Claims relating to foods’ nutrition content and potential health benefits have been shown to influence consumer preferences and purchases regardless of the nutritional quality of the product(1). In Australia, permitted claims include nutrition content claims, which refer to the presence or absence of a nutrient, and health claims, which refer to health benefits of foods or nutrients in a product. Health claims include general level health claims, which refer to normal processes and functions, and high level health claims, which refer to a disease or biomarker of a disease. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC), however this is not required for products to make a nutrition content claim. The aim of this study was to examine the use of nutrition content and health claims made on Australian ready meal products and assess the proportion of products displaying claims that meet the NPSC. Analysis of the ready meal category in the 2023 FoodSwitch database, a repository of Australian food packaging images and label data for over 28,000 foods developed by The George Institute for Global Health, was conducted(2,3). Foods in the ready meal category were identified and data from the nutrition information panel was collated to calculate whether they met the NPSC. Nutrition content and health claims were extracted from product images and categorised according to claim type (nutrition or health claim) and claimed nutrient or attribute. The proportion of products meeting the NPSC was then calculated overall and by claim type (nutrition content vs health claims). Data were available for 777 ready meal products. Of these, 682 (87.8%) met the NPSC. In total, 2051 nutrition content or health claims were identified across the ready meal products, with 1909 (93.1%) of these categorised as nutrition content claims. The remaining 142 claims identified were general level health claims, with no high level health claims identified. Almost all (n = 1857, 97.3%) nutrition content claims and all general level health claims were made on products which met the NPSC. The most common claims related to protein, energy and fibre content. The use of claims was prevalent across the ready meal food category in Australia, with claims relating to nutrient content being most common. While most claims were made on products that met the NPSC, there is a need for further research to ensure the NPSC appropriately distinguishes between healthy and less healthy food products. This will ensure consumers are equipped to make informed decisions when purchasing food products.

Nutrition represents a promising strategy for increasing antioxidants in the brain, with potential implications for mitigating illnesses with oxidative stress-related neuropathology(1). Emerging evidence indicates that bioactive compounds, including phenolics and betalains—responsible for the red, yellow, and purple hues in fruits—may decrease oxidative damage(2). Therefore, research into novel plant-based sources of phenolics and betalains with potential antioxidant properties is needed. This study aimed to examine the neuroprotective effects of key fruit extracts and to correlate effects with their phytochemical and antioxidant profile. Dragon fruit (DF), queen garnet plum (QGP) jaboticaba (JB), green apple (GA), blueberry (BlueB), blackberry (BlackB), watermelon (WM), and apricot (AP) extracts were analysed for their phenolic, flavonoid, anthocyanin and betalain concentrations, and antioxidant capacity (Oxygen Radical Absorbance Capacity (ORAC)). The neuroprotective efficacy of the fruits (10, 25, 50, 100 μg/mL) was then examined in-vitro using H2O2-induced oxidative stress in SH-SY5Y neuroblastoma-like cells. Cells were treated with the fruit extracts either prior to H2O2 administration (to examine protective effects), or after the H2O2 stressor (to determine treatment effects), with cell viability examined using MTT assays. Statistical analyses determined differences between fruits and the controls (healthy (untreated) and H2O2 controls) using one-way ANOVAs and post-hoc Tukey comparisons. Correlations were examined using Spearman’s correlation tests. QGP and BlueB were significantly higher in phenolics and anthocyanins (p < 0.01), QGP highest in flavonoids (p < 0.01), and DF was highest in betalains (p < 0.001) and ORAC (p < 0.01), compared to the remaining fruits. Pre-treatment with DF and JB prevented H2O2-induced loss in cell viability, retaining control-like levels (p > 0.05 vs healthy controls). GA pre-treatment also exhibited significant neuroprotective effects (p < 0.01 vs H2O2 alone) but could not restore control levels (p < 0.01 vs healthy controls). The ability of DF, JB and GA to treat existing damage to cell viability induced by H2O2 was then examined; however, the extracts were ineffective as a treatment (p > 0.001 vs H2O2 alone and healthy controls). Interestingly, there were moderate correlations between cell viability and both ORAC (r2 = 0.680, p < 0.001) and betalain concentration (r2 = 0.446, p < 0.05). This study revealed novel sources of bioactive compounds, including characterisation of betalain concentrations, in these fruits. The results demonstrate an ability of DF and JB to prevent oxidative stress in neuronal-like cells, but not treat damage after it has occurred. This finding agrees with the evidence that implementing a healthy diet rich in bioactive compounds, such as betalains and phenolics, may support brain health(1). The data also support a link between increased betalains, antioxidant capacity and neuroprotection; however, further research into the mechanisms underpinning the beneficial protective effects of DF and JB are required.

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth (PTB) are prevalent pregnancy complications that adversely affect maternal and neonatal health during pregnancy, and increase women’s risk of future type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD)1–5. Pregnancy and postpartum, including intrapartum periods, are critical windows of opportunity to deliver care to support sustained behaviour change(6). There is currently a gap in lifestyle (diet and physical activity) interventions specific to cardiometabolic disease risk awareness and prevention during and following pregnancy(5,7). These are key life stages where early risk factors for cardiometabolic disease may present, women are actively engaged in the healthcare system and their health priorities are shifting as they transition into parenthood. Early intervention in pregnancy may enable commencement of pharmacological and/or lifestyle intervention to reduce the risk or severity of cardiometabolic pregnancy complications(8), whereas postpartum intervention may enable commencement of sustainable lifestyle change for reduction of long-term cardiometabolic risks(9). There are a range of settings where pregnant and postpartum women receive healthcare, including hospitals, primary care clinics, community health institutions and online platforms(8,10,11). The optimum timing and setting to deliver an intervention to these high-risk women is not known. Designing interventions to align with the needs and priorities of stakeholders is a critical first step in developing an acceptable intervention. The aims of this research were to explore stakeholder perspectives and prioritise the optimal timing and setting to deliver a lifestyle intervention to improve long-term cardiometabolic health amongst women at high-risk of or diagnosed with a cardiometabolic pregnancy complication. An embedded mixed-methods research design was utilised. Facilitator-led workshops were used to prioritise the preferred timing (pregnancy or postpartum) and setting (hospital, general practice, community health program, maternal and child health services or online) for an intervention. Women with prior GDM, HDP, IUGR and/or PTB (n = 9), and research partners (n = 15) (obstetricians, endocrinologists, community health representatives, researchers, midwife, general practitioner, dietitian) participated. Workshops were audio recorded, transcribed verbatim and thematically analysed using template analysis. Online polls were used to assess participants preferred timing and setting for an intervention. Women preferred a postpartum intervention delivered online, whereas research partners preferred a pregnancy intervention delivered via hospital antenatal care. Both groups suggested commencing interventions during pregnancy and continuing postpartum. Participants recommended ensuring interventions consider healthcare system barriers to intervention delivery, equity and sustainment, as well as consumer-specific barriers to intervention engagement and lifestyle change during pregnancy and postpartum. Commencing patient-centred interventions during pregnancy and continuing postpartum should be considered to support continuity of care and improve health outcomes across both life stages for this high-risk group of women.

Short-term, immersive international placements are common and have been recognised for facilitating cultural learning, intercultural sensitivity, global-mindedness, and critical thinking. These outcomes are not guaranteed and the impact and inclusion of these experiences in an already comprehensive curriculum remain to be carefully evaluated. This study explores the impact of 4-week international placements on professional and personal development (short-term and enduring) of participating final-year undergraduate and postgraduate dietetic and undergraduate nutrition students. Recent nutrition and dietetic graduates (n = 8) of the program, implemented in underserved communities in the Philippines, Indonesia, and Vanuatu for four weeks during 2022–2021, were interviewed using semi-structured questions until saturation, followed by thematic analysis using a six-step process(1). Graduates were interviewed about their in-country experience and its impact on their professional practice, within 12–18 months of graduating. Findings were further analysed against the national competency standards for dietitians in Australia. Participants expressed significant cultural awareness (appreciation of the strength of other cultures, stronger communitarian values of hosts), greater critical and systems thinking (about socio-economic determinants of health, systems-level thinking) and deeper capacity for empathy and compassion (emotional quotient development). When viewed against the national competency standards, participants did not understand how international placements from developed to developing countries can perpetuate colonisation principles and global-mindedness was not identified as a strong theme. These findings suggest that immersive, international placements result in profound, transformational, and enduring learning that extends into participants’ professional life, especially respect for cultural safety and the development of systems thinking. There is an alignment with accrediting professional peak body competencies for cultural competency, professional practice and collaborative practice with findings suggesting areas for strengthening the nutrition and dietetic curriculum include enhancing learning outcomes of global-mindedness thinking and decolonisation principles.

Understanding individual variability to dietary interventions is emerging as an important consideration in dietary interventions. Prior research has demonstrated ranging success of interventions. For example, Gardner and colleagues (2007) compared 4 weight loss diets in participants over a 12-month period(1), noting the range of weight loss was between 3.1kg to 6.3kg depended on individual and diet. Song and colleagues (2023) examined post prandial glucose response (PPGR) to four different carbohydrate meals. Dependent on the meal, the PPGR varied significantly between individuals(2). As such, it is inappropriate to assume that there is one dietary pattern appropriate for all individuals. Understanding the driving factors behind individual variation to specific foods and dietary patterns will allow us to tailor interventions to create optimal health outcomes for each individual. The aim of our study is to examine individual responses to different diets promoted for health. In our study, we investigated the biological diversity in response to the same dietary inputs among 23 participants at risk of type 2 diabetes and chronic disease over a two-week period. All participants completed four days on three dietary interventions (Mediterranean, Australian and low carbohydrate diets). Urine, serum, plasma, and faecal samples were collected, alongside the use of continuous glucose monitoring data, to explore the metabolic and glycaemic responses. Our findings reveal significant individual differences in blood glucose levels and metabolic outcomes. When examining fasting blood glucose levels, the low carbohydrate and Australian diets were optimal for 8 participants each, while the Mediterranean diet was optimal for 7 participants. However, this did not always correlate with post prandial blood glucose level optimisation. While blood, urine and faecal samples are yet to be analysed, these are expected to provide further understanding of individual biological responses. These results underscore the limitations of a universal dietary approach for optimising glycaemic control and highlight the necessity of personalised dietary recommendations that consider individual metabolic profiles. Our study provides crucial insights for future advances in precision nutrition, suggesting that personalised nutrition plans could lead to more effective management and prevention of T2D.

A recent umbrella review found that overall greater exposure to ultra-processed foods (UPF) was associated with worse outcomes. For cancer incidence overall (k = 7) and for colorectal cancer (k = 7) there was suggestive low-quality evidence of a positive association. There was no evidence for association with cancers of other sites(1). Analysis of data from EPIC found positive associations for UPF consumption with head and neck cancer, and oesophageal adenocarcinoma, with a small proportion of the association mediated via adiposity(2). This study aims to examine the association between UPF consumption and incidence of cancer, using data from the Melbourne Collaborative Cohort Study (MCCS). Adults aged 40–69 years and born in Australia, Greece or Italy (n = 41,513) were recruited between 1990 and 1994; invasive cancer incidence was identified up until June 30th, 2021, by linkage to cancer registries. Dietary data was collected using a food frequency questionnaire developed for the MCCS, and the NOVA classification was used to identify UPF(3). After exclusions, 35,039 (n = 21,244 females and 13,795 males) people were included in the analysis. UPF consumption (% of total grams intake) was modelled as quintiles and as a continuous variable. Flexible parametric models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk associated with UPF consumption after adjusting for sex, country of birth, socio-economic position, average lifetime alcohol intake (grams/day), smoking status and intensity, education, physical activity score. Overall cancer, overall obesity-related cancer, and individual obesity-related cancers where there were more than 100 cases, were considered as the outcomes. There were 10,445 incident cancers identified, of which 4,237 were considered as obesity-related, with more than 100 cases for cancers of pancreas (n = 270), colorectum (1369), endometrium (n = 223), kidney (n = 216), ovary (n = 159), multiple myeloma (n = 187), and post-menopausal breast (n = 1479). The highest UPF consumers included more males and people born in Australia than the lowest consumers. Positive associations were observed for all cancers: HR for continuous variable 1.03, 95% CI (1.01, 1.05); Q5 vs Q1HR 1.09, 95% CI (1.02, 1.16); obesity-related cancers: HR for continuous variable 1.04, 95% CI (1.01, 1.08); Q5 vs Q1HR 1.10, 95% CI (1.00, 1.22), and post-menopausal breast cancer: HR for continuous variable 1.07, 95% CI (1.00, 1.14); Q5 vs Q1HR 1.12, 95% CI (0.90, 1.41). Direct associations between UPF consumption and cancer outcomes were found, although some of those associations were weak. Limiting the consumption of UPF may reduce cancer risk.

Between 2022 and 2024, Somalia’s ongoing drought claimed more than 70 000 lives, with nearly 40% of these deaths among children under 5. This tragic loss highlights the urgent need for action to address the disproportionate impact of the drought on Somalia’s most vulnerable populations. The 2022 drought, which affected nearly half of the country’s population, brought Somalia to the brink of famine, leaving many families without essential resources and health care, particularly in the southern-central regions like Banadir, Bay, and Lower Shabelle. Despite narrowly avoiding famine through the efforts of the Somali government and international partners, the consequences of the drought continue to devastate communities. The study “From Insight to Action: An Update on Mortality Patterns in Somalia” reveals that most excess deaths were children, presenting not only a tragedy for families but also a long-term social and economic setback for the nation. WHO and UNICEF stress the need for a long-term approach to address Somalia’s vulnerabilities, emphasizing the importance of building resilient health systems, investing in climate-resilient agriculture, and empowering communities. The international community must also commit to supporting Somalia’s development to break the cycle of disaster and ensure a brighter future for the nation’s children.

States began passing legislation that bans transgender athletes from competing on teams that match their gender identity in 2020. Republican lawmakers largely introduced and supported athlete bans, but were party preferences the only predictor of support for these bills? What effect did legislator demographics or district-level attributes have on the likelihood that a state legislator would support or oppose an athlete ban? This study explores the voting preferences of individual state legislators in states that passed athlete bans from 2020 to 2023. Using an original dataset and multilevel modeling, this analysis looks beyond party affiliation to determine whether a relationship exists between support and less apparent indicators such as district ideology and composition, gender, race, and electoral success. While party identification is a significant predictor of support, legislators representing districts characterized by lower educational attainment and a high proportion of evangelical Protestants are more likely to support transgender athlete bans.

There has been a proliferation of ultra-processed foods (UPF) in the food environment since the 1980s which have newly been linked to growing number of non-communicable diseases (NCD) including cardiovascular disease, cancers, type 2 diabetes, fatty liver disease, depression, frailty, and hypertension(1). There is intense debate surrounding whether the mechanism for the negative effect on health of consumption of UPF is their nutrition composition or processing(1). There is growing evidence that macronutrient ratios are important for chronic disease risk, predict longevity and may adversely affect micronutrient intakes(2). Intake of macronutrients from ultra-processed sources may lead to macronutrient imbalances and higher energy intakes(3) while being deficient in micronutrients, making it difficult to achieve energy balance and meet micronutrient requirements. Using nationally representative nutrition surveillance data on the Australian population, the National Nutrition and Physical Activity Survey, in this paper we employ the Geometric Framework for Nutrition(2) to examine the multidimensional dietary composition of UPF. Diet was assessed for adults (n = 9.341) with two 24-hour recalls. Diets were classified by degree of processing according the NOVA classification system and classified as ultra-processed diets (UPD, > 60% energy from UPF), moderate or low in UPF i.e., minimally processed diets (MPD, < 20% energy from UPF). Outcomes included the nutrient rich food index (NRF 9.3 index)(4), the Nutri-Score(5), and macronutrient and micronutrient intakes. Micronutrients were plotted over macronutrient ratios for MPD and UPD to determine whether micronutrient intakes could be met within the acceptable macronutrient distribution ranges (AMDR). Scheffe’s polynomials were fitted to the data for total energy intake, macronutrient intake and micronutrient intake. Vitamin and mineral intakes were higher for MPD compared to UPD (p < 0.001). Overall nutrient density decreased and the NRF 9.3 scores were 399.2 for MPD and 297.7 for UPD (p < 0.001). For the Nutri-Score, MPD diets scored A (highest quality) and UPD scored C (moderate quality). Poor scores were due to higher energy density, saturated fat, added sugar and sodium increased with UPD, while protein, dietary fibre and micronutrient density and fruit, vegetable, nut and legume ratios decreased. Diets met the estimated average requirement (EAR) for all micronutrients within AMDR for MPD but not for UPD. Regardless of processing, in almost all nutritional indicators of health, diets high in UPF were unsatisfactory relative to nutritional recommendations. We conclude that compositional factors alone point to the mechanisms through which ultra-processed dietary patterns could lead to poor health, in the full understanding that processing likely has additional effects over and above composition that exacerbates the problem.

Most Australians consume excess sodium and inadequate potassium both causing high blood pressure—the leading risk factor for death in Australia(1). Switching regular salt to potassium-enriched, reduced-sodium salt is a novel solution, shown to lower blood pressure, cardiovascular disease risk and premature death(2). The aim of this study was to explore Australian adults’ knowledge, attitudes and behaviours related to potassium-enriched salt. Adults aged ≥ 18 years and who were the main or joint grocery buyer were recruited through a web panel provider between February and March 2024 to complete an online survey. Quotas were used to achieve representation of the age, sex and geographical distribution in Australia. The survey was developed based on existing questionnaires of consumers’ perception of potassium-enriched salt identified in a systematic review, and the behaviour change wheel framework to allow for a systematic assessment of consumers’ capability, opportunity and motivation to switch to potassium-enriched salt. Survey responses that were completed in less than one-third of the median time (< two minutes and 20 seconds) were excluded from analysis. All data were collated and analysed using the statistical program Stata/SE 14.0 (StataCorp LP). A total of 4113 adults (52% female) with a mean (SD) age of 47.9 years (18.3) completed the survey and were eligible for inclusion. About half (47%) of participants reported that they have seen/heard of a potassium-enriched salt. Of those, 41% always, often or sometimes use potassium enriched salt with the main reasons being it is what’s available at home (32%) and it was recommended by a healthcare professional (29%). However, only 3% of all participants reported that potassium-enriched salt or low-sodium salt was the main type of salt used during cooking and eating at home. Most participants reported that they could be influenced to switch to potassium-enriched salt by the following factors, if it was better for their health (85%), affordable (78%), recommended by healthcare professionals (75%) and tasted good (73%). Most participants believed that individuals (77%), food manufacturers (68%) and fast-food chains (65%) were responsible for making the switch to potassium-enriched when told it was a healthier alternative to regular salt. A greater proportion of participants correctly identified that eating more potassium was beneficial for health (73%) compared to those that correctly identified that eating more sodium was not beneficial for health (57%). While current knowledge and use of potassium-enriched salt is low in Australia, the study identified existing and potential drivers for switching to potassium-enriched salt. The study highlights greater awareness-raising activities about the health benefits and acceptable taste of potassium-enriched salt, particularly by healthcare professionals, could help scale-up the switch to potassium-enriched salt.

Identifying reliable blood pressure biomarkers is essential for understanding how dietary interventions might supported a reduction in hypertension. Metabolomics, which involves the analysis of small molecules in biological samples(1), offers a valuable tool for uncovering metabolic biomarkers linked to both dietary patterns and blood pressure, providing insights for more effective dietary strategies to manage or prevent hypertension. The aim was to evaluate associations between plasma and urinary metabolite concentrations with blood pressure measures (systolic blood pressure [SBP] and diastolic blood pressure [DBP]) in healthy Australian adults. This cross-sectional secondary analysis used baseline data from a randomised, cross-over feeding trial(2). Plasma and urinary metabolomic data were generated using Ultra-high Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-MS/MS) through Metabolon Inc.’s (Morrisville, USA) Global Discovery Panel. Blood pressure was assessed in clinic using the Uscom BP+ supra-systolic oscillometric central blood pressure device, with the cuff positioned on the upper arm at the strongest pulse signal location. Participants sat relaxed and comfortably for 5 minutes before their measurements were taken. They remained seated with legs uncrossed, feet flat on the floor, and were instructed to maintain even breathing throughout the tests. Blood pressure was measured with three consecutive readings taken from the supported left arm, with a 1-minute rest between each reading. The first reading was discarded, and the average of the remaining two was used as the final measurement. Metabolite concentrations were log-transformed. Associations among blood pressure measures and urinary or plasma metabolites were evaluated using linear regression models, adjusting for age and sex. A total of 34 healthy Australian adults (mean age 38.4 ± 18.1 years, 53% females) baseline data was included. After adjusting for multiple comparisons using the Benjamini-Hochberg procedure with a significance threshold of q < 0.2, a negative association between two urinary metabolites (gamma-glutamyl histidine and gamma-glutamyl phenylalanine) and DBP was identified. In addition, 32 plasma metabolites were associated with SBP with 18 showing a negative association, including 1,2-dilinoleoyl-GPC (18:2/18:2) and 1-linoleoyl-GPC (18:2), and 14 showing a positive association (beta-hydroxyisovalerate, 3-Hydroxyisobutyrate). Potential mechanisms based on existing research that might explain these associations include the role of gamma-glutamyl peptides in lowering DBP by reducing oxidative stress and improving endothelial function(3). In contrast, 3-hydroxybutyrate may elevate blood pressure due to metabolic disturbances linked to impaired branched-chain amino acid catabolism(4). Furthermore, 1,2-Dilinoleoyl-GPC and 1-linoleoyl-GPC, both contain linoleic acid, which could contribute to lowering systolic blood pressure (SBP) by mitigating vascular inflammation(5). Although some of these metabolites have been implicated in blood pressure regulation in prior research, others revealed new associations. These findings suggest potential candidate nutritional biomarkers for blood pressure, but further research is needed to confirm their reproducibility, and causal role in blood pressure regulation.

Genome-wide association studies (GWAS) of food preferences(1) and intake(2) have identified hundreds of loci, most previously linked to health conditions. This suggests these loci may reflect participants’ health status, leaving unclear their direct influences on eating behaviour. Given that taste and olfactory perception play a crucial role in food preferences and choices(3), this study aims to: i) investigate the influence of genetic variants within taste and olfactory receptor genes on food preferences and ii) use these variants to investigate the potential causal influence of food preferences on health. We assess the associations across 1214 nonsynonymous variants (minor allele frequency ≥ 0.01) within 425 non-pseudo taste and olfactory receptor genes and 140 food-liking traits in the UK Biobank (n = 162006 unrelated Europeans; mean age = 57). Food likings were measured on a 9-point scale, with 1 being ‘Extremely dislike’ and 9 being ‘Extremely like’. We identify 700 associations (FDR-corrected p < 0.05), of which 88 are also associated with their corresponding food intake traits in the UK Biobank. We replicate 84 associations in the younger Avalon Longitudinal Study of Parents and Children (ALSPAC; n = 2802 unrelated Europeans; mean age = 25), including OR2T6 rs6587467 for onion liking (p = 5.4 × 10-41 in UK Biobank, p = 2.9 × 10-4 in ALSPAC), whereas others cannot be replicated (e.g., OR4K17 rs8005245 for garlic liking, p-value = 1.9 × 10-69 in UK Biobank, p = 0.66 in ALSPAC). These variants account for greater phenotypic variances in food-liking traits in the ALSPAC than in the UK Biobank (e.g., 0.54% and 0.25% for garlic liking in ALSPAC and UK Biobank, respectively), suggesting genetically determined sensory perception has larger impacts on food preferences in young adulthood. Lastly, we use an epidemiological technique, Mendelian randomisation(4), to assess the potential causal influence of food preferences on health outcomes using food-liking-associated variants and summary results from large-scale GWAS. Taking likings for onions and bananas as an example, our results show that both are causally associated with lower systolic blood pressure (onions: beta = −1.257, p = 0.001; bananas: beta = −3.166, p = 0.005; unit = mmHg/liking score). While liking for onions decreases the risk of type 2 diabetes (odds ratio [OR, 95% confidence interval] = 0.856 [0.781, 0.939]), liking for bananas increases it (OR = 1.289 [1.051, 1.579]). We found no evidence for causal associations with coronary artery diseases (onions: OR = 0.995 [0.879, 1.126]; bananas: OR = 0.982 [0.742, 1.299]). This study furthers current knowledge of direct genetic influences on food preferences, which helps understand individual differences in eating behaviour and has implications for personalised nutrition. Results from causal modelling provide complementary evidence for previous observational studies and could be used to guide future trials.

Cognitive function is pivotal for athletic success, encompassing decision-making processes, concentration, and overall performance. Sports beverages include carbohydrates for energy and sodium to enhance rehydration(1). Research has suggested they offer numerous advantages for mental function during exercise(2). The intensity of exercise also has a significant impact on an athletes cognitive ability. High-intensity exercise gradually enhances arousal to an optimal level, shifting from a state of rest to high-alert, consequently leading to improved cognitive performance, confirmed by measurement via an electroencephalogram(3). This aim of this study was to examine the acute effect of a beverage containing carbohydrate and sodium on cognitive performance, including interference control, response inhibition, working memory and cognitive flexibility, following moderate-intensity continuous exercise (MICE) or high-intensity interval exercise (HIIE). Healthy experienced recreational runners were recruited. Baseline data was collected before the first trial. Participants (n = 11) underwent four trials in a randomised crossover design. A combination of 8 KM MICE running (64–76% of maximum heart rate) and 8 KM HIIE running (77–93% of maximum heart rate) were completed, while ingesting either SB (carbohydrate: 6.2%, sodium: 21 mEq/L) or plain water (W); average intake: 308 ± 188 ml. Computer-based cognitive performance tests (Simon task, Go and No-Go task, N-Back task & Stroop task) were conducted after the completion of each exercise session, where response time and accuracy were measured. Paired T-tests were used to determine where the differences existed within the treatments and vs the baseline. A significant impairment of Simon effect was seen in MICE+SB and HIIE+SB compared to baseline (p = 0.022, p = 0.005). Response time in congruent stimuli was significantly improved in HIIE+SB compared to baseline and to MICE+SB (p = 0.008, p = 0.021). Response time in incongruent stimuli was significantly improved in HIIE compared with MICE in both SB and W ingestion (p = 0.001, p = 0.042) and significantly impaired in MICE+SB compared with baseline (p < 0.001). In the Go and No-Go task, no significant differences were observed in response inhibition. In the N-Back task, working memory response time was significantly improved in MICE+SB compared with baseline (p = 0.019). Response time in the Stroop task in incongruent stimuli was significantly improved in MICE+SB and HIIE+W compared to baseline (p = 0.039, p = 0.047). In conclusion, beverages containing carbohydrate and sodium were found to generally improve cognitive performance. In addition, HIIE can be considered a practical approach to improve acute cognitive performance. However, further studies are required to more accurately investigate the optimal combination of exercise intensity and beverage carbohydrate concentration required to maximise cognitive performance.

This paper presents a Location-Allocation-Vehicle Routing Problem to design a humanitarian blood supply chain in response to earthquakes, incorporating quality concepts, reliability, and horizontal communication. The aim of the model is to minimize the total cost, minimize maximum shortage of demand points with high priority and low route value, and maximize the satisfaction of customers, including donors, hospitals, and blood transfusion centers. In order to deal with considerations of real world, the structure of the blood supply chain and all the intricacies incorporated in the model are defined based on the network and challenges of Blood Transfusion Center of Tehran. In addition, the blood demand and reliability of routes and facilities are considered uncertain, and the Interval Evidential Reasoning (IER) approach is used to handle the uncertainty. Since the problem is NP-hard, NSGAII and MOPSO algorithms have been applied to solve it. To demonstrate the efficiency of the model and compare the algorithms, several numerical examples in different sizes are designed. Finally, the most favorable algorithm is chosen for each size using the TOPSIS method.

The food environment plays an important role in nutrition-related health outcomes. The influence of market settings on overall diet quality may be substantial where individuals regularly attend any given market. Salamanca Market (Hobart, Tasmania), and Carriageworks Market (Sydney, New South Wales; NSW) are two popular Saturday markets, attended regularly by locals. Salamanca Market provides a diverse range of edible (~30% of stalls) and non-edible (~70% of stalls) goods with a non-exclusive focus on ‘Tasmania’s own’ products. Carriageworks ‘Farmers Market’ features primarily edible products (~90% of stalls), requiring products to be grown/made/produced by the stallholder in NSW or Australian Capital Territory(1). While benefiting from tourism, these two markets are strongly attended by locals(2), therefore making an important contribution to health of individuals as a food environment experienced frequently and repeatedly. This study examined changes in food/beverage stall offerings at these markets over a 10- to 13-year period, as a reflection on the potential changes in weekly markets and hence food environments experienced across Australia. Stallholder information for Salamanca (summer stallholders 2011–12 to 2023–24) and Carriageworks (2015–2024 inclusive) markets were obtained from the respective official websites and analysed for stall categorisation. Current range of available products and categorisations were confirmed through in-person audits in January 2024. Descriptive statistics were used to summarise the findings. Over the study period, Salamanca Market food and beverage offerings grew by 21% to comprise 31.7% (89/291) of all stalls in 2024. This was driven by an increase in stalls offering primarily ‘discretionary’ foods/beverages: Take Away Food increased by 58% to 38% and Confectionary nearly doubled to 11% of food/beverage stalls. Stalls selling alcohol as their primary product increased from 13% to 64% of all beverage stalls over this time; vendors selling primarily whisky/spirits grew from 1 stall in 2012–13 to 9 stalls in 2023–24. This occurred simultaneously with a reduction in ‘core’ foods availability: Fruit and Vegetable stalls dropped from 24% to 10% and Dairy halved to 3% of food/beverage stalls. However, self-titled ‘farmers market’ Carriageworks demonstrated relative stability in stall composition over 10 years. Notable changes included reduction in number of Meat/Fish/Poultry/Alternatives stalls by 50%, and an almost halving of Condiments stalls, however other stall types (Fruit/Vegetables; Dairy) have remained relatively unchanged in number and proportion; almost two thirds of stalls primarily sold ‘core’ foods. In summary, stall composition at a market prizing a diversity of offerings demonstrated a transition to a poorer food environment, whereas stall composition at a ‘farmers market’ demonstrated less change and a ‘healthier’ composition of food/beverage offerings over 10–13 years. The food environment offered at ‘farmers markets’ is likely to be superior for healthful food purchasing and positive impacts on nutrition-related outcomes, compared to mixed-business markets.

Evidence supports plant-based dietary patterns for preventing cardiovascular diseases (CVD)(1). Fat mass is a strong predictor of CVD(2), however it’s unclear whether this mediates the relationship between plant-based dietary patterns and CVD. Hence, the aim of this study was to determine if longitudinal associations between plant-based dietary patterns and incidence of CVD events, CVD mortality and all-cause mortality are mediated by fat mass in mid-life. Dietary data (Oxford WebQ) from 14,247 adults (median 56 years [IQR 49–61]) in the UK Biobank cohort study were used to derive diet quality index scores for an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Health registries and national records provided CVD event and mortality data. Percentage fat mass was measured by dual X-ray absorptiometry. Cox proportional hazard ratios (95% CI) identified associations between each diet quality index and CVD events, CVD mortality or all-cause mortality. Regression-based mediation analysis was used to identify the direct effect (plant-based diet quality indices on CVD mortality, CVD events, or all-cause mortality), and the indirect effect, which was mediated by fat mass. New CVD events (n = 364), CVD mortality (n = 52) and all-cause mortality (n = 220) were identified with mean follow up of 11.6 (SD ± 0.4) years for CVD events, and 11.5 (SD ± 0.7) years for mortality. The mean score for PDI was 50.5 (SD ± 5.9), hPDI 52.8 (SD ± 7.2), and uPDI 54.0 (SD ± 6.8). The PDI and hPDI were inversely associated with fat mass, and the uPDI was positively associated with fat mass (p < 0.001). There was no association between the diet quality indices and health outcomes, with (direct effect) or without (total effect) the fat mass mediator for males and females (p ≥ 0.1). Fat mass was associated with risk of mortality in some models, after controlling for the indices, such as a lower risk of all-cause mortality after controlling for the hPDI (p < 0.1). There was a significant negative indirect effect of hPDI on CVD mortality via fat mass for females only (observed coefficient 0.81; 95% CI 0.60–0.99). Overall, there was limited evidence of a mediating effect from fat mass in the association between plant-based dietary patterns and incidence of CVD events, CVD mortality and all-cause mortality. Studies with larger samples and longer follow up are needed to determine whether the mediating effect of fat mass on hPDI and CVD mortality in females is reproducible.

Nutrition misinformation is pervasive on frequently accessed online sources such as social media and websites(1). Young adults in particular are at a higher risk of viewing or engaging with this content due to their higher Internet and social media usage(2). As such, this study aimed to understand the preferences, perceptions and use of online nutrition content in this age group. Young Australian adults (aged 18–25 years; n = 20) were individually interviewed via the video calling platform Zoom. Interviews ranged between 19 and 42 minutes. The interviewer followed a semi-structured format and questions were guided using a piloted template. Reflexive thematic analysis was conducted using NVivo. Quotes addressing the research questions were coded. Codes were grouped into themes and sub-themes and were summarised in a narrative format. Results showed that all but one participant used social media (n = 19) and Internet websites (n = 16) to view nutrition content. Content viewed or accessed from social media varied, whereas website content catered to the consumers’ goals and interests. While content from social media and was perceived as easy to use and accessible, perceived reliability varied. Short-form content, prevalent on online platforms, was considered less reliable, despite its engaging nature. This suggests that there exists a trade-off between the engagement and trust of nutrition content. Additionally, content containing sponsorships or product endorsements was less trusted. On the other hand, participants were more likely to trust content created by health professionals. The oversaturation of content also demotivated participants from evaluating the reliability of content. When asked about preferences, participants valued personalised content, mixed formats (i.e., short and long-form content), and evidence-based information such as statistics and references. They also preferred casual and entertaining content that incorporated modern and high audiovisual qualities (e.g., voiceovers). In conclusion, young Australian adults in the study recognise that unreliable nutrition content is not exclusive to certain platforms. The findings suggest that the accessibility and engagement of content and the ambiguity of professional ‘credentials’ may lead them to trust information that is potentially of low quality and accuracy, or alternatively, disregard high quality information. Findings also show that there needs to be a balance between engaging formats and presenting evidence-based information when designing nutrition content. Future research should explore how the factors influencing perceptions and preferences of online nutrition content in young Australian adults, as identified in this study, impact the usage of online nutrition content and dietary behaviours. Further consultation with this cohort can inform tailored interventions that aim to enhance young adults’ food and nutrition literacy and diet quality.

Hyperlactatemia is a common and concerning finding in the paediatric cardiac ICU as it may signify tissue hypoperfusion and/or hypoxia. However, it is important to include other aetiologies for an elevated lactate in the differential, especially when the lactate is significantly elevated (> 8 mmol/L). We present the case of metabolic acidosis with severe hyperlactatemia secondary to Warburg effect and presumed thiamine deficiency in a paediatric heart transplant patient with post-transplant lymphoproliferative disorder.