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Purpose of Review The aim of this short review is to provide an updated commentary on the current literature examining the impact of meal timing on obesity and weight gain in adults. The potential mechanisms, including novel and emerging factors, behind timing of food intake across the 24-h period in the development of obesity, and dietary strategies manipulating meal timing to ameliorate weight gain are also explored. Recent Findings Dietary patterns that feature meal timing outside of the regular daytime hours can contribute to circadian disruption as food is metabolised in opposition to internal daily rhythms and can feedback on the timekeeping mechanisms setting these rhythms. Epidemiological evidence examining the impact of late meal timing patterns is beginning to suggest that eating at night increases the risk of weight gain over time. Mechanisms contributing to this include changes to the efficiency of metabolism across the day, and dysregulation of appetite hormone and gut microbiota by mis-timed meals. Summary When meals are eaten, in relation to the time of day, is increasingly considered of importance when implementing dietary change in order to address the growing burden of obesity, although further research is required in order to determine optimal patterns.

Purpose of Review This review summarizes recent evidence published since a previous review in 2018 on the association between egg consumption and risk of cardiovascular disease (CVD) mortality, CVD incidence, and CVD risk factors. Recent Findings No recent randomized controlled trials were identified. Evidence from observational studies is mixed, with studies reporting either an increased risk or no association of highest egg consumption with CVD mortality, and a similar spread of increased risk, decreased risk, or no association between egg intake and total CVD incidence. Most studies reported a reduced risk or no association between egg consumption and CVD risk factors. Included studies reported low and high egg intake as between 0 and 1.9 eggs/week and 2 and ≥14 eggs/week, respectively. Ethnicity may influence the risk of CVD with egg consumption, likely due to differences in how eggs are consumed in the diet rather than eggs themselves. Summary Recent findings are inconsistent regarding the possible relationship between egg consumption and CVD mortality and morbidity. Dietary guidance should focus on improving the overall quality of the diet to promote cardiovascular health.

Refereed/Peer-reviewed Workers employed in rotating shift schedules are at a higher metabolic risk compared with those in regular day and fixed shift schedules; however, the contribution of diet is unclear. This systematic review aimed to investigate how rotating shift work schedules affect dietary energy intake and dietary patterns compared with regular day and fixed shift schedules. In addition, intraperson energy intake and dietary pattern comparisons within rotating shift schedules were investigated. Database searches were conducted on MEDLINE, Cochrane, CINAHL, PSYCinfo, EMBASE, and Scopus, in addition to manual search of bibliographic references, to identify articles. Two separate meta-analyses compared dietary intake between day work and rotating shift work schedules and within the rotational shift work group (morning/day and night shifts). Differences in dietary patterns were synthesized narratively. Thirty-one studies (n = 18,196 participants) were included in the review, and meta-analyses were conducted with 24-hour mean energy intake data from 18 (n = 16,633 participants) and 7 (n = 327 participants) studies, respectively. The average 24-hour energy intake of rotating shift workers was significantly higher than that of workers in regular daytime schedules [weighted mean difference (WMD): 264 kJ; 95% confidence interval (CI): 70, 458 kJ; P < 0.008; I2 = 63%]. However, the mean difference in 24-hour energy intake between morning/day shifts compared with night shifts within rotational shift schedules was not statistically significant (WMD: 101 kJ; 95% CI: −651, 852 kJ; P = 0.79; I2 = 77%). Dietary patterns of rotating shift workers were different from those of day workers, showing irregular and more frequent meals, increased snacking/eating at night, consumption of fewer core foods, and more discretionary foods. This review highlights that dietary intake in rotational shift workers is potentially higher in calories and features different eating patterns as a consequence of rotating shift work schedules. This review was registered at PROSPERO as ID 182507.

Circadian rhythms, metabolic processes and dietary intake are inextricably linked. Timing of food intake is a modifiable temporal cue for the circadian system and may be influenced by numerous factors, including individual chronotype – an indicator of an individual’s circadian rhythm in relation to the light–dark cycle. This scoping review examines temporal patterns of eating across chronotypes and assesses tools that have been used to collect data on temporal patterns of eating and chronotype. A systematic search identified thirty-six studies in which aspects of temporal patterns of eating, including meal timings; meal skipping; energy distribution across the day; meal frequency; time interval between meals, or meals and wake/sleep times; midpoint of food/energy intake; meal regularity; and duration of eating window, were presented in relation to chronotype. Findings indicate that, compared with morning chronotypes, evening chronotypes tend to skip meals more frequently, have later mealtimes, and distribute greater energy intake towards later times of the day. More studies should explore the difference in meal regularity and duration of eating window amongst chronotypes. Currently, tools used in collecting data on chronotype and temporal patterns of eating are varied, limiting the direct comparison of findings between studies. Development of a standardised assessment tool will allow future studies to confidently compare findings to inform the development and assessment of guidelines that provide recommendations on temporal patterns of eating for optimal health.

Diet is a modifiable risk factor for chronic disease and a potential modulator of telomere length (TL). The study aim was to investigate associations between diet quality and TL in Australian adults after a 12-week dietary intervention with an almond-enriched diet (AED). Participants (overweight/obese, 50–80 years) were randomised to an AED (n62) or isoenergetic nut-free diet (NFD,n62) for 12 weeks. Diet quality was assessed using a Dietary Guideline Index (DGI), applied to weighed food records, that consists of ten components reflecting adequacy, variety and quality of core food components and discretionary choices within the diet. TL was measured by quantitative PCR in samples of lymphocytes, neutrophils, and whole blood. There were no significant associations between DGI scores and TL at baseline. Diet quality improved with AED and decreased with NFD after 12 weeks (change from baseline AED + 9·8 %, NFD − 14·3 %;P< 0·001). TL increased in neutrophils (+9·6 bp,P= 0·009) and decreased in whole blood, to a trivial extent (–12·1 bp,P= 0·001), and was unchanged in lymphocytes. Changes did not differ between intervention groups. There were no significant relationships between changes in diet quality scores and changes in lymphocyte, neutrophil or whole blood TL. The inclusion of almonds in the diet improved diet quality scores but had no impact on TL mid-age to older Australian adults. Future studies should investigate the impact of more substantial dietary changes over longer periods of time.

BACKGROUND: Residential support workers (RSWs) provide 24-hour care to clients and many work overnight sleepover nightshifts. Although RSWs perform safety-critical tasks and are at high-risk of work stress and exhaustion, the health and safety of RSWs has not been investigated. OBJECTIVE: This explorative workplace case study explored the impact of support work on the eating and driving behaviours of RSWs. METHODS: Thirteen RSWs who had worked a dayshift (n = 6) or a sleepover nightshift (n = 7) completed questions on the timing of food intake during their shift, motivations for eating during the shift, subjective work performance, alertness and sleepiness post-shift, and driving performance post-shift. RESULTS: RSWs reported snacking during the night on a sleepover nightshift. Time available was the biggest determinant for when RSWs ate during a day and sleepover nightshift. Ratings of subjective alertness and sleepiness after eating were not different between shift types, however participants reported an increase in work performance after eating during a dayshift. Driving events were more frequently reported post-sleepover nightshift, compared to post-dayshift. CONCLUSIONS: Findings demonstrate an impact of shift type on eating and driving behaviours of RSWs and highlight the importance of further investigation of this under-researched group to identify appropriate strategies for improving health and safety. Refereed/Peer-reviewed

The negative impact of an unhealthy diet on the shiftworker population has been well-documented. However, little evidence exists on the underlying reasons for unhealthy eating behaviours and the existing barriers to healthy eating withinshiftwork environments. This qualitative study investigated the dietary behaviours reported by shiftworkers through Facebook comments. Comments were collected if they were on public shiftworker-relevant posts pertaining to dietary news or dietary information on Facebook and were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. A thematic analysis of the 144 comments collected generated four categories that can be used to understand the motivations for eating behaviour on-shift: what shiftworkers eat, where food is sourced from, when food is eaten, and why certain foods are chosen. Results reveal motivations, attitudes, and both internal and external barriers to healthy eating behaviours, as well as similarities and differences across shiftwork industries. Recommendations for future research include further explorations on the link between scheduled eating (e.g., time-restricted eating) and shiftwork, the impact of a rotating shift arrangements on dietary health behaviours, and the impact of interpersonal relationships on shiftworker dietary choices. Understanding these motivations will inform strategies to promote healthy eating and help understand barriers for shiftworkers. Refereed/Peer-reviewed

Refereed/Peer-reviewed Cardiovascular disease (CVD) poses a serious health and economic burden worldwide. Modifiable lifestyle factors are a focus of research into reducing the burden of CVD, with diet as one of the most investigated factors. Specifically, the timing and regularity of food intake is an emerging research area, with approaches such as time-restricted eating (TRE) receiving much attention. TRE involves shortening the time available to eat across the day and is associated with improved CVD outcomes compared with longer eating windows. However, studies that have examined TRE have not considered the impact of sleep on CVD outcomes despite recent evidence showing that sleep duration can influence the timing and amount of food eaten. In this article, we argue that as TRE and sleep influence each other, and influence the same cardiometabolic parameters, experiencing inadequate sleep may attenuate any positive impact TRE has on CVD. We examine the relationship between TRE and CVD, with sleep as a potential mediator in this relationship, and propose a research agenda to investigate this relationship. This will provide necessary evidence to inform future interventions aimed at reducing the burden of CVD.

Survivors of cancer frequently experience persistent and troublesome cognitive changes. Little is known about the role diet and nutrition plays in survivors’ cognition. We explored the feasibility of collecting cross-sectional online data from Australian survivors of breast and colorectal cancer to enable preliminary investigations of the relationships between cognition with fruit and vegetable intake, and the Omega-3 Index (a biomarker of long chain omega 3 fatty acid intake). A total of 76 participants completed online (and postal Omega-3 Index biomarker) data collection (62 breast and 14 colorectal cancer survivors): mean age 57.5 (±10.2) years, mean time since diagnosis 32.6 (±15.6) months. Almost all of the feasibility outcomes were met; however, technical difficulties were reported for online cognitive testing. In hierarchical linear regression models, none of the dietary variables of interest were significant predictors of self-reported or objective cognition. Age, BMI, and length of treatment predicted some of the cognitive outcomes. We demonstrated a viable online/postal data collection method, with participants reporting positive levels of engagement and satisfaction. Fruit, vegetable, and omega-3 intake were not significant predictors of cognition in this sample, however the role of BMI in survivors′ cognitive functioning should be further investigated. Future research could adapt this protocol to longitudinally monitor diet and cognition to assess the impact of diet on subsequent cognitive function, and whether cognitive changes impact dietary habits in survivors of cancer. Refereed/Peer-reviewed

Unusual meal timing has been associated with a higher prevalence of chronic disease. Those at greater risk include shift workers and evening chronotypes. This study aimed to validate the content of a Chrononutrition Questionnaire for shift and non‐shift workers to identify temporal patterns of eating in relation to chronotype. Content validity was determined using a Delphi study of three rounds. Experts rated the relevance of, and provided feedback on, 46 items across seven outcomes: meal regularity, times of first eating occasion, last eating occasion, largest meal, main meals/snacks, wake, and sleep, which were edited in response. Items with greater than 70% consensus of relevance were accepted. Rounds one, two, and three had 28, 26, and 24 experts, respectively. Across three rounds, no outcomes were irrelevant, but seven were merged into three for ease of usage, and two sections were added for experts to rate and comment on. In the final round, all but one of 29 items achieved greater than 70% consensus of relevance with no further changes. The Chrononutrition Questionnaire was deemed relevant to experts in circadian biology and chrononutrition, and could represent a convenient tool to assess temporal patterns of eating in relation to chronotype in future studies. Refereed/Peer-reviewed

From the discovery of the first clock genes outside of the ‘master clock’ – the suprachiasmatic nucleus (SCN) – to now, there has been extensive research into the location of these peripheral clocks and how they relate to the SCN and other timing signals. The purpose of this review is to provide an overview of the current knowledge in this area. Areas discussed will include: How the timing of sleep and wake in mammals is controlled by the central clock; how physiological processes during sleep and wake in mammals are coordinated by peripheral clocks; what changes in environmental signals affect the timing of SCN and peripheral clocks; how we measure central and peripheral clock timing; which environmental signals can entrain the SCN and peripheral clocks; and how disturbances in central and peripheral clock timing due to aspects of modern lifestyles including shiftwork and jet lag, as well as biological aspects such as blindness and chronotype, may have negative impacts on our health. By understanding how our biological timing systems work, we may be able to develop strategies to minimise disturbances in central and peripheral clock timing and therefore the associated negative health outcomes observed. Refereed/Peer-reviewed

Altering meal timing could improve cognition, alertness, and thus safety during the nightshift. This study investigated the differential impact of consuming a meal, snack, or not eating during the nightshift on cognitive performance (ANZCTR12615001107516). 39 healthy participants (59% male, age mean±SD: 24.5 ± 5.0y) completed a 7-day laboratory study and underwent four simulated nightshifts. Participants were randomly allocated to: Meal at Night (MN; n= 12), Snack at Night (SN; n = 13) or No Eating at Night (NE; n = 14). At 00:30 h, MN consumed a meal and SN consumed a snack (30% and 10% of 24 h energy intake respectively). NE did not eat during the nightshift. Macronutrient intake was constant across conditions. At 20:00 h, 22:30 h, 01:30 h, and 04:00 h, participants completed the 3-min Psychomotor Vigilance Task (PVT-B), 40-min driving simulator, post-drive PVT-B, subjective sleepiness scale, 2-choice Reaction Time task, and Running Memory task. Objective sleep was recorded for each of the day sleeps using Actigraphy and for the third day sleep, Polysomnography was used. Performance was compared between conditions using mixed model analyses. Significant two-way interactions were found. At 04:00 h, SN displayed increased time spent in the safe zone (p < .001; percentage of time spent within 10 km/h of the speed limit and 0.8 m of lane center), and decreases in speed variability (p < .001), lane variability (p < .001), post-drive PVT-B lapses (defined as RT > 355 ms; p < .001), and reaction time on the 2-choice reaction time task (p < .001) and running memory task (p < .001) compared to MN and NE. MN reported greater subjective sleepiness at 04:00 h (p < .001) compared to SN and NE. There was no difference in objective sleep between eating conditions. Eating a large meal during the nightshift impairs cognitive performance and sleepiness above the effects of time of night alone. For improved performance, shiftworkers should opt for a snack at night. Refereed/Peer-reviewed

Nightwork disrupts circadian rhythms and impairs glucose metabolism, increasing the risk for type 2 diabetes. We investigated eliminating or reducing the amount of food consumed during simulated nightwork as a countermeasure to reduce the impact of circadian disruption on glucose metabolism. N=52 healthy, non-shiftworking participants (24.4±4.9 years; 26 Females; BMI 23.8±2.5kg/m2) underwent a 7-day laboratory protocol with an 8h TIB baseline sleep, followed by 4 simulated nightshifts with 7h TIB daytime sleep and an 8h TIB recovery sleep in groups of 4 participants. Each group was randomly assigned to a meal-at-midnight (n=17, 30% energy requirements), snack-at-midnight (n=16, 10% energy requirements) or no-eating-at-midnight (n=19) condition. Total 24h energy and macronutrient intake were constant across conditions. Standard oral glucose tolerance tests (OGTT) were conducted on day2 (baseline), and day7 (recovery). Plasma was sampled at -15, 0, 15, 30, 60, 90, 120, 150 mins, assayed for glucose and insulin. Area under the curve (AUC) was the calculated. Mixed model analyses of glucose AUC found a condition-by-day interaction (p

Circadian misalignment is commonly experienced by shift workers due to night-time wake, day-time sleep, and eating around the clock. These changes in sleep and eating patterns away from traditional timings can cause metabolic disturbances and have been associated with elevated cardiometabolic disease risk in shift workers. This review summarizes and discusses the recent evidence linking meal timing, sleep, and metabolic challenges with a focus on the impact of fasting/feeding length and timing/frequency of consumption. While some impact of meal timing/composition on sleep was found by older studies, more recent work has focused on how meal timing contributes to circadian disruption and cardiometabolic derangement Refereed/Peer-reviewed

Tree nuts and ground nuts are nutrient-rich foods known to improve human health when consumed regularly in the diet. Past observational studies suggest that nuts improve adult and child health; however, limited randomized control trials (RCTs) have assessed the health effects of nuts in children. Using a systematic review approach, we examined the effect of nut intake on health outcomes in children aged 8–18 years. We searched PubMed, Scopus, Web of Science, EMBASE and Cochrane library to identify RCTs of interest. A total of 5783 articles were identified, 4821 were screened by title and abstract and 37 by full text resulting in four articles that met the inclusion criteria for the review. Nut consumption was between 15 and 30 g with durations of between 3 and 16 weeks. Nut consumption was shown to improve children’s diet quality (increase children’s intake of essential nutrients including fats (monounsaturated and polyunsaturated fats), protein and fiber), there were inconsistent effects on biomarkers of cardiometabolic health (improve lipid profiles, microvascular reactivity and inflammation) and gastrointestinal health (increase in the proportion of beneficial fecal bacteria). Further studies exploring the broad health benefits of nuts in children are needed with consideration given to higher doses and longer intervention periods. Refereed/Peer-reviewed

Long term nut consumption is associated with reduced risk of coronary heart disease and better cognitive function. This study examined supplementing habitual diets with almonds or carbohydrate-rich snack foods (providing 15% energy) on biomarkers of cardiovascular and metabolic health, mood and cognitive performance. Participants (overweight/obese, 50&ndash, 80 years) were randomised to an almond-enriched diet (AED) or isocaloric nut-free diet (NFD) for 12 weeks. Body weight, blood lipids, glucose, insulin, blood pressure (BP), arterial stiffness, cell adhesions molecules, C reactive protein (CRP), mood, and cognitive performance (working memory primary outcome), dietary profiles and energy intake/expenditure were measured at baseline and Week 12 in 128 participants (n = 63 AED, n = 65 NFD). Compared with NFD, AED was associated with altered macro and micronutrient profiles, but no differences in energy intake or expenditure. The AED significantly reduced triglycerides and SBP but there were no other changes in cardiometabolic biomarkers, mood, or cognitive performance. The inclusion of almonds in the diet improves aspects of cardiometabolic health without affecting cognitive performance or mood in overweight/obese adults.

Growth factors can be isolated from bovine milk to form a whey growth factor extract (WGFE). This study examined whether WGFE promoted activation of the AKT/mTOR pathway enabling increased lean tissue mass and strength in resistance trained men. Forty six men with >6 months of resistance training (RT) experience performed 12 weeks of RT. Participants consumed 20 g/day of whey protein and were randomised to receive either 1.6 g WGFE/day (WGFE; n = 22) or 1.6 g cellulose/day (control, CONT; n = 24). The primary outcome was leg press one-repetition maximum (LP1-RM) which was assessed at baseline, 6 and 12 weeks. At baseline and 12 weeks body composition was assessed by dual energy x-ray absorptiometry, and muscle protein synthesis and gene expression were assessed (vastus lateralis biopsy) in a sub-sample (WGFE n = 10, CONT n = 10) pre- and 3 hr post-training. RT increased LP1-RM (+34.9%) and lean tissue mass (+2.3%; p < 0.05) with no difference between treatments (p > 0.48, treatment x time). Post-exercise P70s6k phosphorylation increased acutely, FOXO3a phosphorylation was unaltered. There were no differences in kinase signalling or gene expression between treatments. Compared with CONT, WGFE did not result in greater increases in lean tissue mass or strength in experienced resistance trained men.

Longitudinal studies report that regular nut consumption is associated with reduced risk of coronary heart disease and better cognitive function. Thus, nuts may improve cardiovascular and neurocognitive health – especially in ‘at-risk’ populations (e.g. overweight/obese). This study examined the effect of supplementing habitual diets of overweight/obese individuals for 12 weeks with either almonds or carbohydrate rich (CHO-rich) snack foods on biomarkers of cardiovascular and metabolic health, mood and cognitive performance. Participants (n = 151; overweight/obese, 50–80 years) were randomised to replace 15% energy intake with either almonds (Almond) or isocaloric CHO-rich snack foods (Comparator). Body weight, blood lipids, glucose, insulin, blood pressure (BP), arterial stiffness, mood and cognitive performance (memory, executive function, speed of processing) were measured at baseline and 12 weeks. One hundred and twenty eight participants (78F:50M, n = 63 almond, n = 65 control) completed the intervention (M ± SD: age 64 ± 8years, BMI 30.3 ± 3.6kg/m2, stable medication use: 32% BP and 19% lipid lowering). Compared with the CHO-rich comparator foods, there were a number of significant improvements associated with almond consumption. These included reduced serum triglycerides (M ± SEM, almond: 1.30 ± 0.062 to 1.16 ± 0.062 mmol/L vs CHO-rich 1.13 ± 0.061 to 1.17 ± 0.061 mmol/L, p = 0.005 whole population). In those with cholesterol below the ATPIII cut point of < 6.2mmol/L (84% of sample), almond consumption reduced total cholesterol (almond: 5.12 ± 0.13 to 4.93 ± 0.12 mmol/L vs CHO-rich 5.24 ± 0.13 to 5.21 ± 0.11 mmol/L, p < 0.001) and LDL-cholesterol (almond: 3.03 ± 0.11 to 2.87 ± 0.11 mmol/L vs CHO-rich 2.98 ± 0.10 to 3.07 ± 0.10 mmol/L, p = 0.002).). Additionally in a non-BP medicated subgroup only (n = 87, 68% of sample), there was a reduction in systolic BP (almond: 130.73 ± 2.19 to 127.02 ± 2.19 mmHg vs control:128.63 ± 2.32 to 129.48 ± 2.32mmHg, p = 0.035; and improved self-rated alertness (almond 54.73 ± 2.32 to 58.64 ± 2.32 vs CHO-rich 61.75 ± 2.28 to 61.13 ± 2.28, p = 0.048). The inclusion of almonds in the diet has the ability to improve aspects of cardiometabolic health and mood in overweight/obese adults. The lack of change in cognitive performance may reflect the fact that the study population was cognitively high performing at baseline. Future research should be directed at examining the effects of this relatively simple, cost-effective nutritional intervention in populations at greater risk of cardiometabolic and cognitive decline.

Background: Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function. Methods: Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke’s Cognitive Examination-Ill. Results: Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01–0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 − 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function. Conclusion: LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function. Refereed/Peer-reviewed

IntroductionEpidemiological studies indicate an inverse association between nut consumption and body mass index (BMI). However, clinical trials evaluating the effects of nut consumption compared with a nut-free diet on adiposity have reported mixed findings with some studies reporting greater weight loss and others reporting no weight change. This paper describes the rationale and detailed protocol for a randomised controlled trial assessing whether the inclusion of almonds or carbohydrate-rich snacks in an otherwise nut-free energy-restricted diet will promote weight loss during 3 months of energy restriction and limit weight regain during 6 months of weight maintenance.Methods and analysisOne hundred and thirty-four adults aged 25–65 years with a BMI of 27.5–34.9 kg/m2 will be recruited and randomly allocated to either the almond-enriched diet (AED) (15% energy from almonds) or a nut-free control diet (NFD) (15% energy from carbohydrate-rich snack foods). Study snack foods will be provided. Weight loss will be achieved through a 30% energy restriction over 3 months, and weight maintenance will be encouraged for 6 months by increasing overall energy intake by ~120–180 kcal/day (~500-750kJ/day) as required. Food will be self-selected, based on recommendations from the study dietitian. Body composition, resting energy expenditure, total daily energy expenditure (via doubly labelled water), physical activity, appetite regulation, cardiometabolic health, gut microbiome, liver health, inflammatory factors, eating behaviours, mood and personality, functional mobility and pain, quality of life and sleep patterns will be measured throughout the 9-month trial. The effects of intervention on the outcome measures over time will be analysed using random effects mixed models, with treatment (AED or NFD) and time (baseline, 3 months and 9 months) being the between and within factors, respectively in the analysis.Ethics and disseminationEthics approval was obtained from the University of South Australia Human Research Ethics Committee (201436). Results from this trial will be disseminated through publication in peer-reviewed journals, national and international presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618001861246).

There is evidence to indicate that the central biological clock (i.e., our endogenous circadian system) plays a role in physiological processes in the body that impact energy regulation and metabolism. Cross-sectional data suggest that energy consumption later in the day and during the night is associated with weight gain. These findings have led to speculation that when, as well as what, we eat may be important for maintaining energy balance. Emerging literature suggests that prioritising energy intake to earlier during the day may help with body weight maintenance. Evidence from tightly controlled acute experimental studies indicates a disparity in the body's ability to utilise (expend) energy equally across the day and night. Energy expenditure both at rest (resting metabolic rate) and after eating (thermic effect of food) is typically more efficient earlier during the day. In this review, we discuss the key evidence for a circadian pattern in energy utilisation and balance, which depends on meal timing. Whilst there is limited evidence that simply prioritising energy intake to earlier in the day is an effective strategy for weight loss, we highlight the potential benefits of considering the role of meal timing for improving metabolic health and energy balance. This review demonstrates that to advance our understanding of the contribution of the endogenous circadian system toward energy balance, targeted studies that utilise appropriate methodologies are required that focus on meal timing and frequency. Refereed/Peer-reviewed

Purpose: To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment.Methods Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis.This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941). Results: Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies. Conclusion: Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors.Implications for cancer survivors At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity ofresearch on this subject, necessitating further investigations Refereed/Peer-reviewed

Objectives: Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods: Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results: Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P

Shiftworkers have impaired performance when driving at night and they also alter their eating patterns during nightshifts. However, it is unknown whether driving at night is influenced by the timing of eating. This study aims to explore the effects of timing of eating on simulated driving performance across four simulated nightshifts. Healthy, non-shiftworking males aged 18–35 years (n = 10) were allocated to either an eating at night (n = 5) or no eating at night (n = 5) condition. During the simulated nightshifts at 1730, 2030 and 0300 h, participants performed a 40-min driving simulation, 3-min Psychomotor Vigilance Task (PVT-B), and recorded their ratings of sleepiness on a subjective scale. Participants had a 6-h sleep opportunity during the day (1000–1600 h). Total 24-h food intake was consistent across groups; however, those in the eating at night condition ate a large meal (30% of 24-h intake) during the nightshift at 0130 h. It was found that participants in both conditions experienced increased sleepiness and PVT-B impairments at 0300 h compared to 1730 and 2030 h (p < 0.001). Further, at 0300 h, those in the eating condition displayed a significant decrease in time spent in the safe zone (p < 0.05; percentage of time within 10 km/h of the speed limit and 0.8 m of the centre of the lane) and significant increases in speed variability (p < 0.001), subjective sleepiness (p < 0.01) and number of crashes (p < 0.01) compared to those in the no eating condition. Results suggest that, for optimal performance, shiftworkers should consider restricting food intake during the night. Refereed/Peer-reviewed

Objective: Peanuts contain bioactive nutrients beneficial for vascular function. This study investigated whether consumption of unsalted peanuts (with skins) would enhance cerebrovascular perfusion and cognitive performance. Method: In a randomized crossover trial, 61 volunteers (29 males/32 females, 65 ± 7 years, BMI 31 ± 4 kg/m2) consumed their habitual diet ± high-oleic peanuts (56–84 g/day), each for 12 weeks. Nutrient intakes, vascular and cognitive function were assessed at baseline and at the end of each 12-week phase. Differences between the ends of each phase were compared by general linear repeated measures ANOVA controlling for baseline. Pearson's correlation analyses determined relationships between differences in cerebrovascular reactivity (CVR) and cognitive function. Results: Intakes of bioactive nutrients increased during the peanut phase. CVR was 5% greater in the left middle cerebral artery (MCA) and 7% greater in the right MCA. Small artery elasticity was 10% greater after peanut consumption; large artery elasticity and blood pressure did not differ between phases. Measures of short-term memory, verbal fluency, and processing speed were also higher following the peanut phase; other cognitive measures did not change. Differences in CVR in the left MCA correlated with differences in delayed memory and recognition. Discussion: Regular peanut consumption improved cerebrovascular and cognitive function; increased intakes of bioactive nutrients may have mediated these improvements. Refereed/Peer-reviewed

Background: This study examined relationships between adiposity, physical functioning, and physical activity. Methods: Obese (N = 107) and healthy-weight (N = 132) children aged 10-13 years underwent assessments of percent body fat (%BF, dual energy X-ray absorptiometry); knee extensor strength (KE, isokinetic dynamometry); cardiorespiratory fitness (CRF, peak oxygen uptake by cycle ergometry); physical health-related quality of life (HRQOL); and worst pain intensity and walking capacity [six-minute walk (6MWT)]. Structural equation modelling was used to assess relationships between variables. Results: Moderate relationships were observed between %BF and (1) 6MWT, (2) KE strength corrected for mass, and (3) CRF relative to mass (r -0.36 to -0.69, p ≤ 0.007). Weak relationships were found between %BF and physical HRQOL (r -0.27, p = 0.008); CRF relative to mass and physical HRQOL (r -0.24, p = 0.003); physical activity and 6MWT (r 0.17, p = 0.004). Squared multiple correlations showed that 29.6% variance in physical HRQOL was explained by %BF, pain, and CRF relative to mass; while 28.0% variance in 6MWT was explained by %BF and physical activity. Conclusions: It appears that children with a higher body fat percentage have poorer KE strength, CRF, and overall physical functioning. Reducing percent fat appears to be the best target to improve functioning. However, a combined approach to intervention, targeting reductions in body fat percentage, reductions in pain, and improvements in physical activity and CRF may assist physical functioning. Refereed/Peer-reviewed

Flight attendants experience circadian misalignment and disrupted sleep and eating patterns. This survey study examined working time, sleep, and eating frequency in a sample (n=21, 4 males, 17 females) of Australian flight attendants (mean age=41.8 y, SD=12.0 y, mean BMI=23.8 kg/m2, SD=4.1 kg/m2). Respondents indicated frequencies of snack, meal, and caffeine consumption during their last shift. Reported sleep duration on workdays (mean=4.6 h, SD=1.9 h) was significantly lower than on days off (M=7.2 h, SD=1.2 h, p

Vascular stiffness can be measured using numerous techniques including assessments of central haemodynamics, aortic arterial stiffness, and indices of aortic wave reflection and endothelial dilatation. Impaired vascular function is associated with increased risk of cardiovascular disease (CVD). Epidemiological studies indicate that regular nut consumption reduces CVD risk, with one of the proposed mechanisms being via improvements in vascular function. This narrative review summarizes the evidence from a systematic search of the literature of the effects of tree nut and peanut consumption on measures of vascular function excluding flow mediated dilatation. A total of 16 studies were identified, with a mix of acute controlled studies (n = 3), an uncontrolled pre/post chronic study (n = 1), chronic crossover (n = 7) and parallel studies (n = 5). Nut types tested included almonds, peanuts, pine nuts, pistachios and walnuts, with dose and length of supplementation varying greatly across studies. Most studies (n = 13) included individuals at risk for CVD, according to various criteria. Findings were inconsistent, with ten studies reporting no significant changes in vascular function and six studies (one acute and five chronic studies) reporting improvements in at least one measure of vascular function. In summary, nuts have the potential to improve vascular function and future studies should consider the population, dose and length of nut supplementation as well as suitability of the different vascular function techniques. Refereed/Peer-reviewed

Understanding shift workers dietary intake patterns may inform interventions targeted at lowering chronic disease risk. This study examined the temporal distribution of food intake as shift workers rotate between night shifts, day shift and/or days off to identify differences in energy intake, eating frequency, and adherence to dietary guidelines by shift type (night shift vs. day). Night shift (NS) workers completed a four-day food diary that included a minimum of two night shifts and one-day shift (DS)/day off (DO), recording all food, beverages and time of consumption. Comparisons were between shift types, using ANOVA for continuous data and generalized estimating equations for count data, data reported as mean (SE). When comparing NS and DSDO, there were no differences in energy intake (24 h) (8853 (702) vs. 9041 (605) kJ, n = 22) or adherence to dietary guidelines. There was no difference between the number of eating occasions on NS and DSDO (5.6(0.3) vs 5.1(0.6) occasions) but less energy per eating occasion at night (1661(125) vs 1933(159) kJ). When working NS compared with DSDO there was higher total sugar (%E, 19.1(2.0) vs 15.0(2.4)) and lower saturated fat (%E, 13.8(1.2) vs 15.7(1.3)). Further, DSDO were characterized by a pattern of three main meals and a prolonged fasting period. It is important to determine if reducing eating occasions and providing opportunities for fasting improves metabolic health. Refereed/Peer-reviewed

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the airways, underpinned by inflammation and worsening lung function. Omega-3 polyunsaturated fatty acids (n-3PUFA) can modulate inflammatory mechanisms and may therefore impact lung function in people with COPD. This observational, cross-sectional study of 577 adults in the Whyalla Intergenerational Study of Health (WISH), conducted during 2008–09 in regional South Australia, explored associations between fish and PUFA intakes (from food frequency questionnaires) and lung function (spirometry). It also included a nested case-control study which compared fish and PUFA intakes and plasma phospholipid PUFA levels between 40 people with COPD and 80 age-sex matched controls. In the whole population, linear regression models adjusted for age, sex, smoking status and education demonstrated a weak negative association between lung function (FEV1% predicted) and consumption of fried fish (OR -0.12, 95% CI -0.22, −0.01, P = 0.026) but not fish prepared by other cooking methods or estimated intakes of PUFA. There was no association between fish or PUFA intakes and COPD risk. Compared to age and sex matched controls, cases had poorer lung function and a higher rate of smoking prevalence but did not differ in their intakes of fish or PUFA or their PUFA levels in plasma phospholipids. In this sub-population, we found a marginally significant association between COPD risk and total long chain n-3PUFA levels in plasma phospholipids (OR 1.22 95% CI 1.00–1.49, P = 0.046). Given the relatively small number of cases in this analysis, this finding should be interpreted with caution, especially given the lack of association with other markers of n-3PUFA intake or status. Taken together, our data suggest that n-3PUFA intake and status are not determinants of improved lung function in this regional Australian population. Keywords: Lung function, Chronic obstructive pulmonary disease, COPD, Polyunsaturated fatty acid, PUFA

Shiftwork leads to altered eating patterns, with workers often eating foods at all times across the 24h period. Strategies to reduce the burden of shiftwork on the workers should be prioritised and altering these eating patterns is an important area for change. This narrative review examines the current evidence on the individual and environmental factors influencing the eating behaviours of shiftworkers. A systematic search was conducted and yielded 62 articles. These were split into four themes that influence eating patterns; When shiftworkers eat, What type of foods shiftworkers eat, Where the food is sourced from, and Why shiftworkers choose to eat on shift. Irregular working hours was the biggest influence on when workers ate on shift, shift-type was the biggest influence on what workers ate, the majority of food was sourced from canteens and cafeterias, and socialising with colleagues was the biggest reason why workers chose to eat. While more research is needed to explore multiple industries and shift-types, and to investigate the ideal size, type and timing of food on shift, this review has highlighted that future research into shiftworker eating needs to adopt an integrative approach and consider the different individual and social contexts that influence eating patterns. Refereed/Peer-reviewed

Sleep loss is one of the most common causes of accidents and errors in operational environments. Currently, no single method satisfies all of the requisite criteria of an effective system for assessing the risk of injury prior to safety being compromised. Research has concentrated towards the development of a biomarker for individualized assessment of sleepiness-related deficits in neurobehavioral alertness, with salivary alpha-amylase (sAA) recently reported as a potential biomarker during acute total sleep deprivation. The present study extends on previous research by investigating the association between sAA and neurobehavioral alertness during simulated night-shift work, during individuals are required to work at night when biological processes are strongly promoting sleep and sleep during the day when endogenous processes are promoting wakefulness. In a laboratory-controlled environment, 10 healthy non-shift working males aged 24.7 ± 5.3 years (mean ± SD) underwent four consecutive nights of simulated night-shift work. Between 17:30–04:30 h participants provided saliva samples and completed a 3 min psychomotor vigilance test (PVT-B), 40 min simulated driving task, and 3 min digit symbol substitution test (DSST). Higher sAA levels were associated with faster response speed on the PVT-B, reduced lane variability on the simulated driving task, and improved information processing speed on the DSST during the first night-shift. There were no associations between sAA levels and performance outcomes during subsequent night-shifts. Findings indicate that the usability of sAA to assess the risk of neurobehavioral deficits during shift-work operations is limited. However, the robust circadian rhythm exhibited by sAA during the protocol of circadian misalignment suggests that sAA could serve as a potential circadian marker. Refereed/Peer-reviewed

Purpose of Review: We review recent epidemiological and clinical studies investigating the consumption of tree nuts and peanuts and cardiovascular disease (CVD) mortality as well as CVD risk factors. Recent Findings: A greater consumption of tree nuts and peanuts is associated with a reduced risk of CVD mortality, as well as lower CVD events. Furthermore, risk factors associated with the development of CVD such as dyslipidemia, impaired vascular function, and hypertension are improved with regular tree nut and peanut consumption through a range of mechanism associated with their nutrient-rich profiles. There is weak inconsistent evidence for an effect of nut consumption on inflammation. There is emerging evidence that consuming tree nuts reduces the incidence of non-alcoholic fatty liver disease (NAFLD) and promotes diversity of gut microbiota, which in turn may improve CVD outcomes. Summary: Evidence for CVD prevention is strong for some varieties of tree nuts, particularly walnuts, and length of supplementation and dose are important factors for consideration with recommendations. Refereed/Peer-reviewed

Lutein is a carotenoid that reduces the risk of some chronic diseases, possibly by altering physical activity behavior. The objective of this study was to conduct a systematic review of studies examining the relationship between lutein status (dietary intake/blood concentration) and physical activity. Peer-reviewed studies published in Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Embase were included if they reported a measure of association between lutein status and physical activity. Seventeen studies met the inclusion criteria. Eleven reported positive associations, three reported mixed results, and three reported no association. Two studies used objective measures of lutein status (blood concentration) and physical activity (accelerometry) and reported positive associations, with correlations of ≥0.36 and differences of ≥57% in physical activity between upper and lower tertiles. Studies using self-report measures reported weaker correlations (r = 0.06 to 0.25), but still more physical activity (18% to ≥600% higher) in those with the highest compared with the lowest lutein status. Higher lutein status may be associated with higher levels of physical activity, which may contribute to a reduced risk of chronic disease Refereed/Peer-reviewed

Severe demyelinating disorders of the central nervous system (CNS) such as multiple sclerosis (MS), can be devastating for many young lives. To date, the factors resulting in poor remyelination and repair are not well understood, and reparative therapies that benefit MS patients have yet to be developed. We have previously shown that the activity and abundance of Lipoprotein Lipase (LPL)-the rate-limiting enzyme in the hydrolysis of triglyceride-rich lipoproteins-is increased in Schwann cells and macrophages following nerve crush injury in the peripheral nervous system (PNS), suggesting that LPL may help scavenge myelin-derived lipids. We hypothesized that LPL may play a similar role in the CNS. To test this, mice were immunized with MOG35-55 peptide to induce experimental allergic encephalomyelitis (EAE). LPL activity was increased (p < 0.05) in the brain at 30 days post-injection, coinciding with partial remission of clinical symptoms. Furthermore, LPL abundance and activity was up-regulated (p < 0.05) at the transition between de-and re-myelination in lysolecithin-treated ex vivo cerebellar slices. Since microglia are the key immune effector cells of the CNS we determined the role of LPL in microglia. Lipid uptake was decreased (p < 0.001) in LPL-deficient BV-2 microglial cells compared to WT. In addition, LPL-deficient cells showed dramatically reduced expression of anti-inflammatory markers, YM1 (22 fold, p < 0.001), and arginase 1 (Arg1; 265 fold, p < 0.001) and increased expression of pro-inflammatory markers, such as iNOS compared to WT cells (+53 fold, p < 0.001). This suggests that LPL is a feature of reparative microglia, further supported by the metabolic and inflammatory profile of LPL-deficient microglia. Taken together, our data strongly suggest that LPL expression is a novel feature of a microglial phenotype that supports remyelination and repair through the clearance of lipid debris. This mechanism may be exploited to develop future reparative therapies for MS and primary neurodegenerative disorders (Alzheimer's disease (AD) and Parkinson's disease). Refereed/Peer-reviewed

Background: Hypocaloric low-fat diets, high in protein with moderate carbohydrate (HP) can enhance weight loss, improve glycaemic control and improve cardiometabolic health risk factors in type 2 diabetes mellitus (T2DM). However, it is unclear whether the metabolic benefits observed during weight loss are sustained during energy-balance and weight maintenance. Furthermore, there is a lack of evidence regarding the effect of HP diets on food cravings, cognitive function and psychological wellbeing in T2DM, despite carbohydrate food cravings, cognitive impairment and depression being associated with hyperglycaemia. Methods/design: Overweight/obese adults with T2DM were randomised to consume either a HP diet (n. = 32, ~. 32% protein, 33% carbohydrate, 30% fat) or a higher-carbohydrate diet (HC, n. = 29, ~. 22% protein, 51% carbohydrate, 22% fat) for 24 weeks with 30 min of moderate intensity exercise five days/week for the study duration. There were 2 phases: a 12 week weight loss phase followed by a 12 week weight maintenance phase. Primary outcome was glycaemic control (glycosylated haemoglobin; HbA1c). Secondary outcomes were cardiometabolic risk factors (body composition, fasting blood pressure, blood lipids, glucose, insulin and C-reactive protein), food cravings, cognitive function (memory; psychomotor and executive function and psychological well-being. Outcomes were measured at baseline and the end of each 12-week intervention phase. Data will be analysed as intention-to-treat using linear mixed effects models. Conclusion: This study will examine the effects of two dietary interventions on health outcomes in T2DM during weight loss and notably following weight maintenance where there is a paucity of evidence. Refereed/Peer-reviewed

Context: The anti-inflammatory activity of long-chain n-3 polyunsaturated fatty acids (PUFAs) has been established in several chronic inflammatory diseases but has yet to be demonstrated in inflammatory lung diseases such as chronic obstructive pulmonary disease (COPD). Objective: The aim of this systematic review was to investigate, using PRISMA guidelines, the relationship between the intake of long-chain n-3 PUFAs and the prevalence, severity, and health outcomes of COPD. Data Sources: Eight health databases and the World Health Organization’s international clinical trial registry were searched for relevant studies. Study Selection: Experimental or observational studies that were published in English and that assessed long-chain n-3 PUFA intake (by determining habitual consumption and/or tissue levels) in adults with COPD were included. Data Extraction: Publication demographics, participant characteristics, type of intervention or exposure, long-chain n-3 PUFA intake, pulmonary function, COPD mortality, and COPD severity were independently extracted from each article by 2 authors using a prospectively designed data extraction tool. Data Synthesis: All 11 of the studies included in the review were observational. Approximately equal numbers of studies reported significant (n = 6, 5 inverse) relationships or no significant relationships (n = 5) between either consumption of long-chain n-3 PUFAs or levels of long-chain n-3 PUFAS in tissue and a COPD outcome. Conclusions: Current evidence of a relationship between long-chain n-3 PUFA intake and COPD is limited and conflicting, with studies having wide methodological variation. Registration number: PROSPERO 2013:CRD42013004085

Background: Obese children are typically less physically active than their normal-weight peers and are often assumed to be 'unfit'. Objective Investigate the relationships between adiposity, physical activity levels and cardiorespiratory fitness (CRF) in obese and normal-weight children. A secondary aim was to examine obese/normal-weight differences in CRF. Methods Obese (N = 107) and normal-weight (N = 132) 10-13-year-olds participated. Fat-free mass (FFM), percent fat, physical activity and peak oxygen uptake (VO2peak) were assessed. Analyses were adjusted for socioeconomic status (SES). Results Higher percent fat was inversely associated with VO2peak normalized for mass (r = -0.780, P < 0.001) even after controlling for physical activity (r = -0.673, P < 0.001). While higher percent fat was also inversely associated with VO2peak normalized for FFM, this was only significant in males (r = -0.247, P = 0.004) and did not persist after controlling for physical activity (r = -0.059 P = 0.526). Compared with normal-weight children, obese children had higher absolute VO2peak, lower VO2peak corrected for mass (P ≤ 0.009) and lower VO2peak corrected for FFM (P = 0.041) that did not persist after controlling for SES (P = 0.086). Conclusion Obesity-related inefficiencies in CRF were evident. Higher adiposity was associated with poorer CRF relative to mass, irrespective of physical activity levels. However, low physical activity levels may be responsible for associations between adiposity and CRF relative to FFM seen in boys, indicating the importance of encouraging physical activity.

Scientific articles are retracted infrequently, yet have the potential to influence the scientific literature for years. The only randomised controlled trial to explore the effects of omega-3 polyunsaturated fatty acids in people with chronic obstructive pulmonary disease was retracted in 2008 due to falsified data. The objective of this research was to determine the frequency and nature of citations of this retracted paper. Web of Science and Google Scholar were used to determine the number of times the retracted article was cited. Citations were classified as either “retraction acknowledged” or “retraction not acknowledged”. The search was conducted on 6 August 2013 and updated on 25 March 2014. Results: The search resulted in 76 citations, of which 24 occurred prior to the retraction of the article. Of the 52 citations occurring after the retraction, only two acknowledged the retraction. Of the citations not acknowledging the retraction, 20 referred to specific data and 30 cited the reference in passing. This retracted article continues to be cited by authors, suggesting that information about the retraction was unsuccessfully communicated to the scientific community. Continual citation of retracted literature has the potential to bias a field of research and potentially misinform end-users. Refereed/Peer-reviewed