Physical, social and economic access to food at all times (food security) is a basic human right and yet, food insecurity remains a global public health problem(1). Food insecurity, the lack of regular or reliable access to nutritious food, disproportionately affects people living in geographically isolated areas such as rural, regional and remote (RRR) Australia(1). Food security is underpinned by six dimensions: food access, availability, utilisation; stability; agency; and sustainability(1). These dimensions and their determinants are interconnected, characterising food security as a complex, ‘wicked’ problem that requires multidimensional responses(2). Australia’s dominant responses to food insecurity, including emergency food relief, nutrition education programs, and social welfare payments, typically focus on isolated aspects of the issue and therefore fail to address the complexities of the problem(2,3). In contrast, multidimensional responses tackle various determinants of food insecurity simultaneously to better identify and address the underlying causes of the issue(2). The Food Community project has implemented the innovative Systemic Innovation Lab approach to support food security in RRR Western Australia (WA)(2). The project aims to map existing initiatives addressing food security in RRR WA against 36 systems change characteristics associated with a transition towards a more effective way of supporting food security in their location(2). This presentation will focus on identifying and exploring the barriers perceived by food security initiative leaders to undertaking systems change. This study was conducted across six regions of WA, including the Wheatbelt, Midwest, Great Southern, Kimberley, Pilbara and Goldfields. Qualitative, semi-structured interviews were conducted with 101 leaders representing 148 initiatives operating across RRR WA. Initiatives included any program, project or service that was addressing one or more determinant of food security. Interviews were managed using NVivo, and analysed thematically following the six-phase qualitative data analysis approach outlined by Braun and Clarke(4). The most common initiative type was food literacy/health promotion programs (n = 57) and ‘food access’ was the dimension most commonly addressed by initiatives (n = 89). Initiatives in this study were least likely to possess the systems change characteristics associated with undertaking meaningful engagement with government representatives. Participants identified barriers to government-community interaction, including limited opportunities, a perceived lack of interest from government representatives, and challenges to undertaking advocacy. Government-community engagement helps to align policies with local contexts and empower communities to govern their food security(2). Therefore, initiative leaders require support, potentially in the form of toolkits and guides, to enhance their skills and capacity to undertake advocacy and strategically engage with government representatives. These findings provide valuable insights into the perspectives of initiative leaders and highlights key areas for improving food security systems change, including the need to strengthen collaboration between government and community for sustainable food security solutions.

Anthocyanins, a flavonoid subclass present in certain blue, purple and red fruits and vegetables, have potential neuroprotective properties due to their anti-inflammatory, antioxidant, and signalling effects(1). Clinical and epidemiological studies of anthocyanins provide promising evidence for attenuation of memory loss and improved cognitive function(2). We investigated the effects of anthocyanins, provided through diet or supplementation, on cognitive function and related parameters(3). A multi-centre, 24-week randomised, parallel 3-arm clinical trial was conducted in participants aged 60–85y with self-reported memory complaints and scoring ≤ 13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment (T-MoCA). Participants were randomised to high anthocyanin diet, freeze-dried product derived from blackcurrants (250 mg anthocyanins/day), or control (placebo). The primary outcome was auditory episodic memory functioning. Secondary outcomes were additional cognitive functions, subjective memory complaints and self-reported depression symptoms, blood pressure, inflammatory biomarkers, lipid profile, vascular and microvascular endothelial function tests, and gut microbiota. Mixed linear modelling evaluated changes over time. Gut microbial abundance (alpha diversity) was measured using Shannon Simpson’s Index and association between anthocyanin intake and taxa level was assessed using the MaAsLin2 multivariable regression model. Of 110 participants enrolled (mean age 69.2 y SD 6.7; 36 males, 74 females), 94 completed the study. Median anthocyanin intake increased by 76.7 mg, 252.1 mg, and 2.9 mg in the diet, active powder, and control groups, respectively. There was no treatment*time effect on any primary or secondary outcomes. A time effect was observed for the majority of psychometric tests. At baseline, participants with habitual anthocyanin intake ≥ 10 mg/day performed better on a number of cognitive tests compared to those with higher intakes (p < 0.05). They also had a clear difference in microbial abundance with Bacteroides sp. enriched in the higher anthocyanin group, compared to Enterococcus sp. enriched in the lower anthocyanin group. The active powder group had an increase in alpha diversity (p = 0.074) at follow-up which was more pronounced in in participants with a low habitual anthocyanin intake at baseline. In conclusion, this clinical trial found no significant effect of dietary or supplemental anthocyanins, on any of the investigated outcomes in older adults with self-reported memory complaints, except potential improvements in the gut microbiome in the active powder group. We postulate that the potential anti-inflammatory, antioxidant, and signalling effects of anthocyanins were insufficient to significantly modulate any outcomes due to participants’ overall good health and lack of relevant cognitive decline. We recommend future interventional studies focus on subjects with low habitual anthocyanin intakes, those with diagnosed cognitive impairment, such as Mild Cognitive Impairment and dementia, and those with more severe comorbidities, particularly chronic inflammatory conditions.

Live microbes (LM) are naturally present in a variety of commonly consumed foods. These include raw fruits and vegetables, fermented foods, which are defined as foods made through desired microbial growth and enzymatic conversions of food components, and also probiotics, defined as live microorganisms providing health benefits to the host when consumed in adequate amounts(1–3). Interest in consumption of foods that harbour LM has increased recently due to evidence linking these foods to improved health outcomes and reduced risk of chronic diseases, including cardiovascular disease(1–3). However, most research on LM intakes has focused on US population samples or intake of specific foods, and not on total diet(1–3). To-date, no study has quantitatively assessed consumption of LM among the Australian population. The aim of this study was to develop a database for estimating and categorising live microbe (LM) content in common foods and beverages listed in the Australian Eating Survey® (AES) food frequency questionnaire (FFQ)(4). A secondary aim was to apply this database to examine the relationship between LM intake, cardiometabolic health indicators and inflammatory markers. Estimation of LM content (colony-forming unit (CFU)/per gram) was based on previous published methods(1), with foods assigned to three categories based on expected prevalence of viable microorganisms in different food matrices. CFU LM density was defined as low (< 104 CFU/g), medium (104–107 CFU/g), or high (> 107 CFU/g). Estimated LM quantities were applied to Australian AUSNUT 2011–13 food and beverage items included in the AES® FFQ. Using cross-sectional baseline data from a sample of healthy adults (n = 58), usual LM intakes were estimated, and relationships with demographic data, anthropometry and clinical chemistry were evaluated. Results were analysed using adjusted weighted-least squares regression. Estimated LM quantities were determined for more than 200 AUSNUT food codes. The greatest number of items (n = 226) were classified as low, with most being vegetables (22.6%), cereal-based products and dishes (13.3%), and meat, poultry, and game products and dishes (11.1%). Twenty-one food items were classified as medium (57.1% fruit, 28.6% vegetables, 14.3% milk products), and two items as high (yoghurt and cream sour). Consumption of LM was significantly inversely associated with body weight (p = 0.008), BMI (p = 0.005), waist circumference (p < 0.001), and plasma insulin concentration (p = 0.001), and positively associated with HDL-cholesterol (p < 0.001). No significant associations were observed with fasting, plasma glucose, total, LDL and non-HDL cholesterol, triglycerides and TNF-α. Findings suggest that more frequent consumption of foods containing LM is associated with lower cardiometabolic and inflammatory risk factors in this sample. Further research is needed to evaluate LM intake and health outcomes in larger studies.

In African societies, cultural food practices often restrict or prohibit the consumption of certain foods during pregnancy(1). These practices are shaped by cultural, religious, or societal values and beliefs(2). For instance, in some African countries, pregnant women are advised to avoid red meat and eggs due to cultural beliefs that these foods may harm the mother or the foetus(1). Some of these practices may persist after migration, and how healthcare professionals (HCPs) perceive their influence on African migrant women’s food practices in Australia remains unexplored. Gaining insight into HCPs’ perceptions is essential for improving culturally responsive care and supporting African migrant women in making informed dietary choices during pregnancy and postpartum. Understanding HCPs’ perceptions will provide insight into how these practices are understood and addressed in clinical settings. The aim of this study was to explore HCPs’ perceptions of the cultural food practices of African migrant women during pregnancy and the postpartum period in Australia. HCPs were recruited through convenience and snowball sampling. In-depth semi-structured interviews were conducted with 15 HCPs who had experience providing antenatal care to African migrant women in Australia. Interviews were transcribed verbatim, inductively coded using NVivo 14, and analysed using Braun and Clarke’s reflexive thematic analysis(3). Most participants (n = 13) were midwives, and two were obstetricians and gynaecologists. Three themes were identified: (i) HCPs’ perceptions of women’s cultural food practices, (ii) challenges in delivering general healthy eating information, and (iii) strategies for providing effective nutrition advice. Most participants (n = 10) discussed their perceptions of women continuing their traditional dietary practices after migrating to Australia; fewer than half (n = 5) were aware of specific restrictive food practices among the African migrant women they had supported. HCPs perceived that the healthy eating information provided to these women was not always effective and culturally appropriate due to limited consultation time and a lack of culturally appropriate resources. Participants expressed a need for in-service education, tailored nutrition resources including common African foods to enhance culturally appropriate care, and increased continuity of care. This study highlights a gap in HCPs’ awareness of food related cultural practices among African migrant women. Limited awareness of potential food restrictions during pregnancy may negatively impact maternal and infant health. The challenges HCPs face in providing culturally appropriate healthy eating information underscore the need for systemic changes in healthcare. Addressing these gaps through supportive training for HCPs and increasing access to culturally tailored resources, ideally developed in collaboration with dietitians, is urgently needed.

Food policy skills are a core competency for nutritionist registration in Australia(1) and overseas(2). Despite this, research suggests nutrition students and graduates lack understanding of employment opportunities in the nutrition discipline(3), including the role of food policy in nutrition career pathways. This highlights a need to strengthen student understanding of the practical application of food policy in professional nutrition practice. Students as Partners (SaP) is a pedagogical approach in higher education that positions students as active collaborators and co-creators in their university learning experiences, rather than passive recipients of knowledge(4). Through an Equity-First SaP Microgrant, student partners and nutrition and learning innovation academics at Deakin University co-created career-oriented digital resources for a core food policy unit in the undergraduate nutrition science course. This involved co-design workshops, student-led engagement with peers to explore perceptions of food policy career-relevance, and development of video interviews with nutrition professionals to illuminate connections with food policy in the work context. This research aims to explore staff and student experiences with the SaP food policy project using a collaborative autoethnographic (CAE) approach. CAE is a participatory dialogue-based research methodology whereby researchers, as participants, engage in reflective dialogue to collectively examine and interpret their experiences to foster a shared understanding of the project(5). To facilitate the CAE process, student (n = 3) and staff (n = 3) self-reflection sessions were conducted online to explore team members’ experiences in the co-designed SaP project. Key research questions examined perceptions of evolving roles, benefits and challenges of collaboration, impacts on students’ future academic and professional paths, alignment with SaP principles, influence on the quality of project outcomes, and recommendations for future co-designed projects about nutrition curriculum development. Self-reflection transcripts have been generated and reflexive thematic analysis via Braun and Clarke’s six-step process (6) has commenced using NVivo 15. In this presentation we will discuss findings from the collective autoethnographic research process, focusing on the student-staff partnership experience for developing career-oriented food policy curriculum resources. This includes the progression of the student-staff partnership project and insights and perspectives of students and staff on the impact and outcomes of this way of working. To our knowledge, this study is among the first to report on a student-staff partnership approach for developing nutrition curriculum resources in higher education. Our findings will contribute to the growing area of research that centres student experience equally alongside staff researchers and expands the perspectives of SaP practice. By addressing this research gap, we hope to strengthen knowledge and practice in this field and encourage future student-staff partnerships in the nutrition higher education sector.

Primary school-based healthy and sustainable food education initiatives are gaining momentum in research and practice(1). OzHarvest’s Food Education and Sustainability Training (FEAST) is one such program designed to increase Australian children’s fruit and vegetable intake and reduce their food waste behaviours(2). This study analysed teachers’ experiences with FEAST, including perceptions of program impact on children’s fruit and vegetable consumption and food waste behaviours, and associations with school characteristics (school sector, rurality, size and socio-educational advantage). Year 5 and 6 teachers who implemented FEAST between 2021–2023 were invited to complete a post-implementation survey based on the RE-AIM framework(3). Data were collected about program reach; effectiveness (children’s fruit and vegetable intake, junk food consumption, food waste behaviours); implementation (funding, resources, training, program delivery, development of a class cookbook, barriers); intentions for maintenance; and perceptions about program aspects with most impact. Descriptive statistics were generated and chi-square analyses, one-way analyses of variance (ANOVA), t-tests and pairwise correlations were used to examine associations with school characteristics. Participants were 48 primary school teachers from 44 Australian schools. Most schools were government sector (n = 36, 81.8%) and located in a major city (n = 25, 56.8%). Schools had an average enrolment of 333.3 (SD ± 379.8) students and an average socio-educational advantage index of 993.1 (SD ± 69.9) (national average = 1000). The FEAST program reached an average 99.5% (SD ± 0.02%) of students in participating classes. All teachers reported students wasted less food after participating in FEAST, and food waste was reportedly reduced by 10% (n = 16, 35.6%), 20% (n = 13, 28.9%) or 5% (n = 7, 15.6%). Moreover, 55.5% and 33.3% of teachers agreed students ate more fruit and vegetables and less junk food respectively since completing FEAST. All schools received financial support and FEAST implementation resources (for example, lesson plans). Over three quarters of teachers completed FEAST training (n = 37, 77.1%). FEAST was largely implemented as intended, though only 51.1% of teachers created a class cookbook, and this was associated with school-level socio-educational advantage. No other school characteristics were associated with the variables measured. A third of teachers (n = 17, 37.8%) reported barriers that impeded FEAST delivery, for example, inadequate physical space and time. Most teachers reported they would (n = 39, 88.6%) or maybe would (n = 1, 2.3%) continue implementing FEAST in their classroom. Forty-three teachers (89.6%) described aspects of the program that had the greatest impact on students, and these were most commonly food waste activities (n = 24) and cooking (n = 20). The FEAST program is well received by primary school teachers as an effective mechanism for delivering healthy and sustainable food education. Findings from this study can support ongoing quality improvement of FEAST and other healthy and sustainable food education initiatives around the world to increase their uptake and impact on population and planetary health.

Diet is a modifiable risk factor for cardiometabolic diseases, yet establishing causality between diet and disease outcomes remains challenging(1). Most evidence in nutritional epidemiology stems from observational studies, which are susceptible to confounding and reverse causation, and many observational associations have failed to replicate in large-scale randomised controlled trials (RCTs). Although RCTs are considered the gold standard for causal inference, they often face practical barriers in nutrition research. Mendelian randomisation (MR) offers a complementary alternative by using genetic variants as instrumental variables (IVs) to proxy modifiable exposures such as diet(2). As genetic variants are randomly assorted at conception and remain fixed throughout life, MR can be thought of as nature’s RCTs to infer the long-term causal effect of an exposure. However, identifying valid IVs for dietary exposures remains difficult. Conventional significance-based approaches often select variants that exhibit pleiotropy, i.e. affecting multiple traits beyond the dietary exposure of interest. This violates a core MR assumption that IVs only affect the outcome through the exposure and may give misleading conclusions about the true effects of diet. To address this, we used genetic IVs related to taste and smell perception, which are biological drivers of food preferences and intake. Anchoring IVs in the sensory biology of dietary behaviours can minimise pleiotropic bias and improve the reliability of diet-related MR findings(3). MR was applied to assess the causal effects of four dietary patterns (DPs) (Unhealthy, Healthy, Meat-based, Pescatarian) from the UK Biobank (n = 258,758–449,210) on twelve cardiometabolic outcomes (n = 149,006–1,320,000), including body mass index, coronary artery disease (CAD), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglycerides (TG), systolic blood pressure, diastolic blood pressure, type 2 diabetes (T2D), haemoglobin A1c, fasting insulin, and fasting glucose (FG). Findings included robust evidence (Bonferroni-corrected p < 0.00185) that the Unhealthy DP causally increased risk of CAD (odds ratio [95% confidence interval] = 3.23 [1.89, 5.52] per SD increase in Unhealthy DP score, p = 1.86 × 105) and TG levels (beta = 0.45 ± 0.13 SD per SD increase in Unhealthy DP score, p = 5.23 × 104), supporting existing mechanistic understanding between diet and cardiovascular disease risk. Suggestive evidence (p < 0.05) was found for an Unhealthy DP increasing T2D risk, a Healthy DP lowering FG in individuals without T2D, and a Meat-based DP elevating CAD risk. Notably, our chemosensory IVs did not replicate implausible associations identified using conventional significance-based IVs, such as a Healthy DP increasing BMI, suggesting that these may reflect residual bias or pleiotropy. Overall, this study demonstrated the utility of MR in strengthening causal inference and triangulating evidence in nutritional epidemiology, while emphasising the crucial importance of using biologically informed IVs in MR studies on dietary exposures.

Food insecurity, defined as inadequate or uncertain access to food due to financial or social constraints, is increasingly recognised as a key social determinant of health(1). While some estimates suggest around 30% of Australians experience food insecurity(2), regional prevalence statistics are less well documented. International studies have consistently linked food insecurity with poor mental health outcomes, but Australian data, particularly at the local level, remain limited. This study examined associations between food insecurity, self-reported mental health, and social isolation in a regional Australian population. Data were drawn from the Let’s Talk About Food survey, a cross-sectional online survey of adults (≥ 18 years) living in the Illawarra and Shoalhaven regions of New South Wales, conducted in April–May 2024. Food insecurity was assessed using the 18-item Household Food Security Survey Module and classified into four categories (food secure, marginal, moderate, severe) using USDA/Health Canada thresholds(3). Mental health was measured via self-rated mental health, diagnosed mental health conditions, and six social isolation indicators. Multivariable logistic regression models adjusted for age, income, education, household structure, and disability. Among 666 respondents (79.8% female, 57.1% with university education), 38.3% were food insecure compromising 7.8% experiencing marginal food insecurity, 18.8% moderate food insecurity, and 11.7% severe food insecurity. Food insecurity was significantly associated with poor mental health outcomes. Respondents with fair or poor self-rated mental health (n = 107, 22.0%) had more than double the odds of food insecurity (AOR = 2.41, 95% CI: 1.47–3.96), as did those with a diagnosed mental health condition (n = 157, 27.7%; AOR = 2.33, 95% CI: 1.46–3.71). Strong associations were also observed with social isolation indicators. Feeling alone and friendless at least half the time (AOR = 3.13, 95% CI: 1.81–5.43), often feeling separate (AOR = 2.73, 95% CI: 1.65–4.52), isolated (AOR = 2.91, 95% CI: 1.81–4.67), or struggling to reach out (AOR = 1.99, 95% CI: 1.31–3.03) all increased the odds of food insecurity. A lack of emotional support similarly doubled the odds (AOR = 2.41, 95% CI: 1.37–4.24). This is the first Australian study to demonstrate consistent associations between food insecurity, mental health, and social isolation in a regional context. Findings highlight that food insecurity should be treated as both a nutritional and mental health issue. Integrated responses that embed mental health support within food programs, alongside broader policies addressing income, housing, and social connection, are urgently needed.

Obesity affects > 30% of Australian adults and is associated with excess circulating nutrients, particularly saturated fatty acids (SFAs), contributing to chronic low-grade systemic inflammation(1,2). People living with obesity have an increased risk of severe respiratory viral disease, highlighted by the recent SARS-CoV-2 and 2009 H1N1 pandemics(3,4). Previously, we have shown that consuming a meal high in SFAs increases activation of the NLRP3 inflammasome in the airways of adults with asthma(5), with others showing that increased NLRP3 activation is implicated in the pathogenesis of severe inflammation during influenza A virus (IAV)-induced lung disease(6). Pro-interleukin-1β is cleaved via the NLRP3 inflammasome complex to interleukin (IL)-1β, and so can indicate inflammasome activity. We have shown that SFAs increase pro-inflammatory IL-6 and reduce anti-viral interferon (IFN)-λ production in response to IAV infection in a human epithelial cell line (BCi-NS1.1), which indicates a heightened inflammatory and impaired anti-viral response to infection(7). This study aimed to determine if high systemic SFAs contribute to worse respiratory viral disease outcomes. PBMCs from people with obesity (n = 7) and healthy-weight controls (n = 11) were treated with a high-dose (2500 µM) or low-dose (250 µM) of palmitic acid and infected with IAV; and IL-1β and IFN-⍺ were measured as markers of inflammation and anti-viral activity. Plasma fatty acids were profiled via gas chromatography and correlated with infection outcomes of PBMCs. PBMCs from people with obesity treated with high-dose and infected with IAV produced significantly heightened IL-1β compared to healthy weight controls [90.0 pg/ml (6.7, 332.9) vs. 14.5 pg/ml (5.5, 114.5); p = 0.004]. There was a dose-dependent relationship between palmitic acid treatment and anti-viral IFN-⍺ production in response to IAV. IFN-⍺ production was higher in response to low-dose treatment compared to untreated PBMCs from people with obesity [155.6 pg/ml (29.9, 187.2) vs. 59.2 pg/ml (4.0, 154.4); p = 0.017]. Whereas high-dose treatment significantly reduced IFN-⍺ in people with obesity compared to low-dose treatment [6.9 pg/ml (2.5, 14.5) vs. 155.6 pg/ml (29.9, 187.2); p < 0.001]. We found higher levels of plasma monounsaturated fatty acid (MUFA), vaccenic acid, to be significantly associated with higher IFN-α (r = 0.621, p = 0.010) and lower IL-6 production from PBMCs in response to IAV (r = −0.550, p = 0.042). Higher plasma polyunsaturated fatty acid (PUFA), ⍺-linolenic acid, was correlated with reduced IL-6 response to IAV (r = −0.557, p = 0.020). This data implicates that high doses of palmitic acid contribute to more severe inflammation in people with obesity in response to IAV and reduces anti-viral responses to IAV in people with obesity, potentially exacerbating respiratory viral disease severity. Conversely, certain MUFA and PUFA may exert protective effects in the context of IAV infection.

Nutrition during pregnancy and postpartum is critical in maternal and infant health, with poor dietary intake during this period contributing to adverse outcomes and long-term health risks(1). Dietary intake is influenced by behavioural, physiological, and social factors(2), and understanding the patterns, and their determinants, can inform targeted nutrition interventions. This study aimed to assess changes in diet quality and food and nutrient intakes from pregnancy to one year postpartum in Australian women and compare to national nutrition recommendations. Associations between diet quality, sociodemographic and health characteristics were also investigated. This study was an analysis of data from the ORIGINS pregnancy cohort (2017–2022). Women were included if they had complete dietary data at both timepoints, were aged ≥ 19 years, and were not pregnant one year postpartum. Dietary intake was assessed via the Australian Eating Survey food frequency questionnaire and diet quality was assessed using the Australian Recommended Food Score (ARFS). Sociodemographic data were self-reported; clinical health data were extracted from hospital medical records. Paired sample t-tests analysed changes in diet quality and intake. Linear regression estimated associations between maternal characteristics and diet quality, with adjustment for covariates. Food group and nutrient intakes were compared to recommendations in the Australian Guide to Healthy Eating and Nutrient Reference Values. Among 337 women (33.1 (4.5) years, 49.9% Australian-born, 51.3% university educated), mean (95% CI) diet quality was suboptimal during pregnancy and one year postpartum (ARFS 34.0 (33.0, 35.0) vs. 34.8 (33.8, 35.8) points out of 73, p = 0.038). One year postpartum, participants reported consuming more vegetables, meat, protein, and retinol equivalents, but less fruit, dairy, carbohydrate, saturated fat, iodine, and folate (p < 0.05). Across both timepoints, alignment with recommendations was poor for all food groups, macronutrients and key micronutrients. None of the women met the daily intake targets for all five food groups during pregnancy, and only one woman met the targets one year postpartum. Lower diet quality during and after pregnancy was linked to not having had a university education, and a higher pre-pregnancy BMI. Postpartum, younger age and lower income was also associated with poorer diet quality and having a BMI in the overweight category before pregnancy (p < 0.05). Findings underscore persistent nutritional inadequacies and social disparities among pregnant and postpartum women in Australia and provide evidence to support updates to national dietary guidelines and the development of targeted nutrition interventions, particularly for women experiencing socioeconomic disadvantage.

School lunches significantly contribute to children’s dietary intake and nutrition status(1), yet little is known about children’s perceptions regarding school lunches. Therefore, this study aimed to explore Victorian (Australian) primary school children’s current practices and perceptions regarding school lunches. An online survey was used to gather the opinions and practices of children in grades 4–6 (aged 10–12 years). Frequencies and percentages were calculated for quantitative variables, and chi-square tests were used to explore associations between categorical variables. Qualitative responses were analysed using content and thematic analysis approaches. A hundred and thirty-eight children completed the survey between late-2022 and mid-2024. Most children (84%) reported that they bring a packed lunch from home every day to eat during the school lunchtime. Most rarely or never purchase food from the school canteen (81%) and rarely or never use the lunch order system (86%). The top five food items children reported ‘usually eating for school lunch’ included sandwiches, fruits, vegetables, crackers, and yoghurt, whilst the top five food items they ‘would love to have for school lunch’ included sandwiches, chocolates and sweets, pasta, chips, and pizza. Most children agreed that they like to eat lunch before playing (86%), have quick-to-eat food for their lunch (84%), and like to eat warm or freshly cooked food for their lunch (72%). Over 60% of children agreed that they like to eat their lunch outside the classroom and would like to have food warming and cooling facilities in school. Nearly half of children (52%) agreed that the time allocated for eating is long enough to eat their lunch if they want to. More non-government school children (64%) disagreed that the time given for eating is enough compared to government school children (40%) (p = 0.009). The most enjoyable aspects of school lunchtime included the opportunity to socialise with friends, a chance to eat food and not feel hungry, and the opportunity to break from learning. Things children did not like about school lunchtime included not having enough time to eat their food, food rules, the lack of variety in meals or running out of food to eat, and unpleasant social interactions (e.g., fights with friends). When asked if they would like their school to provide school-provided lunches, 47% chose ‘yes’, and 45% chose ‘maybe’. The findings show that home-packed lunch is the main source of food for school lunches and children desire changes in the school food environment such as having food-warming facilities and increasing the time allocated to eat. The findings also show that children welcome the idea of school-provided lunches. These findings provide some insights for policymakers and health promoters to use to devise discrete strategies to improve primary school lunches and the school food environment.

Valid and reliable methods for measuring plate waste are essential to improving foodservice efficiency and patient nutrition management. Although direct weighing is considered the most accurate method for quantifying food waste, it is often impractical in clinical settings due to labour and time constraints(1). Alternative methods such as visual estimation, particularly digital photography, may offer a feasible solution. This study examined the accuracy of a digital photography method for quantifying whole plate waste (aggregate) in an acute care hospital setting. Plate waste data were collected across three main meals over seven breakfasts, 21 lunches, and 21 dinners. Each plate was photographed before and after consumption, and leftover food was weighed using an electronic scale. A total of 1763 plates (n = 108 for breakfast; n = 804 for lunch; n = 851 for dinner) were assessed using both direct weighing and digital photography with a 7-point visual scale (0%, 10%, 25%, 50%, 75%, 90%, 100% of food remaining). A subsample of 200 plate images (n = 20 for breakfast; n = 90 for lunch; n = 90 for dinner) was independently evaluated by two assessors to determine inter-rater reliability. Waste per food component was calculated as: the visually estimated proportion (%) of food remaining × the recommended standard serving size of each menu item(2). Spearman correlation coefficients assessed associations between the two methods, and the Bland-Altman analysis evaluated agreement(3). A strong positive correlation was observed between the two methods (rs = 0.9895, p < 0.001), with consistent results across meals (breakfast: rs = 0.9950, p < 0.001; lunch: rs = 0.9882, p < 0.001; dinner: rs = 0.9882, p < 0.001). Bland-Altman analysis indicated good agreement, with a mean difference of 4.67 g and 95% limits of agreement ranging from −50.51 to 59.84 g. Mean differences were consistent across meals (breakfast: −5.22 g; lunch: 5.05 g; dinner: 5.56 g), with breakfast showing narrower limits of agreement than lunch and dinner (breakfast: −33.96 to 23.51 g; lunch: −50.99 to 61.09 g; dinner: −50.91 to 62.02 g), likely due to simpler meal composition. Inter-rater reliability was high [ICC range: 0.874 (95% CI: 0.815–0.916) to 0.972 (95% CI: 0.958–0.982)], indicating good consistency between assessors. Findings support digital photography as a valid method for quantifying whole plate waste in acute care hospital settings. It also highlights the utility of digital photography in monitoring plate waste over time, informing food waste reduction strategies, and evaluating the effectiveness of interventions to enhance patient satisfaction and improve nutritional intake.

Miracle fruit (Synsepalum dulcificum) contains the glycoprotein miraculin, which provides potential sweetening and taste-modifying effects. When consumed before acidic foods (pH < 6.5), miraculin binds to human sweet taste receptors, generating a temporary perception of sweetness(1). This effect is predominantly studied on sour taste. As informed by our narrative review(2), its effects on other tastes and the impact of miracle fruit doses across all tastes remain underexplored. This pre-post quasi-experimental pilot study aimed to investigate the effects of selected miracle fruit doses (175 mg, 350 mg, 700 mg) on solutions and foods representing different tastes. We hypothesize that miracle fruit decreases the perceived intensities of sourness, tartness, and bitterness while enhancing the sweetness, and seek to establish the optimal dose for future dietary interventions. Ethical approval was obtained from Griffith University Human Research Ethics Committee (2024/052). Forty-five healthy Australian adults of a median age of 22 (20.0–26.0) years and BMI of 22.5 (21.5–23.9) kg/m2 rated the taste intensities of solutions and foods on general Labeled Magnitude Scales from 0–100, before and after consuming miracle fruit tablets of a given dose. Non-acidic solutions and foods were acidified using citric acid and lime juice, respectively, to activate miraculin(3). Socio-demographic data, body composition, saliva pH, and bitter taste sensitivity (TAS2R38 genotype and phenylthiocarbamide response) were recorded as potential covariates. Data were analysed using SPSS 29.0. Generalized linear mixed models examined the effect of dose on taste intensities, after adjusting for covariates (age, sex, phenylthiocarbamide response) and participant variability. The low dose (175 mg) was suitable to significantly decrease the sourness of citric acid solution [β = −1.331, 95% CI = (−1.811, −0.850), p < 0.001], lime [β = −1.177, 95% CI = (−1.519, −0.835), p < 0.001], and bitterness of broccoli [β = −0.674, 95% CI = (−1.091, −0.258), p = 0.002], and enhance the sweetness of sucrose solution [β = 0.433, 95% CI = (0.170, 0.695), p = 0.002] and maple syrup [β = 0.413, 95% CI = (0.152, 0.674), p = 0.002]. The moderate dose (350 mg) masked the tartness of tartaric acid solution [β = −1.063, 95% CI = (−1.483, −0.643), p < 0.001] and Granny Smith apple [β = −0.661, 95% CI = (−1.126, −0.195), p = 0.006]. Miracle fruit did not change the bitterness of the 6-n-propylthiouracil solution. In conclusion, miracle fruit enhances sweetness and masks sour, tart, and bitter tastes under acidic conditions, with effects varying by miracle fruit dose and food matrix (liquid/solid). These findings highlight miracle fruit’s potential as a sweetener in future dietary interventions to replace added sugars and support the consumption of sour/tart fruits and bitter vegetables. Furthermore, it can potentially over-sweeten already sweet items to make them less preferable.

The gastrointestinal (GI) microbiome is considered an additional organ of the human body that is implicated in health and disease(1). Dietary intake is a major modifiable variable contributing to microbial colonisation and fermentation(2). Advancements in microbial sequencing methods and interest in the impact of microbiome on health and disease have led to an exponential increase in studies investigating relationships between diet and the GI microbiome. However, high-quality synthesis of research is limited by considerable heterogeneity in methods used to assess and analyse dietary intake, sequence microbiome data and subsequently analyse diet-microbiome associations. This scoping review aimed to synthesise dietary and microbiome assessment and analysis methods used in human studies that investigate diet-microbiome taxonomic associations, and establish guidelines to inform future research methodology. A systematic literature search identified papers that measured individual-level dietary intake in humans and sequenced GI microbiome using either 16S rRNA or metagenomic shotgun sequencing. Studies were required to investigate associations between dietary intake and some aspect of GI microbiome. Databases searched were MEDLINE, EMBASE, CINAHL, Cochrane and Google Scholar, resulting in 22,228 unique records after de-duplication. After full-text screening, 1,262 relevant articles were identified, then further categorised based on study methods. Additional data were extracted from a subset of 295 studies that captured whole dietary intake and compared this with GI microbiome. Twenty-three percent of included diet-microbiome studies employed comprehensive methods to capture whole dietary intake for analysis with taxonomic microbiome data. The remainder of studies captured a single food, nutrient, or looked at compositional microbiome rather than taxonomy. Within the comprehensive subset, there were 84 different variations of food frequency questionnaires (FFQ), 12 alternative surveys, and 4 types of diet recalls or diaries capturing between 1 and 14 days of dietary intake. Fifty-five percent (n = 163) of studies investigated habitual dietary intake, 35% (n = 101) investigated recent dietary intake, and 10% (n = 30) assessed both. Eighty-one percent of studies employed 16S rRNA sequencing, with wide variation in extraction, sequencing, pre-processing and annotation methods. There were also substantial gaps in reporting of methods for each step of the process, limiting further comparison or consolidation of study outcomes. Microbiome-specific statistical methods were only used in 11% of the identified subset, with preference for correlational methods not well-suited to handling the complexities of microbiome data(3). Only eight studies in this review had both raw dietary and sequencing data deposited in online repositories, limiting future validation and comparison of results. This review reveals the extent of the inconsistencies that exist in exploratory diet-microbiome studies, despite published recommendations to assist researchers in these processes(4). Collaborative efforts towards consensus methods and reporting will help to substantially progress the diet-microbiome research field towards high-quality evidence and meta-analyses.

The rapid growth of commercially produced complementary foods reflects a broader global shift toward the commodification of infant and child feeding within the global food system. A recent scoping review has shown commercial squeeze pouches are a widely used feeding option for children both within the complementary feeding period and beyond(1), yet growing concerns exist about their nutritional quality and impact on feeding development. Another study among Australian children found that these products are commonly consumed and do not align with nutritional guidelines(2). However, limited evidence exists on how and why Australian parents use squeeze pouches with their children. The aim of this study was to explore parental experiences and motivations for providing commercial squeeze pouch products to infants and children in Australia. Data for this cross-sectional, online survey was collected between December 2023 and September 2024. Parents recruited through various convenience sampling methods were invited to complete the open-ended survey questions asking about the role of squeeze pouches in their child’s diet and their reasons or motivations for use. Responses were analysed qualitatively using reflective thematic analysis(3) to explore parental experiences, motivations, and perceived benefits and concerns surrounding the use of commercial squeeze pouch products. Five higher-order themes emerged: behaviour, dietary intake, feeding development, food environments, and environmental concerns. Parents frequently described squeeze pouches as a practical, mess-free solution to time pressures or when travelling, for example: ‘for convenience, when travelling/haven’t made something’. Parents also reported the use of squeeze pouches to manage fussy or neurodivergent eating behaviours, describing them as ‘safe’, ‘predictable’ foods. Another common theme was using these products as a treat to reward good behaviour, often when at the supermarket in replacement of other ‘treat’ foods, with one parent stating: ‘we use fruit pouches instead of lollies’. However, many parents also expressed concerns about cost, packaging waste, and feeding skill development. The responses also reflected a broader societal paradox—where convenience and modern parenting demands often outweighed nutritional or environmental ideals. As one parent admitted: ‘They are an environmental disaster so we avoid them … except for the occasional yoghurt’, highlighting the gap between feeding values and the practical realities that shape parental decision-making. Despite some reservations, commercial squeeze pouches appear to be routinely used by Australian parents to navigate complex feeding challenges and household constraints shaped by broader social and commercial determinants of health. These parental insights demonstrate the need for clearer policy, regulatory and practice frameworks to protect children and caregivers from structural and commercial drivers supplanting best practice nutritional guidance when making food choices, as well as the need for better support for families such as accessible, evidence-based feeding guidance and public health programs and interventions.

Higher habitual dietary flavonoid intakes have been consistently associated with lower mortality and chronic disease risk(1). However, the role of flavonoid diversity has never been investigated. We aimed to investigate the independent roles of flavonoid intake quantity and diversity on the risk of all-cause mortality and major chronic disease incidence. In this cohort study, 124,805 UK Biobank participants [mean (SD) age: 60.2 (7.8) years; ~55% female] were followed for up to 11.8 years. Flavonoid intakes were estimated from repeated 24-hour dietary assessments and diversity calculated using our novel method which factors for both the variety and distribution of consumption. Associations with all-cause mortality and incidence of cardiovascular disease (CVD), type 2 diabetes (T2DM), total cancer, respiratory disease, and neurodegenerative disease were assessed using Cox models. Following mutual adjustment and after accounting for socio-demographic, lifestyle and dietary factors, both a higher quantity and a wider diversity of dietary flavonoid intake associated with a significantly lower risk of all-cause mortality and several chronic diseases: comparing higher (Quintile 5) to lower intakes (Quintile 1), the Hazard ratios (95% CIs) for quantity and diversity respectively were 0.84 (0.76–0.92) and 0.86 (0.78–0.95) for all-cause mortality, 0.88 (0.81–0.96) and 0.90 (0.82–0.98) for CVD, 0.75 (0.66–0.84) and 0.80 (0.70–0.91) for T2DM, 0.92 (0.85–0.99) and 0.92 (0.85–0.99) for cancer, and 0.91 (0.86–0.97) and 0.92 (0.86–0.98) for respiratory disease; only intake quantity associated with neurodegenerative disease risk [Q5 vs. Q1: 0.80 (0.68–0.94)]. We then tested for interactions between quantity and diversity of flavonoid intake (across all outcomes), and although none were observed (all p > 0.05) the independent associations still suggest there is a benefit to consuming a higher diversity beyond that of simply consuming a high quantity (and vice versa). In conclusion, consuming both a higher quantity and wider diversity of dietary flavonoids appears better for longer-term health than higher intakes of either component alone.

Nutrient profiling systems are designed to assess the nutritional quality of packaged foods and beverages, and guide public health policy initiatives(1). In Australia, the Nutrient Profiling Scoring Criterion (NPSC) is used to determine whether foods or beverages are eligible to carry health claims. The NPSC assesses nutrient content using a per 100 g or 100 mL reference amount. While this approach allows for standardisation of nutritional content across foods, it does not reflect the typical amount consumed. Ready meals, for example, are often sold and consumed as a single serve portion exceeding 300 g. As a result, some products may be deemed healthy enough to carry a health claim despite providing a substantial amount of energy, saturated fat, sugar or sodium per serve. This study aimed to examine the impact of applying ‘per serve’ nutrient profiling criteria on the classification of ready meals and compare the proportion of products meeting proposed per serve thresholds with those assessed using per 100 g nutrient values. Data on the nutritional composition and serve sizes of ready meals available in the Australian market was obtained from the 2023 FoodSwitch database, a repository of Australian food packaging images and label data for over 17,000 foods developed by The George Institute for Global Health(2). Four nutrient profiling models were applied to assess the relative healthfulness of ready meals: Model 100g (comparison model using per 100 g values; the status quo), Model A (standardised 350 g serve), Model B (serve size declared on-pack), and Model B Adjusted (declared serve with thresholds scaled to 350 g). Products were assessed against per serve nutrient thresholds for energy, saturated fat, total sugars, and sodium. Cut off-points were set at 1/3 of daily recommended intakes based on nutrient reference values and other labelling guidance. Products meeting all four nutrient thresholds were classified as meeting model criteria. Cochran’s Q test and McNemar’s post hoc tests were used to compare classification outcomes across models. Data were available for 775 ready meal products. Of these, 97% met model criteria under Model 100g. Under the per serve models, 16% of products met model criteria for Model A, 20% for Model B, and 16% for Model B Adjusted. Model 100g resulted in a significantly higher proportion of ready meal products meeting nutrient thresholds than all per serve models (p < 0.001). Applying per serve nutrient profiling models substantially reduced the proportion of ready meals meeting model criteria. This study revealed limitations of classifying foods according to nutrient content per 100 g, particularly for single serve foods like ready meals that are likely exceed recommended levels of nutrients to limit when consumed as intended. Incorporation of per serve disqualifying criterion into nutrient profiling systems should be considered to better reflect consumption and strengthen food labelling policies.

Increased consumption of foods with pulses (e.g., lentils or chickpeas), which are a source of protein, is recommended due to their lower environmental impact than animal-sourced foods(1). However, data for the environmental and nutritional trade-offs for such a dietary shift has been lacking in the Australian context, and nutritional implications for specific population groups not considered. The diets of Australian adolescents are particularly poor, yet this age is critical for developing healthy lifestyle behaviour that can persist into adulthood. We aimed to assess the nutritional and environmental impact of increase pulse consumption, through a case study of a dietary shift of Australian adolescents from a ham sandwich to hummus sandwich. Nutritional analysis was undertaken using the Nutrient Rich Food index for adequate intake (NRF-ai) to evaluate nutritional value, weighted to reflect the proportion of the Australian adolescent population with inadequate/excessive intakes of 22 key nutrients(2). Environmental impact of each sandwich was assessed using Life Cycle Assessment methodology across five impact categories: global warming potential, eutrophication, acidification, freshwater ecotoxicity and water scarcity. A sensitivity analysis was undertaken to test the influence of key variables for ham (imported from Europe or Australian) and hummus (commercial, or homemade with either canned or dried chickpeas). The NRF-ai score was also used as a functional unit to determine the nutritional ecoefficiency of each type of sandwich (environmental impact per NRF-ai). Nutritional affordability (NRF-ai per dollar cost to the consumer) was also calculated. Based on an equivalent nutritional value (one unit NRF-ai), a hummus sandwich has a lower impact on the environment than a ham sandwich, across all environmental impact categories. For example, considering adolescent boys’ diets, the global warming potential (GHGE) from a ham sandwich (using imported ham) is 10 times that of a hummus sandwich (using commercially made hummus). Per serve, a hummus sandwich has a much lower environmental impact, greater nutritional benefit, and is more affordable than a ham sandwich. The biggest contributors to environmental impact of the ham sandwich is feed and on-farm production (e.g., emissions from manure). The growing of pulses has environmental benefits reducing acidification and eutrophication. Consumer choice can make a substantial difference to environmental and nutritional outcomes of the food system. If 50% of Australian adolescents consumed a hummus sandwich once a week for a year, instead of a ham sandwich, the reduction in GHGE would be equivalent to a person flying from Paris to Brisbane 3358 times (15,450,000 kg CO2eq). Strategies are needed to support consumer decisions to choose foods with environmental and nutritional benefits, such as pulses, through increasing access to healthy and appealing pulse based foods, and increasing consumer’s knowledge and skills to purchase, prepare and consume pulses.

Increased consumption of pulses (the edible grains of legumes) is recommended to promote healthy and sustainable dietary patterns(1). However, the lack of knowledge and skills have been identified as major barriers to their consumption(2). Supporting adolescents to regularly consume pulses can contribute to improved total dietary intake, and positive dietary patterns that can be carried into adulthood impacting future generations(3). This project aimed to increase adolescents’ knowledge, skills and motivation to prepare and consume pulse-based foods. Highschool students (14–15 years old, n = 16) participated in two one-hour home economics lessons in a government-funded high school in Brisbane, Australia. The lessons were facilitated by a member of the research team and dietitian, and included the presentation and discussion of information about the nutritional and environmental benefits of pulses, and preparation and consumption of three pulse dishes (hummus, falafel and bean burgers). Participants completed a paper survey at baseline, immediately after, and six months after the final lesson regarding their knowledge, skills, motivation and consumption of pulse foods. A home economics teacher (n = 1) who was involved in assisting the facilitation of the classes participated in a 15 minute interview evaluating the effectiveness and potential scalability of the lessons. Survey responses were analysed for change in responses across time point using the Mann-Whitney U test with statistical significance determined when p < 0.05. The teacher interview was analysed using an inductive thematic approach. Adolescents’ knowledge of the term ‘pulses’ and awareness of environmental benefits of consuming pulses increased across each time point (p < 0.001). There was no statistically significant change in skills, motivation or consumption of pulses. The teacher reported that having a guest teacher increased student engagement and improved student behaviour, and expressed intentions to increase the use of pulses in home economics classes more broadly across the high school curriculum. Home economics classes alone can significantly increase knowledge of pulse foods. However to effectively increase consumption of pulse based foods amongst adolescents future strategies should concurrently involve a range of strategies aimed to improve the accessibility, availability and appeal of pulse-based foods, whilst addressing social and cultural norms of eating pulse foods.

Skeletal muscle is an important site for nutrient metabolism. The capillaries in the skeletal muscle and the blood flowing through these capillaries, known as muscle microvascular blood flow (MBF), enhance glucose delivery and disposal in the muscle in response to insulin infusion(1) or ingestion of a mixed nutrient meal(2). Polyunsaturated fatty acids (PUFA), particularly omega-3 (n-3) PUFA, have demonstrated a variety of cardiometabolic benefits, including inhibiting inflammation, improving lipid profiles, endothelial function, insulin sensitivity, and reducing the risk of metabolic and chronic diseases(3). However, the impact of PUFA on muscle microvascular health and function remains unknown. The aim of this systematic review is to determine the effects of PUFA interventions on muscle microvascular health and function in animals and humans. A systematic search of Medline Complete, PubMed, Embase, and Cochrane Library was conducted. Studies were considered eligible if they examined the effect of PUFA interventions on microvascular measures including capillary density or MBF in skeletal muscle of animals or humans. Quality assessment was conducted through the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE’s) risk of bias tool for animal studies and the revised Cochrane risk of bias tool for randomized trials (RoB) for human studies. Twelve eligible studies were included in this systematic review, out of which nine involved animal models, and three studies were conducted in humans. Four animal studies showed that PUFA increased capillary density in skeletal muscle in various models. Out of these four studies, three studies used n-3 PUFA-rich fish oil with doses ranging from 5% to 20% weight (w)/w of diet and 0.64 g/100 g of body weight (BW)/day and duration of 14 to 28 days and one study used n-6 PUFA-rich primrose oil (10% w/w of diet for 2 months). In terms of muscle MBF, three animal studies showed n-3 PUFA-rich fish oil (5% to 14.5% w/w of diet and 0.64 g/100 g of BW/day and duration of 14 days to 6 weeks) prevented the impairment in muscle MBF caused by various experimental conditions such as ischemia, endotoxin infusion or during vasoactive agent infusion. None of the animal studies using n-6 PUFA oils showed an effect on muscle MBF. In humans, neither n-3 nor n-6 PUFA affected muscle MBF. While there seems to be a wide range of intervention dose and duration used in the animal studies, they do suggest n-3 PUFA may be beneficial for microvascular health and function; however, further investigation in humans is warranted.