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From 2015 to 2020 a state-wide salt-reduction initiative was launched in Victoria, Australia, including an awareness campaign focused on parents with children

Fatty acid taste (FAT) perception is involved in the regulation of dietary fat intake, where impaired FAT is associated with increased fatty food intake. There are a number of FAT receptors identified on human taste cells that are potentially responsible for FAT perception. Manipulating dietary fat intake, and in turn FAT perception, would elucidate the receptors that are associated with long-term regulation of FAT perception. The present study aimed to assess associations between diet-mediated changes to FAT receptors and FAT perception in humans. A co-twin randomised controlled trial was conducted, where each matching twin within a pair were randomly allocated to either an 8-week low-fat (LF;20 % energy fat) or an 8-week high-fat (HF;35 % energy fat) diet. At baseline and week 8, fungiform papillae were biopsied in the fasted state and FAT receptor gene expressions (cluster of differentiation 36 (CD36), free fatty acid receptor 2 (FFAR2), FFAR4, G protein-coupled receptor 84 (GPR84) and a delayed rectifying K+ channel (K+ voltage-gated channel subfamily A member 2; KCNA2)) were measured using RT-PCR; and FAT threshold (FATT) was assessed using three-alternate forced choice methodology. Linear mixed models were fitted, adjusting for correlation between co-twins. Intake was compliant with the study design, with the LF and HF groups consuming 14·8 and 39·9 % energy from fat, respectively. Expression of FFAR4 increased by 38 % in the LF group (P = 0·023; time-diet interaction P = 0·063). ΔFFAR4 (Δ, week 8-baseline) was associated with Δfat intake (g) ( = -159·4; P0·001) and ΔFATT ( = -8·8; P = 0·016). In summary, FFAR4 is involved in long-term diet-mediated changes to FAT perception. Manipulating dietary fat intake, and therefore FFAR4 expression, might aid in reducing taste-mediated passive overconsumption of fatty foods.

The aim of this study was to assess the association between parent and child sodium (Na) and potassium (K) intake as assessed by 24-h urinary excretion (24hUE). Primary school children and their parent(s) provided one 24-h urine sample and information on cooking and children's discretionary salt use. Valid urine samples were provided by 108 mothers (mean age 41.8 (5.1) (SD) years, Na 120 (45) mmol/day) (7.0 g/day salt equivalent) and 40 fathers (44.4 (4.9) years, Na 152 (49) mmol/day (8.9 g/day salt), and 168 offspring (51.8% male, age 9.1 (2.0) years, Na 101 (47) mmol/day (5.9 g/day salt). When adjusted for parental age, child age and gender a 17 mmol/day Na (1 g/day salt) increase in mother's 24hUE was associated with a 3.4 mmol/day Na (0.2 g/day salt) increase in child's salt 24hUE (p = 0.04) with no association observed between father and child. Sixty-seven percent of parents added salt during cooking and 37% of children added salt at the table. Children who reported adding table salt had higher urinary excretion than those who did not (p = 0.01). The association between mother and child Na intake may relate to the consumption of similar foods and highlights the importance of the home environment in influencing total dietary sodium intake.

15 p., Background The Global Alliance for Chronic Diseases comprises the majority of the world’s public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. Methods Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. Results There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation. Conclusions The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.

As part of its endorsement of the World Health Organization's Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action.A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies.A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government's Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015.In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.

Introduction: A high sodium intake stimulates thirst and in turn may promote greater consumption of high energy sugary beverages, which are linked to obesity risk in children. In this study we assessed the hypothesis that sodium intake, as measured by 24-hr urinary sodium excretion, would be positively associated with weight status in primary school-aged children. Methods: Cross-sectional study completed within a convenience sample of Victorian primary schools (n=43). Sodium intake was assessed via one 24-hr urine collection. Fourteen percent of samples were deemed invalid and excluded. BMI was calculated from measured weight and height and converted to BMI z-scores using the 2000 Centers for Disease Control and Prevention reference growth charts. Participants were grouped into weight categories using the International Obesity Task Force cut-points. Differences in sodium intake and weight status were assessed using multi-level linear and logistic regression analysis with adjustment for random effects (gender, age) and fixed effect (school cluster). Results: Of the 667 children with valid urine samples 55% were male and the average age was 9.3±(SD) 1.8 years. Ten percent were classified as underweight, 73% healthy weight, 14% overweight and 3% obese. Average sodium intake differed across weight categories, underweight 82±29 mmol/day (salt equivalent 4.8±1.7 g/day); healthy weight 102±43 mmol/day (salt 6.0±2.5 g/day); overweight 125±55 mmol/day (salt 7.3±3.2 g/day); obese 148±97 mmol/day (salt 8.7±5.7 g/day) (p=0.001). In the fully adjusted model sodium intake (mmol/d) was significantly associated with BMI z-score (b=0.006, P Conclusions: Higher sodium intake is associated with overweight and obesity in Victorian schoolchildren. This may be related to increased energy intake, and this association should be explored further.

Background: The aim was to assess iron status and dietary iron intake in a sample of premenopausal female regular and new blood donors. Study Design and Methods: Premenopausal women blood donors were invited to participate. Blood samples were analyzed for serum ferritin and hemoglobin. An iron checklist assessed dietary iron intake. Donors were classified as regular donors or new donors. Results: Twenty-one new donors (mean [SD] age, 28.6 [6.0] years; body mass index [BMI], 25.6 [4.5] kg/m2) and 172 regular donors (mean age, 29.4 [5.5] years; BMI, 24.7 [3.8] kg/m2) participated. Fifty percent of regular donors and 24% of new donors had depleted iron stores (serum ferritin < 15 μg/L; difference p = 0.036). Dietary iron intake was higher in regular donors (mean [SE], 12.6 [0.7] mg/day) compared to new donors (9.9 [0.4] mg/day; p = 0.006). Eighty-five percent of regular donors and 79% of new donors met the estimated average requirement for iron. Conclusions: Despite the fact that most of these donors had an adequate dietary iron intake, more than half of the blood donors had depleted iron stores. Increasing dietary iron intake through supplements and/or dietary means is expected to be necessary to maintain adequate iron status in this group.

Department of Nutrition and Food Science (I.L.), University of the Basque Country, 01006 Vitoria, Spain; GENUD (Growth, Exercise, Nutrition, and Development) Research Group (I.L., G.R., L.A.M.), Faculty of Medicine and Department of Pediatrics (G.R.), Instituto Aragones de Ciencias de la Salud (G.R.), and University School of Health Sciences (L.A.M.), University of Zaragoza, 50009 Zaragoza, Spain; Department of Physical Education (J.R.R.), School of Physical Education and Sport Sciences, University of Granada, 18071 Granada, Spain; Unit for Preventive Nutrition (J.R.R., F.O.P.), Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, SE-17177 Huddinge, Sweden; Department of Public Health (I.H., S.D., K.E.V.), Faculty of Medicine, Ghent University, and Department of Nutrition and Dietetics (K.E.V.), Faculty of Health Care Vesalius, University College Ghent, 9000 Ghent, Belgium; Department of Medical Physiology (F.B.O., D.J.-P.), School of Medicine, University of Granada, 18014 Granada, Spain; Department of Nutrition and Food Science (C.B.), University of Bonn, D-53117 Bonn, Germany; National Research Institute on Food and Nutrition (L.C.), 00178 Roma, Italy; Department of Pediatrics (D.M.), University of Pecs, H-7623, Pecs-Jozsef A 7, Hungary; Division of Nutrition and Metabolism (K.W.), Department of Pediatrics, Medical University of Vienna, A-1090 Vienna, Austria; University of Crete School of Medicine (A.K., M.P.), GR-71033 Crete, Greece; Immunonutrition Research Group (L.E.D., A.M.), Department of Metabolism and Nutrition, Spanish Council for Scientific Research, Madrid, Spain; Institut National de la Sante et de la Recherche Medicale Unite 995 (F.G.), IFR 114, Faculty of Medicine, University of Lille 2, 59044 Lille, France; and Department of Pediatrics (F.G.), Jeanne de Flandre Children’s University Hospital, 59037 Lille, France

The scientific literature related to vitamin D and bone health in older adults is extensive.This article aims to summarise key practice points regarding vitamin D and bone health in older adults, relevant to general practitioners, and to provide an overview of the background literature to enable GPs to appreciate the extent of the supporting evidence.Vitamin D supplementation can prevent falls, particularly in the vitamin D deficient elderly. However, adequate vitamin D levels and dietary calcium intake are needed for effective primary fracture prevention with greatest benefits occurring in the elderly with vitamin D deficiency and/or low dietary calcium intakes. For secondary fracture prevention, ie. preventing further fractures in the elderly who have already sustained a fragility fracture, specific anti-osteoporosis treatment is necessary. However, to maximise the benefits of these medications, vitamin D deficiency should be corrected and adequate dietary calcium consumed.

Migration to industrialised countries poses a "double whammy" for type 2 diabetes among sub-Saharan African migrant and refugee adults. This population group has been found to be at an increased risk of obesity and type 2 diabetes, which may be further aggravated by inadequate vitamin D status. Thus, this study aimed to describe the demographics of vitamin D insufficiency, obesity, and risk factors for type 2 diabetes among sub-Saharan African migrants and refugees aged 20 years or older living in Melbourne, Australia (n=49). Data were obtained by a questionnaire, medical assessment, and fasting blood samples. The mean serum 25-hydroxyvitamin D level was 27.3 nmol/L (95% CI: 22.2, 32.4 nmol/L); with 25-hydroxyvitamin D levels50 nmol/L occurring in 88% of participants. Participants displayed a cluster of risk factors for type 2 diabetes and cardiovascular disease: 62% were overweight or obese, 47% had insulin resistance (HOMA-IR=2), 25% had low density lipoprotein cholesterol levels=3.5 mmol/L, 24.5% had high density lipoprotein cholesterol levels=1.03 mmol/L, 34.6% had borderline or high levels of total cholesterol (=5.2 mmol/L), 18.2% had borderline or high levels of triglyceride (=1.7 mmol/L), and 16% had hypertension (systolic blood pressure=140 mmHg or diastolic blood pressure=90 mmHg). These findings suggest that sub-Saharan African migrants and refugees may be at risk of type 2 diabetes and atherosclerosis-related diseases such as ischemic heart disease, stroke, and peripheral vascular disease. Well-designed vitamin D interventions that incorporate lifestyle changes are urgently needed in this sub-population.

The risk of malnutrition is high among elderly population, yet few studies have measured indicators of nutritional status among Australian aged-care residents. To determine the relationship between nutritional status and bone density, hand grip strength, and the timed-up and go test, in a group of Australian aged-care residents. Anthropometric and biochemical analysis measured in subjects recruited to be part of a six month multivitamin supplementation study. One hundred and fifteen subjects participated (68% female). The mean (SD) age and body weight was 80.2(10.6) years, and 66.5(15.0) kg, respectively. Eleven percent were underweight (body mass index, BMI,or =20.0 kg/m(2)), and 20% were obese BMIor =30 kg/m(2)). Low serum 25-hydroxy-vitamin D (25(OH)D,or =50 nmol/L) concentrations were found among 79% of subjects. After adjustment for body weight, there was an association between serum 25(OH)D and bone density (heel ultrasound) (r=.204, p=.027). Low serum zincor =10.7 micromol/L) concentrations were found among 46% of subjects; this group had a slower timed up and go time compared with those with higher zinc concentrations (n=19, 44.6 +/- 5.6 seconds vs. n=27, 30.0 +/- 3.3 seconds, p=.020). There were no associations between nutritional markers and hand grip strength. In this group, more than (3/4) of subjects had low serum 25(OH)D, and 46% had low zinc concentrations. Serum 25(OH)D was associated a lower bone density and zinc with a slower walking time. This indicates that the elderly in long term residential care facilities are at high risk for poor nutritional status, potentially increasing morbidity and mortality.

To determine the prevalence of vitamin D deficiency in older people in residential care and the influence that the level of vitamin D may have on their incidence of falls.Prospective cohort.Residential care facilities for older people in several states of Australia.Six hundred sixty-seven women in low-level care and 952 women in high-level care, mean age 83.7 years.Serum 25-hydroxyvitamin D (25D) levels and recognized risk factors for falls including current medication use, a history of previous fractures, weight, tibial length (as a surrogate for height), cognitive function, walking ability, and frequency of going outdoors were determined. The women in low-level care and high-level care were followed for an average of 145 and 168 days, respectively. Falls were recorded prospectively in diaries completed monthly by residential care staff.Vitamin D deficiency (defined as a serum 25D level below 25 nmol/L) was present in 144 (22%) women in low-level care and 428 (45%) in high-level care. After excluding 358 bed-bound residents and adjusting for weight, cognitive status, psychotropic drug use, previous Colles fracture, and the presence of wandering behavior, log serum 25D level remained independently associated with time to first fall. The adjusted hazards ratio was 0.74 (95% confidence interval=0.59-0.94; P=.01), implying a 20% reduction in the risk of falling with a doubling of the vitamin D level.Vitamin D deficiency is common in residential care in Australia. A low level of serum vitamin D is an independent predictor of incident falls.

Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis.This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies.Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.