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Background: A healthy diet has been proposed to support good mental health, but the addition of either red meat or meat alternatives is nuanced. Objectives: We aimed to determine if psychological and physiological well-being is differentially affected by consuming recommended weekly amounts of either lean red meat or plant-based meat alternatives (PBMAs) supplemented with a plant-rich diet. Methods: The trial was a parallel 2-arm randomized intervention of 10 wk duration. Eighty healthy omnivorous young adults were clustered as 40 cohabitating household pairs. Each pair was randomly assigned to consume 3 weekly servings of either fresh New Zealand beef and lamb or the equivalent PBMA. They maintained an otherwise ovo-lacto vegetarian diet, aided by a weekly meal kit and supported by engaged advice from research dietitians. Psychological measures were well-being (World Health Organization–Five Well-Being Index); depression, anxiety, and stress (depression anxiety stress scales-short form-21); and fatigue (multidimensional fatigue symptom inventory-short form) assessed weekly throughout the trial. Blood biomarkers included neurotransmitter-related compounds, iron status and vitamins B12 and D. Physical activity and sleep were estimated by a fitness wristband. Mixed effect modeling evaluated changes in each outcome over time relative to its baseline and compared the 2 interventions accounting for randomization unit clustering. Results: Thirty-nine household pairs completed the trial. Participants measured as psychologically healthy at baseline. There were no significant differences between groups in the degree of change from baseline for the psychological outcomes, nor for the majority of the circulatory markers. Differences in changes to vitamin B12 status and 3 neurotransmitter-related compounds (adenosine, agmatine, and tyrosine) from baseline to week 10 were observed between groups. Results were similar in all sensitivity analyses when adjusting for physical activity, sleep, and diet quality covariates. Conclusions: There was no effect on the psychological measures and limited change to physiological status when comparing a balanced diet containing either red meat or PBMAs in healthy young adults.

Laat jij je kennen? Wanneer kent iemand jou echt, ten diepste? Kan dat überhaupt wel? En hoe goed kan een mens zichzelf kennen? Dit soort vragen spelen in elk mensenleven een rol. Maar wat als een leven op z’n kop komt te staan? Als alles op losse schroeven staat, als niets meer zeker is. Wie ben je dan? En wie kent jou dan?

IntroductionNutrition trials are important for informing dietary and clinical guidelines. Central to the success of these trials is participant adherence to dietary behaviors. However, trials commonly experience poor adherence. This study seeks to understand if and how researchers consider supporting participant adherence to dietary behaviors and their relationship to using behavior change science when designing trials.MethodsA mapping exercise was undertaken to create matrices that describe the landscape of current nutrition trials. A total of 12 researchers participated in semi-structured, one-on-one interviews. Transcripts were analyzed using (i) the theoretical domains framework (TDF) to identify themes in current practice and beliefs, and (ii) the capability, opportunity, motivation, and behavior model to identify barriers and enablers to using behavior change science in the design of nutrition trials.ResultsTwenty-two belief statements were identified across all 14 TDF domains and were conceptualized as 5 key themes with respect to designing nutrition trials to improve participant adherence: (i) what was done, (ii) how it was done, (iii) why it was done, (iv) adherence challenges, and (v) conflicting beliefs. Regarding using behavior change science when designing trials, some researchers felt this would be beneficial but lacked the knowledge and skills to do so, while others were skeptical of its value over the current experience-based practice.DiscussionResearchers are motivated to encourage participant adherence to dietary behaviors, and, consciously and subconsciously, implement a range of strategies through non-systematic methods in their trials. Future publications would benefit from the explicit documentation of levels of adherence to dietary behaviors and strategies implemented to improve adherence.

BackgroundFollowing a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. He Rourou Whai Painga is a dietary intervention trial with behaviour change support that seeks to determine whether a MedDiet pattern can provide equivalent benefits in Aotearoa New Zealand (NZ), a country where cardiovascular disease is a leading cause of death. To do this, the MedDiet needs to be adapted in an acceptable way for NZ, with consideration of the Māori (indigenous) population.MethodsThe MedDiet was defined using existing MedDiet scoring tools and adapted to the NZ context using local guidelines. The resulting NZ MedDiet pattern was used to develop a kai/food basket, including products from industry partners, for participants in He Rourou Whai Painga. Criteria set for the kai/food basket included providing up to 75% of energy requirements and falling within the Australia/NZ Acceptable Macronutrient Distribution Range to reduce risk of chronic disease. Māori researchers on the team provided support to ensure Mātauranga Māori (Māori knowledge and values) was upheld through this process.ResultsThe NZ MedDiet pattern criteria was similar to the identified MedDiet scoring tools, with differences in recommendations for dairy, red meat, alcohol and olive oil. The resulting kai/food baskets were estimated to provide on average 73.5% of energy requirements for households, with 36% from fat, 8.6% from saturated fat, 17% protein, and 42% carbohydrate. Forty-two industry partners, including 3 Māori businesses, agreed to provide 22 types of food products towards the total.ConclusionSmall, feasible changes to the MedDiet can be made to align with the NZ guidelines and food environment. However, this eating pattern still differs from what the population, particularly Māori, are currently consuming. Continued partnership with Māori and additional behavioural support is important to facilitate adherence to this dietary pattern within He Rourou Whai Painga.Trial registration: https://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056.

Abstract Background Behaviour change science is proposed to improve participant retention and enhance the validity of trials. However, researchers seldom systematically consider and implement behaviour change strategies within trials for this purpose. The objective of this article is to evaluate how an eHealth behaviour change support (BCS) program enhances young adults’ adherence to behaviours required within a dietary intervention. Methods The Nine Principles framework was used to develop BCS to implement across both arms of a 10-week randomised parallel-group intervention to enhance adherence to (i) eating healthily and (ii) reporting dietary intake. Key components of the BCS included access to a dietitian-led Facebook group, text reminders, and food delivery. Effectiveness was measured using the following analyses of the 78 participants who completed the study; pre-post change in targeted dietary habits over time using a subscore of the Healthy Diet Habits Index, questionnaire to assess change in perception of barriers to eating healthily over time, Facebook group engagement, and impact evaluation of the BCS. Participants received a dietary reporting score out of 100 to assess adherence across the 10 weeks. Results The total Healthy Diet Habits Index subscore out of 16 significantly increased from baseline to week 10 (10.6 ± 2.6 to 11.2 ± 2.6, p value

BackgroundCardiometabolic diseases are highly prevalent in Aotearoa New Zealand. Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health. This study aims to test whether an intervention including a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) and behavior change science can improve the metabolic health of participants and their household/whānau.Methods and analysisThis is a multi-center, three-stage trial with two parallel group superiority randomized controlled trials (RCTs), and a longitudinal cohort study embedded within the trial design. The first RCT (RCT 1) is a comparison of the NZMedDiet pattern compared to usual diet for 12 weeks. The Behavior Change Wheel was used to select and implement strategies to support participant adherence to the NZMedDiet, such as web-based nutrition education on healthy shopping and cooking. The second (RCT 2) compares online social support to no online social support for 12 weeks, administered to participants immediately following RCT 1. The third stage is a longitudinal cohort study where all participants are followed from the beginning of their start of the active intervention for 12 months in total. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). The duration of enrolment is 12–15 months. The total recruitment target is 200 index participants and their household/whānau members who participate with them, and the primary analyses will be intention to treat on index participants.DiscussionThe trial will test whether the NZMedDiet pattern and behavior change support improves the cardiometabolic health of people in Aotearoa New Zealand.Clinical trial registrationhttps://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056 (Spirit 2).

Introduction Innovative health promotion strategies are crucial for enhancing global quality of life and curbing premature deaths. Digital health promotion is particularly impactful for young individuals often using internet-connected devices. Collaborative methodologies in digital intervention research offer insights into supporting youth during key life stages, such as adolescence. This review sought to examine the literature on digital health interventions for youth co-designed via participatory frameworks. Methods Following the Joanna Briggs Institute Manual and an adapted Arksey & O’Malley's 6-stage framework, this review utilised the PRISMA-ScR checklist for structured reporting. Peer-reviewed research where young individuals (15–35 years) contributed to digital health intervention design was analysed. Systematic synthesis adhered to Braun & Clarke's Thematic Analysis Guidelines, mapping data to research queries and thematic framework. Results Eighteen articles were systematically synthesised, revealing seven main themes: digital tool, inquiry field, report aim, participatory activities, intervention attributes and behavioural change support. Seventeen distinctive digital health interventions were assessed, mostly within risk mitigation and mental health domains. Predominantly, interventions were web-based, with mental wellness websites emerging as the prevalent tool. User experience testing stood out as the primary reported outcome. Conclusion Several innovative digital health interventions targeting youth have been identified. Platforms including social media, specialised apps, websites and video games are instrumental for health advice and clinical support dissemination, overcoming access and cost barriers. Participatory techniques are integral for the efficacy of digital health resources, encompassing youth aspirations and anticipations. Continued efforts will enrich comprehension of optimal practices in digital health promotion and intervention formulation.

Abstract Background As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets. Methods This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6–6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance. Results The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment – Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption. Conclusions As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents’ dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents’ acceptance. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).

BackgroundFlexitarian, vegetarian and exclusively plant-based diets are increasingly popular, particularly amongst young adults. This is the first randomised dietary intervention to investigate the health, wellbeing, and behavioural implications of consuming a basal vegetarian diet that additionally includes low-to-moderate amounts of red meat (flexitarian) compared to one containing plant-based meat alternatives (PBMAs, vegetarian) in young adults (ClinicalTrials.gov NCT04869163). The objective for the current analysis is to measure adherence to the intervention, nutrition behaviours, and participants’ experience with their allocated dietary group.MethodsEighty healthy young adults participated in this 10-week dietary intervention as household pairs. Household pairs were randomised to receive either approximately three serves of red meat (average of 390 g cooked weight per individual, flexitarian group) or PBMAs (350–400 g per individual, vegetarian group) per week on top of a basal vegetarian diet. Participants were supported to adopt healthy eating behaviours, and this intervention was developed and implemented using a behaviour change framework. Adherence (eating allocated red meat or PBMA, abstaining from animal-based foods not provided by researchers) was continuously monitored, with total scores calculated at the end of the 10-week intervention period. Eating experiences were measured by the Positive Eating Scale and a purpose-designed exit survey, and a food frequency questionnaire measured dietary intake. Analyses used mixed effects modeling taking household clustering into account.ResultsThe total average adherence score was 91.5 (SD = 9.0) out of a possible 100, with participants in the flexitarian group scoring higher (96.1, SD = 4.6, compared to 86.7, SD = 10.0; p

Abstract Background The EU-project GRACIOUS developed an Integrated Approach to Testing and Assessment (IATA) to support grouping high aspect ratio nanomaterials (HARNs) presenting a similar inhalation hazard. Application of grouping reduces the need to assess toxicity on a case-by-case basis and supports read-across of hazard data from substances that have the data required for risk assessment (source) to those that lack such data (target). The HARN IATA, based on the fibre paradigm for pathogenic fibres, facilitates structured data gathering to propose groups of similar HARN and to support read-across by prompting users to address relevant questions regarding HARN morphology, biopersistence and inflammatory potential. The IATA is structured in tiers, allowing grouping decisions to be made using simple in vitro or in silico methods in Tier1 progressing to in vivo approaches at the highest Tier3. Here we present a case-study testing the applicability of GRACIOUS IATA to form an evidence-based group of multiwalled carbon nanotubes (MWCNT) posing a similar predicted fibre-hazard, to support read-across and reduce the burden of toxicity testing. Results The case-study uses data on 15 different MWCNT, obtained from the published literature. By following the IATA, a group of 2 MWCNT was identified (NRCWE006 and NM-401) based on a high degree of similarity. A pairwise similarity assessment was subsequently conducted between the grouped MWCNT to evaluate the potential to conduct read-across and fill data gaps required for regulatory hazard assessment. The similarity assessment, based on expert judgement of Tier 1 assay results, predicts both MWCNT are likely to cause a similar acute in vivo hazard. This result supports the possibility for read-across of sub-chronic and chronic hazard endpoint data for lung fibrosis and carcinogenicity between the 2 grouped MWCNT. The implications of accepting the similarity assessment based on expert judgement of the MWCNT group are considered to stimulate future discussion on the level of similarity between group members considered sufficient to allow regulatory acceptance of a read-across argument. Conclusion This proof-of-concept case-study demonstrates how a grouping hypothesis and IATA may be used to support a nuanced and evidence-based grouping of ‘similar’ MWCNT and the subsequent interpolation of data between group members to streamline the hazard assessment process.

Aims: To test if a New Zealand food–based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing. Methods: A randomised controlled trial comparing 12 weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score [MetSSS] > 0.35). The intervention group was provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was (MetSSS) after 12 weeks. Results: Two hundred individuals with mean (SD) age 49.9 (10.9) years of which 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% confidence interval [CI]) of −0.05 (−0.16 to 0.06), p = 0.35. The Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1–2.1), p < 0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (−1.9 kg [−2.0 to −0.34]), p = 0.006 and wellbeing, assessed by the SF‐36 quality of life questionnaire, and improved across all domains. For example, the physical component summary score difference (95% CI) was 4.0 (2.4–5.7), p < 0.001, and the mental component summary score difference was 3.0 (0.7–5.2), p = 0.01. Conclusion: In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve metabolic risk scores but was associated with reduced weight and improved quality of life. [ABSTRACT FROM AUTHOR]

Background: Young women spend 50 min daily on social media (SM); thus, SM platforms are promising for health interventions. This study tested the feasibility and preliminary efficacy of the co-designed SM intervention the Daily Health Coach (DHC). The DHC is a 3-month healthy lifestyles intervention programme, targeting eating, physical activity, and social wellbeing behaviours in women aged 18–24, via the dissemination of health and nutrition content on social media platform Instagram. Methods: The programme was tested using an assessor-blinded, two-arm pilot randomised controlled trial with 46 participants over 12 weeks. Engagement was assessed via SM metrics; acceptability via post-programme questionnaires; and feasibility included retention, randomisation, recruitment, and data collection. Secondary outcomes—dietary quality, physical activity, social influence, disordered eating behaviours, body image, and digital health literacy—were assessed using validated surveys. Analyses included t-tests, chi-squared tests, and linear mixed models. The treatment effects were estimated by testing mean score differences from baseline to 3 months for intention-to-treat populations. Results: The DHC scored 83.6% for programme satisfaction. Over time, a significant decrease in body image disturbance was observed (p = 0.013). A significant group-by-time interaction for digital health literacy (p = 0.002) indicated increased ability to discern evidence-based nutrition information (p = 0.006). The waitlist control group showed increased social influence compared to the intervention group (p = 0.034). No other significant changes were observed. Conclusion: The DHC is a feasible and acceptable method for disseminating nutrition information. Larger studies are needed to determine efficacy. [ABSTRACT FROM AUTHOR]

Successful implementation of Safe and Sustainable by Design (SSbD) and grouping approaches requires simple, reliable, and cost-effective assays to facilitate hazard screening at early stages of product development. Especially for nanomaterials (NMs), which exist in many different forms, efficient hazard screening is of utmost importance. Oxidative potential (OP), which is the ability of a substance to induce reactive oxygen species (ROS), is an important indicator of the potential to induce oxidative damage and oxidative stress. A frequently used assay to measure OP of NMs is the ferric reducing ability of serum (FRAS) assay. Although the widely used cuvette-based FRAS protocol is considered a robust assay, its low throughput makes the screening of multiple materials challenging. Here, we adapt the original cuvette-based FRAS assay protocol, into a 96-well format and thereby improve its user-friendliness, simplicity, and screening capacity. The adapted protocol allows for the screening of multiple NMs per plate, and multiple plates per day, where the original protocol allows for the screening of one NM dose-range per day. When comparing the two protocols, the adapted protocol showed slightly decreased assay precision as compared to the original protocol. The results obtained with the adapted protocol were compared using eight reference NMs in an interlaboratory study and showed acceptably low intra- and interlaboratory variation. We conclude that the adapted FRAS assay protocol is suitable to be used for hazard screening to facilitate SSbD and grouping approaches. [ABSTRACT FROM AUTHOR]

Abstract Background Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function. Methods Patients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPMwalking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery. Results Thirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p

BackgroundDigital health interventions, including apps and web-based services, are on the rise due to their facilitated access to target groups. The constant evolution of technology calls for participatory research methodologies to understand youth expectations and the use of technology. The creative and collaborative nature of co-design allows for the active integration of youth desires and may enhance acceptability when it comes to digital health tools. ObjectiveThe primary objective of this review is to assess the breadth of literature on digital health interventions that have been co-designed for and by young adults, including the types of available evidence, the identification of key characteristics relevant to young adult co-design, and the examination of research conduct in this space. MethodsThe proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Scoping Reviews. As well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting scoping reviews, an adaptation of Arksey and O’Malley’s 6-stage framework for scoping reviews will be referenced. Peer-reviewed primary research, where young adults (aged 15-35 years) were actively involved in the design and development process of digital health interventions, will be collated for analyses. Five databases, including MEDLINE (Ovid), Cochrane, CINAHL Plus, Google Scholar, and Scopus, will be searched for relevant papers. Search strategies will be comprehensive to identify both published and unpublished literature. Relevant gray literature and secondary research will be excluded but pooled for separate analysis and citation chaining. Results will be presented in one or multiple forms, including narrative, tabular, or diagrammatic. ResultsData collection commenced in October 2021. Following data extraction according to the JBI results extraction instrument and independent quality assurance of included studies, a narrative synthesis of each paper included in the final pool will allow for data charting. As of May 2022, 19 papers are included for analysis. We expect the results to be published by autumn 2022. ConclusionsThis protocol provides guidance for researchers who plan to conduct a similar style of investigation and promotes standardization of the scoping review process. We anticipate the provision of an overview of participatory digital health research involving young adults, highlighting any gaps in this research area, as well as potential areas for further study. International Registered Report Identifier (IRRID)DERR1-10.2196/38635

The food environment has been implicated in creating an obesogenic generation; and while previous research has focused on population-wide initiatives, the university population resides in a research gap. To explore detailed components of the university food environment and what shaped dietary behaviors, we retrieved literature from the following databases: ScienceDirect, Scopus, PubMed, Medline, and EMBASE. Eleven studies were identified for qualitative content analysis and study quality assessment identified most of the studies as of good quality (n 8) and some as of fair quality (n 3). The certainty of evidence remained at a low level for all (n 11) studies due to the cross-sectional, observational nature of studies. Three major themes emerged: (1) food environment, (2) student perceptions (SPs), and (3) dietary outcome (DO). In a university food environment, the taste of food was paramount for the food choices of students, followed by the availability of food and the price of food. When university students perceive and choose foods and beverages, they sometimes regard unhealthy foods and beverages as healthy options. The diet quality of university students is more susceptible to living arrangements and socioeconomic status, but higher salt, fat, and added sugar consumption generally resulted in poorer quality of diet on campus. Future research could use novel methods to explore a wider range and deeper level of students' dietary behavior determinants in university food environments.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021283562.