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10)., Conclusion: Older adults with better diet quality had a reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻². Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Cancer treatment either by surgery alone or in a combination of surgery, radiotherapy±chemotherapy has significant consequences on the physical, mental, emotional and psychosocial wellbeing of the patient. Measurement of quality of life (QOL) is necessary to understand the patient's perception of their own treatment, as clinicians' views can be biased. Reconstruction of a cancerous defect with a free vascular flap is ideal in large, often composite defects, provided it is appropriate to the advanced stage and prognosis of the disease, medical condition of the patient, availability of surgical and financial resources and allows the prosthetic rehabilitation of the anatomic area. Using University of Washington Quality of life 4 questionnaire (UW-QOL4), we assessed the QOL of 38 patients, who underwent local surgical reconstructions after resection of T1/T2 tongue/floor of mouth squamous cell carcinoma defects. Objective assessment of speech and swallow function was also carried out using therapy outcome measure (TOM) scores by the speech and language therapy team (SALT) aiming to see the differences in the scores obtained in patients who underwent post-operative radiotherapy. Our study, conducted 6months after completion of all oncologic treatment for the primary disease, showed satisfactory levels of quality of life parameters with good function showing that local reconstructive methods are successful and may have benefits in the management of early oral cancers involving the tongue and floor of mouth. They are beneficial by providing a good quality in terms of function, by reducing the operating time, the surgical morbidity, simplifying post-operative care and thereby becoming an efficient, effective and a cost effective method., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Limited evidence suggests habitual dairy consumption to be protective against metabolic syndrome (MetSyn) and type 2 diabetes among older adults. We assessed the association of baseline consumption of dairy products with the incidence of MetSyn and type 2 diabetes among a cohort of Australian adults aged 49 years and over., Methods and Results: A validated 145-item semi-quantitative food frequency questionnaire was used to assess food and nutrient intake at baseline. Ten-year incidence of MetSyn and type 2 diabetes were obtained from 1807 and 1824 subjects respectively. Odds ratios (OR) were calculated by discrete time logistic regression modelling. Compared with subjects in the lowest intake quartile of regular fat dairy products, those in the highest quartile had a 59% lower risk of MetSyn (multivariate adjusted OR: 0.41; 95% CI: 0.23-0.71; p(trend) = 0.004), after adjustment for risk factors. Among obese subjects, an association between a high intake of regular fat dairy foods and reduced risk of type 2 diabetes was also found (age and sex adjusted OR 0.37; 95% CI: 0.16-0.88; p(trend) = 0.030), but the association did not persist after adjustment for additional confounders. There was no association between total dairy consumption and risk of MetSyn or type 2 diabetes., Conclusions: We found an inverse association between regular fat dairy consumption and risk of MetSyn among Australian older adults. Further studies are warranted to examine the association between weight status, dairy consumption and risk of type 2 diabetes., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Type 2M von Willebrand disease (VWD) includes qualitative defects in von Willebrand factor (VWF) function, with normal multimer distribution but a defect in VWF activity with respect to platelet or collagen binding. We characterized novel VWF gene mutations found in type 2M VWD subjects enrolled in the Zimmerman Program for the Molecular and Clinical Biology of VWD. Subjects were enrolled based on a pre-existing diagnosis of type 2M VWD. Testing included full-length gene sequencing, VWF antigen (VWF:Ag), VWF ristocetin cofactor activity (VWF:RCo), VWF collagen binding and multimer distribution. Recombinant VWF variants were synthesized using site-directed mutagenesis and expressed in HEK293T cells. Platelet binding was measured by flow cytometry with fixed platelets and ELISA with recombinant glycoprotein Ibα (GPIbα). Four novel VWF A1 domain mutations were found in individuals with type 2M VWD: S1358N, S1387I, S1394F and Q1402P. All subjects had a history of bleeding, VWF:RCo < 40 IU dL(-1) , VWF:RCo/VWF:Ag ratios <0.6 and normal multimer distribution. No defect in expression, secretion, or multimerization was found for any of the mutations. All showed decreased binding to intact platelets, and decreased or absent binding to a mutant GPIbα construct with spontaneous VWF binding. 1387I had decreased binding to all collagen types tested. 1402P had reduced binding exclusively to type VI collagen. Type 2M VWD is a heterogeneous category comprised of both collagen- and platelet-binding defects. Understanding the precise defect for each mutation may ultimately lead to better diagnosis and treatment., (© 2013 John Wiley & Sons Ltd.)

Aims: Dietary modifications may play an important role in the prevention of diabetes. We aimed to assess the temporal association between diet quality and both impaired fasting glucose and Type 2 diabetes among older adults., Methods: A total of 2564 participants aged 49+ years at baseline were examined between 1992 and 1994 and 2002-2004 and had their fasting blood glucose measured. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine Total Diet Score. Incident diabetes (or impaired fasting glucose) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level ≥ 7.0 mmol/l (or 6.1-6.9 mmol/l)., Results: After adjusting for age, sex, current smoking, body mass index, hypertension and serum triglycerides, comparing highest with lowest tertile of total diet score, a significant 75% decrease in risk of incident impaired fasting glucose was observed in men (P(trend) = 0.02). Also, in men, each two-point increase in Total Diet Score was associated with a 52% reduction in the 10-year incidence of impaired fasting glucose, (OR 0.48, 95% CI 0.33-0.69). No significant associations were observed among women or with the 10-year incidence of diabetes., Conclusions: Greater compliance with published dietary guidelines (better diet quality) was associated with a reduced risk of pre-diabetes in men, but not women., (© 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.)

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992-4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, P(trend)=0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines.

Issue Addressed: To examine the prevalence and socio-demographic distribution of adherence to national dietary and physical activity recommendations among Australian secondary school students., Methods: Cross-sectional survey of 12,188 students in Years 8 to 11 (aged 12-17 years). Students' self-reported eating, physical activity and sedentary behaviours were assessed using validated instruments administered via an online questionnaire., Results: Less than one-quarter of students (24%) reported meeting the daily requirement of at least four serves of vegetables, while 41% reported consuming the recommended three or more daily serves of fruit. Just 15% of students reported engaging in at least 60 minutes of moderate-to-vigorous activity every day, and only one in five students met the recommendation of spending no more than two hours per day in small screen recreation. Males were performing better than females in terms of fruit intake and physical activity, but worse in relation to frequency of consumption of sugary drinks and fast food, and time spent using electronic media. The proportion of students meeting fruit and vegetable recommendations declined with advancing year level, while lower socio-economic position (SEP) students were faring less well than those from high SEP neighbourhoods, particularly with regards to healthy eating., Conclusions: There is considerable scope for improving young people's health behaviours in line with national dietary and physical activity recommendations.

Objective: This study aimed to estimate the dietary glycemic index (GI) and glycemic load (GL) of Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children and identify the main foods contributing to their GI and GL., Methods: A cross-sectional analysis of food intake of 215 children (38.1% were Aboriginal and Torres Strait Islanders) 10 to 12 y old obtained by three 24-h recalls was conducted. The foods were ranked according to their total contribution to total carbohydrates, GI, and GL., Results: Aboriginal and Torres Strait Islander participants had a significantly higher dietary GL (155.8 ± 46.8 versus 135.4 ± 31.2, P < 0.001) and GI (58.3 ± 3.9 versus 56.9 ± 3.8, P = 0.008) than the non-Indigenous participants. White breads were the main contributors of GI and GL in both groups and were a main driver for the increasing GI. Fiber was not associated with GI, whereas sugar and starch were positively associated. Subjects with a higher GI tended to be less physically active., Conclusion: The quality of carbohydrates in the diets of the participants was low, with poorer dietary items contributing most of the GI and GL. Substituting white breads with low/lower GI alternatives may be a useful strategy., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: von Willebrand factor (VWF) binds to subendothelial collagen at sites of vascular injury. Laboratory testing for von Willebrand disease (VWD), however, does not always include collagen binding assays (VWF:CB) and standard VWF:CB assays use type I and/or type III collagen rather than type VI collagen., Objectives: We report here on several mutations that exclusively alter binding to type VI collagen., Patients/methods: Healthy controls and index cases from the Zimmerman Program for the Molecular and Clinical Biology of VWD were analyzed for VWF antigen (VWF:Ag), VWF ristocetin cofactor activity and VWF:CB with types I, III and VI collagen. VWF gene sequencing was performed for all subjects., Results: Two healthy controls and one type 1 VWD subject were heterozygous for an A1 domain sequence variation, R1399H, and displayed a selective decreased binding to type VI collagen but not types I and III. Expression of recombinant 1399H VWF resulted in absent binding to type VI collagen. Two other VWF A1 domain mutations, S1387I and Q1402P, displayed diminished binding to type VI collagen. An 11 amino acid deletion in the A1 domain also abrogated binding to type VI collagen., Conclusions: VWF:CB may be useful in diagnosis of VWD, as a decreased VWF:CB/VWF:Ag ratio may reflect specific loss of collagen binding ability. Mutations that exclusively affect type VI collagen binding may be associated with bleeding, yet missed by current VWF testing., (© 2012 International Society on Thrombosis and Haemostasis.)

Background: von Willebrand factor (VWF) plays a key role in coagulation by tethering platelets to injured subendothelium through binding sites for collagen and platelet GPIb. Collagen binding assays (VWF:CB), however, are not part of the routine work-up for von Willebrand disease (VWD)., Objectives: This study presents data on collagen binding for healthy controls and VWD subjects to compare three different collagens., Patients/methods: VWF antigen (VWF:Ag), VWF ristocetin cofactor activity and VWF:CB with types I, III and VI collagen were examined for samples obtained from the Zimmerman Program., Results: Mean VWF:CB in healthy controls was similar and highly correlated for types I, III and VI collagen. The mean VWF:CB/VWF:Ag ratios for types I, III and VI collagen were 1.31, 1.19 and 1.21, respectively. In type 1 VWD subjects, VWF:CB was similar to VWF:Ag with mean VWF:CB/VWF:Ag ratios for types I, III and VI collagen of 1.32, 1.08 and 1.1, respectively. For type 2A and 2B subjects, VWF:CB was uniformly low, with mean ratios of 0.62 and 0.7 for type I collagen, 0.38 and 0.4 for type III collagen, and 0.5 and 0.47 for type VI collagen., Conclusions: Normal ranges for type I, III and VI collagen are correlated, but higher values were obtained with type I collagen as compared with types III and VI. The low VWF:CB in type 2A and 2B subjects suggests that VWF:CB may also supplement analysis of multimer distribution. However, these results reflect only one set of assay conditions per collagen type and therefore may not be generalizable to all collagen assays., (© 2012 International Society on Thrombosis and Haemostasis.)

Background/objectives: It has been postulated that a higher dairy consumption may affect blood pressure regulation. The aim of this study was to examine the association between dairy consumption and blood pressure in mid-childhood., Subjects/methods: Subjects (n = 335) were participants of a birth cohort at high risk of asthma with information on diet at 18 months and blood pressure at 8 years. Multivariate analyses were used to assess the association of dairy consumption (serves) and micronutrient intakes (mg). In a subgroup of children (n = 201), dietary intake was also measured at approximately 9 years., Results: Children in the highest quintile of dairy consumption at 18 months had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 8 years (2.5 mm Hg, P=0.046 and 1.9 mm Hg, P = 0.047, respectively) than those in the lowest quintiles. SBP was lowest among children in the highest quintiles of calcium, magnesium and potassium intakes. Significant negative linear trends were observed between SBP and intakes of dairy serves, calcium, magnesium and potassium. Furthermore, SBP and DBP were lowest in the group of children that consumed at least two dairy serves at both 18 months and the follow-up dietary data collection at 9 years, compared with all other children (SBP 98.7 vs 101.0 mm Hg, P = 0.07; and DBP 56.5 vs 59.3 mm Hg, P = 0.006, respectively)., Conclusion: These results are consistent with a protective effect of dairy consumption in childhood on blood pressure at age 8 years.

Background: In 2007, we commenced the Healthy Beginnings Trial (HBT) Phase 1 study, which is the first randomised controlled trial (RCT) to test the effectiveness of an early childhood obesity intervention in children aged up to 2 years. The results were promising with significant improvements in infant feeding practices and a lower mean body mass index (BMI). The aims of this proposed Phase 2 study are to determine if the early intervention will lead to a lower mean BMI, lower screen time, improved dietary behaviours and demonstrated cost-effectiveness of the intervention, in children aged 3½ and 5 years., Methods/design: In Phase 1 of HBT 667 families participated in the RCT. No further intervention will be carried out in HBT Phase 2. In this study the intervention and control groups will be compared for children's outcomes at ages 3½ and 5 years. Primary outcome measures will be 1) BMI, 2) selected dietary measures using a validated survey tool, and 3) physical activity and screen time using a new generation of tri-axial accelerometers. Intention to treat principles will be used in the analysis. Multiple imputation will be used to impute outcomes for subjects lost to follow-up. A cost-effectiveness analysis (CEA) and cost-utility analysis for both HBT Phase 1 and 2 will also be conducted., Discussion: This is the first time that a home-based early intervention strategy has been implemented to prevent the development of childhood obesity and obesity-conducive behaviours. The results of this trial will ascertain whether early intervention during the first 2 years of life is effective and cost-effective in preventing childhood overweight and obesity at 3½ and 5 years old., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: Diet is one of the few modifiable risk factors for age-related hearing loss. We aimed to examine the link between dietary and supplement intakes of antioxidants, and both the prevalence and 5-year incidence of measured hearing loss., Design: Cross-sectional and 5-year longitudinal analyses., Setting: Blue Mountains, Sydney, Australia., Participants: 2,956 Blue Mountains Hearing Study participants aged 50+ at baseline, examined during 1997-9 to 2002-4., Measurements: Age-related hearing loss was measured and defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz >25 dB HL. Dietary data were collected in a semi-quantitative food frequency questionnaire, and intakes of α-carotene; β-carotene; β-cryptoxanthin; lutein and zeaxanthin; lycopene; vitamins A, C and E; iron and zinc were calculated., Results: After adjusting for age, sex, smoking, education, occupational noise exposure, family history of hearing loss, history of diagnosed diabetes and stroke, each standard deviation (SD) increase in dietary vitamin E intake was associated with a 14% reduced likelihood of prevalent hearing loss, odds ratio, OR, 0.86 (95% confidence interval, CI, 0.78-0.98). Those in the highest quintile of dietary vitamin A intake had a 47% reduced risk of having moderate or greater hearing loss (>40 dB HL) compared to those in the lowest quintile of intake, multivariable-adjusted OR 0.53 (CI 0.30-0.92), P for trend = 0.04. However, dietary antioxidant intake was not associated with the 5-year incidence of hearing loss., Conclusions: Dietary vitamin A and vitamin E intake were significantly associated with the prevalence of hearing loss. However, dietary antioxidant intake did not increase the risk of incident hearing loss. Further large, prospective studies are warranted to assess these relationships in older adults.

Background/objectives: To assess the changes in the consumption of core foods among Australian children between the 1995 National Nutrition Survey (1995 NNS) and the 2007 Australian National Children's Nutrition and Physical Activity Survey (2007 Children's Survey)., Subjects/methods: Core food consumption was analysed using 24-h recall data from 2-16 year old children using the 1995 NNS (n=2435) and the 2007 Children's Survey (n=4380). Differences in percent consuming, amounts consumed and percent energy contribution were assessed., Results: The consumption of core foods increased significantly between the 1995 and 2007 surveys, including per-capita consumption and percent energy contribution (both P0.001). Core foods contributed to 59% of energy intake in 1995 compared with 65% in 2007. The types of core foods consumed also changed during this time period with more children reporting eating healthy options such as wholemeal bread, reduced-fat milk, reduced-fat cheese and fruit in the 2007 Children's Survey. Conversely, the consumption of white bread, full-fat milk and low-fibre breakfast cereals was lower in 2007., Conclusions: Overall, reported dietary intake had improved from 1995 to 2007 among Australian children with an increase in the amounts of core foods consumed and healthier types of foods being chosen. Continued health-promotion activities and monitoring of food consumption are highly warranted.

A comprehensive literature search was undertaken to examine the relationship between dairy consumption and overweight/obesity in prospective cohort studies. A literature search from 1980 through to April 2010 was conducted. Nineteen cohort studies met all the inclusion criteria and were included in the systematic review. Of the 19 cohort studies, 10 were among children and adolescents (aged 2 to 14 years, n = 53 to 12,829, follow-up 8 months to 10 years) and nine among adults (aged 18 to 75 years, n = 248 to 42,696, follow-up 2 years to 12 years). A range of dairy food exposure measures were used. Eight studies (three out of 10 studies involving children and five out of nine studies involving adults) showed a protective association against increasing weight gain (measured in various ways); one reported a significant protective association only among men who were initially overweight; seven reported no effect; one reported an increased risk (among children), and two reported both a decreased and increased risk, depending on the dairy food type. The evidence from prospective cohort studies for a protective effect of dairy consumption on risk of overweight and obesity is suggestive but not consistent, making firm conclusions difficult., (© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.)

Folate, vitamin B(12), iron, and zinc are particularly important nutrients for women of childbearing age. We tested the hypothesis that an electronic, 235-item, semiquantitative food frequency questionnaire (FFQ) is a valid measure of dietary intake when compared with repeat dietary 24-hour recalls. Biomarkers of folate, vitamin B(12), iron, and zinc were determined because their measurement errors are unrelated to errors in dietary questionnaires. Female adults (N = 256) aged 18 to 35 years completed the FFQ, and a representative subset (n = 53) completed repeat dietary 24-hour recalls. The FFQ estimates (mean ± SD) were 315 ± 132 μg for folate, 3.1 ± 2.1 μg for vitamin B(12), 15.4 ± 5.6 mg for iron, and 15.1 ± 6.4 mg for zinc. The percentage of women classified within the same ±1 quartile for energy intake by the 2 methods was 77.3%. There was moderate agreement between the 2 dietary methods, and no systematic bias was noted for energy, folate, vitamin B(12), and zinc. The deattenuated energy-adjusted correlation coefficients ranged from 0.41 (dietary folate equivalents) to 0.60 (folate). Significant correlations between biomarker and nutrient intakes were found for folate (r = 0.37, P < .01) and vitamin B(12) (r = 0.27, P < .01). The electronic FFQ developed in the present study is a relatively valid tool that was able to adequately assess and rank individuals according to their nutrient intakes., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To describe a standardized method to assign glycemic index (GI) values to food items, obtained from 3 x 24-h recalls among Aboriginal and Torres Strait Islander and non-Indigenous Australian children, which can be adapted for use with simple food composition databases., Methods: Four published GI databases were used as the source of GI values. Changes were made to a previously published methodology for GI value assignment to accommodate the needs of the Many Rivers Diabetes Prevention Project., Results: There were 1132 food items in the recall database. Two hundred nineteen (19.3%) food items were directly linked to the FoodWorks GI database and 545 (48.1%) items were assigned the GI value of a "closely related" food item in the four GI databases used. Among the top carbohydrate contributors, 113 (35.3%) items have a direct linkage with the FoodWorks GI database. The mean ± SEM dietary GI and glycemic load (GL) of the study population resulting from this methodology are 57.5 ± 0.3 and 143.4 ± 2.6, respectively., Conclusion: This simple method provides opportunities for countries without food composition database that are comprehensive for GI/GL but which contain accurate information on carbohydrates in foods to assign high-quality GI values to food items in epidemiological studies based on 24-h recalls., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Several studies suggest that carbohydrate nutrition is related to oxidative stress and inflammatory markers., Objective: We examined whether dietary glycemic index (GI), dietary fiber, and carbohydrate-containing food groups were associated with the mortality attributable to noncardiovascular, noncancer inflammatory disease in an older Australian cohort., Design: Analysis included 1490 postmenopausal women and 1245 men aged ge 49 y at baseline (1992-1994) from a population-based cohort who completed a validated food-frequency questionnaire. Cox proportional hazards ratios were calculated both for death from diseases in which inflammation or oxidative stress was a predominant contributor and for cardiovascular mortality., Results: Over a 13-y period, 84 women and 86 men died of inflammatory diseases. Women in the highest GI tertile had a 2.9-fold increased risk of inflammatory death compared with women in the lowest GI tertile [multivariate hazard ratio in energy-adjusted tertile 3 (tertile 1 as reference): 2.89; 95% CI: 1.52, 5.51; P for trend: 0.0006, adjusted for age, smoking, diabetes, and alcohol and fiber consumption]. Increasing intakes of foods high in refined sugars or refined starches (P = 0.04) and decreasing intakes of bread and cereals (P = 0.008) or vegetables other than potatoes (P = 0.007) also independently predicted a greater risk, with subjects' GI partly explaining these associations. In men, only an increased consumption of fruit fiber (P = 0.005) and fruit (P = 0.04) conferred an independent decrease in risk of inflammatory death. No associations were observed with cardiovascular mortality., Conclusion: These data provide new epidemiologic evidence of a potentially important link between GI and inflammatory disease mortality among older women.

Background/objectives: Few longitudinal population-based cohort studies of older people have described dietary intakes over time. The objective of this study was to assess changes in the food and nutrient intake in a cohort of older Australians, using longitudinal data collected over 10 years., Subjects/methods: Population-based cohort of people aged 49 years and over at baseline (82% of those eligible) living in two postcode areas, west of Sydney. In 1992-1994, 3654 people were examined; 2334 were reexamined after 5 years and 1952 after 10 years (75% survivors at both examinations). A 145-item food frequency questionnaire was used to assess food and nutrient intake on each occasion, and 1166 participants provided usable dietary data at all three examinations., Results: Energy and sugar intake significantly increased among women over the 10-year period (P-value for trend <0.0001). Long-chain omega-3 fatty acid and fish intake significantly increased in both men and women (P-value for trend <0.0001). Folate intake significantly increased in both men and women (women: 325 dietary folate equivalents (DFE) vs 403 DFE; men: 346 DFE vs 425 DFE, P<0.0001). Wholemeal/grain bread consumption decreased in both men and women (P-value for trend <0.0001)., Conclusions: Many of the observed changes in diet over the 10-year period were consistent with current population dietary recommendations. Some changes, however, appear to have been due to poorer dietary choices. This information could be used to inform nutrition policy and programs targeted to older persons. These data highlight the need to identify barriers to better food choices.

Background: Type 2M von Willebrand disease (VWD) is characterized by a qualitative defect in von Willebrand factor (VWF) and diagnosed by a disproportionate decrease in VWF ristocetin cofactor activity (VWF:RCo) as compared with VWF antigen (VWF:Ag)., Objective: We report here on the spurious diagnosis of VWD in a patient with a sequence variation in the ristocetin-binding domain of VWF., Patients/methods: The index case had a VWF:RCo of 11 IU dL(-1), with VWF:RCo/VWF:Ag ratio of 0.09. DNA sequencing revealed a novel P1467S mutation in a known ristocetin-binding region of the A1 domain. Because of the discrepancy between the laboratory findings, consistent with type 2M VWD, and the patient's lack of bleeding symptoms, further studies were performed to determine whether this mutation affected VWF function or merely reduced its ability to interact with ristocetin., Results: Studies with recombinant VWF showed normal platelet binding with botrocetin, but a significant decrease in binding in response to ristocetin. Ristocetin-induced binding to recombinant GPIb was also absent, but normal binding was seen when a gain-of-function GPIb construct was used in the absence of ristocetin. VWF function under shear stress was normal when analyzed with a cone and plate(let) analyzer., Conclusions: The decreased VWF:RCo seen with the P1467S sequence variation likely represents an artifact as a result of the use of ristocetin to measure VWF activity. The normal VWF function in other assays correlates with the lack of hemorrhagic symptoms, and suggests the need for more physiologically relevant assays of VWF function.

Objective: To assess the relationship between baseline dietary fatty acids and 10-year incident age-related macular degeneration (AMD)., Methods: In an elderly Australian cohort, 3654 participants were examined at baseline and 2454 were examined 5 and/or 10 years later. We assessed AMD from retinal photographs. Participants completed a semiquantitative food frequency questionnaire., Results: After adjusting for age, sex, and smoking, 1 serving of fish per week was associated with reduced risk of incident early AMD (relative risk, 0.69 [95% confidence interval, 0.49-0.98]), primarily among participants with less than the median linoleic acid consumption (0.57 [0.36-0.89]). Findings were similar for intake of long-chain omega-3 polyunsaturated fatty acids. One to 2 servings of nuts per week was associated with reduced risk of incident early AMD (relative risk, 0.65 [95% confidence interval, 0.47-0.91]). Protective associations between the intake of nuts and reduced risk of pigmentary abnormalities were seen among nonsmokers, participants with less than the median ratio of serum total to high-density lipoprotein cholesterol, and those with beta carotene intake greater than the median level., Conclusions: This study provides evidence of protection against early AMD from regularly eating fish, greater consumption of omega-3 polyunsaturated fatty acids, and low intakes of foods rich in linoleic acid. Regular consumption of nuts may also reduce AMD risk. Joint effects from multiple factors are suggested.