Foods in squeeze pouches are widely available and are marketed as practical, convenient, and healthy food options for infants and children. However, these products do not provide adequate nutrition for growth(1) or align with the front-of-pack health claims. To develop effective strategies and guidance for squeeze pouch consumption, we need to understand which squeeze pouches are used, by whom, and why. A cross-sectional online survey of Tasmanian residents was conducted and included questions about the frequency and types of squeeze pouches consumed by infants and children (aged 0–18 years), the demographics of families who use squeeze pouches frequently and an open-ended question to explore parental motivations for using these products. Data were analysed using descriptive statistics and logistic regression identified demographic predictors of frequent squeeze pouch use (weekly or more). Thematic analysis of qualitative survey responses explored parental experiences. Parents (n = 179; 78% female, 37% aged 35–45 years, 84% born in Australia; 73% university educated) reported on the squeeze pouch use of n = 248 children. Most infants (0–2 years; 71.4%) used squeeze pouches weekly (85.7% consumed in past year), favouring fruit-based (57%), dairy-based (57%), vegetable-based (50%), and meal-based (36%) pouches. Over half of children aged 2–5 years (62.5%) consumed pouches weekly (81.3% consumed in past year), preferring dairy-based (73%) and fruit-based (19%) pouches. Over a third of 6–12-year-olds (35.2%) consume pouches weekly (69.3% consumed in past year), including dairy-based (66%) and fruit-based pouches (20%). A smaller proportion (13.1%) of teenagers (13–17 years) consume pouches weekly (33.3% consumed in past year), primarily choosing dairy-based (26%) and fruit-based (6%) pouches. Younger parents were over 5 times more likely to be frequent users than parents aged over 46 years (18–34 years OR: 5.3, 95% CI 1.8–15.7; 35–45 years OR: 6.0, 95% CI 2.8–12.8). Speaking a language other than English (OR: 4.8; 95% CI 1.5–14.6) also significantly predicted frequent squeeze pouch use, while gender, education, employment status, income, and food security were not associated. Key themes from parents who identified as frequent squeeze pouch users centred around convenience, on-the-go feeding, and managing fussy eating or sensory needs. Parents discussed the societal paradox they experienced, with parents expressing a dislike for squeeze pouches yet using them for behaviour modification as a food reward or buying in bulk when discounted. An understanding of commercial food influences, and greater environmental consciousness were the most common themes described by parents who identified as non-users. This study highlights the widespread use of squeeze pouches among children, particularly in younger age groups but also into middle childhood and adolescence. Comprehensive national data is needed to inform public health strategies that minimise the use of squeeze pouches in children of all ages.

Hospital food service quality significantly impacts patient satisfaction with overall care(1) and can influence food intake, thereby increasing the risk of malnutrition(2). By contrast, meals tailored to patients’ needs result in lower complications and hospitalisation costs(3). With Australia’s ageing population and projected increases among racial and ethnic minority migrants, service delivery must adapt to promote equity and inclusion in the healthcare system. However, data is lacking on the lived experience, preferences, and acceptance of hospital food service and meal quality among older patients from culturally and linguistically diverse (CALD) backgrounds. This study aimed to bridge this gap by investigating the differences in hospital food services related to cultural and ethnic backgrounds. Semi-structured qualitative interviews were planned among 15 Australian-born and 15 CALD-background patients, aged 65 years or over, admitted to the Department of General Medicine at Flinders Medical Centre. Patients admitted with a highly contagious infectious disease (e.g., COVID-19), those referred for palliative care, receiving parenteral or enteral nutrition, or on nil-by-mouth orders were excluded. Translators were available to participants upon request. With participants’ consent, all interviews were audio recorded and transcribed verbatim. Transcripts were analysed thematically using Braun and Clarke’s six-phase process(4). Data was inductively coded with a phenomenological perspective to explore participants’ experiences with hospital food services. Similar codes were grouped together and further developed into themes through iterative discussions with the research team. The current analysis involved six participants from each group to present preliminary results. Among the 12 participants, the mean age was 82 years, ranging from 72–92 in the Australian-born group and 68–92 in the CALD group. Five primary themes emerged: (1) No Complaints—participants did not want to complain about their meals, preferring staff to focus on their healthcare. This attitude was compounded for CALD participants who lacked the language to voice complaints; (2) Food and Identity—CALD participants viewed themselves separately from Australian-born patients, with the lack of culturally familiar food contributing to a feeling of being the minority; (3) Acceptance—the food service was viewed in the context of the overall hospital system, with participants accepting that meals may not suit their preference; (4) Experiences of the Food Service—influenced by participant’s individual preferences for meal quality, menu options, and staff interactions; and (5) Nutrition and Health—All participants had a preference for smaller portions due to their perception of reduced nutritional needs, yet meals were also valued for enjoyment. These preliminary results indicate that hospital food services should offer culturally familiar options, improve patient-staff communication, and provide personalised, smaller portions to enhance patient experience. Addressing the enablers and barriers to meeting cultural and individual dietary needs in hospitals will promote equity, diversity, and inclusion in healthcare.

Dietary fat type has been suggested as a risk factor for development of multiple sclerosis (MS)(1); however, the evidence is inconclusive. We aimed to test associations between dietary patterns correlated with intake of saturated fat (SFA), polyunsaturated fat (PUFA), monounsaturated fat (MUFA), along with the Dietary Approaches to Stop Hypertension (DASH) score, and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to the diagnosis of MS. We used data from the Ausimmune Study, a multicentre Australian case-control study of people with an FCD, aged 18–59 years. Using dietary intake data from a 101-item food frequency questionnaire(2), dietary patterns characterised by fat type (DP1; DP2) were generated through reduced rank regression with SFA, PUFA and MUFA as response variables. DASH scores were calculated. Logistic regression with full propensity score matching (matched on age, sex, study region, education, smoking history, history of infectious mononucleosis, deseasonalised serum 25-hydroxyvitamin D concentration, total energy intake, dietary misreporting) was used to test associations between dietary patterns (DP1, DP2, DASH) and FCD (cases = 259, controls = 497). Interactions between dietary exposures and sex were explored. DP1 was positively correlated with all fats and was characterised by high positive factor loadings for whole milk, processed red meat, and high-fat cheese, and high negative factor loadings for skimmed milk and fruits. DP2 was negatively correlated with SFA, but positively correlated with PUFA and MUFA, and was characterised by high positive factor loadings for margarine, nuts, and wholemeal bread, and high negative factor loadings for butter, whole milk, and sugar, preserves and confectionary. There were no associations between DP1, DP2 or DASH with FCD. These dietary patterns, characterised by fat type, showed no association with risk of FCD. To generate robust evidence on the role of dietary fat in MS onset, dietary patterns characterised by fat type could be explored in other population groups.

Childhood obesity persists at historically high rates globally, including an increasing number of children with severe obesity(1–3). Despite the growing demand of families with children needing treatment, effective interventions are largely unavailable or inaccessible(4,5). Using technology to transform such services that are conventionally delivered in person and offering electronic health (e-Health) interventions, may address limitations of current childhood obesity treatment. A randomised control trial (RCT) with a waitlisted control group evaluated the effectiveness of a 10-week family-focused web-based healthy lifestyle program with health coaching sessions, for treating childhood overweight and obesity, over 10 weeks. Outcome measures included change in children’s body mass index (BMI) z-score, waist circumference, dietary intake, physical activity, and quality of life, collected online at baseline and end of the web-based program (10 weeks). A total of 148 children (125 families) aged 7–13 years, with BMI ≥ 85th percentile, living in Victoria, Australia, were recruited and randomised to intervention (Cohort 1) or waitlist control (Cohort 2), of which 102 children (85 families) completed the RCT. Cohort 2 received no intervention during the control period. A clinically meaningful decrease in BMI z-score, in the context of weight maintenance and height growth, was observed in Cohort 1 compared to a negligible change found in Cohort 2 (mean difference in change in BMI z-score Cohort 1 vs Cohort 2 = −0.1; 95% confidence interval, −0.2, –0.0). Compared with Cohort 2, Cohort 1 adopted health-supporting lifestyle behaviours, such as improved diet quality and increased physical activity; and reported a clinically significant improvement in children’s quality of life at 10 weeks. Cohort 2 demonstrated similar changes in outcome measures after receiving the web-based program. Findings from this study furthers the growing body of evidence on the potential of e-Health interventions to upscale childhood obesity treatment. E-Health interventions, including a low-intensity program that requires minimal contact time with health professionals online, can enhance the effectiveness of conventional treatment services.

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction that affects 3.5% of Australians and is characterised by abdominal pain and altered bowel motions(1). People with IBS have described low treatment satisfaction from healthcare providers and services, citing a lack of person-centred care(2). This is concerning given that the dietary management of IBS using the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet (LFD) is the most efficacious dietary treatment for global symptom improvement(3). This study aimed to explore people with IBS’s experiences of a dietetic-mediated LFD and identify strategies for optimising LFD implementation. A qualitative descriptive study design involved semi-structured interviews with adults with IBS who participated in a dietetic-led research study on predictors of response to the LFD. Participants who commenced at least one of the three LFD phases between October 2020 and April 2022 were invited to participate. An inductive, iterative process was used to code participant transcripts and confirm the final themes. Themes were mapped against the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) to inform interventions to optimise the delivery of the LFD. Seventeen adults (32%, 17/53 response rate) aged 39 ± 15 years and 88% female-identifying consented to interviews. All phases of the LFD were completed by n = 9, with n = 4 completing Phases 1 and 2, n = 1 completing Phase 1 only and n = 3 commencing but not completing the first phase. Two main themes emerged. Firstly, patients wanted more dietetic appointments and support to implement the LFD. Participants wanted more frequent dietetic contact (approximately halfway through Phase 1, early to mid-Phase 2 and three to six months after commencing Phase 3) and appointments that were tailored to their individual needs and circumstances (face-to-face, phone and/or email) in each phase to troubleshoot diet implementation and manage symptoms. Further, more detailed education materials were requested, including recipes, acceptable foods, including commercial foods, and meal plans. Secondly, participants wanted a person-centred, multidisciplinary care approach with health professionals working together to be considered, given the complexity of IBS, especially with incomplete symptom resolution with the LFD. Participants recognised that stress, general anxiety and lifestyle factors contributed to symptoms and further support beyond the LFD was required. When mapped to the TDF and BCW, it was evident that environmental context and resources, knowledge, skills, beliefs and capabilities of the TDF and restructuring of the environment, education, training and self-monitoring domains of the BCW overlapped. The findings emphasise the need for a more person-centred care model using varied modes of delivery designed to suit individual needs and behaviour change requirements. Implementing multidisciplinary care, alongside behaviour change techniques, may assist treatment completion and IBS management.

Discretionary foods that are energy-dense and nutrient-poor contribute to over one third of total energy intake in Australian children and adults, and the typical portion sizes of many discretionary foods have increased significantly in the last two decades(1). The portion size norms (described as a typical perception of how much of a given food people choose to eat at a single eating occasion) are likely to have increased concurrently, with larger sizes now being considered the new normal(2). Public health interventions are urgently needed to reduce the portion size norms and consumption of discretionary foods(3), but the acceptability of such interventions remains unknown. Therefore, this qualitative study aimed to gain insights into consumers’ attitudes towards potential interventions targeted at promoting portion control of discretionary foods. Four online focus group sessions were conducted via Zoom with healthy Australian adults who regularly consume discretionary foods. A question guide was developed to gather participants’ perspectives around four potential public health interventions; reduction of the default serving sizes, increasing serving size options, changes to package sizes, and improving serving size labelling. A female facilitator moderated all focus groups, with a second moderator present to capture other relevant details. Collected data were analysed using a hybrid approach combining deductive and inductive thematic analyses. A total of 35 participants completed the study (19 females, mean age 38 ± 14 years). Participants identified the current food environment as promoting overconsumption; larger serving sizes were reported to be more ubiquitous and better value for money than smaller size options. An overall positive attitude towards the proposed interventions was noted. Out of the four proposed interventions, participants considered the most acceptable intervention to be providing a wider range of serving size options while maintaining a consistent unit price. Other acceptable interventions included reducing the default serving sizes with concurrent price reduction; education and clear guidance around portion size selection (for example, the involvement of health professionals to promote portion control, along with relevant recommendations of appropriate portion sizes from health authorities); more practical on-pack serving size suggestions; and innovative package designs that enable better portion control without contributing to food and plastic waste. In conclusion, participants identified a need for and were in support of interventions aimed at the portion control of discretionary foods. Further research should focus on examining the feasibility and effectiveness of the potential interventions to reduce the purchasing and consumption of large serving sizes. More efforts from public health authorities are required to develop practical and tailored recommendations for consumers around appropriate portion sizes for discretionary foods. Collaboration with the food industry and policy makers is also necessary for implementing public health interventions to reduce the excessive intake of discretionary foods.

The various COVID-19 lockdowns and restriction periods significantly changed both food accessibility and availability, which considerably impacted food practices of Australians. Food insecurity prevalence increased in Tasmania(1), but data from elsewhere in Australia is scarce and other changes in food shopping habits have not been reported. We aimed to explore Australian adults’ self-reported experiences of running out of food, spending on food and food shopping habits during the COVID-19 restriction periods in 2020. An online survey of Australian adults was administered via Qualtrics. Chi-square tests examined bivariate associations between categorical variables (gender, age, change in employment status, education level, main language spoken at home and marital status), and responses to the main research questions. Respondents (n = 764) were predominantly female (86%), primarily from Victoria (48%), with the majority over 55 years of age (57%, mean age [SD] 53.4 [18.1] years). Additionally, half (51%) were not in paid employment. Overall, 11% reported running out of food and not being able to purchase more. There was an association between age and running out of food (4% of the 64–74 and 75+ year old age groups ran out of food compared to 23% of the 18–24 year olds, p < 0.001, chi square). The most reported reasons for running out of food, out of six provided options, were ‘lack of availability in the shops’ (74%) and ‘lack of money’ (34%). There was no association with gender, employment status change, education level, main language spoken at home, or marital status and running out of food. When asked how the amount of money spent on food changed during COVID-19, most respondents (n = 318, 42%) reported spending about the same amount of money as before the pandemic, 284 (37%) reported spending more and 162 (21%) reported spending less on food. About a third of respondents (38%, n = 293) reported buying more food than they needed since the start of COVID-19 and 9% (n = 66) reported wasting more food than usual. This did not differ with age, gender, employment status change, education level, main language spoken at home, or marital status. Nearly two-thirds (63%) reported that they had changed how they bought their food since the start of COVID-19.Of these 75% reported a change in frequency of food shopping and 45% reported a change in the amount of time spent food shopping. Just under half (44%) reported a change in the amount of money spent on food and 42% reported a change in the food bought. The COVID-19 pandemic restrictions caused significant changes to Australians’ food procurement and younger people appeared more at risk of food insecurity. Policies that support young people are important to ensure food security in the most vulnerable groups.

Handgrip strength (HGS) is a marker of protein-energy status in people on haemodialysis (HD). Best practice guidelines recommend measuring HGS before the commencement of the dialysis session, which is not always possible(1). No previous research has compared the reliability, reproducibility and agreement of HGS values pre- and mid-dialysis. Here we aimed to determine the reliability, reproducibility and agreement of HGS values pre- and mid-dialysis. Participants were recruited from four HD units (n = 47). Eligible participants were stable on HD for at least 3 months and not acutely unwell. HGS was measured in triplicate on the non-fistula arm before dialysis (pre-dialysis HGS) and two hours into dialysis (mid-dialysis HGS) for three consecutive weeks. Wilcoxon signed ranked tests were used to determine the difference between pre and mid-HGS. Friedman tests with Dunn’s post hoc test were used to determine the repeatability of the HGS measures over three weeks. Bland Altman plots were used to determine the agreement between pre- and mid-measures. We observed that HGS measures taken pre- and mid-dialysis differed statistically (19.0 kg [IQR, 14.5–28.1] vs 19.9 kg [IQR, 15.0–28.4], p = 0.005), but not to a clinically relevant level(2,3). There were no significant differences in pre-dialysis HGS measures (p = 0.34) nor mid-dialysis HGS measures (p = 0.16) over the 3 weeks. Bland Altman plots indicated agreement between pre- and mid-dialysis HGS measures, suggesting no systematic bias in HGS. This study found that HGS taken at either pre- or mid-dialysis were reliable and reproducible. These data indicate reasonable agreement between pre- and mid-dialysis HGS measures. Mid-dialysis HGS is a valuable tool for monitoring changes in the nutritional status of HD patients, providing HGS is consistently measured mid-dialysis.

Children attending Early Childhood Education and Care settings (ECEC) receive half of their daily nutritional needs from these services(1,2). Issues such as poor menu quality and high food waste in ECEC have been documented(3), which has implications for human and planetary health. Thus, monitoring food served and wasted in ECEC is crucial. Weighed measures are most rigorous, but reliable weighing protocols are needed to support accuracy(4). A self-administered audit tool for ECEC cooks was developed to measure the weight of food served (for nutritional analysis) and food wasted at pre-consumer (serving waste) and post-consumer (plate waste) levels. This tool was used in previous ECEC research(3) and offers a low cost, scalable option for monitoring diet quality and food waste. The aim of the present study was to assess the equivalence of the audit tool across administrators. Data was collected in June 2024 at a university food laboratory by a trained researcher (TR) and six research assistants (RAs) using the same protocol, and under conditions similar to those in ECEC settings. Menu and waste data from previous ECEC research(3) were used to simulate provision and waste of one meal and two snacks for 25 children over two days. Raw ingredients, simulated serving waste and plate waste were weighed and photographed first by the TR, followed by RAs. Weighing was conducted individually, and data entry sheets coded to ensure blinding of data among researchers. Coded data were entered into an Excel spreadsheet, with accuracy checks. The mean % difference and standard deviation of difference between TR and RAs for weights of raw ingredients, total food served, serving waste and plate waste were calculated. Equivalence testing was used to verify if the mean % (and 90% CI) were within established margins (± 10%). Results showed high reliability of the tool between users, with statistical equivalence for weight comparisons of total prepared food served, total serving waste and total plate waste (all p’s < 0.001). For raw ingredients most items (45 of 54) were statistically equivalent (all p’s < 0.05). Results were inconclusive for prepackaged items, grated apple and sweet chilli sauce (n = 5) and not equivalent for some small items (oil and garlic, n = 4). The audit tool could therefore be considered reliable for measuring total food served, serving waste, and plate waste, and provided accurate measurements for most individual raw ingredients. The tool provides a scalable, low-cost option to audit food provision and waste in ECEC settings. Its self-measurement enables research in geographically diverse ECEC settings. It also has the potential of becoming a support strategy for ECEC to monitor and improve their own food provision and waste levels. Future research could focus on digitalisation of the tool.

Chinese immigrants living in Western countries are at a higher risk of developing chronic diseases compared to those in China, due to the development of unhealthy dietary patterns during the process of acculturation(1). Australia, with 2.3% of its population being Chinese-born(2), serves as a representative country to explore Chinese immigrants’ food choice determinants. Food choice determinants have been widely researched, with numerous factors identified such as affordability, taste preferences and hunger/satiety. Contento (2018) developed a comprehensive framework which identified and categorised over 30 determinants into four socio-ecological groups(3). Therefore, the focus of current research is not the identification of food choice determinants but to explore the interactions among these determinants. Understanding the cultural influence on food choice is vital for target groups with a shared ethnic background. This study aimed to qualitatively explore the similarities and differences in food choice determinants between Chinese people in mainland China and those living in Australia. Ethical approval for this study was obtained from Monash University Human Research Ethics Committee. Eighteen participants were recruited for semi structured in-depth interviews from June 2021 to March 2022, with eight from Australia and ten from mainland China. Convenience and snowball sampling methods were employed to ensure a diverse sample regarding socio-economic background, occupation, health status, age, and education level. Interviews were conducted in Mandarin via in-person or video/voice calls and were audio-recorded and transcribed verbatim. Thematic analysis and investigator triangulation were used for data analysis. Four themes were identified. (a) Food choice determinants were influenced by nutrition perceptions and personal food philosophy. Chinese Australian immigrants were influenced by Western nutrition beliefs to a greater extent than their counterparts living in mainland China. Non-scientific or controversial nutrition beliefs were common. Personal food philosophy (e.g., eating food is for survival only, or for enjoyment, or for health) profoundly influences food choices. (b) Chinese people adjusted their dietary habits in response to clinical symptoms or self-observed physiological changes, such as, gaining weight or digestive issues. (c) Convenience was a predominant food choice determinant due to factors like long working hours, lack of motivation to cook, lack of cooking skills, time restrictions, and viewing cooking as a chore. (d) Different food environments in China and Australia lead to distinctive food choices. Chinese Australians were more price-sensitive, had more food safety concerns, and cooked more frequently at home than mainland Chinese, due to differences in food affordability, accessibility and information exposure between these two countries. Importantly, nostalgia for childhood foods had a unique influence on certain food choice behaviours in Chinese Australians. These cultural characteristics in food choice determinants should be considered by health educators, nutrition professionals, and policymakers when developing culturally appropriate health interventions for Chinese people.

Flavonoids, found in plant foods, are becoming increasingly recognised for their health benefits(1). A valid, reliable and short dietary assessment tool is necessary to assess flavonoid intake, as current methods are burdensome for researchers and participants. This study aimed to evaluate the validity and reproducibility of a flavonoid food frequency questionnaire (Flav-Q), which was derived from the Kent & Charlton Flavonoid Food Frequency Questionnaire (FFQ)(2). The Flav-Q contains 23 items and was validated against repeated 24-hour dietary recalls in an Australian adult population (18y+). The Flav-Q was administered at four time-points over 12 months period (n = 80). At each time-point, two 24-hour dietary recall surveys were completed using Intake-24(3). Usual flavonoid intake was assessed by cross-referencing food lists with the Phenol-Explorer database and averaged using the multiple source method (MSM) for participants who had at least 4 recalls. The criterion validity of the Flav-Q at baseline was compared against the usual intake using the Wilcoxon signed-rank test, Spearman’s correlation coefficient, Bland-Altman plots, and Cohen’s kappa (κ)(4). The reproducibility of the baseline Flav-Q (Flav_Q1) was compared with time points 2, 3, and 4. Mean total flavonoid intake was higher for Flav-Q1 compared to usual intake (443.2 mg/day vs 234.4 mg/day, p < 0.001) and overestimated subclass intake except for flavanones. Moderate to strong correlations were found between Flav-Q1 and usual intake for total flavonoids (r = 0.66, p < 0.001; κ = 0.45, p < 0.001) and subclasses flavan-3-ols (r = 0.72, p < 0.001; κ = 0.53; p < 0.001)), flavonols (r = 0.55, p < 0.001; κ = 0.40, p < 0.001), flavanones (r = 0.49, p < 0.001; κ = 0.30, p = 0.007), and a weaker non-significant correlation for anthocyanin (r = 0.38, p < 0.001; κ = 0.15, p = 0.18) and flavones (r = 0.34, p < 0.001; κ = 20, p = 0.07). Bland-Altman plots showed a large bias and wide limits of agreement (61.64%) for total flavonoid intake. Flav-Q demonstrated high reproducibility across all timepoints (Flav-Q1 vs Flav-Q2 r = 0.82, p < 0.001; κ = 0.70, p < 0.001), Flav-Q1 vs Flav-Q3 (r = 0.68, p < 0.001; κ = 0.47, p < 0.001), Flav-Q1 vs Flav-Q4 (r = 0.63, p < 0.001; κ = 0.47, p < 0.001). Mean percentage differences between repeated timepoints for total flavonoid ranged from 19% to 31%, with Bland-Altman plots showing good levels of agreement. Overall, the Flav-Q tool was reproducible and demonstrated some agreement for assessing the intake of total flavonoid and its subclasses. However, further validation to determine reasons for over-estimation is necessary.

Traditional Cambodian recipes have been prepared the same way over time, with their nutritional quality largely unknown. Poor nutritional status is common among Cambodian children with 22% experiencing stunting and 16% underweight(1), while Cambodian women exhibit the double burden of malnutrition with 44% having anaemia and 33% above the healthy weight range(1). Most Cambodian women have inadequate intakes of key nutrients including vitamin A, thiamine, zinc and iron(2). Recent Cambodian studies have focused on increasing nutrient intakes, with improved nutritional quality of mixed dish recipes a novel, potential approach(3). However, the absence of a Cambodian-specific food composition database means nutrient information for common mixed dishes is unavailable. This study aimed to quantify the nutrient profile of traditional mixed dishes commonly consumed by Cambodian women and children. A secondary aim was to qualitatively explore Cambodian women’s receptiveness to nutrient-enhanced traditional mixed dishes. A sequential mixed methods approach was used to collect traditional recipes and nutritionally analyse Khmer mixed dishes, then conduct qualitative focus groups to assess recipe acceptability. Over 900 recipes were collected by Cambodian women who had a child < 5 years via a custom-built smartphone app, as part of a dietary assessment study in Cambodia in 2019 and 2020. After grouping and counting recipes to determine consumption frequency, ingredients and quantities, these were consolidated into 27 commonly consumed recipes. The nutrient composition of consolidated recipes was determined using an INFOODS template(4). Dietitians then created six nutritionally-enhanced versions of Khmer mixed dishes by switching or adding common high-nutritive ingredients. In Siem Reap province four 90-minute focus groups were conducted with Cambodian mothers (two rural, two urban). Three dishes per group were prepared and served with rice, and women’s responses to each nutritionally-enhanced Khmer mixed dish were discussed. Nutrient analysis indicated that a median serve of traditional Khmer fish soup contributed 25% protein, < 10% iron and folate, and < 20% zinc and thiamine required daily for non-lactating women. Initially Cambodian women were sceptical about modifying traditional Khmer recipes, expressing resistance to change: ‘They would wonder, where did you learn that?’. Inspecting each dish, they discussed how strange the ingredients seemed, disbelieving their acceptability: ‘It is weird […], never put other green leaves’. After tasting, women expressed surprise they liked the flavour, describing these modified dishes as ‘unique’ or ‘creative’, recognising they would ‘gain more nutrition’ with this enhanced recipe. Most women declared they would try this modified dish at home ‘I would like to share it to my sister and my friends and family’. Results highlight future interventions promoting nutritionally-enhanced recipes of commonly consumed meals need to support women to overcome initial resistance through trialling them to evaluate acceptability, prompting them to share with their household.

Food security is a crucial issue for policymakers, practitioners, and researchers(1). Network analysis, which examines complex systems and relationships(2), can provide valuable insights into food security through the interactions of individuals and organisations. This study aimed to explore the Twitter network discussing food security in Australia, focusing on user connections and key influencers. Data was collected from 2019 to 2021 using the Twitter API and Python software(3). Eligible tweets were those sent by Australian users, in English, and containing at least one food security-related search term. From this data the interactions (re-tweets, replies and quote tweets) between users was extracted, including only users who interacted with another user from the dataset at least twice. Social network analysis was conducted using the software Gephi(4) where interactions (edges represented as lines) between users (nodes represented as circles) were visualised. Sentiment and topic analysis of the tweets were also used to explore what was being said and in what tone(3). The network comprised n = 2,172 Twitter users and 3,304 connections. However, 394 connections (11.9%) were self-interactions, contributing to a low network density of 0.001. The median number of users each user connected with (degree) was 1 (25th, 75th percentiles 1, 2), ranging from 1 to 346. The most common topic discussed by n = 589 users (27.1%) was global food production and the most common sentiment was positive (n = 1,228 users, 56.5%). High modularity (0.740/1) indicated the network could be divided into distinct communities that had dense connections within but not necessarily outside of their community. There were 353 communities, with 209 (59.2%) of these communities containing only one user. The largest ten communities represented 71.9% of the network, with the largest community (n = 530 users) focusing on Australian food insecurity and food banks, discussed from a political and refugee perspective with a generally negative tone. Betweenness centrality identified key influencers who connected various parts of the network. The top 20 influential users included seven non-profit organisations, seven academics, three advocacy groups, two political accounts, and one government account. Non-profit organisations often interacted with each other, while academics were mainly clustered in the same community. High-degree users, who had the most direct connections (≥ 35 connections), were predominantly non-profit organisations, with fewer academic and more political accounts than those with high betweenness centrality (≥ 12,000). Despite the overall low network density due to isolated users and relatively insular communities, some individuals exhibited extensive connections, highlighting their central role and potential influence in Twitter discussions. Future research could examine how these dynamics evolve and explore strategies to enhance connections, thereby enabling diverse social media users to better influence public discourse and ultimately policy on food security issues.

Nutrition professionals are needed to be change agents for promoting healthy and sustainable food systems, however, the best methods for preparing students are unclear(1,2). Experiential learning opportunities, such as hands-on activities with sustainable food systems, could bridge the gap between theoretical knowledge and practical application(3). This study aimed to evaluate how an experiential learning activity using Farmwall Vertical Garden, an aquaponics system for growing nutrient-dense microgreens, influenced third-year university nutrition students’ perceptions, awareness, and knowledge of local food systems, as well as their attitudes and behaviours towards sustainability and local food consumption. Pre-surveys assessed students’ baseline knowledge, attitudes, and diet quality was measured using the Australian Recommended Food Score (ARFS)(4). The hands-on activity with Farmwall, including a seeding activity and recipe development, aimed to deepen their understanding of local food systems, sustainable diets, and links to future professional practice. Post-surveys measured changes in these areas, intentions for behaviour change, and their main learnings from the activity. Quantitative data analysis included descriptive statistics, Chi-Square tests, linear regression models, and McNemar-Bowker tests. Qualitative data was analysed thematically. In the pre-survey, students (n = 58) reported limited knowledge of local food systems (60.3%) but recognised their importance (77.6%) and positive environmental impact (73.3%). Sustainable practices students valued most included purchasing minimally packaged foods (69.0%), ethically certified products (56.9%), and locally grown produce (58.6%), with less emphasis on consuming plant-based (27.6%) and organic foods (31.0%). Chi-square tests revealed that students who believed sustainable food practices were important were significantly more likely to engage in these behaviours (p < 0.05). The average ARFS diet quality score was 39.7 ± 8.4, classified as ‘excellent ‘. Linear regression revealed that engagement in sustainable practices, such as growing own food (B = 4.4; p = 0.047) and buying locally grown (B = 5.2; p = 0.029) and seasonal foods (B = 5.8; p = 0.021), was associated with significantly higher diet quality score. The Farmwall activity significantly increased students’ knowledge of local food systems (p < 0.001) and increased their intentions towards buying locally grown foods (pre = 57.9% to post = 86.8% p < 0.001) and growing their own food (pre = 36.8% to post = 78.9% p < 0.001). Post-activity responses highlighted students’ learning about the complexity of sustainability, the benefits of sustainable dietary practices, and the relationship with the future professional practice. In conclusion, an experiential learning activity with Farmwall significantly improved students’ knowledge, attitudes, and intentions regarding sustainability and local food systems. Integrating similar experiences into the curriculum could enhance theoretical knowledge with practical skills, better preparing nutrition professionals to advocate for and implement sustainable practices into future professional practice.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide(1). As poor diet quality is a major contributor to CVD burden; dietary intervention is recommended as a first-line approach to CVD prevention and management(2). Personalised nutrition (PN) refers to individualised nutrition care based on genetic, phenotypic, medical, and/or behavioural and lifestyle characteristics(3). Medical nutrition therapy by dietitians shares many of these principles and can be categorised as PN(4). PN may be beneficial in improving CVD risk factors and diet, however, this has not previously been systematically reviewed. The aim of this systematic review was to evaluate the effectiveness of PN interventions on CVD risk factors and diet in adults at elevated CVD risk. A comprehensive search was conducted in March 2023 across Embase, Medline, CINAHL, PubMed, Scopus and Cochrane databases, focusing on randomised controlled trials (RCTs) published after 2000 in English. Included studies tested the effect of PN interventions on adults with elevated CVD risk factors (determined by anthropometric measures, clinical indicators, or high overall CVD risk). Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria checklist. Random-effects meta-analysis were conducted to explore weighted mean differences (WMD) in change or final mean values for studies with comparable data (studies with dietary counselling interventions), for outcomes including blood pressure (BP), blood lipids, and anthropometric measurements. Sixteen articles reporting on 15 unique studies (n = 7676) met inclusion criteria and were extracted. Outcomes of participants (n = 40–564) with CVD risk factors including hyperlipidaemia (n = 5), high blood pressure (n = 3), BMI > 25kg/m2 (n = 1) or multiple factors (n = 7) were reported. Results found potential benefits of PN on systolic blood pressure (SBP) (WMD −1.91 [95% CI −3.51, −0.31] mmHg), diastolic blood pressure (DBP) (WMD −1.49 [95% CI −2.39, −0.58] mmHg), triglycerides (TG) (WMD −0.18 [95% CI −0.34, −0.03] mmol/L), and dietary intake in individuals at high CVD risk. Results were inconsistent for plasma lipid and anthropometric outcomes. Dietary counselling PN interventions showed promising results on CVD risk factors in individuals at-risk individuals. Further evidence for other personalisation methods and improvements to methodological quality and longer study durations are required in future PN interventions.

Observational studies suggest higher intake of cruciferous vegetables (e.g., broccoli, cauliflower, kale) is associated with lower chronic disease risk(1,2). Glucosinolates (GSL) and cysteine sulfoxides such as S-methyl cysteine sulfoxide (SMCSO) are sulfur-containing compounds found in high amounts in these vegetables(3). Currently, no data exists on SMCSO levels in Australian-grown cruciferous vegetables and limited data exists for glucosinolates (GSL). The levels of SMCSO retained in cruciferous vegetables after various domestic cooking methods is unknown, and measurement of SMCSO and GSL levels in cooked Australian-grown cruciferous vegetables is limited. This study sought to (1) quantify SMCSO and GSL in Australian-grown cruciferous vegetables and (2) identify the most preferable cooking methods to retain levels in these vegetables. Using liquid chromatography mass spectrometry, we quantified SMCSO and ten GSL in seven cruciferous vegetables before and after steaming. We further quantified levels in broccoli before and after microwaving, stir-frying, and boiling. Each cooking method; steaming (3 minutes), microwaving (2 minutes), boiling (3 minutes), stir-frying (4 minutes); was chosen so vegetables remained firm and not overcooked to mimic healthy cooking recommendations(4). Student t-tests were used to compare the differences in raw and steamed levels for all vegetables, and analysis of variance with Tukey post-hoc assessed the differences in raw and cooked broccoli (i.e., steamed, microwaved, boiled, stir-fried). Overall, SMCSO contributed greater dry weight (0.6–1.9%) than total GSL combined (0.3–1.2%). SMCSO levels from lowest to highest were Chinese cabbage < white cabbage < cauliflower < kale < red cabbage < broccoli < Brussels sprouts (6–19 mg/g dry weight [DW]) and GSL levels were cauliflower < Chinese cabbage < red cabbage < kale < broccoli < white cabbage < Brussels sprouts (3–12 mg/g DW). SMCSO increased after steaming (1–24%) in all vegetables except white cabbage (−31%), kale (−18%), and Chinese cabbage (−5%), but only reached statistical significance in Brussels sprouts (+16%, p < 0.05). Most vegetables increased total GSL (ranging 1–34%) after steaming, except kale (−38%) and Chinese cabbage (−8%). Stir-frying and boiling broccoli led to significant losses in SMCSO (−34% and −50%, respectively) and in the two dominant GSL in broccoli; glucoraphanin (−47% and −52%, respectively) and glucobrassicin (−46% and –51%, respectively) (all p < 0.05). We have quantified SMCSO and GSL levels in a selection of Australian-grown cruciferous vegetables (broccoli, kale, Brussels sprouts, cauliflower, red, white, and Chinese cabbages) before and after cooking. SMCSO and GSL levels were relatively stable after light steaming. Additionally, light steaming or microwaving were the most preferable methods to retain SMCSO and GSL levels in broccoli. Boiling or stir-frying broccoli were the least favourable. These results have important implications when estimating intake of these beneficial sulfur-containing compounds.

Parents are pivotal in shaping healthy eating, physical activity and screentime behaviours in the early years(1). Early Childhood Education and Care (ECEC) services provide an ideal setting for parent communication initiatives to promote positive lifestyle behaviours in young children(2). This study aimed to determine the feasibility, acceptability and potential efficacy of the Healthy Adventures Book (HAB) pack in increasing parent and carer capacity to support positive dietary intake, physical activity and screen use behaviours of their 3–5-year-old children. ECEC services in western Sydney (n = 136) and families with 3–5-year-old children (n = 258) participated in the study. Families were provided with a HAB pack to take home, consisting of a scrapbook containing health information, a vegetable-shaped toy and story book. Families were encouraged to read the information and story book, and to support their child to complete the activity in the book. A quasi-experimental mixed-methods design was used. Parents completed pre- and post-intervention questionnaires that included questions on demographics, and readiness and confidence to support behaviour change. Process data were collected from parents and ECEC directors. Semi-structured interviews were conducted with parents post-intervention. Changes in parent readiness and confidence were analysed using Mann Whitney U tests. Thematic analysis was conducted on parent interview data. There was a significant improvement in parent confidence to support physical activity from pre- to post-intervention (p < 0.01). No significant changes were found for other behaviours. Process evaluation showed high acceptability, with 93% of parents reporting children were excited to use the pack, 91% finding it easy to complete, and 86% finding it useful for learning about healthy behaviours. All ECEC directors agreed the pack was well-received, easy to implement, appealing to families, and facilitated conversations about health behaviours. Qualitative analysis revealed six key themes: whole family involvement, easy access to relevant health information, reinforcement of key health behaviours, vegetable intake, screen time, and continuation of learning. Parents reported the pack encouraged family engagement, provided useful strategies, and reinforced health messages. However, parents expressed that they would like ongoing support to maintain behaviour changes. Study limitations included a small sample size, no control group, and potential selection bias of already health-conscious families. In conclusion, the HAB pack was feasible and acceptable to both ECECs and families, demonstrating potential as a health promotion tool, particularly for encouraging physical activity. Further, it has the capacity to improve communication between the ECEC setting and home environment to ensure consistency of health messaging to children. More research is needed to determine efficacy and explore strategies for sustained behaviour change.

A clear understanding of nutrient intake at a national scale is important to ensure food security into the future. National nutrition surveys are expensive and slow, with the latest data in Australia from 2011–13. However, nutrients available for consumption in Australia can be easily accessed from the food balance sheets produced by the Food and Agriculture Organization of the United Nations (FAO), with the latest data from 2021. This project compares nutrient intake and nutrient supply data from 2011–2013 to determine whether nutrient supply data is an acceptable surrogate measure for estimating national nutrient intake levels. To compare national nutrient intake and supply, data were collected from the Australian Health Survey 2011–13(1); the 2011–2013 FAO food balance sheets(2); and Nutrient Reference Values (NRVs) for Australia and New Zealand for 23 essential nutrients(3). Nutrient supply data were adjusted with both consumer waste and inedible portions, and inedible portions alone. Nutrient intake and nutrient supply per capita per day were converted to a relative percentage of the target value from the NRVs. One-sample, two-tailed t-tests were conducted to identify statistical differences between intake and supply of individual nutrients. A p-value < 0.01 was considered a significant difference between nutrient intake and nutrient supply. For 18 nutrients there was a significant difference between nutrient intake and supply adjusted for inedible portions only. For 15 nutrients there was a significant difference between nutrient intake and nutrient supply adjusted for both consumer waste and inedible portions. There was no difference between intake and supply adjusted for inedible portions of calcium, dietary fibre, iodine, riboflavin, and long- chain omega-3 fatty acids. For r calcium, magnesium, zinc, iron, iodine, riboflavin, long-chain omega-3 fatty acids, and folate equivalents there was no difference between intake and supply adjusted for consumer waste and inedible portions. When supply data was adjusted for both consumer waste and inedible portions this reduced the differences between intake and supply, making it a better representation of nutrient intake data. This study found that nutrient supply data from the FAO, even after adjustment for inedible portions and consumer waste, was not suitable for estimating nutrient intake of the Australian population. A key limitation was the unavailability of consumer food waste data specific to Australia (the data used was representative of Oceania), which may further reduce the differences between supply and intake data. Assessing national dietary intake is challenging(4,5) but current survey practice cannot easily be replaced for understanding the nutrient intake of Australians.

Micronutrient malnutrition is a public health concern in many developing countries including Sri Lanka. Rural poor households are more vulnerable to micronutrient malnutrition due to their monotonous rice-based diet, which lacks dietary diversification(1). Despite the potential of home gardens on increased food access and diversity, their contribution to household dietary diversity remains unclear. This study aimed to investigate the impact of home gardens on diet diversity among rural Sri Lankan households. Low-income households with children under five were randomly selected from the Samurdhi beneficiary list, and 450 households having a home garden agreed to be interviewed. We collected information on types of crops and livestock produced over the past 12 months and their utilisation. We also collected the socio-demographic characteristics of the households. We measured household dietary diversity using the Household Dietary Diversity Score (HDDS) based on FAO guidelines. Multiple linear regression was used to identify the predictors of HDDS. Complete data sets were only available for 411 households and were included in the analysis. The HDDS ranged from 3 to 10 with a mean of 6.4 (±1.37 SD) indicating a moderate level of dietary diversity. However, only 20.4% of the households met the adequacy threshold, which is higher than the third quartile(2). Cereals, and fats and oils were the only food groups consumed by all the households. Although many households produced fruits (67.2%) and reared livestock (48.2%), the consumption of these groups were the lowest among the 12 food groups. Predictors of HDDS included monthly household income which had a strong positive relationship, especially earnings above 35,000 LKR (β = 1.02; S.E = 0.246; p = 0.000). Surprisingly, living far from the market was associated with increased HDDS (β = 0.026; S.E = 0.008; p = 0.004). Conversely, living further away from the main road reduced the HDDS (β = −0.133; S.E = 0.049; p = 0.007). Growing staples reduced the HDDS (β = −0.395; S.E = 0.174; p = 0.023), whereas growing leafy vegetables increased the diet diversity (β = 0.394; S.E = 0.154; p = 0.010). Selling homegrown products also increased HDDS (β = 0.276; S.E = 0.136; p = 0.043). However, other covariates such as the education level of the female adult, household food security status, home garden yield (kg), and livestock richness, which showed significant correlation in the bivariate analysis did not significant in the multiple regression analysis. Although all households in this district engage in some form of home gardening, 79.6% of households did not have adequate dietary diversity. There is a need to understand how home gardens can better contribute to dietary diversity.