9995 results in Proceedings of the Nutrition Society
A qualitative study of patients’ perceptions of DASH diet apps for dietary self- management of hypertension in Saudi Arabia
- G. Alnooh, E. Williams, M. S Hawley
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E224
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Nutrition smartphone apps have become a popular and readily accessible approach to improving dietary behaviour. Hypertension is often associated with a poor diet, and its prevalence is increasing in Saudi Arabia(1). The Dietary Approaches to Stop Hypertension (DASH) eating plan has been shown to reduce blood pressure in people with hypertension(2). A previous study identified two high-quality, safe, and potentially effective smartphone apps for managing hypertension: NOOM and DASH To TEN(3). This study aimed to explore the potential of these two DASH diet self- management apps for controlling blood pressure in the Saudi Arabian context.
Fifteen patients were recruited at King Abdullah bin Abdulaziz University Hospital in Riyadh, Saudi Arabia. Ten patients had hypertension, and five had prehypertension (mean age = 45). Patients were given the two apps and asked to try each for one week. Focus groups (n=4) were held at the end of the trial to understand the patient perceptions of the apps. Discussions were recorded, and the transcriptions were analysed using a thematic framework analysis(4).
The following four themes emerged:
1. Managing hypertension through diet was perceived as important. Most patients reported that
adhering to the DASH diet was challenging due to a lack of motivation and willpower,
inadequate support from household members, and high prices for healthy food.
2. The potential and current reach of dietary apps emerged as a main theme, and many
comments related to patients’ belief that dietary apps could increase their motivation and awareness about the DASH diet. Barriers to the use of apps were also identified including their difficulty of use, a preference for dietetic monitoring, and cost.
3. Interactive app functionality was identified as a key theme, as evidenced by comments about a straightforward sign-up process, an extensive food database for dietary self-monitoring, feedback, goal setting, and reminders, considered essential for diet adherence.
4. A preference for the NOOM app emerged. Patients perceived the NOOM app more suitable in the Saudi context. Noom was deemed to support DASH self-management because it supports weight reduction, which helps lower blood pressure. NOOM was perceived as highly interactive, offering motivational reminders, feedback, realistic dietary plans, and a comprehensive food database. Patients made several recommendations for app improvement; these included Arabic language support, automatic calculation of sodium and potassium consumption, and lower cost. Patients also expressed a desire for training in the use of the app.
This qualitative analysis suggests that the NOOM app could be suitable for use with hypertensive patients in Saudi Arabia. Further research is needed to determine the feasibility and efficacy of long- term use of the NOOM app with a Saudi Arabia population.
Effects of dietary nitrate supplementation on markers of oral health: A systematic review
- S. Alhulaefi, A. Watson, S.E Ramsay, N. Jakubovics, J. Matu, A. Griffiths, R. Kimble, K. Brandt, OM. Shannon
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E210
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The oral cavity is a vital part of the digestive system. Poor oral health can impact an individual’s ability to eat and has been associated with increased risk of non-communicable diseases and reduced longevity. Conversely, positive oral health has been associated with improved cardiometabolic, cognitive and systemic health and greater longevity. Consumption of dietary nitrate, which is processed in the mouth into nitrite, and is subsequently converted into nitric oxide (NO) in the body (1), has been demonstrated to reduce blood pressure, improve endothelial function, and enhance exercise performance. Interestingly, recent studies suggest that nitrate consumption could also positively modulate markers of oral health (2). To our knowledge, no systematic review has been published examining the effect of inorganic dietary nitrate on oral health. However, this could be valuable to summarise current state of the knowledge, identify effect modifiers and highlight gaps for future research. Therefore, this systematic review aims to investigate the effects of dietary nitrate supplements on markers of oral health in vivo in randomised controlled trials (RCTs).
This study was pre-registered with PROSPERO (CRD42023411159). Five databases (PubMed, The Cochrane Library, CINAHL, MEDLINE, and SPORTDiscus) were searched from inception until March 2023 to identify studies that met the following criteria: adult participants (≥ 18 years) and RCTs investigating the effects of oral dietary nitrate versus placebo on markers of oral health. A narrative synthesis of data was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
Nine articles reporting data on 284 participants were included. Nitrate was provided via beetroot juice (six studies), a beetroot-derived supplement dissolved in mineral water (one study), and lettuce juice (two studies). The duration of the interventions ranged from one day to a maximum of six weeks. Dietary nitrate supplementation increased the relative abundance of several individual bacterial genera including Neisseria (increased in three studies) and Rothia (increased in three studies). Dietary nitrate supplementation increased salivary pH (increased in two studies) and decreased salivary acidification resulting from the consumption of a sugar-sweetened beverage (decreased in two studies). Furthermore, dietary nitrate supplementation resulted in a decrease in the gingival inflammation index in one study. Overall, the risk of bias in studies was mixed. One study had a low risk of bias, while the rest were rated as having some concerns. No study was considered to have a high risk of bias.
The results show that dietary nitrate is a potential nutritional strategy that can potentially benefit oral health by modifying the oral microbiome, altering salivary pH, and minimising gingival inflammation.
Characterising dietary protein intake in Irish adults on the island of Ireland
- H. Griffin, A.P Nugent, B. A McNulty, D. Wright, L. Brennan
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E207
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Shifting dietary protein intakes from animal to plant-based sources is suggested as a path to sustain the world’s food consumption and maintain planetary resources (1). However, to facilitate change, it is important to characterise baseline dietary protein patterns. This study aimed to examine dietary protein intakes on the island of Ireland in order to determine population characteristics and food sources influencing protein intake.
Analyses were performed on the Northern Ireland sub cohort of the UK National Dietary Nutrition Survey (NDNS 2016-2019) (2) and the Irish National Adult Nutrition Survey (2008-2010) (3). Both surveys used a four-day food diary and a final sample of 1484 adults, aged 18-64 years was extracted (NANS; n =1274 and NI NDNS; n=210). Mean daily intakes for protein (MDI; % total energy, TE) for the total population were calculated and the population was divided into three tertile groups based on low, medium and high protein intake (%TE). Differences in population characteristics, energy MDI, key nutrients (%TE or per 10MJ) and contributing food sources were examined across these tertiles, using chi-square and one-way ANOVA with covariates (age and BMI) and correcting for multiple comparisons as appropriate (P<0.005).
Overall, 17.1% of TE was obtained from protein and 77% of participants met their protein DRV based on EFSA recommendations of 0.83g/kg/body weight (4). The difference in protein intakes between the highest and lowest tertiles was 7.8% TE (21.2 % TE vs 13.4% TE) with high protein consumers reporting lower energy intakes (1734 ±564kcal) compared to low consumers (2185± 661 kcal). High protein consumers were older (42.5 ± 12.8 years) and had a higher BMI (27.7 ± 6.0 kg/m2). They also had higher MDI of dietary fibre, calcium, zinc, sodium, iron, folate and vitamins A, C, D and B12 (per 10MJ) (p<0.001) and lower MDI of carbohydrates, fat, saturated fat (%TE) in comparison to low consumers (p<0.001). The % contribution of ‘chicken, turkey and dishes’ (18.3%), ‘beef, veal and dishes’ (12.8%) and ‘fish and fish products (7.0%) to protein intakes were significantly higher in the high versus the low consumption group (10%, 7.4%, 4.4% TE respectively; P<0.001). In contrast, those in the lowest protein intake group had a significantly higher intakes of protein coming from dietary sources including ‘burgers, sausages and meat products (9.9 vs 5.9%), ‘white bread and rolls’ (6.9 vs 3.9%), ‘potatoes (including chips)’ (4.1 vs 2.9 %) and ‘cakes, pastries, buns and fruit pies’ (1.7 vs 0.8%) compared to high consumers.
In general, animal protein sources contributed more to total daily protein intakes than plant sources, however, the pattern of protein foods differed according to level of protein intake. These findings will aid in the development of strategies to diversify protein intakes on the Island of Ireland.
Dietitians’ perspectives on clinical pathways and practice in relation to the dietary management of irritable bowel syndrome in the UK: A qualitative study
- K. Belogianni, P. Khandige, S. Silverio, S. Windgassen, R. Moss-Morris, M.C.E Lomer
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E205
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Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition which negatively impacts quality of life(1). Dietary triggers are common and dietary management is central to the IBS treatment pathway with dietitians being the main education providers for patients(2). The aim of this study was to explore the perceptions of dietitians towards current practices in IBS services in clinical settings across the UK.
Qualitative semi-structured interviews were undertaken to explore current practices, barriers, and facilitators to dietetic practice and expected treatment outcomes. Eligible participants were dietitians specialising in IBS and working in the National Health System (NHS) in the UK. Interviews were held virtually. Audio was recorded and transcribed following intelligent transcription. Data were analysed using template analysis (3).
Thirteen dietitians (n=12 female) specialising in gastroenterology consented to participate in the study. Dietitians were working in various NHS Trusts across the country (Southeast England n=3; Southwest England n=3; Northwest England n=2; Northeast England n=1; West Midlands n=1; Southwest Wales n=1 and Southcentral Scotland n=2). Ten out of 13 dietitians had more than five years of experience in IBS management. Three main themes emerged: 1) Dietetic services as part of IBS referral pathways; 2) Practices in relation to dietetic services and 3) Implications of services on patients’ expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist IBS dietitians was reported, alongside the use of digital innovation to facilitate practice and access to dietetic care. The use of Internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centred approach to dietary counselling and recognise the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations.
The study identified areas and practices which can facilitate access to dietetic services and patient- centred care in IBS management as outlined in guidelines (4).
Effects of a multicomponent lifestyle modification intervention on liver function, lipid profile, and body composition in adults with elevated hepatic steatosis index
- P. Moitra, A. Jhaveri, P. Tailor, P. Khedekar, J. Madan
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E234
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Parallel to the escalating burden of obesity is the steadily increasing prevalence of metabolic dysfunction associated steatotic liver diseases (MASLD), a chronic condition that progresses from simple steatosis to advanced stages of steatohepatitis, fibrosis, and cirrhosis (1-2). MASLD, regarded as the hepatic manifestation of metabolic syndrome is known to be exacerbated by unhealthy lifestyle choices and the presence of comorbidities such as diabetes, dyslipidemia, and obesity (3-4). Therefore, early identification of the general population at risk of MASLD and the development of multicomponent interventions that can prevent the progression of liver damage and mitigate associated adverse cardiometabolic health outcomes are important. Our study aimed to evaluate the effects of a lifestyle modification program on glucose levels, lipid profile, liver function, and body composition measures in community-living adults with elevated hepatic steatosis index in Mumbai, India.
Adults (n= 231, mean age 46.1(13.7) years), 58.6% men) were screened for risk of MASLD using a non-invasive screening tool, Hepatic Steatosis Index (HSI) (calculated as (HSI)= 8 x (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus) (5). Eligible participants with HSI >36 (predictive of the presence of MASLD) were randomized to receive either a multicomponent lifestyle intervention (experimental group, EG) comprising weekly sessions of individualized dietary counseling (Participants having BMI >23kg/m2 (n = 36) received hypocaloric diets with 40% carbohydrates, 40% fat and 30% proteins (WLD) and those having BMI <22.9kg/m2 (n= 22) received weight maintenance diet (WMD) plans including 55% carbohydrates, 15% protein and 30% fats) and fortnightly group sessions of structured exercise and nutrition education or a standard of care package (control group, CG, n= 43) including general healthy eating and activity guidelines for the 8- week study duration. Paired t test and independent sample t tests were used to determine within and between group changes in variables from baseline to endline.
Trial Registration: This study is registered as CTRI/2022/05/042927.
Overall, the prevalence of MASLD was 52.2%, 32.8% were hypertensive, and 26.7% and 15.4% had diabetes and hypertriglyceridemia respectively. The intervention (WLD) resulted in decreased weight (mean (M)= 3.4 kg, standard error (SE) = 1.88 k, p = 0.02), body fat percent (M = 2.2%, SE = 1.1%, p= 0.042), serum triglycerides (M=28.8mg/dL, SE 8.5mg/dL, p<0.001) and AST (M= 3.8 U/L, SE= 2.2U/L, p <0.05) values. The WMD group reported improvements in serum cholesterol levels, and ALT/ AST ratio as compared to CG (p <0.001). In WMD, HDL-C increased from 45.8 mg/dl to 47.2 mg/dl and the mean AST values reduced from 28.8 (10.6) U/L to 25.6 (9.9) U/L, but these changes were not statistically significant.
Multicomponent lifestyle modification programs integrating diet, physical activity and education are effective strategies to improve liver outcomes and optimize cardiometabolic health in people with MASLD.
Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam
- X. Tan, P.Y Tan, V. Som, S. Nguyen, D.T Tran, T.N Tran, V.K Tran, Y.Y Gong, J. B. Moore
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E228
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Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.
1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) < −2 SD), thinness (BMI-for-age z-score (BAZ) < −2 SD) and overweight (BAZ > 1). Iron deficiency was defined as serum ferritin<15μg/L (<70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol<1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein >5 mg/L or α1-acid glycoprotein >1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.
Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.
Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.
Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.
Effects of pre- versus post-conceptional iron and n-3 fatty acid supplementation of deficient rat dams on neurodevelopmental outcomes in the offspring
- A. Shaw, E.T Kemp, L. Zandberg, B.H Harvey, C.M Smuts, J. Baumgartner
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E217
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This abstract was awarded the Student Competition Prize.
Periconception is the period spanning the weeks directly before and after conception and is a crucial window for optimising neurodevelopment in offspring(1-4). Iron and omega-3 fatty acids (n-3 FAs) are two vital nutrients for the development of the nervous system however, little research has been conducted into their importance during the periconceptional window(5-8). This study investigated whether supplementing iron and n-3 FA deficient (ID and n-3 FAD) rat dams before conception compared to after conception results in different neurodevelopmental outcomes in offspring. We hypothesised that initiating iron and n-3 FA supplementation in deficient dams after conception would not be as efficacious in preventing impaired offspring neurodevelopment induced by double- deficiency, compared to initiating supplementation before conception.
Female rats consuming an ID and n-3 FAD diet were randomly allocated to receive iron and DHA/EPA supplementation either 10 days before (Pre-Fe+DHA/EPA) or 10 days after conception (Post-Fe+DHA/EPA). Dams and offspring (Pre-: n = 24; Post-: n = 26) were subsequently maintained on supplemented diets throughout the experiment. Between postnatal days 31–41, cognitive and behavioural tests were conducted on offspring. Offspring were euthanised between postnatal day 42–45 and n-3 FAs, iron and monoamine concentrations were measured in the hippocampus, striatum and frontal cortex. All outcomes were compared to offspring who were either iron and n-3 FA deficient (ID+n-3 FAD: n = 24) or sufficient (Control+Fe+DHA/EPA: n = 22). One-way ANCOVA, with sex as a covariate, was used to determine between-group differences and two-way ANOVA was used to explore diet-sex interactions.
There were no differences in brain iron or n-3 FA levels between Pre- and Post-Fe+DHA/EPA offspring (P > 0.05). Female Post-Fe+DHA/EPA offspring had greater norepinephrine concentrations in the frontal cortex (Pre-: 3.21± 0.57 ng/mg vs Post-: 2.50± 0.55 ng/mg; P = 0.014) and consumed less sucrose in the sucrose preference test (Pre-: 96.16± 1.73%; Post-: 90.15± 1.66%; P = 0.010) compared to Pre-Fe+DHA/EPA offspring. Female Post-Fe+DHA/EPA offspring also had significantly lower liver iron concentrations compared to female Pre-Fe+DHA/EPA offspring (Pre-: 537± 47.13 μg/L vs Post-: 310± 45.28 μg/L; P = 0.034). There were no other significant differences in monoamine concentrations or behavioural tests.
Our results indicate that supplementing ID and n-3 FAD mothers both before and after conception is efficacious in preventing neurodevelopmental deficits associated with deficiency. However, ID and n-3 FAD during the periconceptional period may alter reward-based learning in female offspring(9-11). Additionally, optimising iron provision during periconception may have important implications for the prevention of postnatal ID-anaemia, particular during early infancy(12).
The effects of resistance exercise on cardiometabolic health and body composition in obese or overweight individuals undergoing dietary weight loss interventions: A systematic review and meta-analysis
- A. Binmahfoz, A. Dighrir, C.M Gray, S. Gray
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE2 / June 2024
- Published online by Cambridge University Press:
- 03 July 2024, E238
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Obesity prevalence has tripled in over the past 35 years and has detrimental effects on physical and psychological health(1). Weight loss via dietary intervention is a mainstay for the treatment of obesity and reduces body fat(2), but also results in loss of lean tissue(3). A potential solution to mitigate the loss of lean tissue, and thus enhance the benefits of weight loss, is resistance exercise. The aim of the current systematic review was to examine the impact of resistance exercise on body weight/composition and markers of cardiometabolic health, as well as physical function, in people living with overweight or obesity undergoing dietary weight loss interventions.
A search was performed in PubMed, Embase, CINAHL, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) based on the set inclusion and exclusion criteria. Systematic searches yielded N=5147 studies of which n=27 were relevant for inclusion after screening for eligibility. We included randomised controlled clinical trials of adult participants (18-65 years of age) with body mass index (BMI) ≥ 25kg/m2) that compared dietary weight loss interventions including resistance exercise with 1) dietary weight loss interventions including other non-resistance exercise and/or 2) dietary weight loss interventions without any exercise. Resistance exercise was classed as any form of resistance or muscle strengthening exercise (e.g. gym or home- based, supervised or non-supervised, used equipment or body weight only). Key data were extracted, risk of bias was assessed using the Cochrane risk of bias tool, and the quality of evidence assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Meta-analysis was performed including only studies that compared dietary weight loss plus resistance exercise interventions to diet-only (i.e. not including any other exercise) weight loss interventions to explore differences in body weight/composition and cardiometabolic health changes between diet plus resistance exercise and diet only interventions.
Overall, resistance exercise in addition to diet-induced weight loss had no effect on weight loss (mean difference between groups: -0.32kg, 95% confidence interval [CI] -1.00 to 0.35; p=0.35) but did preserve fat free mass (between-group standardised mean difference (SMD): 0.40, 95%, [CI] 0.18 to 0.61; p=0.0003) and increase loss of fat mass (SMD: -0.36, 95% [CI] -0.49 to -0.23; p< 0.00001). Muscular strength was also improved (SMD: 2.36, 95% [CI] 1.38 to 3.34; p=0.00001) by the inclusion of resistance exercise. No effects of resistance exercise were seen in any of the other cardiometabolic markers studied, although data were limited.
In people who are obese or overweight, the addition of resistance exercise to dietary restriction may enhance its beneficial effects. Current evidence, therefore, supports the inclusion of resistance exercise during weight loss to attenuate the loss of lean mass, increase fat mass loss and improve muscle strength.
Sex and gender in sports nutrition research: bridging the gap
- Sharon M. Madigan
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- Proceedings of the Nutrition Society , First View
- Published online by Cambridge University Press:
- 01 July 2024, pp. 1-7
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The Olympic Games have grown to be the largest, gender-equal sporting event in the world, and the International Olympic Committee is committed to gender equality in sports encouraging and supporting the promotion of women in sports at all levels and in all structures with a view to implementing the principle of equality of men and women (IOC, 2023). Women competed for the first time at the 1900 Olympic Games in Paris, and the number of women competing has grown exponentially over the last 100 years, so an estimated 5494 female athletes (48 %) competed in the Summer Olympic Games 2021 in Tokyo. Supporting women (alongside men) in achieving optimum performance is crucial, and understanding that there are sex and gender gaps in sports nutrition research is important. One reason for this gap is the historical bias in sports and exercise science research towards male participants. This has led to a poor understanding of the unique physiological and nutritional needs of female athletes. In summary, a balanced approach is crucial to address the nutritional needs of both male and female athletes. Researchers should continue exploring this important area to optimise performance and health for all athletes. The aim of this review is to summarise current sports nutrition literature and highlight research that seeks to understand and address where the gaps are with respect to several key areas in sports nutrition recommendations that can impact advice and practice with both males and females.
Managing malnutrition and multimorbidity in primary care: dietary approaches to reduce treatment burden
- Rebecca J. Stratton
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- Proceedings of the Nutrition Society , First View
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- 16 May 2024, pp. 1-9
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There are many health and nutrition implications of suffering from multimorbidity, which is a huge challenge facing health and social services. This review focuses on malnutrition, one of the nutritional consequences of multimorbidity. Malnutrition can result from the impact of chronic conditions and their management (polypharmacy) on appetite and nutritional intake, leading to an inability to meet nutritional requirements from food. Malnutrition (undernutrition) is prevalent in primary care and costly, the main cause being disease, accentuated by multiple morbidities. Most of the costs arise from the deleterious effects of malnutrition on individual’s function, clinical outcome and recovery leading to a substantially greater burden on treatment and health care resources, costing at least £19·6 billion in England. Routine identification of malnutrition with screening should be part of the management of multimorbidity together with practical, effective ways of treating malnutrition that overcome anorexia where relevant. Nutritional interventions that improve nutritional intake have been shown to significantly reduce mortality in individuals with multimorbidities. In addition to food-based interventions, a more ‘medicalised’ dietary approach using liquid oral nutritional supplements (ONS) can be effective. ONS typically have little impact on appetite, effectively improve energy, protein and micronutrient intakes and may significantly improve functional measures. Reduced treatment burden can result from effective nutritional intervention with improved clinical outcomes (fewer infections, wounds), reducing health care use and costs. With the right investment in nutrition and dietetic resources, appropriate nutritional management plans can be put in place to optimally support the multimorbid patient benefitting the individual and the wider society.
Oral health and multimorbidity: is diet the chicken or the egg?
- Teresa A. Marshall, Riva Touger-Decker
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- Proceedings of the Nutrition Society , First View
- Published online by Cambridge University Press:
- 14 May 2024, pp. 1-8
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Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition and oral and systemic diseases that contribute to multimorbidity. Diet- and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables and nutrient-poor diets which are similar to diet- and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility and swallowing. Oral dysfunction makes it difficult to eat nutrient-dense whole grains, fruits and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our ‘canary in the coal mine’ for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy-dense, nutrient-poor foods – typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multimorbidities. Disruption of this pathway will reduce the risk of multimorbidities and enable individuals to fully engage in society throughout the lifespan.
Editorial
- Oonagh Markey
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- Proceedings of the Nutrition Society , First View
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- 14 May 2024, pp. 1-5
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Multimorbidity, the existence of two or more concurrent chronic conditions in a single individual, represents a major global health challenge. The Nutrition Society’s 2023 Winter Conference at the Royal Society, London focused on the topic of ‘Diet and lifestyle strategies for prevention and management of multimorbidity’, with symposia designed to explore pathways for prevention of multimorbidity across the lifecourse, the role of ageing, the gut-brain-heart connection and lifestyle strategies for prevention and management of multimorbidity. It also considered machine learning and precision nutrition approaches for addressing research challenges in multimorbidity. The opening plenary lecture discussed advancing diet and lifestyle research to address the increasing burden and complexity of multimorbidity. The two-day programme concluded with a plenary which addressed the key dietary risk factors and policies in multimorbidity prevention.
Does continuous glucose monitoring influence adherence to time-restricted eating?
- J. Tater, M. Roy, R. Taylor
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E125
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Obesity is a significant health issue in Aotearoa; effective and pragmatic strategies to facilitate weight loss are urgently required. Growing recognition of the circadian rhythm’s impact on metabolism has popularised diets like time-restricted eating (TRE)(1). The 16:8 TRE method involves limiting food intake to an 8-hour daily eating window and can lead to weight loss without other substantial changes to diet(2). Nonetheless, TRE requires accountability and tolerating hunger for short periods. Continuous glucose monitors (CGM) are small wearable biofeedback devices that measure interstitial glucose levels scanned via smartphones. By providing immediate feedback on the physiological effects of eating and fasting, CGM use may promote adherence to TRE(3). This pilot study aimed to 1) investigate how CGM affects adherence to TRE and 2) assess the feasibility of CGM use while undertaking TRE. This two-arm randomised controlled trial enrolled healthy adults from Dunedin, assigning them to TRE-only or TRE+CGM groups for 14 days. Successful adherence to TRE was defined a priori as maintaining an 8-hour eating window on 80% of days. CGM feasibility was defined a priori as scanning the glucose monitor thrice daily on 80% of days. Secondary outcomes included well-being, anthropometry, glucose levels, and overall TRE and CGM experiences via semi-structured interviews. Twenty-two participants were randomised into two groups: TRE-only (n = 11) and TRE+CGM (n = 11, with n = 2 excluded from analysis post-randomisation for medical reasons). Participants had a diverse range of ethnicities, the mean age was 32 (+/-14.9) years, and 55% were female. The TRE+CGM group adhered to the 8-hour eating window for an average of 10.0 days (range 2-14) compared with 8.6 days (range 2-14) in the TRE-only group. Both groups had similar mean eating window durations of 8.1 hours. Five (56%) participants in the TRE+CGM group achieved the a priori criteria for TRE adherence, compared to 3 (27%) in the TRE-only group. Participants in the TRE+CGM group performed an average of 8.2 (+/-5.6) daily scans, with n = 7 (78%) of participants meeting the a priori CGM feasibility criteria. Neither group reported consistent adverse psychological impacts in DASS-21 and WHO-5 scores. Interviews highlighted that CGM increased hunger tolerance during fasting as participants felt reassured by their normal glucose levels. CGM aided TRE accountability by acting as a biological tracker of food intake. Participants reported that TRE led to improved energy and self-efficacy, a more productive daily routine, and healthier food choices. Promisingly, 72% of participants would use CGM and undertake TRE in future. This study demonstrates that using CGM while undertaking TRE is feasible and can improve adherence by enhancing hunger tolerance and accountability. Overall, participants experienced increased awareness of eating habits and physiological mechanisms. Over the longer term, this simple and synergistic approach may be a helpful weight loss strategy.
Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review
- S. Torkel, R. Wang, R. Norman, L. Zhao, K. Liu, L. Moran, S. Cowan
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E84
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While there is a recognised role of optimising lifestyle behaviours such as diet and physical activity in the management of infertility, the best practice for lifestyle management of infertility remains unknown, and factors influencing the lifestyle behaviours of people with infertility are not well understood. The aim of this systematic review is to evaluate the barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies for lifestyle management of infertility. Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL Plus were searched from inception to 12th September 2022. Eligible studies were qualitative, quantitative or mixed-methods primary studies which explored barriers and/or enablers to lifestyle for infertility management, from the perspectives of people with infertility and/or health professionals. Two independent reviewers performed quality assessment, using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool (quantitative and mixed-methods studies) and the Critical Appraisal Skills Programme Qualitative Checklist (qualitative and mixed-methods studies). Data were analysed by inductive thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model(1) and Theoretical Domains Framework (TDF)(2). Relevant behaviour change techniques (BCTs)(3) to target the identified enablers and barriers were suggested. After screening 10703 citations and 82 full-texts, 22 studies were included (12 quantitative, 7 mixed-methods and 3 qualitative) with 18 studies including women with infertility (n = 2442), 10 including men with infertility (n = 1372) and 6 including health professionals (n = 261). From the perspectives of people with infertility, themes related to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources and money) and motivation (e.g. interplay between lifestyle and emotional state); themes mapped to 8 TDF domains. From the perspectives of health professionals, themes related to capability (e.g. identification of patients appropriate for lifestyle intervention), opportunity (e.g. mode of delivery) and motivation (e.g. professional responsibility); themes mapped to 6 TDF domains. 34 BCTs were identified across the suggested interventions. This systematic review found that several interacting factors influence lifestyle in people with infertility as well as health professional behaviour with regards to provision of lifestyle interventions for infertility. These factors can be targeted for optimisation of interventions. In light of the limited number of qualitative studies, there is a need for more qualitative research to gain deeper insights into the perspectives of people with infertility and health professionals for further exploration of the complex and interacting factors which shape lifestyle during the fertility journey.
Bitter taste sensitivity and frequency of bitter food intake in healthy Australian adults: a cross-sectional, mixed-methods study
- S. Chen, L. Hassan, A. Turner, L. Newman, J. Danaher, J. Biesiekierski
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E138
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Bitter taste perception plays a dual role in human nutrition and evolutionary biology; being identifiable in nutrient-dense foods such as cruciferous vegetables and historically signalled toxic compounds. The TAS2R38 gene, part of the taste 2 receptor family, is central to individual differences in bitter taste perception(1). While genetic variations are influential, dietary habits and food preparation also impact taste perception. However, research investigating the interplay between these factors and genetic variations in influencing bitter taste sensitivity and food intake is limited. This study aimed to elucidate the relationship between bitter taste sensitivity and TAS2R38 haplotype variations in the context of bitter food consumption among Australian adults. A cross-sectional, mixed-methods study was conducted. Healthy adults who had maintained a stable diet for at least three months were eligible. Data collection was via an online survey (REDCap), capturing self-reported demographics, dietary patterns specific to bitter foods including metrics of bitter food avoidance, frequency, liking and perceived healthfulness, alongside a Dietary Quality Index (DQI) derived from a food frequency questionnaire(2). Bitter taste sensitivity was assessed using self-reported intensity perceptions of 6-n-propylthiouracil (PROP) taste strips(3). Genotyping was conducted via TaqMan qPCR assays on DNA extracted from buccal swabs to ascertain TAS2R38 haplotypes. Data analysis utilised Analysis of Covariance (ANCOVA) and regression models, with all tests adjusted for confounding variables such as gender, age, and smoking status. A total of 222 participants (47.5 ± 17.7 years; 86% female; BMI 27.3 ± 7.1 kg/m2) completed the study. PROP sensitivity was strongly correlated with TAS2R38 haplotype, with supertasters predominantly having PAV/PAV, medium tasters with PAV/AVI, and non-tasters with AVI/AVI (p = 0.002). However, no relationship was observed between PROP sensitivity and either the frequency, liking, or avoidance of bitter foods (p>0.05). DQI was significantly related to bitter food consumption; individuals in the lowest DQI quintile consumed bitter foods more frequently than those in the third (p = 0.007) and top quintiles (p = 0.001). The perceived healthfulness of bitter foods was significantly higher in those with AVI/AVI haplotypes (non-tasters) compared to those with PAV/AVI (medium tasters) (p = 0.001). Counterintuitively, participants who reported greater enjoyment of bitter tastes consumed bitter foods less frequently (p<0.001). Our study confirms that TAS2R38 variants are predictive of PROP taste sensitivity, consistent with literature that identifies PAV/PAV individuals as supertasters. However, neither PROP sensitivity nor TAS2R38 haplotype influenced bitter food frequency or preference consumption patterns. Interestingly, those with lower Dietary Quality Index scores and less enjoyment of bitter taste consumed bitter foods more often. These observations highlight the need to investigate other factors influencing bitter food intake, such as additional sensory characteristics or psychological and behavioural aspects.
Changes in psychological outcomes and sleep quality following energy restriction with and without almonds
- S. Carter, A.J. Carter, A.M. Hill, V. Do, J.D. Buckley, J. Dorrian, S-Y. Tan, G.B. Rogers, A.M. Coates
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E76
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Associations between obesity and mental illness have been identified, but they are complex and bidirectional(1). Weight loss interventions have been proposed as a potential strategy to improve mental health in individuals with overweight or obesity, but the evidence remains inconclusive(2). Additionally, the role of specific foods in a weight loss diet and mental health outcomes is not well understood(3). This study aimed to explore the association between weight loss (with and without almonds) and self-administered psychological and sleep assessments, including the Profile of Mood States (POMS), the Perceived Stress Scale (PSS), the Zung Self-Rating Depression Scale (ZSDS), and the Pittsburgh Sleep Quality Index (PSQI). Participants (n = 140, 47.5 ± 10.8 years) with overweight or obesity (BMI: 30.7 ± 2.3 kg/m2) were randomised to an energy-controlled almond-enriched diet (AED) or nut-free diet (NFD). Psychological and sleep assessments were conducted at baseline, after 3 months of weight loss, and after 6 months of weight maintenance. Data were analysed using mixed-effects models and linear regression. For POMS, total mood disturbance score (TMDS) (60.2%, p = 0.01), fatigue-inertia (21.2%, p = 0.003), and vigor-activity (19.9%, p<0.001) improved over time (with no different between groups), with improvements associated with the magnitude of weight loss (TMDS: β = 0.059, p = 0.02; fatigue-inertia: β = 0.268, p = 0.016; vigor-activity: β=-0.194, p = 0.048). No significant changes were observed in tension-anxiety, depression-dejection, anger-hostility, or confusion-bewilderment. A significant group x time interaction (p = 0.048) was found for the PSS, which increased in the NFD group (10.1%) and decreased in the AED (1%) during the weight maintenance phase. No significant changes were observed for the ZSDS. The PSQI demonstrated significant improvement in both groups over time for sleep quality (11.3%, p<0.001), sleep latency (24.3%, p<0.001), sleep disturbance (39.2%, p = 0.04), and daytime dysfunction (290.4%, p<0.001), but not for sleep duration or habitual sleep efficiency. Summed scores, generating the global sleep score (GSS), demonstrated an overall significant improvement in both groups over time (33.5%, p<0.001), and these improvements were associated with weight loss (GSS: β = 0.863, p<0.001). The findings emphasise the importance of evaluating mental health outcomes in weight loss interventions and highlight the potential influence of weight management on mood and sleep quality. Further research is warranted to explore the impact of diet composition on perceived stress and other mental health outcomes.
Dietary intake of adolescent rowers - analysis of energy intake
- J. Speedy, K. Beck, S. Watts, C. Badenhorst
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E43
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Adequate energy intake (EI) is essential for adolescent athletes to support health, performance, and growth(1). Rowing is a physically demanding sport where intense training begins in adolescence. Research is needed to assess whether current EI is sufficient to support healthy physiological functions and training in adolescent rowers. The aim of this study was to evaluate the energy status (energy availability (EA) or energy balance (EB)) including EI and exercise energy expenditure (EEE) of adolescent rowers in New Zealand. A total of 35 rowers (23 females, 16.8yrs ± 1.9yrs; 12 males, 17.3yrs ± 1.6yrs) who had been rowing for at least one season participated. A bioimpedance analyser measured body composition in 11 participants (8 females, weight 63.0±7.0kg, fat free mass (FFM) 50.8 ± 6.5kg; 3 males, weight 78.5 ± 15.9kg, FFM 70.7 ± 12.2kg) enabling calculation of EA. Due to COVID-19 restrictions, the remaining 24 participants (15 females, 9 males) provided estimated body weight (74.7 ± 9.2kg) and EB was then used to evaluate energy status. All participants completed four days of food and training diaries, two ‘recovery’ and two ‘hard’ training days. EI was determined in FoodWorks10 software using the New Zealand Food Composition Database. For training, metabolic equivalent of tasks (MET)(2) were assigned using bodyweight, heart rate, and rating of perceived effort to estimate EEE. Paired sample t-tests or Wilcoxon Signed Rank test (non-parametric data) was used to determine differences between EI, EEE, EA, and EB on the high and low training days for each gender. Significance was set at p< 0.05. The average EI for females on hard and recovery days was 10837 ± 3304kJ and 10461 ± 2882kJ respectively, and for males was 15293 ± 3971kJ and 13319 ± 4943kJ, respectively. No significant differences were found between EI on hard vs. recovery days in both genders. Significant differences between average EEE on hard vs. recovery days were found in both genders (females, hard day 4609 ± 2446kJ, recovery day 3146 ± 1905kJ, p<0.001; males, hard day 6589 ± 1575kJ, recovery day 3326 ± 2890kJ, p = 0.001). EA on hard and recovery training days was classified as suboptimal at 142 ± 80kJ/FFMkg/day and 167 ± 79kJ/FFMkg/day respectively with no significant difference in EA between hard and recovery days (p = 0.092). Average EB on hard training days was −484 ± 4267kJ and on recovery training days was 572 ± 3265kJ, with no significant difference between training days (p = 0.177). Both genders showed no significant difference in EB between hard and recovery training days (females p = 0.221, males p = 0.978). The results suggest that adolescent rowers do not adjust their nutritional intake to match EEE. This may increase the risk of adolescent rowers presenting with suboptimal EB or EA, with females being at a greater risk than males.
Macronutrient intakes of adolescent rowers for growth, development and sports performance
- S. Watts, K. Beck, J. Speedy, C. Badenhorst
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E44
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Dietary intake plays a key role in athletic performance in rowing(1). Suboptimal nutrition within the adolescent rowing population may negatively affect performance, normal growth and development, professional athlete development, and career longevity. Previous research has indicated that suboptimal carbohydrate intakes are a common issue in rowing(2). The quality of nutritional intake in adolescent rowers has seldom been explored. During moderate training, adolescent athletes should aim for 5-7g.kg-1 of carbohydrates, 1.3-1.8g.kg-1 of protein, and 20-35% energy from fat(3). This study aimed to examine the dietary intake of adolescent rowers in New Zealand and compare it with nutritional guidelines for normal growth, development, and sports performance. A cross-sectional study design involved data collection on two ‘hard’ training days, and two ‘recovery’ days from rowers (14-21 years) recruited from clubs and secondary schools around New Zealand. Participants completed four 24-hour collection periods, recording food intake, training duration and intensity. The food records were verified for accuracy, and dietary data was entered into Foodworks software for nutritional analysis. IBM SPSS software was used to calculate mean intakes for carbohydrate, protein, fat, and standard deviations. Independent t-tests were used to compare carbohydrate and protein intakes between males and females. Of the initial 40 participants, 35 fully (n = 23 females, 16.8 ± 1.9 years and n = 12 males, 17.3 ± 1.6 years) completed the study. Participants consumed 319 ± 116g (4.5 ± 1.7g.kg-1/day) of carbohydrates, 121 ± 56 g (1.7 ± 0.7 g.kg-1/day) of protein and 113 ± 46 g (1.6 ± 0.6g.kg-1/day) of fat per day. Females consumed 290 ± 80g (4.4 ± 1.3g.kg-1/day) of carbohydrates and males consumed 400 ± 78 g (5.0 ± 1.4g.kg-1/day) per day, with no significant difference between males and females intake per kilogram of bodyweight per day (p = 0.165). Minimum carbohydrate levels of 5g.kg-1 per day were only achieved by 7 females (30.4%) and 4 (33.3%) males. Females consumed significantly less protein per day, 106 ± 38g (1.6 ± 0.6 g.kg-1/day), in comparison to males who consumed 164 ± 46 grams (2.0 ± 0.5 g.kg-1/day) per day (p = 0.04). Fourteen females (60.9%) and 10 males (83.3%) consumed more than the minimum requirement of 1.3g.kg-1 of protein per day. The findings suggest that 2 out of 3 adolescent rowers in New Zealand fail to reach the minimum recommendations for carbohydrate intake(3), and males more readily meet the recommended intakes of protein when compared to females. Nutrition education for adolescent rowers in New Zealand should emphasise adequate carbohydrate and protein intakes that meet sports nutrition guidelines in order to support normal growth, development and optimised performance for these athletes.
Associations between food groups and biomarkers of inflammation: Are some foods groups more protective than others?
- C. English, M. Jones, A. Lohning, H. Mayr, H. MacLaughlin, D. Reidlinger
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E189
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The consumption of healthy foods such as whole grains, vegetables, fruits, nuts, legumes, dairy, and fish is associated with decreased risk of cardiovascular disease (CVD). CVD is an inflammatory disease caused by atherosclerosis. Inflammation is measured clinically using hsCRP, however hsCRP is not specific to CVD. Novel pro-inflammatory markers, such as platelet-activating factor (PAF) and lipoprotein-associated phospholipase A2 (Lp-PLA2), have garnered attention due to their specific roles in endothelial dysfunction and CVD risk. During the COVID 19 outbreak research highlighted a potential interaction between PAF and Lp-PLA2 and the SARS COVID 19 virus(1-3) and related adenovirus-vector and mRNA vaccines.4 This cross-sectional study investigated the association between PAF, Lp-PLA2, hsCRP, and intake of healthy food groups including fruit, cruciferous and other vegetables, grains, meat and poultry, fish and seafood, nuts and legumes, and dairy in 100 adults (49 ± 13 years, 31% male) with variable CVD risk. Data were collected across four groups during May and July 2021 (Groups 1 and 2 - CVD risk factors) and January and April 2022 (Groups 3 and 4 - no CVD risk factors). Fasting PAF, Lp-PLA2 and hsCRP and usual dietary intake (food frequency questionnaire) were measured. Food intake was converted into serves and classified into food groups. Correlations and multiple regressions were performed. Contrary to expectations, mean PAF was lower for groups 1 and 2 (n = 46, mean PAF 3.31 ± 1.66 ng/mL) compared to groups 3 and 4 (n = 54, mean PAF 19.82 ± 12.95 ng/mL) p < 0.001 with a large effect size (eta squared 0.665). Cruciferous vegetables were associated with lower levels of PAF (β = -.27, CI [−0.41, −0.14], p < .001) with a one serve increase in cruciferous vegetables per day associated with an 24% reduction in PAF. Nuts and legumes were associated with lower levels of hsCRP (β = -.51, CI [−0.81, −0.22], p<.001) with an increase of one serve per day associated with a 40% reduction in hsCRP. There were small inverse associations between cheese and both PAF (β = -.15, CI [−0.27, −0.03], p = .017) and Lp-PLA2 (β = -.26, CI [−0.47, −0.04], p = .024), however these were not significant at the Bonferroni-adjusted P<.005 level. In conclusion, cruciferous vegetables and nut and legume consumption were associated with lower levels of inflammation. The lack of associations between PAF and Lp-PLA2 and other healthy foods may be due to confounding by COVID-19 infection and vaccination programs which prevents any firm conclusion on the relationship between PAF, Lp-PLA2 and food groups. Future research should aim to examine the relationship with these novel markers and healthy food groups in a non-pandemic setting.
Adherence to a Mediterranean diet is not associated with severity of menopausal symptoms: a cross-sectional analysis of Australian peri-menopausal and menopausal women
- M. Byrne-Kirk, E. Mantzioris, N. Scannell, A. Villani
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E184
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During the menopausal transition, women often encounter a range of physical and psychological symptoms which negatively impact on health-related quality of life (HRQoL)(1). Diet quality has previously been identified as a modifiable factor associated with mitigating the severity of these symptoms in peri-menopausal and menopausal women(2). We therefore explored the independent associations between adherence to a Mediterranean diet (MedDiet) and the severity of menopausal symptoms in peri-menopausal and menopausal women living in Australia. We also explored the association between MedDiet adherence and HRQoL in this same cohort of women. We conducted a cross-sectional study of Australian peri-menopausal or menopausal women aged between 40 to 60 years. An 86-item self-administered questionnaire was used to assess the relationship between adherence to a MedDiet and severity of symptoms. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS), the Menopause Rating Scale (MRS) was used to assess the severity of menopausal symptoms related to somatic, psychological and urinary-genital symptoms and the 36-item short form survey instrument (SF-36) was used to assess HRQoL. Multivariable linear regression analysis (and 95% CI) was used to investigate the independent association between adherence to a MedDiet, severity of menopausal symptoms and HRQoL subscales using one unadjusted and five adjusted predictor models. A total of n = 207 participants (50.7 ± 4.3 years; BMI: 28.0 ± 7.4 kg/m2) were included in the final analyses. Participants reported low-moderate adherence to a MedDiet (5.2 ± 1.8; range: 1-11). We showed that MedDiet adherence was not associated with severity of menopausal symptoms. However, when assessing individual dietary constituents of the MEDAS, we showed that low consumption of sugar-sweetened beverages (<250ml per day) was inversely associated with joint and muscle complaints, independent of all covariates (β = −0.149; CI: −0.118, −0.022; P = 0.042). Furthermore, adherence to a MedDiet was positively associated with the physical function subscale of HRQoL (β = 0.173, CI: 0.001, 0.029; P = 0.031) and a low intake of red and processed meats (≤ 1 serve per day) was positively associated with the general health subscale (β = 0.296, CI: 0.005, 0.014; P = <0.001), independent of all covariates used in the fully adjusted model. Our results suggest that diet quality may be related to severity of menopausal symptoms and HRQoL in peri-menopausal and menopausal women. However, exploration of these findings using longitudinal analyses and robust clinical trials are needed to better elucidate these findings.