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.

Endogenous biological rhythms synchronise human physiology with daily cycles of light-dark, wake-sleep and feeding-fasting. Proper circadian alignment is crucial for physiological function, reflected in the rhythmic expression of molecular clock genes in various tissues, especially in skeletal muscle. Circadian disruption, such as misaligned feeding, dysregulates metabolism and increases the risk of metabolic disorders like type 2 diabetes. Such disturbances are common in critically ill patients, especially those who rely on enteral nutrition. Whilst continuous provision of enteral nutrition is currently the most common practice in critical care, this is largely dictated by convenience rather than evidence. Conversely, some findings indicate that intermittent provision of enteral nutrition aligned with daylight may better support physiological functions and improve clinical/metabolic outcomes. However, there is a critical need for studies of skeletal muscle responses to acutely divergent feeding patterns, in addition to complementary translational research to map tissue-level physiology to whole-body and clinical outcomes.

The workplace is a key environmental determinant of health and well-being. Food choices can be influenced by several workplace-related factors including, but not limited to, working hours, the workplace food environment, job roles and workplace culture. Therefore, the workplace is increasingly viewed as an important place for public health nutrition interventions. However, research in this area is fragmented and heterogeneous due to the wide range of workplace settings and occupational groups. This editorial summarises the research presented at The Nutrition Society Workplace Diet and Health Special Interest Group Satellite Symposium in July 2024 as part of the inaugural Nutrition Society Congress.

The current review will examine the field of food intake biomarkers and the potential use of such biomarkers. Biomarkers of food intake have the potential to be objective measures of intake thus addressing some of the limitations associated with self-reported dietary assessment methods. They are typically food-derived biomarkers present in biological samples and distinct from endogenous metabolites. To date, metabolomic profiling has been successful in identifying several putative food intake biomarkers. With respect to food intake biomarkers, there has been a proliferation of publications in this field. However, caution is needed when interpreting these as food intake biomarkers. Many have not been validated thus hampering their use. While much of the focus to date is on discovery of food intake biomarkers there are excellent examples of how to utilise these biomarkers in nutrition research. Applications include but are not limited to: (1) measurement of adherence to diets in intervention studies (2) objectively predicting intake with no reliance on self-reported data and (3) calibrating self-reported data in large epidemiological studies. Examples of these applications will be covered in this review. While significant progress is achieved to date in the food intake biomarkers field there are a number of key challenges that remain. Examples include lack of databases focused on food-derived metabolites thus hindering the discovery of new biomarkers and the need for new statistical approaches to deal with multiple biomarkers for single foods. Addressing these and other key challenges will be key to development of future opportunities.

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.

A person’s chronotype reflects individual variability in diurnal rhythms for preferred timing of sleep and daily activities such as exercise and food intake. The aim of this review is to provide an overview of the evidence around the influence of chronotype on eating behaviour and appetite control, as well as our perspectives and suggestions for future research. Increasing evidence demonstrates that late chronotype is associated with adverse health outcomes. A late chronotype may exacerbate the influence of greater evening energy intake on overweight/obesity risk and curtail weight management efforts. Furthermore, late chronotypes tend to have worse diet quality, with greater intake of fast foods, caffeine and alcohol and lower intake of fruits and vegetables. Late chronotype is also associated with eating behaviour traits that increase the susceptibility to overconsumption such as disinhibition, food cravings and binge eating. Whether an individual’s chronotype influences appetite in response to food intake and exercise is an area of recent interest that has largely been overlooked. Preliminary evidence suggests additive rather than interactive effects of chronotype and meal timing on appetite and food reward, but that hunger may decrease to a greater extent in response to morning exercise in early chronotypes and in response to evening exercise in late chronotypes. More studies examining the interplay between an individual’s chronotype, food intake/exercise timing and sleep are required as this could be of importance to inform personalised dietary and exercise prescriptions to promote better appetite control and weight management outcomes.

Randomised controlled trials are the ‘gold standard’ approach in nutrition research to show a causal relationship between a dietary intervention and clinically relevant outcomes at the population level. Here we review why different study designs are needed to establish the efficacy of dietary interventions at the individual level and to better account for relevant factors that can also influence the outcomes. Over the past decade, precision nutrition approaches have been developed as a new way to measure the effectiveness of dietary interventions at the individual and population level. Precision nutrition aims to determine the individual factors that are associated with differences in responses to dietary interventions. This is complex, typically needing studies with a large number of participants and using advanced statistical approaches and machine-learning algorithms to identify predictors that can explain why individuals do or do not respond to consuming specific foods, meals or diets, for a given outcome. N-of-1 study designs, which are new to nutrition science, offer a robust alternative approach to assess how an intervention and everyday behaviours affect individual health outcomes. They utilise repeated measures within individuals, rather than baseline and end measures in a larger number of participants, to provide the statistical power required to determine an individual’s responsiveness to an intervention. The adoption of new study designs and modelling approaches, particularly the N-of-1 approach, to examine responses to interventions within individuals, will help to further the understanding of the relationships between diet and health within individuals more effectively and accurately.

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.

Obesity is a chronic, complex and multi-factorial condition with an increasing prevalence worldwide. Irregular eating schedules might be a contributing factor to these numbers through the dysregulation of the circadian system. Time-restricted eating (TRE), an approach that limits eating windows, has been studied as a strategy to treat obesity, aligning eating occasions with metabolic circadian rhythms. This review aims to provide an overview of the impact of TRE protocols on metabolic, inflammatory, oxidative stress and circadian rhythm biomarkers in people with overweight or obesity. Most studies report significant weight loss following TRE protocols. While glucose levels decreased in nearly all TRE interventions, only a few studies demonstrated statistically significant differences when compared to the control groups. The findings for c-reactive protein and TNF-α were inconsistent, with limited significant differences. Changes in lipid profile changes were variable and generally did not reach statistical significance. Both 4-hour and 6-hour TRE interventions significantly reduced 8-isoprostane levels. Additionally, TRE significantly altered clock gene expression, as well as that of genes associated with metabolic regulation in subcutaneous adipose tissue. While the evidence is still inconsistent, limiting eating to a consistent daily window of 8 to 12 h can improve insulin sensitivity, reduce blood glucose, cholesterol and triglyceride levels and promote weight loss. These effects are likely attributable to both direct metabolic impacts and indirect benefits from weight loss and improved dietary habits. However, data on circadian, inflammatory and specific metabolic biomarkers remain scarce and occasionally contradictory, highlighting the need for further research on these interventions.

Systems thinking is deeply rooted in history, as far back as Aristotle. However, it has only relatively recently reemerged as an approach to help us understand and intervene in health and food systems. This is particularly salient, given its impact on environmental and population health. Whilst global food is abundant, many people cannot access affordable, healthy and culturally appropriate food. On the other hand, foods of low nutrient density are widely available. Food systems are complex and require complex thinking and approaches that allow us to consider the influence of multiple factors and how the might system respond to change. In turn, this enables the identification of ‘leverage’ points, where policies or interventions are most likely to have a sustained impact. The Foresight obesity map inspired others to adopt systems approaches to help understand the broader social, economic and environmental determinants of obesity to support intervention/policy development. Evaluation of these requires a consideration of complexity to explore why intervention goals may or may not have been successful and how relationships between components or approaches can be enhanced to support implementation and thereby increase the potential for effectiveness. Overall, approaches to understand, intervene, govern and evaluate food systems must themselves be sufficiently complex, or will ultimately be destroyed by the system it seeks to improve. This review paper aims to introduce readers to the application of systems approaches in research within the context of food systems and health, including its traditional/historical origins.

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.

Sleep is vital for the maintenance of physical and mental health, recovery and performance in athletes. Sleep also has a restorative effect on the immune system and the endocrine system. Sleep must be of adequate duration, timing and quality to promote recovery following training and competition. Inadequate sleep adversely impacts carbohydrate metabolism, appetite, energy intake and protein synthesis affecting recovery from the energy demands of daily living and training/competition related fatigue. Sleep’s role in overall health and well-being has been established. Athletes have high sleep needs and are particularly vulnerable to sleep difficulties due to high training and competition demands, as such the implementation of the potential nutritional interventions to improve sleep duration and quality is commonplace. The use of certain nutrition strategies and supplements has an evidence base i.e. carbohydrate, caffeine, creatine, kiwifruit, magnesium, meal make-up and timing, protein and tart cherry. However, further research involving both foods and supplements is necessary to clarify the interactions between nutrition and the circadian system as there is potential to improve sleep and recovery. Additional research is necessary to clarify guidelines and develop products and protocols for foods and supplements to benefit athlete health, performance and/or recovery. The purpose of this review is to highlight the potential interaction between sleep and nutrition for athletes and how these interactions might benefit sleep and/or recovery.

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.

By involving stakeholders to identify issues, co-design facilitates the creation of solutions aligned with the community’s unique needs and values. However, genuine co-design with consumers across all stages of nutrition intervention research remains uncommon. The aim of this review was to examine notable examples of interventions to improve diets in rural settings that have been co-designed by rural communities. Six studies were identified reporting on community-based and digital interventions to improve diets in rural settings that have been co-designed by rural communities. The level of co-design used varied, with two interventions describing co-design workshops and focus groups over a period of between 6 and 11 months, and others not reporting details on the co-design process. Collectively, most interventions demonstrated positive impacts on dietary markers, including an increase in purchase of fruit and vegetable, an increase in percentage energy from nutrient dense foods and a decrease in intake of high fat meats. While these interventions show promise for improving diets in these under-served communities, it is widely recognised that there is a lack of dietary interventions genuinely co-designed with and for rural communities. Future research should build on these studies to co-design dietary interventions that integrate the benefits of both community-based and digital interventions.