Head and neck cancer (HNC), characterised by malignant neoplasms originating in the oral cavity, upper aerodigestive tract, the sinuses, salivary glands, bone, and soft tissues of the head and neck, is diagnosed in approximately 600 people annually in New Zealand. Although HNC is a less common cancer, it has a profound effect on almost all aspects of the lives of those affected, particularly the nutritional and social domains. This is due to the common treatment modality being surgery and/or radiotherapy, which can result in major structural and physiological changes in the affected areas, which in turn affects chewing, swallowing, and speaking(1). Specific nutrition impact symptoms (NIS) of HNC have been identified and are significant predictors of reduced dietary intake and malnutrition risk(2). We aimed to identify and describe the malnutrition risk, prevalence of NIS, and protein and energy intake of community living adult HNC survivors 6 months–3 years post treatment in New Zealand. Participants were recruited through virtual HNC support groups in New Zealand. A descriptive observational case series design was used. Malnutrition risk was determined using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). Malnutrition was defined as a PG-SGA SF score between 2 - 8 (mild/suspected - moderate malnutrition) or ≥9 (severely malnourished). NIS were obtained via a validated symptom checklist specific for HNC patients(3), and dietary data was collected using a four-day food record. Participants (N=7) are referred to as PTP1 – PTP7. PTP1 was well-nourished. PTP3 through PTP7 were categorised as mildly/suspected to moderately malnourished (scores ranged from 2-7), and PTP2 was severely malnourished (score of 16). NIS were experienced by all seven participants, with “difficulty chewing” and “difficulty swallowing” being the most selected and highest scored NIS that interfered with oral intake. PTP2 (severely malnourished) scored loss of appetite, difficulty chewing, and difficulty swallowing highly (interfering “a lot”), indicating a high degree of prevalence and impact. Despite being well-nourished, PTP1 had inadequate energy intake (85.5% of their estimated energy requirement (EER)). PTP2, 3, 6, and 7 also had inadequate energy intake (79.3%, 79.3%, 73.9%, and 99.3%, respectively, of their EER). All participants had adequate protein intake based on a range of 1.2-1.5 g/kg body weight per day. The prevalence of malnutrition and NIS in this case series indicates an urgent need for research to identify the true extent of malnutrition in community living HNC survivors post treatment.

In New Zealand, Māori and Pasifika have the lowest foodborne illness notification rates (per 100,000 people) for most foodborne illnesses(1); with underreporting of illness and differing food safety practices as possible factors. New Zealand Food Safety (NZFS) is responsible for regulating the New Zealand food safety system to make sure food is safe and suitable for all New Zealanders. Supporting consumers to make informed food choices and understand safe food preparation practices is a key priority for NZFS(2). As part of this, NZFS communicates food safety advice through various traditional channels including published material and campaigns.To better understand consumer attitudes, knowledge and behaviours around food safety and suitability, NZFS conducted an online survey of 1602 New Zealanders 15 years and over between 24 November and 17 December 2023. The survey used a quota sampling method and included booster samples for Māori and Pasifika. The margin of error was ±2.9% at a 95% confidence interval. The survey was available in English and Te Reo Māori.(3). The study highlighted key insights into food safety practices for Māori and Pasifika. For example, NZFS advises consumers not to wash raw chicken due to the potential for cross-contamination during food preparation. In the survey(3), we found that 67% of consumers who prepare chicken said they washed it either sometimes or always; further, 79% of consumers who prepare chicken believe they should. The most common reason for washing raw chicken was because of hygiene (23%). Even though NZFS messaging is clear to not wash raw chicken, it is concerning that the advice is not adhered to, and the risks are not recognised. In the survey, Pasifika who prepare chicken were more likely to say they wash raw chicken either sometimes or always (79% of Pasifika). As a food safety regulator, it is important to understand our Māori and Pasifika consumers and their perceptions, knowledge and behaviours around food safety practices, but also to consider how we can communicate effectively with them. For example, of the food safety information sources most trusted, Māori were more likely to trust friends, family and or whanau (49%), and Pasifika were most likely to trust health professionals (53%)(3). With a view of trying to better understand our Māori and Pasifika consumers models such as Te Whare Tapa Wha(4) (the Māori Health Model) provide an important and holistic view of health-based concepts of taha whanau (family and social wellbeing), taha tinana (physical wellbeing), taha hinengaro (mental and emotional wellbeing) and taha wairua (spiritual wellbeing). There are opportunities for NZFS to reflect on and use Te Whare Tapa Wha throughout the survey development and implementation process, through to the delivery of targeted food safety messages.

‘I just don’t know what to eat!’ is a frequent statement from people seeking nutrition support. With a magnitude of information available, confusion and limited confidence is a common complaint. People face myriad challenges in their attempts to have a healthy diet, including cost and time constraints, challenging food environments, and limited knowledge and skills(1). Challenges about eating well are often raised, yet enablers to eating well are not as readily discussed. Intention for healthy behaviours, self-efficacy and social support are examples of favourable elements which support healthy diets(1,2). As such, existing knowledge, skills, and positive influences should also be considered. As part of a wider qualitative study, and using an interpretive description approach, we sought to identify enablers to healthy eating perceived by people engaged with Green Prescription (GRx) and Active Families programmes. Nineteen clients aged 18 years and over, engaged with six GRx services were interviewed between May and October 2023. Eighteen whānau (family) members, (19-53 years) attending Active Families sessions facilitated in the Waitematā area participated in focus group discussions during May-August 2024. Participants were asked in these discussions (kōrero) to share what helps them and their whānau to eat well. Braun and Clarke’s(3) thematic analysis approach was used to analyse responses from these kōrero through data familiarisation, coding, and cyclical review of thematic relationships. Several themes were identified in this analysis: ‘confidence in personal skills,’ ‘supportive environments’, and ‘being open and willing’. Personal skills such as planning meals, managing household budget and efforts to procure ‘good’ food were identified as strengths. These wider food skills have been suggested as potentially more important to enhancing dietary behaviours than cooking skills(4). Participants relayed experiences of developing skills that improved their confidence in eating well including growing, gathering and preserving food, experimenting with recipes, and knowing where to find affordable, nutritious food. Environments where people learned food and cooking skills and household members supported their endeavours to eat well were described as influential to encourage people in their efforts. Participants also expressed that being open to trying new foods and ways of eating led to inspiration and new knowledge. This attitude resulted in increased variety in the diet and further enhanced confidence to seek recipes and food information and spurred on efforts to make changes. People who have sought nutrition advice have often expressed challenges and uncertainty impacting their efforts to eat well. Nevertheless, there are also strengths which have meaningful impact on their eating. In nutrition advice provision, it would be beneficial to thoroughly explore the strengths people exhibit to support healthy eating. Identifying these insights may powerfully effect people’s confidence to eat well and identify more effective support and information provision.

FODMAPs (Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols) are indigestible, short-chain carbohydrates fermented in the large intestine, causing discomfort in patients with irritable bowel syndrome (IBS). FODMAPs, specifically fructans, galacto-oligosaccharides (GOS), lactose, fructose in excess of glucose, and polyols, are found in fruits, vegetables, grains, milk and their processed products. The aim of this project was to identify the major sources of FODMAPs in the New Zealand diet to guide research into reducing FODMAPs in those major sources. FODMAP data were collected from the New Zealand Food Composition Database(1), in-house data and published sources(2-5). NZ food consumption data were sourced from multiple published sources. Estimated potential dietary intake of FODMAPs in NZ was calculated in grams per capita per annum. Foods and beverages were ranked to ascertain major FODMAP sources within each food group. Without replicated data for individual foods, inferential statistical analysis was not possible. NZ food consumption data on a per capita per annum basis is limited, therefore consumption data were calculated based on serving size and serves per day per capita for some foods. Comprehensive FODMAP data are not available for NZ foods and beverages. In terms of FODMAP data, the New Zealand Food Composition Database(1) contains only fructose and glucose data (to calculate excess fructose) and lactose data. The main cereal and grain source of FODMAPs is wheat flour (763–831 g fructan) and the main cereal-based product sources are breads (55–1194 g fructan, up to 121 g excess fructose and 55–159 g GOS) and breakfast cereals (60–525 g fructan, up to 99 g excess fructose, up to 159 g GOS, and 2409 g lactose if consumed with cow’s milk). The main fruit source of FODMAPs is apples, providing up to 456 g excess fructose and 68–81 g sorbitol. The main vegetable sources are onion bulb (134–662 g fructan), cauliflower (131 g mannitol) and mushroom (53 g mannitol). Consumption data for garlic were unavailable. Cow’s milk is the main source of lactose (4516–5259 g), followed by ice cream (415–937 g), cheeses and butter. The main beverage sources are milk and milk-based café-style coffee (1407–4220 g lactose) and apple-based fruit juices (486–836 g excess fructose). Little data exist for sweeteners and confectionery. Honey and pear juice (containing excess fructose) are sources, as are artificial sweeteners such as erythritol, maltitol and xylitol (i.e. polyols), commonly found in chewing gum, diabetic and low-carb food products. Milk chocolate contributes to lactose consumption. More comprehensive New Zealand food consumption data (on a per capita per annum basis) are required to obtain a more accurate picture of dietary FODMAP intake. Adding oligosaccharide and polyol data to the New Zealand Food Composition Database would be beneficial to provide complete FODMAP data of New Zealand foods.

New Zealand ranks among the highest globally for childhood obesity(1). One of the main platforms to maximize the prevention of child excess adiposity is the establishment of healthy diets in early life(2,3). Despite this recommendation, Aotearoa has limited information on children’s whole diet quality and its associations with child healthy weight. This study explored the associations between dietary patterns and indicators of excess adiposity among 4.5-year-olds within the Growing Up in New Zealand birth cohort study (n= 6,048, 98.2% of the children who took part of the 4.5-year data collection wave). At 4.5 years, two dietary patterns were previously derived and described: “Refined, high in sugar, sodium and fat” and “Fruit and vegetables”(4). The indicators of excess adiposity examined at 4.5 years were body-mass-index-for-age (BMI/A) (>+2 z-score) and waist-to-height ratio (WtHR) > 90th percentile. Information on child and maternal sociodemographic and maternal health behaviour characteristics was sourced from the antenatal and the 4.5-year-interviews. Children’s scores in both dietary patterns were ranked in tertiles. Multiple Poisson regressions with robust variance were performed to examine the associations between the dependent variables (BMI/A z-score >+2 and WtHR >90th percentile) and the independent variables (dietary patterns), adjusted by child and mother characteristics (IBM SPSS software). Sensitivity analyses excluding children with outliers for BMI/A (<-5 z-score or >+5 z-score) was also performed. Findings were reported as adjusted risk ratio (RR) and 95% confidence intervals (CIs). Children in the highest tertile of the “Refined high in sugar, salt and fat” dietary pattern were more likely to be overweight/obese (BMI/A) compared to children in the lowest tertile (RR:1.51; 95% CI: 1.20-1.90; p<0.001). This significant association was confirmed in the sensitivity analyses (RR:1.49; 95% CI: 1.18-1.89; p <0.001). There were no significant associations between this dietary pattern and WtHR > 90th percentile nor between the “Fruit and vegetables” dietary pattern and the indicators of child excess adiposity. This study provided nationally generalizable information that poor diet quality in early life is associated with child excess adiposity. National strategies to prevent childhood obesity need to encompass approaches to reduce the availability and intake of refined foods and those high in sodium, sugar and unhealthy fats in children.

In Aotearoa New Zealand, approximately 1 in 3 adults and 1 in 8 children are classified as obese, with Māori and Pacific communities disproportionately affected(1). While maternal nutrition has been extensively studied, paternal impacts and the combined effect of both parents’ obesogenic environments on offspring health remain underexplored(2). The primary objective of this study is to characterise the metabolic phenotype of parent rats fed a High Fat High Sugar (HFHS) diet and investigate the birth characteristics of their offspring, from a factorial mating design.Eighty female and 40 male Sprague-Dawley rats were randomised to a standard chow diet (SD) (24% protein, 18% fat, 58% carbohydrates) or HFHS diet (Specialty Feeds SF23-120: 16% protein, 41% fat, 43% carbohydrates) for five weeks prior to mating. Females were then continued on their respective diets throughout pregnancy and lactation. Four mating combinations were established: SDmum-SDdad, SDmum-HFHSdad, HFHSmum-SDdad, and HFHSmum-HFHSdad. A subset of parents (n=38) underwent body composition assessments using dual-energy X-ray absorptiometry (DEXA). Additionally, a subgroup (n=23) was evaluated for metabolic profiles using Prometheon metabolic cages. Offspring birth weights and body lengths were recorded. The HFHS diet’s efficacy was confirmed in both male and female rats, with HFHS groups showing higher body weight (females: 327.1 g ± 19.7 vs. 288.2 g ± 20.1; males: 575.8 g ± 39.8 vs. 532.6 g ± 50.3; p < 0.05), greater fat percentage (females: 46.8% ± 5.6 vs. 29.2% ± 5.6; males: 40.5% ± 7.2 vs. 28.7% ± 6.8; p < 0.001), and a lower respiratory exchange ratio (RER) (females: 0.8108 ± 0.0275 vs. 0.8679 ± 0.0288; males: 0.8257 ± 0.0304 vs. 0.8759 ± 0.0266; p < 0.05) compared to the SD group. In male offspring, birth weights in HFHSmum-SDdad (6.3 g ± 0.9) and HFHSmum-HFHSdad (6.0 g ± 0.9) groups were significantly lower (p < 0.0001) than in SDmum-SDdad (6.980 g ± 0.7753) and SDmum-HFHSdad (7.0 g ± 0.7) groups. Birth weights were further reduced in HFHSmum-HFHSdad versus HFHSmum-SDdad (Mean Diff. = 0.3g; p < 0.05).Body lengths in HFHSmum-HFHSdad males were shorter (43.1 mm ± 3.2; p < 0.0001) compared to other groups (≥ 45.3 mm). Female offspring birth weights were lower in the HFHSmum-SDdad (5.8g ± 0.8) and HFHSmum-HFHSdad groups (5.8 g ± 0.9; p<0.0001) compared to the other groups (means ≥ 6.4g) but paternal HFHS diet had no additional effect on birth weight. As with males, body lengths in the HFHSmum-HFHSdad female offspring were significantly shorter (4 mm ± 3; p<0.0001) compared to all other groups (≥44mm). Parental HFHS diets synergistically reduce offspring birth length and weight, with stronger effects in males. These findings underscore the importance of inclusive dietary guidelines for both parents to reduce intergenerational obesity risk and support long-term health.

The Tohu Manawa Ora | Healthy Heart Award programme helps early learning services across Aotearoa create an environment that promotes nutritional health and physical activity. It achieves a sustainable change to the environment by using a ‘whole-service’ approach, through governance and management, learning and teaching, collaboration and professional development. The programme aims to foster happy tamariki with awareness of how to have hearts fit for life, ensuring healthier futures for whānau across Aotearoa New Zealand. To evaluate and understand the impact and social value of the Tohu Manawa Ora | Healthy Heart Award programme on fostering healthy habits and creating supportive environments in early learning settings across Aotearoa New Zealand the Heart Foundation undertook this evaluation with ImpactLab. Two hundred and fifteen early learning services and 33,717 tamariki across Aotearoa New Zealand, who were enrolled in or had achieved a Tohu Manawa Ora | Healthy Heart Award, were used to determine the impact and social value of the programme. This was achieved through using a social value calculation which integrates multiple data sources and analytical methods. Firstly, impact values derived from the programme were combined with evidence from global literature on the effectiveness of similar health promotion programmes. Secondly, the size of the opportunity for participants—early learning services across Aotearoa New Zealand—to achieve more positive health outcomes was assessed. Thirdly, the number of people supported by the programme was considered. Every year, the Tohu Manawa Ora | Healthy Heart Award programme delivers $6,163,581 of measurable good to society in New Zealand. Outcomes for tamariki of improved oral health, physical activity and reduced diabetes and improved physical activity for whānau directly contribute to the social value. Improved health equity, nutrition, increased food exposure and physical activity, promotion of lifelong wellbeing and positive health behaviours, reduced cardiovascular disease and sugar consumption indirectly contributed to the social value. This means that every dollar invested in the Tohu Manawa Ora | Healthy Heart Award programme delivers $4.50 of measurable good to New Zealand. The Tohu Manawa Ora | Healthy Heart Award programme delivers significant measurable social value to Aotearoa New Zealand. Growth, development and continued funding of the programme should continue to further positively impact the future of tamariki and their whānau in Aotearoa New Zealand.

Dietary protein provides amino acids, nine of which are indispensable (IAAs) as they are not synthesised within the body. Adoption of a vegan diet has shown an increased trend in several Western countries.(1) Past assessments of total protein intake of vegan populations were found to be low but not necessarily below daily requirements.(2) However, plant-sourced proteins generally have lower quantities of digestible IAAs as compared to animal-sourced proteins.(3) Simply accounting for protein intake without considering amino acid profile and digestibility could overestimate protein adequacy among vegans. This study aims to quantify protein intake and protein quality (digestible IAAs) among a cohort of NZ vegans as compared to individual requirements. Dietary intake data was obtained through a four-day recall from 193 individuals participating in a cross-sectional study of adult vegans (above 18 years) residing in New Zealand who have followed a vegan diet for at least two years. Ethical approval was granted (HDEC 2022 EXP 12312). Anthropometric data was collected at Massey University, Auckland. Protein and IAA composition of all foods were derived by comparing dietary data to food composition data from New Zealand FoodFiles and the US Department of Agriculture. Mean values for protein and IAA were adjusted for true ileal digestibility and body weight (kg).(4,5) Mean protein intakes for males and females were 0.99 and 0.81 g/kg of body weight/day, respectively. Overall, 78.8% of males and 74.5% of females met the Estimated Average Requirement (EAR) for daily protein. Plant-sourced proteins in the vegan diet provided 52.9 mg of leucine/g of protein and 35.7 mg of lysine/g of protein, which were below the reference scoring patterns (leucine: 59mg/g, lysine: 45mg/g).(5) When adjusted to individual body weight, average IAA intakes were above daily requirements, but lysine just met requirements at 31.2 mg/kg of body weight/day (reference: 30 mg/kg/d). The importance of adjusting for digestibility is noted as the percentage of vegans meeting adequacy for protein and IAAs decreased as compared to using only IAA compositions without this adjustment. In contrast to grains and pasta, legumes and pulses were the foods that contributed most to overall protein and lysine intake while providing lower energy intake. Lysine followed by leucine were the two most limiting IAAs in the diet of this NZ vegan cohort. Increased proportion of legumes and pulses, and decreased proportion of grains and pasta within the diet can potentially increase leucine and lysine intake but must be considered in the context of the whole diet.

The significance of human milk in an infant’s diet is well-established, yet accurately measuring human milk intake remains challenging. Current methods are either unsuitable for large-scale studies, such as the dose-to-mother stable isotope technique, or rely on set amounts of human milk, regardless of known variability in individual intake(1). There is a paucity of data on how much infants consume, particularly in later infancy (>6 months) when complementary foods have been introduced. This research aimed to estimate human milk intakes and total infant milk intakes (including infant formula) in New Zealand infants aged 7-10 months, explore factors that predict these intakes, and develop and validate equations to predict human milk intake using simple measures. Human milk intake data were obtained using the dose-to-mother stable isotope technique in infants aged 7-10 months and their mothers as part of the First Foods New Zealand study (FFNZ)(2). Predictive equations were developed using questionnaire and anthropometric data (Model 1) and additional dietary data from diet recalls (Model 2)(3). The validity of existing methods to estimate human milk intake (NHANES and ALSPAC studies) was compared against the dose-to-mother results. FFNZ included 625 infants, with 157 mother-infant dyads providing complete data for determining human milk volume. Using the dose-to-mother data, the measured mean (SD) human milk intake was 785 (264) g/day. Older infants had lower human milk and total milk intakes, male infants consumed more total milk. The strongest predictors of human milk intake were infant age, infant body mass index, number of breastfeeds a day, infant formula consumption, and energy from complementary food intake. When the predictive equations were tested, mean (95% CI) differences in predicted versus measured human milk intake (mean, [SD]: 762 [257] mL/day) were 0.0 mL/day (-26, 26) for Model 1 and 0.5 mL/day (-21, 22) for Model 2. In contrast, the NHANES and ALSPAC methods underestimated intake by 197 mL/day (-233, -161) and 175 mL/day (-216, -134), respectively. The predictive equations are presented as the Human Milk Intake Level Calculations (HuMILC) tool, designed for use in large-scale studies to more accurately estimate human milk intakes of infants. The use of objective quantifiable assessment methods enhances our understanding of infant human milk intakes, improving our ability to accurately assess nutritional adequacy in infants.

Food security constitutes a worldwide concern closely correlated with population growth. By 2050, the global population is expected to reach 9.3 billion(1). The rising population, along with increasing life expectancy and shifts toward Western dietary patterns, is expected to drive higher food demand and contribute to a rise in metabolic conditions(2). In this context, looking for alternative and sustainable food and protein sources is imperative. Pasture legumes including lucerne (Medicago sativa) and red clover (Trifolium pratense) are becoming popular as they can be used as an alternative protein and functional food source. Both crops play an important role in New Zealand’s agriculture. Their seeds can be used in human nutrition as alternative food and protein options; however, the presence of anti-nutritional factors (ANF) and their distinct taste make them less favourable for human consumption. Fermentation can be used as a possible strategy to mitigate these limitations. Lactobacillus fermentation was conducted using Lactocillus plantarum, Lactobacillus. acidophilus and Lactobacillus. casei. Proximate composition and mineral content were determined following Association of Official Analytical Chemists (AOAC) methods. Total phenol content (TPC), total flavonoid content (TFC) and antioxidant activity (2,2-Diphenyl-1-picrylhydrazyl and 2,2′-azino-bis-(3-ethylbenzothiazoline-6-sulfonic) acid) and ANF including phytic acid, trypsin, and chymotrypsin inhibition were assessed using colourimetric techniques. For the enzyme inhibition assays, enzyme-substrate reactions were performed with sample extracts before measurement. All the experiments were replicated three times, and the results were expressed as mean ± SD. A factorial analysis of variance (ANOVA) was conducted (4 legume seed samples × 3 LAB cultures) with a Tukey’s post-hoc test for mean comparison at P < 0.05 using IBM SPSS Statistics 29.0. All the legume seeds demonstrated high nutritional content, with crude protein and fibre levels around 40 and 16% respectively. The seeds were also rich in minerals, particularly magnesium, phosphorus, iron and zinc. In addition, fermentation led to an increase (P < 0.05) in TPC, TFC and antioxidant activity, while significantly reducing ANF. For instance, fermentation led to an increase in TPC (18.8 to 47.1% increase), TFC (9.6 to 34.5% increase) and AOA via DPPH and ABTS. Lactobacillus fermentation has proven to be an effective processing technique to enhance the nutritional value of lucerne and red clover seeds. These findings support the potential of using fermentation to develop novel and sustainable protein sources, contributing to improved dietary quality and nutrition. Moreover, further work to study the effect of fermentation on the nutrient digestibility of lucerne and red clover seeds is warranted.

Food waste is a global problem, with estimates of a third of all food produced going to waste(1). In 2015, the United Nations set Sustainable Development Goal (SDG) Target 12.3, to halve food waste by 2030(2). To reach this goal, following the Target-Measure-Act approach is considered best practice(3). At the University of Otago, in Dunedin, Aotearoa New Zealand, approximately 3,500 students live across 14 fully catered residential colleges. The University of Otago has formally committed to pursuing the SDGs, and therefore reducing food waste. To track progress towards SDG 12.3, baseline measurements of food waste at the residential colleges are required. This research aimed to quantify food waste from the residential colleges, as well as to qualitatively discuss reasons for the waste and potential ideas to reduce waste. On three days at each of the 14 residential colleges, preparation, servery, and plate waste were measured from breakfast, lunch, and dinner, following a protocol developed from the Waste and Resources Action Programme Food Loss and Waste Standard. Additionally, five focus groups were conducted across three residential colleges, with students and staff, to discuss food waste at the residential colleges. An average of 172 g (95% CI 154 g to 191 g) of food waste were produced per student per day, with approximately 50% being plate waste, 35% being servery waste, and 15% being preparation waste. Reinforcing the quantitative data, in the focus groups staff voiced that the plate waste was a concern to them. Ways to reduce plate waste were discussed and included increasing awareness through making the waste more visible, as well as improving communication between kitchen staff and students particularly regarding serving sizes and preferred menu items. Servery waste was also considered, with more consistent forecasting of meal attendance across the residential colleges and a range of solutions for leftovers, such as a fridge for students or donation to other organisations, being suggested. With these baseline measurements of quantities of food waste produced at the University of Otago’s residential colleges, actions taken to reduce and mitigate food waste can be measured for effectiveness, and steps can be taken towards achieving SDG 12.3 collaboratively across the tertiary education sector.

Breastfeeding is the recommended way to feed infants. However, a safe and nutritious substitute for human milk is needed for infants when breastfeeding is not possible. As infants are a vulnerable population group, infant formula products are regulated by prescriptive provisions for composition and labelling. Any changes to the composition of these products must be established as safe prior to being permitted. As our knowledge of human milk expands, infant formula ingredients are developed to better replicate it. Food Standards Australia New Zealand (FSANZ) has assessed the addition of ingredients for the addition to infant formula products including human identical milk oligosaccharides (HiMOs) isolated using precision fermentation methodology. These ingredients are considered to be nutritive substances as their addition to food is intended to achieve specific nutritional purposes. In accordance with the Ministerial Policy Guidelines, FSANZ must assess both the safety and the health effect of nutritive substances for their use in infant formula. FSANZ risk assessments are undertaken by a multidisciplinary team covering toxicological and nutritional considerations using the best available scientific evidence. FSANZ assessments of the health effects concluded that the use of HiMOs in infant formula products would have a beneficial outcome for infants and align with the equivalent role of these substances in human milk(1,2). The weight of evidence supports health effects through an increase in the abundance of Bifidobacterium spp. in the infant gut microbiota, anti-pathogenic effects, inflammatory suppression and facilitation of appropriate immune responses and antigenic memory. FSANZ safety and technical assessments concluded that there are no public health and safety concerns associated with adding HiMOs to infant formula products(1, 2). The permitted levels are comparable to levels in human milk and are chemically and structurally identical to the naturally occurring forms. Food Standards Australia New Zealand, Canberra, 2606, Australia Based on the available evidence and intended purpose, a number of HiMOs have been permitted for use in infant formula products including 2′- fucosyllactose, lacto-N-neotetraose, difucosyllactose, lacto-N-tetraose, 3'-sialyllactose sodium salt, 6'-sialyllactose sodium salt. Evidence continues to emerge on the beneficial effects of HiMOs on infant health.

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease globally(1) whereby there is a loss of dopaminergic neurons in the brain and a deficiency of dopamine. PD is characterised by dyskinesia, rigidity, tremor and postural instability, and non-motor symptoms which include neuropsychiatric, sleep and autonomic dysfunction which often occur before motor symptoms(2). Several of these motor and non-motor symptoms can adversely affect nutritional status(3) and a significant number of people with PD are at risk of malnutrition(4). Observational studies have examined the relationship between dietary intake, symptoms and disease progression yet there is a lack of randomised controlled trials of dietary interventions. This presentation will examine the evidence base and suggest future directions for nutrition research in this important area.

The estimated global preterm birth rate in 2020(1) was more than 10% of livebirths or 13.4 million infants. Despite the importance of neonatal nutrition in optimising growth, neurodevelopment, and later metabolic disease risk, there is inconsistency in nutrition recommendations for preterm infants(2). Incomplete or inconsistent reporting of outcomes in nutrition intervention studies is part of the reason for the lack of consensus on optimal nutrition. To reduce uncertainty in measuring or reporting nutritional intake and growth outcomes in preterm studies, a consensus process is needed to identify relevant measures for patients, parents/caregivers, researchers, and health professionals. We aimed to develop a minimum reporting set (MRS) for measures of nutritional intake and growth in preterm nutrition studies. We collaborated with a group of international researchers from 13 countries and registered this study at the COMET initiative (registration number 3185). The target population was individuals born preterm at any gestational age and study location whose nutritional intake was assessed before first hospital discharge and whose growth was assessed at any age. Measures reported in preterm nutrition studies were systematically reviewed and used to develop the real-time Delphi survey(3) using Surveylet (Calibrum) software, including 13 questions about nutritional intake and 14 about growth outcomes. We used a snowball process to recruit participants from the consumer, healthcare provider, and researcher stakeholder groups with expertise in preterm infants, nutrition, and growth to rate the importance of each measure on a 9-point Likert scale. Participants initially rated the survey items without seeing other participants’ responses, saved and refreshed the page to see the anonymous responses of other participants, and had the option to change their rating and provide reasons for their answers. Participants’ final scores for each item will be used to identify the consensus criteria for that item(3). To date, we have recruited 246 participants from 31 countries across 5 continents, including 58 (24%) consumers, 156 (63%) healthcare professionals, and 26 (11%) researchers. Preliminary findings indicate that 12 measures of nutritional intake and 4 of growth have met the criteria for inclusion in the MRS. However, participant recruitment and survey responses are ongoing. A final consensus meeting is planned for November 2024 to confirm the MRS.

As many as 1 in 12 people in residential care are likely to have a pressure injury at any time(1). Our pragmatic intervention, consented by both patients and their Enduring Power of Attorney, provided 20g whey protein concentrate (WPC) in 200ml whole milk to be consumed by the resident in the morning with breakfast or morning tea, to compensate for the likely lowest protein meal of the day(2), and increase total protein intake. WPC has a number of beneficial substances that support wound healing, such as arginine, and glutamine(3), plus the branch chain amino acids(4). The intervention was uncomplicated, well tolerated and resulted in wound healing, as evidenced by the pictures of the three initial cases. We need further trials to show that this is better than usual interventions. However, we believe this is a useful protocol to address a recognised problem of poor protein intake for those who need extra to heal wounds

The objective of the food safety system is to provide safe and suitable food in New Zealand(1). This is of particular importance for our youngest members– infants and young children. During the first 2000 days of life, food and nutrition have crucial roles. Nutrient requirements are high, and children often have an increased vulnerability to hazards associated with chemical and microbiological contamination. Foods targeted to this age group typically have strict regulations, as the quality and safety of foods for infants and young children is of great concern to caregivers, public health authorities and regulatory bodies worldwide. The recent First Foods New Zealand Study (FFNZ) and Young Foods New Zealand (YFNZ) Study have provided important data into what, and how, we feed our infants and young children under four years of age(2). Insights from the dietary intakes and health of 925 infants and young children from these studies are being used by NZFS to inform its work on food monitoring surveillance and food policy. Currently New Zealand Food Safety (NZFS) is conducting the 2024 New Zealand Total Diet Study (NZTDS) (Infants and Toddlers)(3). The NZTDS is a food monitoring and surveillance programme which aims to evaluate the risk to New Zealanders from exposure to certain chemicals such as agricultural chemicals, contaminants (including from food packaging), and nutrients. The 2024 NZTDS will, for the first time, focus exclusively on infants and young children. The FFNZ and YFNZ studies informed the selection of 117 foods to be tested from four New Zealand regions throughout 2024/2025. The dietary intake data will then be used to estimate the dietary exposure to each of the 362 chemicals analysed. This monitoring programme informs policy decision-making and food standard setting and provides assurance on the safety of our food supply. Concerns around the nutrient quality and labelling of some commercial products for infants and young children have been identified in Australia and New Zealand. Within the joint food regulatory system, consultation is underway to consider regulatory and non-regulatory options for improving commercial foods for infants and young children(4). This presentation will discuss NZFS’s role in monitoring foods and diets of infants and young children in Aotearoa New Zealand, the importance of, and application of evidence to inform policy, food safety, and potential regulatory and non-regulatory options to ensure that the food safety system continues to deliver safe and suitable food in New Zealand.

New Zealand and Australian governments rely heavily on voluntary industry initiatives to improve population nutrition, such as voluntary front-of-pack nutrition labelling (Health Star Rating [HSR]), industry-led food advertising standards, and optional food reformulation programmes. Research in both countries has shown that food companies vary considerably in their policies and practices on nutrition(1). We aimed to determine if a tailored nutrition support programme for food companies improved their nutrition policies and practices compared with control companies who were not offered the programme. REFORM was a 24-month, two-country, cluster-randomised controlled trial. 132 major packaged food/drink manufacturers (n=96) and fast-food companies (n=36) were randomly assigned (2:1 ratio) to receive a 12-month tailored support programme or to the control group (no intervention). The intervention group was offered a programme designed and delivered by public health academics comprising regular meetings, tailored company reports, and recommendations and resources to improve product composition (e.g., reducing nutrients of concern through reformulation), nutrition labelling (e.g., adoption of HSR labels), marketing to children (reducing the exposure of children to unhealthy products and brands) and improved nutrition policy and corporate sustainability reporting. The primary outcome was the nutrient profile (measured using HSR) of company food and drink products at 24 months. Secondary outcomes were the nutrient content (energy, sodium, total sugar, and saturated fat) of company products, display of HSR labels on packaged products, company nutrition-related policies and commitments, and engagement with the intervention. Eighty-eight eligible intervention companies (9,235 products at baseline) were invited to participate, of whom 21 accepted and were enrolled in the REFORM programme (delivered between September 2021 and December 2022). Forty-four companies (3,551 products at baseline) were randomised to the control arm. At 24 months, the model-adjusted mean HSR of intervention company products was 2.58 compared to 2.68 for control companies, with no significant difference between groups (mean difference -0.10, 95% CI -0.40 to 0.21, p-value 0.53). A per protocol analysis of intervention companies who enrolled in the programme compared to control companies with no major protocol violation also found no significant difference (2.93 vs 2.64, mean difference 0.29, 95% CI -0.13 to 0.72, p-value 0.18). We found no significant differences between the intervention and control groups in any secondary outcome, except in total sugar (g/100g) where the sugar content of intervention company products was higher than that of control companies (12.32 vs 6.98, mean difference 5.34, 95% CI 1.73 to 8.96, p-value 0.004). The per-protocol analysis for sugar did not show a significant difference (10.47 vs 7.44, mean difference 3.03, 95% CI -0.48 to 6.53, p-value 0.09).In conclusion, a 12-month tailored nutrition support for food companies did not improve the nutrient profile of company products.

Gut health is a 50-billion-dollar (US) industry that is forecast to continue growing. This growth is attributed to our increased understanding and interest in the gut microbiome and its association with many chronic diseases, mental health and gut and autoimmune disorders. In 2024, “dysbiosis”, “gut microbiome” and “gut probiotics” were some of the most commonly google searched words but, what constitutes “good gut health”? There is no exact definition but in clinical practice we may use symptoms as a proxy for gut health, for example normal gastrointestinal function and the absence of chronic gastrointestinal symptoms that negatively impact on our quality of life. Consumer research found that consumers regard gut health as well-being and are interested in latest science but that does not inform their purchasing behaviours(1). Interestingly, symptoms of suboptimal gut health, which may include abdominal bloating, diarrhoea, constipation, excessive flatulence, were most likely to influence consumer behaviours.1 In this presentation, I review the latest scientific evidence about foods and dietary patterns that are associated with markers of gut health. I also provide examples of how we can practically educate and advise New Zealanders on implementation of dietary changes that may support sustainable gut health.

Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were 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. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 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% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 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, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.

Masters athletes tend to have higher intakes of calcium, magnesium, iron, and zinc when compared to Australian national population data from similar age groups(1). However, little is known about the diets of New Zealand Olympians as they get older. This study aimed to describe the micronutrient intakes of New Zealand Olympic and Commonwealth Games athletes over the age of 60 years and make comparisons with National Nutrition Survey data. Thirty-three individuals (mean age 76±8 years, n=27 male) who had represented New Zealand at an Olympic or Commonwealth Games participated in this study. Dietary intake was assessed using three 24-h diet recalls. The first recall was conducted face to face in the participant’s home and the second and third were completed over a voice or video call on non-consecutive days following this. All recalls were performed using a multiple-pass technique and entered into FoodWorks dietary analysis software (Version 9, Xyris Software Ltd., Brisbane, Australia). Mean intakes across the three recalls were used to represent the intake of each individual.This study was approved by the University of Otago Ethics Committee (Health; H23/054, April 2023).The mean intakes of iron (males 13.3±5.1 mg, females 9.9±1.9 mg) and zinc (males 10.7±4.0 mg, females 9.6±1.9 mg) in Olympians were similar to those reported in those over 70 y in the 2008/09 New Zealand Adult Nutrition Survey, but more than 60% of Olympians had intakes below the estimated average requirements for these nutrients. Intakes of calcium (males 1048±474 mg, females 810±139 mg) and selenium (males 66.7±49.1 µg, females 48.4±17.7 µg) were higher in Olympians when compared to the 2008/09 New Zealand Adult Nutrition Survey data, however 39% and 61% of Olympians still had intakes below the estimated average requirements, respectively. While this group of older New Zealand Olympians did have higher intakes of some nutrients than a representative sample of their peers, a marked number are still at risk of inadequate intakes and may benefit from a nutrition intervention to improve the overall quality and adequacy of their diet.