Depression and eating disorder (ED) risk are heightened during adolescence(1) and both were exacerbated during COVID-19 lockdowns. This analysis reports changes in self-reported symptoms of depression and eating disorders throughout the Fast Track to Health trial. Fast Track to Health was a 52-week multi-site randomised-controlled trial, conducted 2018-2023, comparing intermittent (IER) and continuous energy restriction (CER) in adolescents with obesity and ≥1 associated comorbidity(2). The Centre for Epidemiologic Studies Depression Scale-revised 10-item version for adolescents (CESDR) was used to assess symptoms of depression (no symptoms, sub-threshold, or possible, probable, major depressive episode). Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED risk; defined as global score ≥2.7, ≥2 episodes of binge eating with/without loss of control, or ≥1 episode of purging within the last 28-days. The Binge Eating Scale (BES) assessed severity of binge eating (no binge eating, mild/moderate, severe). Adolescents were monitored for disordered eating during dietetic consults. Linear mixed models, retaining all data consistent with intention-to-treat analysis, were used to estimate the change in outcomes from baseline to week-52. Descriptive statistics were used to describe the number of participants meeting screening criteria at baseline and week-52. One hundred and forty one adolescents were enrolled and 97 completed the trial, with median (IQR) EDE-Q score 2.28 (1.43 to 3.14), CESDR 9.00 (4.0 to 14.5) and BES 11.0 (5.0 to 17.0) at baseline. EDE-Q (change in estimated marginal means [SE], IER −0.63 [0.18], CER −0.56 [0.17]) and CESDR (IER −2.70 [1.15], CER −3.87 [1.07]) scores reduced between baseline and week-52 in both groups (p<0.05) with no difference between groups. There was a between group difference (p = 0.019) in change in BES. The IER group had a reduction between baseline and week-52 (−3.72 [1.27]) and the CER group had no change. At baseline, 31 (22%) adolescents were classified as having a possible/probable/major depressive episode, 110 (78%) met ≥1 ED criteria and 28 (21%) as mild/moderate or severe binge eating, reducing to 8 (9%), 56 (61%) and 15 (16%) respectively at week-52. A small sub-group of adolescents required additional support for disordered eating. Overall, treatment-seeking adolescents with obesity have symptoms of depression and ED. Although symptoms reduce for most, some required additional support. Screening and monitoring for depression and ED are important to ensure early intervention.

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

Within rural Australia, only 47% and 9% of adults meet recommendations for fruit and vegetable intake, respectively, which is a leading contributor to the increased risk of non-communicable disease. Previous literature has identified barriers and facilitators to increasing fruit and vegetable intake in rural Australian settings, such as having greater access to fresh produce(1). However, this literature is limited by observing fruit and vegetables as a single food group and small sample sizes. This study aimed to determine the barriers and facilitators to meeting fruit and vegetable recommendations (as separate food groups) in rural Australian adults. It was hypothesised that barriers and facilitators to consumption of fruits and vegetables would be identified at the individual, social-environmental and physical-environmental levels of a socio-ecological framework and these would differ between fruit and vegetables(2). Data from the 2019 Active Living Census were used, completed in the Loddon Campaspe region of north-west Victoria, Australia. Data were available at the level of the individual (socio-demographic characteristics, health behaviours, education level, financial stability), social-environment (household size), and physical-environment (use of community gardens). Information on fruit and vegetable consumption was collected using two open-ended questions asking how many serves were consumed each day. Survey weighting was used to account for the survey design. Descriptive statistics were reported for continuous (mean and standard errors [SE]) and categorical (frequencies) data. Multivariate logistic regression analyses were used to determine odds ratios (OR) and 95% confidence intervals (CI) for meeting fruit and vegetables recommendations according to barriers and facilitators at the individual, social-environmental and physical-environmental level. A total of 13,464 adults with complete data were included in the analysis (51% female; mean age 48 (0.17) years). Mean fruit intake was 2.85 (0.02) serves per day and mean vegetable intake was 1.56 (0.01) serves per day. A total of 48% of participants consumed the recommended two serves of fruit daily, while 19% consumed the recommended five serves for vegetables. Multivariate analyses determined distinct barriers and facilitators to consumption between fruit and vegetables. For example, a larger household size facilitated meeting vegetable recommendations (OR: 1.41; 95% CI: 1.22, 1.63), but not fruit, and greater alcohol consumption was a barrier to meeting fruit recommendations (OR: 1.47; 95% CI: 1.31, 1.64), but not vegetables. Common facilitators across both fruit and vegetables included higher age, lower BMI, being a non-smoker, and engaging in more vigorous activity. The results of this research will help inform future policies to increase both fruit and vegetable intake in rural communities, therefore contributing to efforts to improve the health of rural Australians.

The nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between early life nutrition and academic achievement in adolescence. The Pacific Islands families (PIF) birth cohort(1) were born in the year 2000. When their child was 6 weeks old mothers were asked questions concerning food security over the last year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). Records of academic achievement for 649 youth were obtained from the National Certificate of Educational Achievement database in 2019. Highest qualifications and a composite ranking score allowed achievement to be assessed at levels 1, 2 and 3 of NCEA and for University Entrance (UE, lowest to highest). More females (27%) than males (18%) achieved UE as their highest qualification and more males (40%) than females (31%) achieved level 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food secure households and 17% from food insecure households. Logistic regression demonstrated that being female increased the odds of achieving UE 1.8 fold and food security a further 1.6 fold. The prevalence of food insecurity was not different by sex but high at 29% and 42% using the PIF and MOH measure of food insecurity respectively. This work emphasises the importance of maternal and early life food security for subsequent academic achievement and the well-being of future generations.

Nutrition intervention trials play a key role in informing clinical and dietary guidelines. Within these trials, we need participants to change their behaviours; however, researchers seldom systematically consider how to support participants with these changes, contributing to poor adherence. Here we evaluate how using a behaviour change framework to develop support within a dietary intervention impacts young adults’ adherence to required trial behaviours. In the Protein Diet Satisfaction (PREDITION) trial, 80 young adults were randomised to a flexitarian or vegetarian diet for 10-weeks to investigate the psychological and cardiometabolic effects of moderate lean red meat consumption as part of a balanced diet(1). To understand these outcomes, it was key that participants within the trial (i) ate a healthy, basal vegetarian diet (excluding meat, poultry, and fish not provided by research team) and (ii) reported their dietary intake daily on a smartphone application (required to evaluate intervention compliance). To enhance adherence to these behaviours the Nine Principles framework was used to develop behaviour change support (BCS)(2). 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, adherence score to reporting over 10-weeks, Facebook group engagement, and impact evaluation. Analysis included linear imputation modelling, t-tests, and chi-square analysis. 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 = 0.011), demonstrating maintenance of a healthy diet. Overall adherence to reporting was high across the 10 weeks, with the total population mean reporting score 90.4 ± 14.6 out of a possible 100. This strengthens study validity, allowing us to confidently report if participants complied with study requirements of consuming the intervention protein (red meat or plant-based meat alternatives) on top of a basal vegetarian diet. Although relatively low active Facebook engagement was observed (on average <1 ‘react’ per post), most participants agreed the text messages and Facebook groups supported them to adhere to recording (63%) and eating healthily (60%), respectively. This is the first study to provide an example of how a framework can be used to systematically develop, implement, and assess BCS within a nutrition trial. This appears to be a promising way to enhance adherence to study-related behaviours, including the burdensome task of reporting dietary intake. We believe this has great potential to improve research validity and decrease resource waste, not only for the PREDITION trial but in future dietary intervention trials.

Flexitarian, vegetarian and vegan 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 compared to one containing plant-based meat alternatives (PBMAs) in young adults (NCT04869163)(1). The objective for the current analysis is to measure adherence to the intervention, nutrition behaviours, and participants’ experience with their allocated dietary group. Eighty healthy young adults participated in this 10-week dietary intervention as household pairs. Household pairs were randomised to receive approximately three serves of beef and lamb meat (average of 390 g total cooked weight per person per week, flexitarian group) or PBMAs (350–400 g, vegetarian group) 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(2). Diet adherence (eating allocated meat or PBMA, abstaining from animal-based foods not provided by researchers) was monitored daily, 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 modelling taking household clustering into account. The average total 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 < 0.001). Those receiving meat were generally more satisfied with this allocation compared to those receiving the PBMAs, even though a leading motivation for participants joining the study was an opportunity to try plant-based eating (35% expressed that that interest). Participants in both intervention groups had increased vegetable intake (p < 0.001), and reported more positive eating experiences (p = 0.020) and satisfaction with eating (p = 0.021) at the end of the 10-week intervention relative to baseline values. Behavioural methods to encourage engagement with the trial were successful, as participants demonstrated excellent adherence to the intervention. The flexitarian and vegetarian diets elicited different responses in adherence and eating experience. This holds relevance for the inclusion of red meat and PBMAs in healthy, sustainable dietary patterns beyond this study alone.

The prevalence of food allergies in New Zealand infants is unknown; however, it is thought to be similar to Australia, where the prevalence is over 10% of 1-year-olds(1). Current New Zealand recommendations for reducing the risk of food allergies are to: offer all infants major food allergens (age appropriate texture) at the start of complementary feeding (around 6 months); ensure major allergens are given to all infants before 1 year; once a major allergen is tolerated, maintain tolerance by regularly (approximately twice a week) offering the allergen food; and continue breastfeeding while introducing complementary foods(2). To our knowledge, there is no research investigating whether parents follow these recommendations. Therefore, this study aimed to explore parental offering of major food allergens to infants during complementary feeding and parental-reported food allergies. The cross-sectional study included 625 parent-infant dyads from the multi-centred (Auckland and Dunedin) First Foods New Zealand study. Infants were 7-10 months of age and participants were recruited in 2020-2022. This secondary analysis included the use of a study questionnaire and 24-hour diet recall data. The questionnaire included determining whether the infant was currently breastfed, whether major food allergens were offered to the infant, whether parents intended to avoid any foods during the first year of life, whether the infant had any known food allergies, and if so, how they were diagnosed. For assessing consumers of major food allergens, 24-hour diet recall data was used (2 days per infant). The questionnaire was used to determine that all major food allergens were offered to 17% of infants aged 9-10 months. On the diet recall days, dairy (94.4%) and wheat (91.2%) were the most common major food allergens consumed. Breastfed infants (n = 414) were more likely to consume sesame than non-breastfed infants (n = 211) (48.8% vs 33.7%, p≤0.001). Overall, 12.6% of infants had a parental-reported food allergy, with egg allergy being the most common (45.6% of the parents who reported a food allergy). A symptomatic response after exposure was the most common diagnostic tool. In conclusion, only 17% of infants were offered all major food allergens by 9-10 months of age. More guidance may be required to ensure current recommendations are followed and that all major food allergens are introduced by 1 year of age. These results provide critical insight into parents’ current practices, which is essential in determining whether more targeted advice regarding allergy prevention and diagnosis is required.

Reliable dietary assessment is key to our understanding of diet-health interactions(1). Most current dietary assessment methods are self-reported, making them prone to a range of biases(2). Objective markers, such as certain metabolite concentrations in human tissue, may prove a more reliable method of dietary assessment in the future while reducing participant burden(2,3). An example of these metabolite markers are alkylresorcinols, a family of compounds found in the bran layer of common grains. High concentrations of alkylresorcinols reflect high wholegrain intakes, very low levels indicate only refined grain intake, while no alkylresorcinols would indicate a gluten-free diet. We conducted a randomised crossover feeding study of three interventions (one standardisation day followed by a feeding day where known amounts were consumed under observation). Each feeding day differed by which food groups were provided (e.g., chicken, legumes, and fruit) or entirely absent (e.g., grains, fish, and dairy). Participants provided 24-hour urine samples on all six days (standardisation days and feeding days), as well as a 24-recalls and fasted blood samples the morning after each day. Known metabolite markers of dietary intake (approximately 70) were identified in blood and urine with LC-MSqToF, and semi-quantified with a known standard. Twenty-four hour urine sodium content was also measured as the current best known objective marker of dietary intake(4). Twenty-four participants (74% female, age (SD) 24.8 (6.1), BMI 24.1 (4.0)) commenced the study, with 21 (88%) completing all three interventions. Mean energy intake on feeding days (11720 kJ (2943.01)) was higher than self-reported energy intake on standardisation days (9243.57 kJ (3582.92)). Meals were well tolerated, with mean (range) intakes of 9.8 (6.3 – 16.1) serves whole grains, 2.4 (1.6 – 4.8) serves fish, 3.1 (1.9 – 5.5) serves dairy, 5.6 (4.5 – 9.1) serves chicken, 8.2 (7.0 – 14.1) serves legumes, 3.1 (1.3 – 4.6) serves fruit, 3.9 (2.6 – 6.4) serves red meat, 1.7 (1.35 – 2.6) serves nuts and seeds, or 13.4 (9.4 – 19.5) serves vegetables on their respective feeding days. The three feeding days provided clearly identifiable clusters when assessing the overall metabolic profile, both in terms of what was measured on the feeding days, and the difference in metabolite concentrations between standardisation day and feeding day. The relative correlations between self-reported intakes and individual metabolite concentrations reflecting specific foods or food groups with the known dietary intakes from feeding days will be presented first at the conference.

The adoption of dietary patterns emphasising higher intakes of plant foods and lower intakes of animal foods (plant-based diets, PBDs), continue to rise worldwide. PBDs have been associated with a lower risk of cardiovascular morbidity and mortality as well as major risk factors such as overweight/obesity and type 2 diabetes. Evidence regarding the dietary profile and disease risk associated with various PBDs in comparison to traditional meat-eating diets are scarce within the Australian population. The aim of this study is to investigate the 5-year and 10-year risk of developing cardiovascular disease (CVD) among Australians habitually following various PBDs compared to a regular meat diet (RMD). The Plant-based Diet (PBD) Study is a cross-sectional study consisting of healthy adults between aged 30-75 years from the Hunter Region (NSW) between 2021-2023. A validated FFQ was used to assess eligibility and categorise individuals who were habitually consuming one of five dietary patterns for at least 6 months into the following groups: vegan (nil animal products), lacto-vegetarian (LOV, including eggs and dairy), pesco-vegetarian (PV, including seafood with/without dairy and eggs), semi-vegetarian (SV, minimal consumption of animal products) or RMDs (including animal meat daily or multiple times/day)(1). 5-year and 10-year CVD risk was quantified using the Framingham Risk Equation(2) and the Australian Absolute CVD risk calculator, respectively. CVD risk and other quantitative measures was compared using One-way ANOVA or Kruskal Wallis, and Chi-square or Fisher’s Exact for qualitative data. Directed acyclic graphs displayed confounding variables and mediators and a regression model was used to adjust for these. A total of 240 participants (median age 55(16), 77.5% female) with 48 participants in each group showed a significant difference in predicted 5-year risk of CVD (P<0.05), however 10-year risk did not significantly differ across groups. 5-year CVD risk was significantly lower in the vegan group (1%) compared to the RMD, SV, PV, and LOV diet groups (all 2%). In comparison to a vegan diet, crude association showed those consuming a RMD had a 2.4% (95% CI 0.7, 4.1) higher 5-year risk of developing CVD, followed by 1.7% in LOV (95% CI 0.6, 2.9), 1.8% in PV (95% CI 0.5, 3), and 1.1% in SV (95% CI 0.2, 2.1). Significance was lost after adjusting for confounders such as age, gender, smoking status, alcohol intake, physical activity levels and BMI. This is the first study to purposefully sample Australians habitually following PBD, presenting novel population-based evidence for CVD risk. These findings suggest more restrictive PBDs such as vegan diets when compared to RMD may lead to lower CVD risk, however population-based longitudinal studies primary investigating the development of CVDs in the context of PBDs are warranted.

Primary school aged children (aged 4-12 years) in Australia consume approximately 40% of daily energy from energy-dense, nutrient poor foods and fewer than 5% meet the recommended guidelines for vegetables and fruit (ABS 2018). Poor eating habits in children can track into adulthood increasing the risk of non-communicable diseases later in life (Nicklaus 2013). Children spend a large amount of time at school where they are provided with social contexts which influence behaviour development (FAO, 2022) and thus are ideal settings for teaching children about food and nutrition (FAO, 2022; WHO 2017). This pilot study was designed in response to a call to action from a local primary school in southeast Melbourne facing disadvantage. Anecdotally, the school reported poor food literacy with many students bringing unhealthy lunches. The school asked us to design, pilot, and evaluate a student education program enabling healthier lunches among these children. The aim of the study was to explore the effectiveness of a 4-week food and nutrition education program delivered to grade 4 students within a disadvantaged area targeting, children’s food-related knowledge, behaviours and self-efficacy (confidence) to pack a healthy lunch. The program delivered weekly 1-hour interactive sessions over four weeks (October-November 2022). Topics included healthy eating, designing healthy lunches and food safety and were delivered using interactive games, activities, quizzes and food tasting. Students completed an online survey measuring their knowledge, self-efficacy and behaviour (e.g. foods packed in their lunchbox) pre- and post- program. A comparative analysis of the pre- and post-survey responses was performed using McNemar Tests in SPSS version 29.0. Sixty students completed both the pre- and post-surveys. A significant increase (p<0.001) in knowledge of recommended daily serves of fruit (pre 43%, post 80%) and vegetables (pre 17%, post 54%) was observed. There was also a significant (p<0.001) increase in student’s ability to identify ‘sometimes food’. No changes were observed in identification of ‘everyday food’, sources of protein and sources of dairy food or safety knowledge. Children’s confidence to make healthy food swaps significantly increased from pre- to post- program (27%45%, p = 0.035). We observed significant increases in children’s food and nutrition related knowledge for some topics and confidence to make healthy food swaps following completion of the program. A program of longer duration may be beneficial to observe additional improvements in knowledge as well as behaviour change, including foods packed in school lunches.

Osteoporosis is a degenerative disease of the bone. The rate of bone loss is accelerated during the first postmenopausal years in women which results in their disproportionate prevalence of osteoporosis(2). Some of the factors contributing to the development and maintenance of bone mineral density (BMD) relate to diet, particularly the intake of protein, calcium and other micronutrients that play a crucial role in bone composition(3). The most common method of measuring BMD is dual-energy X-ray absorptiometry (DXA) which generates a two-dimensional image of the scan site (typically spine, hip and/or forearm) to determine areal BMD (aBMD). However, new methods have recently emerged, including High Resolution peripheral Quantitative Computed Tomography (HRpQCT), that offer more accurate three-dimensional measurements of volumetric BMD (vBMD) and microstructure of distal tibia and radius(4). The aim of this study was to examine the differences in the dietary intake of nutrients that represent organic or inorganic components of the bone, in early postmenopausal women with different spine aBMD and tibia and radius vBMD levels. One hundred and fourteen healthy early postmenopausal women with a lumbar spine or total hip BMD T score > −2.5 (measured by DXA) were recruited as part of a larger interventional study. Dietary intake was recorded using a 297-point self-reported validated food frequency questionnaire(5) for assessing the intake of energy, macro and micronutrients. Physical activity was self-reported using the validated Active Australia Questionnaire. Years since menopause were self-reported. DXA and HRpQCT scans measured L1-L4 spine, proximal femur aBMD, and distal tibia and radius vBMD respectively. Non-parametric statistical tests examined differences in dietary intake and physical activity levels between women at different levels of aBMD and vBMD. Data reported as median and interquartile ranges. There were no significant differences observed in the total sample between tertiles of aBMD and vBMD, regarding nutrient intake. However, for women with less than 3 years since menopause (i.e., the time-period of accelerated bone loss), lower dietary intakes of energy [8,658(3,324) vs 10,068(3,688) kJ/day; p = 0.047], protein [94(29) vs 103(32) g/day; (p = 0.044)], sodium [1,927(992) vs 2,625(2,185) mg/d; (p = 0.044)], potassium [4,064(1,373) vs 5,121(2,377) mg/d; (p = 0.041)], calcium [969(325) vs 1,214(652) mg/d; (p = 0.028)] and zinc [10(3) vs 12(4) mg/d; (p = 0.005)] were observed for women with osteopenia (−1< L1-L4 aBMD T-score <2.5) compared to those with normal L1-L4 aBMD (i.e., T-score > −1). No significant differences were observed for women with more than 3 years since menopause, with the only exception of alcohol intake (p = 0.033), which was found to be lower in women with osteopenia compared to those with normal aBMD. These findings highlight the importance of targeting osteopenic women within the first 3 years following menopause as candidates for tailored dietary intervention programs for preventing osteoporosis.

People with polycystic ovary syndrome (PCOS) have higher weight gain and psychological distress compared to those without PCOS(1). While COVID-19 restrictions led to population level adverse changes in lifestyle, weight gain and psychological distress(2), their impact on people with PCOS is unclear. The aim of this study was to investigate the impact the 2020 COVID-19 restrictions had on weight, physical activity, diet and psychological distress for Australians with PCOS. Australian reproductive-aged women participated in an online survey with assessment of weight, physical activity, diet and psychological distress. Multivariable logistic and linear regression were used to examine associations between PCOS and residential location with health outcomes. On adjusted analysis, those with PCOS gained more weight (2.9%; 95% CI; 0.027–3.020; p = 0.046), were less likely to meet physical activity recommendations (OR 0.50; 95% CI; 0.32–0.79; p = 0.003) and had higher sugar-sweetened beverage intake (OR 1.74; 95% CI 1.10–2.75; p = 0.019) but no differences in psychological distress compared to women without PCOS. People with PCOS were more adversely affected by COVID-19 restrictions, which may worsen their clinical features and disease burden. Additional health care support may be necessary to assist people with PCOS to meet dietary and physical activity recommendations.

Folic acid (FA) and iodine supplements are recommended by the Ministry of Health (MOH) for pregnant and/or lactating women in New Zealand (NZ)(1). Evidence suggests that many NZ women are not just taking FA and iodine in the form of a single-nutrient supplement (SNS) but are taking FA and iodine as part of a multivitamin supplement (MVS) which may or may not contain the recommended doses, and some are using a combination of both(2). No NZ study has examined the daily dose taken from both SNS and MVS for both FA and iodine across all time periods (2, 3). The aim of this study was to investigate what nutritional supplements containing FA and iodine were taken by postpartum NZ women, preconception, during the three trimesters of pregnancy and post-partum, and examine how well the women’s supplement use aligned with the NZ MOH recommendations. This cross-sectional observational study utilised data gathered on FA and iodine supplement use from an anonymous survey between February and August 2022. Descriptive statistics including frequency and percentages were reported. Folic acid and iodine weekly intakes from SNS and MVS were calculated by multiplying the amount of nutrient in each supplement, with the number of times per day taken, and the average number of days taken per week reported. A total of 584 women were included in the analysis. In addition to the SNS for FA (0.8mg and 5mg) and iodine (150 ug), women took 28 different MVS. Fifty-eight percent (preconception; 30% from SNS, 18% from MVS, and 10% from both) and 96% (1st trimester pregnancy; 61% from SNS, 17% from MVS, and 19% from both) of women took FA containing supplements. More than 75% of women reported taking iodine containing supplements during pregnancy (1st and 2nd trimesters: 93%, 3rd trimester: 89%) and postpartum (76%).Approximately 60% took SNS, 18% took only MVS and 14% took both. Based on the MOH recommendations, only 30% (preconception) and 62% (1st trimester) achieved sufficiency of FA supplementation at 0.8mg/day; 35% (preconception) and 69% (1st trimester) achieved sufficiency of FA at 5mg/day; around 50% women achieved sufficiency of iodine supplementation at 150 µg/day during pregnancy while only 37% during postpartum. The balance either took none, an insufficient dose or a dose that exceeded the recommended dose and many took them during non-recommended periods (FA after the 1st trimester; iodine preconception). Most women reported taking FA and/or iodine containing supplements at some point before, during and after their pregnancy. However, it is concerning that a large number of women do not seem to be adhering to the MOH recommendations for FA and iodine supplementation.

Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ).

This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.

Food environments surrounding secondary schools are a known influence on the purchasing and consumption habits of adolescents(1). Understanding their obesogenic potential is important for informing strategies to create more healthful food environments for adolescents, particularly for those living in regional areas, and is a key component of Australia’s National Obesity Strategy(2). This repeated cross-sectional study examined the food environment surrounding secondary schools in regional and metropolitan New South Wales from 2007-2023. Google Street View was used to collect data regarding food outlets within a walkable distance (1.6 km) of all secondary schools in Wagga Wagga and Blacktown, our regional and metropolitan case study areas respectively, over 17 years. A Food Environment Score(3) tool was used to characterise the healthfulness of food environments by categorising food outlets into Food Outlet Type categories (e.g. Cafés, Fast-Food Franchises, Restaurants etc.) and Healthfulness categories (“Healthful”, “Less Healthful”, “Unhealthful”). Descriptive statistics were used to characterise changes in the food environments by Food Outlet Type and Healthfulness categories from 2007-2023. Chi-Squared tests were used to determine any significant differences in the proportion of healthful, less healthful and unhealthful food outlets between the regional and metropolitan study areas and between 2007 and 2023 in both areas. In both Wagga Wagga and Blacktown, the most common food outlet types surrounding secondary schools from 2007-2023 were classified as less healthful or unhealthful. As of 2023, less healthful food outlets [restaurants (19.4%), cafes (16.8%)] and unhealthful food outlets [fast-food franchises (15.1%), independent takeaway (14.1%)] were the most common food outlet types in Wagga Wagga, making up 52% and 36% of all identified food outlets respectively. These outlet types have remained the most prevalent over the 17-year period, though restaurants and cafes have since surpassed fast-food franchises and independent takeaway stores, by proportion, which were the most common in 2007. Similarly in Blacktown, 2023, less healthful [restaurants (21.1%), cafés (11.1%)] and unhealthful [fast-food franchises (17.4%)] were the most common food outlets, making up 41% and 37% of all identified food outlets. Restaurants, cafés and fast-food franchise outlets were consistently observed to be the most prevalent in Blacktown food environments over the 17-year study period. No significant difference was found when comparing the healthfulness profiles of regional and metropolitan food environments nor were significant changes observed between 2007 and 2023 in Wagga Wagga and Blacktown (p > 0.05 for all). The prevailing high proportion of less healthful and unhealthful food outlets near secondary schools in regional and metropolitan areas upholds the need for public health policies and planning strategies to address the obesogenic potential of school food environments.

Vegan diet consumption is gaining popularity globally and in New Zealand. However, plant foods provide absent or limited quantities of important micronutrients such as vitamin B12, iron, zinc, and omega-three fatty acids(1). A restrictive and unplanned vegan diet may thus increase risks of nutrient deficiencies especially during pregnancy and early life if the nutrient demands are not fulfilled. Health professionals who provide primary support for pregnant women and their children are important figures in monitoring the nutritional statuses during the antenatal and postnatal periods(2). (Being knowledgeable about the nutritional risks of poorly-planned vegan diets, and having access to appropriate educational resources would support vegan mothers and children to achieve a well-balanced diet. Currently, there are insufficient studies investigating the perspectives of New Zealand’s health professionals within the realm of vegan diets during pregnancy and early life. The aim of the research is to utilise a mixed-methods approach to explore these concerns, attitudes, and experiences. Healthcare professionals, including dietitians, nurses, general practitioners and midwives were invited to participate in the study. Knowledge and attitude scores were collected with an online questionnaire and scores were recorded as a proportion of the participants. Subsequently, descriptions of experiences, concerns, and perspectives about the adoption of vegan diets during pregnancy and early life were collected with semi-structured interviews. A total of 14 health professionals completed the study. All health professionals showed positive attitudes towards the adoption of vegan diets during pregnancy but some exhibited greater concern about their restrictive nature especially in early childhood. Achieving intake adequacy and subjecting young children to intensive assessments for nutrient adequacy were among the concerns raised. More than 90% of health professionals were concerned about iron and vitamin B12 deficiencies while less than 50% were concerned about deficiencies in protein, omega-three fatty acids, iodine, zinc and vitamin D. Less than 50% of participants were aware that plant foods do not provide sufficient vitamin B12. More than 50% disagreed that sufficient information about vegan diets during pregnancy and early life is available. Insufficient evidence-based consensus and government guidelines, and limited access and referrals to dietitians for guidance on vegan diets were highlighted as challenges that reduce the overall knowledge and confidence. Hence, continual professional education and updated evidence-based resources would be important steps to support health professionals in providing guidance to individuals on vegan diets.

Providing access to food in schools can serve as a platform for food system transformation, while simultaneously improving educational outcomes and livelihoods. Locally grown and procured food is a nutritious, healthy, and efficient way to provide schoolchildren with a daily meal while, at the same time, improving opportunities for smallholder farmers(1). While there is significant potential for school food provision activities to support healthy dietary behaviours in the Pacific Islands region, there is limited evidence of these types of activities(2), including scope and links to local food production in the region. Therefore, the aim of this scoping study was to understand the current state of school food activities (school feeding, gardening and other food provision activities) and any current, and potential links to local agriculture in the Pacific Islands. A regional mapping activity was undertaken, initially covering 22 Pacific Island countries. The mapping included two steps: 1) a desk based scoping review including peer-reviewed and grey literature (2007-2022) and 2) One-hour semi-structured online Zoom interviews with key country stakeholders. Twelve sources were identified, predominately grey literature (n = 9). Thirty interviews were completed with at least 1 key stakeholder from 15 countries. A variety of school food provision activities were identified, including school feeding programs (n = 16, of varying scale), programs covering both school feeding and school gardens (n = 2), school garden programs (n = 12), and other school food provision activities (n = 4, including taste/sensory education, food waste reduction, increasing canteen capacity for local foods, supply chain distribution between local agriculture and schools). Existing links to local agriculture varied for the different programs. Of the 16 school feeding programs, 8 had a requirement for the use of local produce (policy requirement n = 6, traditional requirement from leaders n = 2). Of the 12 school garden programs, 6 used local or traditional produce in the garden and 5 involved local farmers in varying capacities. Challenges to linking local agriculture into school food provision programs were reported for 17 activities and were context dependent. Common challenges included limited funding, inflation, Covid-19, inadequate produce supply for the scale of program, limited farmer capacity, limited institutional support for local produce, low produce storage life, climatic conditions and disasters, water security, delayed procurement process, and limited professional development and upskilling opportunities. Modernisation and colonisation of food systems resulting in a preference for hyperpalatable foods and challenges in incorporating local produce in a way that is accepted by students was also identified as a challenge. This evidence can be used to develop a pathway to piloting and implementing models of school food provision programs and promoting opportunities for shared learning and collaboration with key stakeholders across the Pacific Islands region.

Postprandial metabolic imbalances are important indicators of later developing cardiovascular disease (CVD)(1). This study investigated the effects of food anthocyanins on vascular and microvascular function, and CVD associated biomarkers following a high fat high energy (HFHE) meal challenge in overweight older adults. Sixteen subjects (13 female, 3 male, mean age 65.9 SD 6.0 and body mass index 30.6 kg/m 2 SD 3.9) participated in a crossover, randomised, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry # ACTRN12620000437965). Participants consumed a HFHE breakfast meal (65g total fat; 33g saturated fat) together with a 250 mL dose of either intervention (Queen Garnet Plum providing 201 mg anthocyanins) or control (apricot) juice. A wash-out period of 14 days occurred between meal challenges, with a 4-day run-in period for juice consumption before each challenge. Blood samples and blood pressure measures were collected at baseline, 2 h and 4 h following the HFHE meal. Vascular function, assessed using flow mediated dilatation (FMD), and microvascular cutaneous vascular reactivity, measured using Laser Speckle Contrast Imaging (LSCI), were evaluated at baseline and 2 h after the HFHE meal. Participants had a higher 2 h postprandial FMD (+1.14%) and a higher microvascular post-occlusive reactive hyperaemia (+0.10 perfusion units per mmHg) when allocated to the anthocyanin compared to the control arm (P = 0.019 and P = 0.049, respectively). C-reactive protein was lower 4 h postprandially in the anthocyanins (1.80 mg/L, IQR 0.90) vs control arm (2.30 mg/L, IQR 1.95) (P = 0.026), accompanied by a trend for lower concentrations of interleukin-6 (P = 0.075). No significant postprandial differences were observed between treatments for blood pressure, triacylglycerol, total cholesterol, serum derivatives of reactive oxidative metabolites, tumor necrosis factor α, interleukin-1 β, or maximum microvascular perfusion following iontophoresis of acetylcholine. Fruit-based anthocyanins attenuated the potential postprandial detrimental effects of a HFHE challenge on parameters of vascular and microvascular function, and inflammatory biomarkers in overweight older adults. Anthocyanins may reduce cardiovascular risk associated with endothelial dysfunction and inflammatory responses to a typical high fat ‘Western’ meal.

Pacific Island Countries and Territories (PICTs) are experiencing a Diet-Related Non-Communicable Disease (DR-NCD) health crisis(1). Increasing rates of DR-NCDs such as Type 2 diabetes and cardiovascular disease have been linked to dietary transitions and increasing food insecurity in the region(2). Anthropogenic climate change has also been identified as a significant threat to food security in PICTs(3). Additionally, the impacts of the COVID-19 Pandemic have been identified as both a contributor to food insecurity in the region and as an opportunity to transform PICT food systems and reduce rates of DR-NCDs(4). Yet, the drivers of dietary change, food security and agricultural practices in peripheral PICT communities are not well documented or understood. To determine how these drivers may change in the future and the impacts this may have on Pacific peoples, a deeper understanding of the historical and contemporary drivers of change is necessary. The aim of this scoping review was to collate existing information to improve this understanding, by mapping key factors evident in the literature that underpin the links between DR-NCDs and food security with a focus on women in PICT peripheral communities, to better clarify the challenges, working definitions and conceptual boundaries in the research area. The review maps where research has been conducted geographically and how the links between DR-NCDs and food security in PICTs have been investigated over time and identifies projections and suggestions for the future. The scoping review was conducted in accordance with a pre-defined protocol available online(5). A total of 476 peer-reviewed sources and 126 grey literature sources were identified by the initial search criteria. Two independent researchers completed title/abstract and full text screening using Covidence, and data extraction using a data extraction tool. The resulting data was quantified in table format, with common themes and ideas presented qualitatively. Sources spanned all sectors of PICT food systems with a heavy focus on production from fisheries and agriculture. Most PICTs were represented in the findings. Many drivers of change within food systems were identified, some of which included the impacts of anthropogenic climate change, the COVID-19 pandemic, and urbanisation. The drivers impacted all four pillars of food security, and many were directly or indirectly related to dietary and lifestyle changes associated with DR-NCD risk factors. This data is accompanied by an interpretation of results and a narrative summary. These results provide a useful platform to further explore the drivers of dietary change, food security, agricultural practices and DR-NCD’s in this region.

Dysregulation of immune responses results in the development of chronic inflammatory conditions. The current frontline therapy, glucocorticoids, are effective immunosuppressive drugs but come with a trade-off of cumulative, debilitating side effects with sustained use. Clearly, alternative drug options with improved safety profiles are urgently needed. Macrophage Migration Inhibitory Factor (MIF) is a pleotropic pro-inflammatory cytokine and integral component of immune and inflammatory responses. MIF counter-regulates the immunosuppressive effects of glucocorticoids and promotes NLRP3 inflammasome activation.1, 2 Elevated MIF is a feature of multiple diseases, including multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematous. Given the association of increased MIF in serum with multiple disease models, it is considered MIF may be a plausible, specific druggable target in treatment of chronic inflammatory and autoimmune diseases, particularly as a target for glucocorticoid-sparing therapy to reduce the dose or duration of glucocorticoid treatment. The organosulfur isothiocyanate phytochemical sulforaphane (SFN) is extracted from cruciferous vegetables, including broccoli and Brussel sprouts following hydrolysis of its inactive precursor, glucoraphanin. SFN has antioxidant and cancer chemoprotective properties, and promotes NRF2 antioxidant signalling to upregulate the expression of numerous antioxidant enzymes. SFN has been shown to covalently modify MIF with high reactivity and is a potent inhibitor of MIF tautomerase activity. However, to date, no such study has evaluated the role of SFN as a novel inhibitor of MIF-mediated inflammatory pathway activation. Using cell-based assays, we have sought to investigate the role of SFN as an inhibitor of multiple inflammatory pathways which have previously implicated MIF as a possible regulator. Our initial work has examined SFN as an inhibitor of NF-κB activity, inflammasome activation, and evaluated if MIF is required for this effect. RAW264.7 murine macrophage cells stably expressing NF-κB-luciferase reporter construct were pre-treated with SFN (2.5 µM) before the induction of inflammation, via LPS (100ng/mL). For NLRP3 inflammasome activation, cells were subsequently treated with the NLRP3-specific inflammasome activator, nigericin (10 µM). TNF, IFN-β and IL-1β cytokine expression was measured by ELISA and NF-κB activity by luciferase reporter assay. We found SFN is a potent inhibitor of NF-κB activity and inhibits release of the pro-inflammatory cytokine IL-1β through inhibition of NLRP3 inflammasome activation. Finally, co-incubation of SFN with the glucocorticoid dexamethasone significantly suppressed TNF and IFN-β expression, demonstrating steroid sparing activity of SFN in vitro. Thus, SFN may be a suitable treatment for disruption of inflammatory pathways and suggest some of these effects may be mediated through direct interactions with MIF.