Currently, there is no food frequency questionnaire (FFQ) that has been validated in Australia to assess both nutrient intake and food safety practices in pregnant women(1). Validation of FFQ for use in pregnant women is important given the specific nutritional requirements and increased food safety risks during pregnancy, particularly listeriosis, as compared with the general population. Additionally, many pregnancies in Australia are unplanned, and preconception nutrition is strongly linked to positive pregnancy outcomes. Therefore, the Pregnancy-Australian Eating Survey (Preg-AES) FFQ was developed to assess dietary intake and food safety practices among women of childbearing age in Australia. This study aimed to: (i) evaluate the preliminary outcomes of reproducibility and relative validity of nutrient intakes derived from the Preg-AES FFQ against 24-hour dietary recalls (24HRs) and weighed food records (WFRs) among women of childbearing age in Australia, (ii) evaluate the preliminary outcomes of reproducibility of food safety practices of the Preg-AES FFQ, and (iii) assess the feasibility and acceptability of the validation methodology. The Preg-AES FFQ was adapted from the validated AES FFQ(2), consists of 127 questions, with an additional ten questions related to dietary intakes of foods potentially harbouring Listeria monocytogenes and 27 questions on safe food handling practices. The FFQ was administered twice, three months apart to assess reproducibility, and compared with mean intakes from three-day WFR and three-day 24HR, respectively, to assess relative validity. All nutrients were adjusted using the nutrient density method. Reproducibility of nutrient intakes and food safety practices were measured using intra-class correlation coefficient (ICC) and weighted kappa. Relative validity was assessed using Pearson correlations and Bland-Altman plots. Feasibility was described from recruitment and follow-up data. Acceptability was analysed using frequency data, via closed- and open-ended responses at three months. At baseline, 51 participants were included (mean age 27.3 ± 6.8; 66.7% Australian-born; 33.3% university-educated). Reproducibility testing included n = 35; relative validity testing included n = 29 (WFR) and n = 36 (24HR). Preliminary reproducibility results indicated ICCs ranged from 0.133 (thiamine) to 0.725 (protein). Preliminary relative validity coefficients confirmed that the Preg-AES FFQ had moderate validity against WFR and relatively lower validity against 24HR. Preliminary acceptability findings showed 91–97% of participants were satisfied with the administration of all dietary assessment methods and in-person sessions. This pilot study may inform a larger validation study in a representative Australian sample, to enhance the accuracy of the Preg-AES FFQ as a dietary assessment tool in clinical and research settings in Australia to optimise perinatal health outcomes.

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.

In 2019, the 33rd International Conference of the Red Cross and Red Crescent adopted the landmark Resolution 2 on “Addressing the Mental Health and Psychosocial Needs of People Affected by Armed Conflicts, Natural Disasters and Other Emergencies”. By examining Resolution 2’s origin and the time and context in which it was adopted, and by analyzing its normative influence on subsequent international instruments adopted by States, this article explores how Resolution 2 has contributed to advancing and establishing norms and standards for responding to the mental health and psychosocial needs of people affected by armed conflicts and other emergencies.

Reliable estimation of dietary nitrate and nitrite exposure is essential for understanding their potential health effects, which are increasingly recognised as dependent on food source, while their food content is determined by multiple factors such as preparation method and geographic origin. To address the lack of standardised, comprehensive data, we developed the Nitr-Navigator (nitr-navigator.com), the world’s most extensive, up-to-date and open-access nitrate and nitrite food composition database(1–3). It compiles over 150,000 analytical values across more than 800 unique foods and includes detailed metadata on cooking and processing methods, quantification techniques, growing conditions, seasonality, and geographic origin. Using these enriched data, we conducted in-depth analyses to investigate how food preparation, sampling season, and location influence nitrate and nitrite content. For example, cooking-specific retention factors for plant-based foods showed that boiling retained nitrate at a median of 55.00 ± 19.24% (interquartile range [IQR] 39.59–65.56%), while frying increased nitrate content to 279.53 ± 153.60% (IQR 179.53–386.89%), compared to raw equivalents. Geographic variability was observed across both plant and animal foods, with large seasonal effects on vegetable nitrate levels, especially in leafy greens. Longitudinal trends revealed a decline in nitrate content in selected vegetables over the past three decades, which has stabilised since 2010, while nitrate and nitrite levels in animal-based foods remained relatively constant over time. These stratified data enable more accurate, context-specific exposure assessments for epidemiological and clinical studies. To support usability, we also developed NitriXplorer, an integrated data portal that allows users to search, visualise, and filter data by variables such as country of sampling and food processing. NitriXplorer incorporates a language model-powered matching tool to align food items from dietary records with entries in the Nitr-Navigator database. This harmonised and validated pipeline facilitates accurate data extraction by accounting for regional variability and analytical method differences, thereby enhancing reproducibility and cross-study comparability. Since its launch in July 2024, the Nitr-Navigator website has received over 20,000 views from users in more than 60 countries, supported over 10 peer-reviewed publications, and facilitated collaborations with institutions in the US, UK, EU, and China. The database has been cited by the French food safety authority (ANSES) in support of a legislative bill to reduce nitrite use in cured meats, and referenced, alongside oral evidence, in inquiries by the UK House of Lords Environment and Climate Change Committee. Together, Nitr-Navigator and NitriXplorer represent a globally relevant infrastructure for advancing research, risk assessment, and evidence-based policymaking on nitrate and nitrite exposure(4).

The application of the WILD research framework (Worldwide, In situ, Local, Diverse) to developmental psychology exposes further WEIRD biases. I suggest that Diversity must extend beyond Worldwide sampling to include within-nation variation and suggest that structural and cultural barriers maintaining WEIRD dominance can be mitigated through lightening bureaucratic loads, researcher reflexivity, and cross-disciplinary collaboration.

The marketing of ultra-processed and discretionary foods on social media significantly influences dietary choices and consumer engagement, particularly among younger demographics(1). As investment by food brands in digital media increases, identifying the strategies used across various platforms becomes crucial for public health interventions and policy development. However, comparative analyses of these marketing strategies across multiple platforms remain scarce. This study aimed to examine marketing strategies used by leading food and beverage companies across four major social media platforms and assess their influence on consumer engagement. A comparative analysis of 1,000 posts (25 posts per company per platform) from ten internationally recognized food and beverage brands was conducted on Facebook, Instagram, TikTok, and X (formerly Twitter). Posts were manually categorized into one or more of eight predefined marketing strategies(2). Engagement metrics including likes, comments, and shares were collected, with non-parametric statistical tests used to identify differences in engagement across platforms, strategies, and brands(3). Corporate Social Responsibility (CSR) posts were the least frequent (0.7%) but generated the highest median engagement, particularly in comments (p < 0.001). In contrast, Affective Branding (33.5%) and Product Endorsement (29.9%) were the most used strategies but yielded only moderate engagement. Engagement differed significantly across platforms, with Instagram achieving the highest median likes (3307, p < 0.001) and shares (416, p < 0.005), while X recorded the lowest engagement overall. Brands such as McDonald’s and Sour Patch Kids had significantly higher engagement levels compared to other brands (p < 0.001). These findings suggest public health campaigns and policymakers could effectively use emotionally engaging and socially responsible marketing strategies like those successfully employed by food brands, potentially improving consumer engagement and healthier dietary choices. Furthermore, the distinct differences in strategy effectiveness across platforms highlight the importance of tailored, platform-specific health promotion approaches. This study provides novel insights by systematically comparing digital food marketing strategies and consumer engagement across multiple major social media platforms and brands, contributing essential information for targeted public health initiatives and the development of digital marketing regulations.

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.

Depression is a psychological condition characterised by alterations in the mood and behaviour regulation in women experiencing 50% greater burden of depression than men(1). Additionally, cardiovascular disease (CVD) is the leading cause of death in women globally while both CVD and depression can predict the incidence of each other reciprocally. Postmenopausal women particularly, during the menopause transition, are at increased risk of developing CVD and depression(2). Life’s Essential 8 (LE8), is a recently developed cardiovascular health assessment index comprising eight health behaviours and factors: dietary quality, physical activity level, nicotine exposure, sleep health, body mass index, blood glucose, non-high-density lipoprotein cholesterol, and blood pressure(3). It may be used to predict the risk of depression prevalence. This study investigated the association between LE8 and depression prevalence among postmenopausal women using the National Health and Nutrition Examination Survey (NHANES) 2011–2020 data. The LE8 score was calculated as the average of all eight components categorised into low (0–49), moderate (50–79), or high (80–100) cardiovascular health status(3). Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9)(4). Complex survey-adjusted regression models were used. A total of 5472 postmenopausal women were included (mean age: 63.0 years), of whom 654 (12%) met the criteria for depression. The LE8 scores (mean ± SD) for those with and without depression were 53.2 ± 14.6 and 64.9 ± 14.7 (p < 0.001), respectively. Higher LE8 scores were significantly associated with lower odds of having depression (odds ratio [OR] per 10-point increase: 0.65, 95% CI: 0.60–0.72, p < 0.001). Moderate and high cardiovascular health statuses were associated with a 54% and 88% lower odds of depression, respectively, compared to the low cardiovascular health status (p < 0.001). Furthermore, both health behaviour and health factor scores were inversely associated with depression (OR: 0.77, 95% CI: 0.73–0.82, and OR: 0.83, 95% CI: 0.77–0.90, respectively). A graded relationship was also observed across health behaviour and health factor statuses: moderate and high (vs. low) statuses were associated with 54–39% and 73–61% lower odds of depression, respectively (p < 0.001). Dietary quality was inversely associated with the likelihood of having depression (p = 0.02). Women in the 50th–74th percentile of the Healthy Eating Index (HEI-2015) score had 49% lower odds of depression (OR: 0.51, 95% CI: 0.29–0.91) and those in the ≥ 95th percentile had 77% lower odds of depression (OR: 0.23, 95% CI: 0.08–0.67) compared with lowest dietary quality group (1st–24th percentile). These findings suggest that the inverse association between total LE8 scores and depression supports the potential utility of integrating LE8 metrics into CVD management strategies to predict and mitigate depression in postmenopausal women.

The new Aged Care Act and Food and Nutrition Standards focus on nutritional needs of residents however, protein and calcium intakes in older adults in aged care remain below recommended levels. Improving protein and calcium intake in residents to recommended levels is associated with reduced falls, fractures, weight loss and malnutrition, with falls and weight loss being performance indicators in aged care. This intervention was undertaken through food service over 2-years with compliance maintained for the entire period indicating a feasible means to reduce adverse health outcomes in residents. To upscale benefits of this dietary improvement, we developed a training program to up skill food service staff to deliver foods in line with intervention. We aimed to determine if food service staff training results in increased protein and calcium intakes in residents. This 12-week cluster randomised trial involved 12 aged care homes; 6 randomised to intervention (staff training) and 6 to control (residents consume from regular menus). Residents consented to food intake (plate waste analysis), nutritional status (mini nutrition assessment tool) and quality of life (EQ-5D-5L) assessments at baseline and week 12 with medical records reviewed at baseline. Staff were interviewed before and after training and intervention to determine barriers to implementation. Analysis of dietary outcomes was performed using a linear mixed effects model, with home entered as a random intercept, and baseline values entered as covariates. Data was obtained from 78 residents (median age 84.5 years; IQR: 80–89, 85% female, n = 52 intervention). Baseline protein (65 g/day; IQR 53–78, 0.9 g/kg body weight; IQR:0.7–1.1) and calcium (773 mg/day; IQR: 605–982) intakes were below the respective recommended levels of 1 g/kg body weight and 1100 mg/day. Following intervention group differences were observed for daily intakes of protein (16 g/day; 95%CI: −3, 35), calcium (302 mg/day; 95%CI: 117, 486) and dairy servings (0.9 s/day; 95%CI: 0.3, 1.5). Staff provided insights into implementation barriers. Improvements to protein and calcium intakes in residents were observed, that are associated with reduced adverse clinical outcomes. However, operational constraints may impeded intervention efficacy and detection of anti-fracture efficacy limited by the short study duration. A potential solution is mandating food standards in aged care to ensure nutritional adequacy in residents to reduce adverse clinical outcomes such as falls and fractures.

Childhood is a cultural project with shared goals, constant adaptation, and struggle; child well-being requires the engaged participation of a child in the cultural activities deemed desirable in that community. The evidence and conceptual frame of this paper show the remarkable varieties of childhoods and cultural contexts found around the world, which affect attachment and shared intention/coordinated joint engagement theories.

Nutrition science programs in Australian universities often include curriculum components focused on career development, employability skills, and professionalism(1). However, they typically lack clear scope-of-practice guidance, largely due to the absence of formalised tools, such as decision-making frameworks, specifically designed for use in client-facing settings where individuals or groups may seek dietary advice. Decision-making frameworks have the potential to enhance health professionals’ self-confidence, minimise scope creep between professions, and may foster broader public recognition of the evolving healthcare roles and responsibilities of different professions(2,3). Therefore, developing a new decision-making framework specific to nutrition science (or equivalent) qualifications is an important next step. The aim of the present study was to explore practising nutrition professionals’ perspectives towards the scope-of-practice of nutrition science graduates, especially in client-facing roles where dietary advice is commonly sought. This exploratory qualitative study was grounded in interpretivism and drew upon the participants’ unique experiences to allow a meaningful exploration of a topic not examined in-depth previously. Convenience, purposive, and snowball recruitment strategies were used to recruit eligible participants who were aged 18 years or more, had a nutrition qualification from an Australian tertiary institution, and included recent nutrition graduates, nutritionists/nutrition scientists, dietitians, and course convenors of nutrition and/or dietetics programs. Data was audio-recorded, transcribed verbatim, de-identified, and analysed using an inductive, reflexive thematic framework. Seventeen Australian-qualified dietitians and nutritionists/nutrition scientists participated in six focus groups and two interviews. Three themes emerged: (i) confusion surrounding the understanding of scope-of-practice, associated with a lack of clarity and definitions regarding qualifications and roles; (ii) consequences for nutrition graduates, including perceptions that dietetics is the only pathway, as well as potential breaches of scope-of-practice especially in client-facing settings; (iii) potential solutions, such as the need for a specific scope-of-practice decision-making framework to help nutritionists in client-facing settings, using design elements found in existing documents, such as flow charts. Confusion about the scope-of-practice in nutrition is expressed by a range of nutrition professionals, stemming from uncertainty about what graduates with non-dietetic qualifications can do in practice. Participants stated the need for greater clarity, including the development of nationally-applicable scope-of-practice guidelines and decision-making frameworks, as well as a role for universities to embed work-integrated-learning opportunities within programs. These initiatives would benefit graduates by enhancing their professional identity, improving the public’s recognition of their qualifications, and have the potential to better guide employers, nutrition educators and peak bodies in their efforts to prepare and support the next generations of nutrition graduates.

Scholarship on fascism during interwar China has hitherto focused on the ‘Blue Shirt Society’ and the ‘CC Clique’, two Guomindang (GMD) right-wing cliques loyal to their patron Chiang Kai-shek. So far the Generalissimo’s own perceptions and agendas with fascism have been shrouded in myth, probably due to his evasive attitude and the availability of sources. Scholars dealing with the topic have also tended to delineate a peculiar variant of ‘Chinese Fascism’ by drawing on various theories of fascism. This article proposes an alternative approach inspired by transnational fascism—rather than seeing it as an analytical tool, it treats fascism as a highly malleable concept. Focusing on Chiang Kai-shek, the article historicizes his evolving engagements (perception, interaction, appropriation, etc.) with the idea during the Nanjing Decade by diving into critical primary sources, in particular the Diplomatic and Historical Archives of Foreign Ministry in Rome (ASDMAE), the Chiang Kai-shek Archives at Academia Historica (Guoshiguan) in Taipei, Chiang’s diary and writings, among others. It shows that rather than a fixed view, Chiang’s engagements with the idea during the period underwent a process of changes as situation and relevance of fascism evolved. It thus intends to contribute to the topic both empirically and methodologically.

Nutrition plays a critical role in athletic performance and recovery, with particular emphasis on adjusting macronutrient intake, especially carbohydrate and protein, to match the increased energy demands of training and competition(1). Athletes may rely on sports nutrition products to meet their increased carbohydrate and protein requirements due to the inherent convenience of these products. This behaviour may displace nutrient-dense whole foods and compromise overall diet quality. Higher-quality diets, rich in a variety of core food groups, are linked to improved health and reduced chronic disease risk(2) and may potentially enhance performance in athletes through better recovery and reduced injury risk. Notably, better diet quality is frequently linked to better nutrition knowledge(3). Despite these potential benefits, diet quality in older athletic populations has been infrequently evaluated. Therefore, the aim of this study was to describe and assess associations between diet quality and sports nutrition knowledge in masters distance runners (≥ 35 years, ≥ 30 km/week). Dietary intake was captured via 3-day food-records (FoodWorks; Xyris Australia), with diet quality assessed using the Dietary Guideline Index (DGI)(4). Total DGI scores ranged from 0–120, with sub scores for consumption of core (0–70) and non-core foods (0–50). For all scores, a higher score reflects better diet quality. Sports nutrition knowledge was assessed using the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ, % correct). Differences in diet quality and nutrition knowledge between sexes were assessed using independent t-tests / Mann-Whitney U-tests as appropriate. Data are reported as mean ± standard deviation or median (interquartile range). Spearman rho (rs) evaluated associations between Total DGI and A-NSKQ scores. Participants were predominantly middle-aged (48.5 ± 8.2 years), of healthy weight (BMI 22.8 ± 2.8 kg/m2), and averaged 46.1 ± 18.2 km of running per week, with a near equal distribution of males and females (54:45). Diet quality scores were low with no difference between sexes for Total DGI (males 55.5 (22.2) vs. females 56.0 (39.1), p = 0.694), core (males 37.8 (14.6) vs. females 38 (16.5), p = 0.684) or non-core (males 10 (10) vs. females 10 (30), p = 0.433) sub-scores. Participants tended to meet recommended serves of grains (50% meeting), but the majority failed to meet recommended serves of vegetables (15%), fruits (25%), protein foods (31%) or dairy and alternatives (19%). Only 28% met recommendations for discretionary foods. Most participants met alcohol guidelines (88%). Sports nutrition knowledge was on average ‘poor’ with females scoring higher than males (55.5 ± 12.2% vs. 45.4 ± 13.5% respectively, p < 0.001). There was no relationship between Total DGI and A-NSKQ scores (rs = 0.160, p = 0.113). These findings emphasise the importance of including diet quality when assessing dietary intake in athletes and suggest that older athletes may benefit from both general and sports-specific nutrition education.

This paper offers the first detailed examination of riverine depositional practice in the Roman Middle Thames, using a comprehensive, multi-period dataset of river finds. The study reveals an abrupt deviation from long-standing martial traditions, replaced largely by low-value coinage and coarse-ware pottery. Comparative analysis of two crossing sites, the urban Kingston bridge and the rural Goring ford, demonstrates that deposition was a highly structured, likely intentional practice. It is argued that this change reflects Imperial influence and ‘soft control’, alongside the conscious adoption of new material proxies to maintain the role of ritual deposition within the new socio-political landscape.

Bard et al. rightly call out Western-centric bias to champion Worldwide, in-Situ, Local and Diverse developmental research. Yet this inclusivity must be grounded in evolutionary theory to model development. Comparative evidence strengthens accounts of shared intentionality and attachment. Integrating within-species variation through WILD with between-species variation engaging evolutionary perspectives will offer more robust explanations of universal and diverse developmental pathways.

Biodesign projects often stall between promising material prototypes—bacterial cellulose textiles, mycelium composites, algae-derived materials—and scalable, economically viable production systems. This gap emerges from fragmented decision-making across material design, cultivation processes, and techno-economic evaluation, since each domain operates with distinct metrics, vocabularies, and decision thresholds—making cross-domain reasoning difficult to formalize and transfer. We present agents.design.bio, a decision-support framework that enables students, designers, educators, and founders to engage interdisciplinary expertise through structured reasoning. The platform offers a unified conversational interface in which users interact with domainspecific agents: Designer (@designer), Farmer (@farmer), and CFO (@cfo). Together, they operate on a shared knowledge base, manufacturing datasets, and techno-economic models. Rather than generating speculative ideas, the agents evaluate user-defined scenarios and highlight trade-offs, sensitivities, and risks—making cross-domain dependencies explicit and testable. The demonstration walks through four phases— material evaluation, process optimization, scale-up stress testing, and trade-off analysis—reframing scale-up as a structured learning process rather than a late-stage financial constraint.

Patient-centred care represents the gold standard in nutrition management, consistently demonstrating superior outcomes across multiple health variables by incorporating patients’ experiences and preferences into treatment decisions(1). While this approach is well-established in clinical practice, translating patient-centred principles to population-level health resources remains challenging. Co-design methodologies offer a framework for developing lifestyle resources in conjunction with those who will benefit from them, ensuring that it meets their needs. As a result, this facilitates better resource implementation through improved resource uptake. This study applies co-design principles to lifestyle resource development, in the context Polycystic Ovary Syndrome (PCOS) lifestyle management resources. We aimed to demonstrate how co-design methodologies can be applied and implemented to create more patient centred resources through a pragmatic process that can be adopted by other health professionals. We utilised a comprehensive co-design approach involving 11 individuals with PCOS and 20 health professionals. The methodology utilised the LAUNCH (Linking and Amplifying User-Centred Networks through Connected Health) framework incorporating seven key phases: problem identification, contextual discovery, problem defining, solution ideation, prototype refining, implementation and testing(2). Specific techniques included facilitated workshops, design-thinking sessions, prototyping and iterative user testing. Throughout the process, we actively managed power sharing, balancing different perspectives, ensure all opinion and values were equally represented and respected, particularly amplifying the perspectives of those with lived PCOS experience. Across four online workshops, participants engaged in a range of verbal and written activities. A critical barrier to lifestyle management for all was the lack of explanation regarding the rationale behind lifestyle recommendations specific to PCOS pathophysiology. Co-design sessions revealed that participants prioritised visual communication strategies and contextualised explanations that clearly linked lifestyle recommendation to PCOS-specific metabolic and hormonal mechanisms. Those with PCOS had a preference for more in-depth explanations of ‘why’ than health professionals thought was necessary. The iterative design process resulted in resources that emphasised visual elements and provided clear explanations of ‘why’ specific lifestyle modifications are recommended in the context of PCOS management, to the detail level desire by those with PCOS. This research demonstrates the practical application of co-design principles. The methodology successfully allowed participants to share their experience and have equal opportunity to contribute to the resource development. The combination of co-design framework and guiding principles presented provides health professionals with concrete strategies for applying co-design methodologies for resource development across population-level health contexts for the impactful implementation of patient centred care. Co-design methodologies offer a valuable tool for developing lifestyle resource that better align with stakeholder needs and preferences. This PCOS project provides a replicable model and example for nutrition professionals seeking to implement evidence-based co-design approaches in their research or clinical outcomes, potentially improving intervention effectiveness and user engagement across various contexts.

Change is slow and elusive. Well-meaning cross-cultural collaborations still reproduce colonial patterns. For the WILD approach to be transformative, it must move beyond a mindset and toward procedural changes that promote equitable and respectful conditions. The WILD approach must resist creating a false dichotomy with WEIRD and acknowledge that culture is alive and globalized.

Sustainable healthy diets meet nutrient requirements and are environmentally sustainable, and socioeconomically and culturally appropriate(1). The UK Livewell Diet was developed using optimisation modelling to meet national nutritional recommendations, be socially acceptable and minimise environmental impacts related to carbon footprint, land and water use, acidification, eutrophication and biodiversity loss(2). Versions of the Livewell diet have been developed for other countries, but not currently Australia(3). This study aimed to adapt the UK Livewell diet(2) for the Australian context and assess the potential dietary and nutritional implications of adoption by Australian adults. To adapt the UK Livewell diet to Australia, we calculated recommended percentage changes in intake across 29 food groups between the average UK diet (ages 19–64 years) and the Livewell diet. These changes were then applied to the average dietary intake for Australian adults (19–70 years, n = 14,944) from the Australian 2011–2 National Nutrition and Physical Activity Survey(4). Due to the modelled 18% reduction in total energy intake, compensatory adjustments were made by increasing cereals (+59 g), potatoes (+71 g) and fat/oils (+16 g). This resulted in the Adjusted Australian Livewell Diet (AALD)—estimated energy content 8,456 kJ (5% lower than 2011–2 adult mean). We compared the AALD with the 2013 Australian Dietary Guidelines recommendations(5) and modelled its likely impact on key nutrient intakes using substitution dietary modelling. Compared with 2011/12 Australian diets, the AALD was substantially lower in animal-source foods—red and processed meat, shellfish and cheese were decreased by 67%, poultry by 61%, eggs by 33% and milk/milk products by 13%. Intakes of other foods were also reduced: milk alternatives (−59%), snacks/desserts (−53%), sugar/confectionery (−47%), and fruit juice and miscellaneous foods (−46%). In contrast, intake of fish increased by 102%, meat alternatives by 114%, cereals/cereal products by 68%, fruit by 48%, potatoes by 59% and other vegetables by 44%. To adopt the AALD, Australian adults would need to increase their daily intake by an average of 0.4 serves of fruit, 1.6 serves of vegetables and 2.2 serves of grains, and reduce their intake of both the meat/alternatives and the dairy/alternatives food groups by 0.3 serves. Replacement of the Australian diet with the AADL would likely increase intakes of dietary fibre (+26%), long chain omega-3 fatty acids (+31%), vitamin A (+14%) and folate (+23%), while reducing intakes of sodium (−15%) and saturated fat (−11%)—changes considered beneficial. However, protein (−18%), riboflavin (−15%), vitamin B12 (−27%), calcium (−11%), phosphorus (−12%) and zinc (−18%) intakes would likely decrease, potentially exacerbating existing inadequacies in Australian adults. Adoption of the AALD may both positively and negatively impact adult nutrient intakes. Further research evaluating potential effects on usual dietary intakes of all population groups and achievement of nutritional recommendations is recommended.