Metabolic dysfunction-associated steatotic liver disease (MASLD) parallels the obesity epidemic in Australia and contributes to rising morbidity and mortality(1,2). Improving disease knowledge and health literacy may support lifestyle modification in this population(3,4). This study aims to assess disease knowledge and health literacy among Australians with MASLD and explore their association with lifestyle behaviours. This was an online cross-sectional national survey, with participants recruited via social media platforms, liver health-related websites, and tertiary clinics. Adults aged ≥ 18 years with a self-reported diagnosis of MASLD and no other known cause of steatogenic liver disease and without psychological disorder(s) were eligible for inclusion. Following informed consent, participants completed validated questionnaires assessing disease knowledge, health literacy, physical activity, and sleep quality. Dietary intake was evaluated using the Cancer Council Victoria food frequency questionnaire and diet quality was assessed using the Mediterranean Diet Score (MedDietScore). The survey was administered online via Qualtrics, and personalised links for dietary intake assessment were emailed to eligible participants. Binary and ordinal logistic regression analyses were used to assess the associations between disease knowledge, health literacy levels, and lifestyle behaviours. A total of 93 participants completed the demographics, while 91 and 86 participants completed the disease knowledge and health literacy questionnaires, respectively. The mean age was 63.9 ± 10.9 years, and 91.4% were females. Only 6.6% of participants were aware of the threshold of liver fat required for a MASLD diagnosis (> 5%). Most participants (~80%) reported good knowledge of the recommended lifestyle interventions for MASLD management, but 47.7% incorrectly identified excessive alcohol intake as a risk factor for MASLD, and only 47.3% were aware of its cardiovascular disease consequences. More than half (58.2%) exhibited either inadequate or problematic health literacy, particularly in the ability to appraise health information. Disease knowledge was inversely associated with BMI, with each one-unit increase in BMI linked to an 8% lower likelihood of having high disease knowledge (p = 0.041). Disease knowledge and health literacy were not associated with overall diet quality. However, each one-unit increase in legume intake score was associated with a 35% higher likelihood of high disease knowledge (p = 0.039). Health literacy increased with physical activity, with each additional minute of daily activity associated with significantly higher odds of greater health literacy (OR: 1.01; 95% CI: 1.01–1.02). Higher health literacy was 61% less likely among participants with sleep disturbances (OR: 0.39; 95% CI: 0.15–0.94). This national survey of Australian adults with self-reported MASLD found moderate disease-related knowledge and limited health literacy, with both associated with lifestyle behaviours. These findings highlight the need for educational strategies that enhance disease knowledge and ability to appraise health-related information, supporting adherence to lifestyle modifications in this population.

Obesity is a complex and heterogeneous condition with diverse presentations and highly variable responses to treatment. While interventions such as lifestyle modification, dietary changes, bariatric surgery, and pharmacotherapy can lead to meaningful and sustained weight loss, their effectiveness is influenced by numerous individual factors(1). Currently, there is no reliable system to match patients to the most appropriate treatment options. Precision nutrition aims to personalize interventions by considering biological, behavioural, and environmental factors. Improved understanding of individual molecular responses is essential to guide targeted treatment strategies. We investigated shared molecular features in adipose tissue from individuals (n = 185, 71% female) who successfully lost weight through bariatric surgery or lifestyle interventions by analysing publicly available transcriptomic datasets from the Gene Expression Omnibus (GEO). Three studies per intervention type were included. Paired linear mixed models using the limma package in R were used to identify differentially expressed genes pre- and post-intervention(2). In a complementary approach, genes differentially expressed in Peripheral Blood Mononuclear Cells (PBMCs) between high and low responders (n = 55, 38% female) were used to build a logistic regression model to predict weight loss, across four separate dietary interventions. In adipose tissue, both intervention types modulated the Adipogenesis pathway (WP236). Leptin expression was positively associated with weight loss, but only up to 10%, suggesting that dysregulation beyond this threshold may contribute to weight regain. A novel association between RBL2 expression and weight loss was also identified. For the PBMC-based model, one trial served as the discovery cohort. Four genes—OLFM4, DEFA3, ELANE, and MS4A3—were significantly downregulated (p < 0.05) in high responders. Using these genes, a prediction model was fitted. The final fitted model combined OLFM4 expression with baseline weight to predict treatment response with 76.4% accuracy, 41.7% sensitivity, and 100% specificity. The transcriptome appears to be sensitive to weight loss and can predict weight loss response. The exact genes and pathways that are sensitive appear to be tissue-specific and suggest that weight loss affects multiple tissues across the body. This study highlights the potential of tissue-specific transcriptomic profiling to inform personalized obesity treatment. Shared molecular responses in adipose tissue suggest common biological pathways underlying successful interventions. Additionally, gene expression in PBMCs can be used to develop predictive models for treatment response, with potential for clinical translation using digital droplet PCR as a scalable alternative to sequencing. Further validation in larger, more diverse cohorts is warranted.

Human milk oligosaccharides (HMOs) are the third most abundant biomolecules in breast milk, with over 200 structural variants, mainly fucosylated, sialylated, and neutral core types. Key HMOs include 2′-fucosyllactose (2′-FL), and 3′/6′-sialyllactose (3′/6′-SL), which enhance brain development in animal models(1). Lactoferrin (Lf), a sialylated glycoprotein, also supports neurodevelopment by promoting neurogenesis and reducing neuroinflammation(2). However, the combined effects of HMOs and Lf on brain metabolism remain unknown. We therefore investigated their synergy on brain metabolites and neurotransmitters in neonatal piglets using in vivo ¹H-MRS. Three-day-old male domestic piglets (Sus scrofa – Large White × Duroc × Belgian Landrace) were randomly assigned to one of three groups and fed a standard pig milk replacer with the following supplements: control (methyl cellulose at 1.8 g/L; n = 14), combined HMOs (70% 2′-FL and 30% 3′-SL:6′-SL in a 1:2.5 ratio at 1.8 g/L; n = 16), or cHMOs + Lf (cHMOs at 1.8 g/L + lactoferrin at 0.5 g/L; n = 14). In vivo ¹H-MRS was performed on postnatal day 38/39 using a 3T scanner (TE = 30 ms) to assess regional brain metabolite profiles. The research protocol was approved by the ACECs of Charles Sturt University (A23566) and Monash University (38776). Our results demonstrated that the group received combined HMOs and Lf exhibited significantly higher absolute levels of total lipids and macromolecules, along with increased relative concentrations of glutathione (Glth), total creatine (TCr), total choline (TCh), and total lipids and macromolecules at 2.0 ppm (TLM20) (p < 0.05). In contrast, the cHMOs group were observed to have significantly increased levels of absolute total N-acetylaspartate (TNAA) (p < 0.05). Collectively, these findings suggest that combined HMOs and lactoferrin supplementation may synergistically support neurodevelopment by enhancing lipid mobilization, energy metabolism, and antioxidant capacity, while cHMOs alone promotes brain development by improving neuronal integrity and synaptic activity in piglets—a translational model for human infants. To our knowledge, these findings have not been previously reported.

Poor diet is a leading contributor to cardiovascular disease (CVD) in Australia(1), and frequent consumption of home-cooked meals is associated with healthier dietary patterns(2). The Heart Foundation has been developing culinary nutrition resources for many years to support people to adopt a heart-healthy eating pattern. Recipe formats have evolved over time to keep pace with consumer preferences and digital marketing trends. The refreshed version of the Heart-Healthy Dinner Plans (HHDP) program, a free four-week intervention, delivers heart-healthy recipes weekly via email, supported by practical nutrition tools and resources. The program aims to translate evidence-based heart-healthy eating patterns into practice by increasing cooking confidence and skills while addressing common barriers. Based on insights from the initial pilot program (2020), refinements to the updated HHDP include tailored recipe streams (standard, vegetarian, serves-two), dynamic email/SMS prompts, refreshed recipes, step-by-step recipes featuring ingredient and method images, short instructional recipe videos, and condensed surveys, aimed to enhance engagement and completion. The survey, sent to all participants at the end of the 4-week journey, evaluates their program experience and any behaviour changes. The survey currently has a 5% response rate, and the data is reported live to an interactive dashboard. The refreshed program commenced with a soft launch and no active promotion allowing for the identification and resolution of digital performance issues to ensure an optimal user experience. Recruitment occurred primarily via social media (n = 8,381; 53%), Heart Foundation website (n = 5,477; 35%), and health professional referral (n = 840; 5%). Between 4 May 2025 and 10 August 2025, participants registered for the program. The mean participant age was 54 years, predominantly female (87%). Participants represented all Australian states, remoteness classifications, and socioeconomic quintiles. Pre-program, motivators for joining HHDP included improving health (n = 4,005; 79%), diet quality (n = 2,926; 58%), and increasing meal variety/inspiration (n = 1,347; 27%). Reported barriers at sign up included lack of inspiration time constraints and cost. Post-program survey cooking an average. Most agreed HHDP helped them overcome their main barrier, especially for those that identified inspiration, planning, and taste as their biggest barriers. Following completion, 94.3% reported adopting at least one heart-healthy behaviour, including reduced saturated fat (84%), increased vegetable, fruit, and whole grain intake (82%), and reduced sodium consumption (80%). Additionally, 89% found the supporting heart-health information and resources easy to understand. Preliminary program evaluation results suggest program refinements such as incorporating tailored content via dynamic email and SMS, multiple dietary streams, refreshed recipes, and simplified surveys enhanced consumer engagement and improved nutritional quality of meals prepared. The program demonstrates potential as a scalable, population-level strategy to promote heart-healthy eating, with further research needed to evaluate long term dietary impact.

Higher dietary fibre consumption is linked to positive gastric function; however, there is less evidence for associations with risk of stomach cancer(1,2), the fifth most common cancer globally(3). We evaluated associations between energy-adjusted dietary fibre intake and risk of stomach cancer overall and by subtype and population subgroup. Analyses were conducted using data from participants across 21 cohort studies (n = 2,085,078) within the Pooling Project of Prospective Studies of Diet and Cancer. At baseline, total dietary fibre intake, and, in a subset of studies, dietary fibre intake from fruits, vegetables and grains, were assessed. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression for incident stomach cancer in relation to dietary fibre intake. We assessed whether associations varied by sex, smoking status, body mass index (BMI), geographical region, or tumour subtype. During follow-up (mean 8–23 years across cohorts), 8,629 incident cases of gastric adenocarcinoma (3,072 female, 5,557 male; 1,866 cardia, 4,595 non-cardia) were documented. Large variations in dietary fibre intake were observed across studies. In multivariable models, higher total dietary fibre intake was associated with lower stomach cancer risk for both sexes combined (HR: 0.87; 95% CI: 0.79–0.96 ≥ 25 g/day vs. < 10 g/day). Using continuous fibre intake, we observed HRs of 0.94 per 10 g/day increment (95% CI: 0.90–0.98) for both sexes combined, 0.93 (95% CI: 0.88–0.97) for males, and 0.98 (95% CI: 0.91–1.05) for females (pinteraction-sex = 0.16). Associations were stronger for current smokers (HR: 0.83 per 10 g/day increment; 95% CI: 0.76–0.90; pinteraction-smoking = 0.07), those with BMI < 25 kg/m2 (HR: 0.90; 95% CI: 0.87–0.98) and BMI = 25–29.9 kg/m2 (HR: 0.94; 95% CI: 0.88–1.00) (pinteraction-bmi = 0.06), and studies from Australia/Europe (HR: 0.90; 95% CI: 0.83–0.97) and North America (HR: 0.94; 95% CI: 0.89–1.00) (pinteraction-region = 0.02). Associations were similar for cardia (HR: 0.94 per 10 g/day increment; 95% CI: 0.87–1.02) and non-cardia cancers (HR: 0.96; 95% CI: 0.90–1.01). Similarly lower risks for total stomach cancer were observed with intake of dietary fibre from grains (HR: 0.87; CI: 0.79–0.97 ≥ 8 g/day vs. 2–4 g/day); association with dietary fibre from vegetables was weak (HR: 0.94; 95% CI: 0.84–1.05 ≥ 8 g/day vs. 2–4 g/day) and with fruits showed increased risk (HR: 1.12; 95% CI: 1.01–1.25 ≥ 8 g/day vs. 2–4 g/day). Our findings support the hypothesis that dietary fibre intake may lead to lower stomach cancer risk. Ongoing analyses will assess possible residual confounding by smoking and H. pylori infection.

Fish, particularly oily fish, is a rich source of nutrients with anti-inflammatory and neuroprotective properties and its consumption has been associated with lower risk of chronic diseases(1). Higher fish consumption has been associated with lower risk of multiple sclerosis (MS)(2); however, evidence regarding its association with patient-reported outcome measures (anxiety, depression, and fatigue) in people with MS is limited. We used data from the AusLong Study, a longitudinal cohort of people with MS. Patient-reported outcome measures were assessed at 5, 10, and 15-year follow-ups. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale; fatigue was assessed using the Fatigue Severity Scale. Higher scores indicate higher levels of anxiety, depression or fatigue symptoms. Fish consumption (tinned, grilled, fried, and total: sum of tinned, grilled, fried fish; g/day) was derived from dietary intake data collected using a food frequency questionnaire at 5, 10 and 15-year follow-ups. Diet quality was assessed using the alternate Mediterranean diet score (aMED), excluding the fish component. Higher adherence to the Mediterranean dietary pattern associates with a higher diet quality(3). All three patient-reported outcome measures were not normally distributed and were Box-Cox transformed. Multivariable mixed-effect generalized linear models, adjusted for relevant covariates, were used to test associations between fish consumption (per 30 g/day, equivalent to approximately two servings of fish per week) and Box-Cox transformed patient-reported outcome measures. Analyses were adjusted for sex, age, study region, follow-up time point, smoking, disease-modifying medication use, education (depression only), employment status (anxiety and fatigue only), total energy intake, and diet quality (aMED excluding fish). Results were Box-Cox back transformed for reporting purposes. Most participants were female (95/119) with the median age of 54 years (IQR = 12.86) at the 15-year follow-up. The results revealed that higher consumption of total fish (Box-Cox transformed β coefficient = −0.19, back transformed β coefficient = 0.72, 95% CI 0.56, 0.90) and tinned fish (Box-Cox transformed β coefficient = −0.34, back transformed β coefficient = 0.59, 95% CI 0.36, 0.86) were significantly associated with lower depression score. No association was found between fish consumption (total, tinned, grilled, fried) and symptoms of anxiety or fatigue. Our result that higher fish consumption was associated with lower symptoms of depression in people with MS supports findings of other studies showing that higher fish consumption associates with lower risk of depression in healthy populations(4). In our study, fish consumption was associated with lower symptoms of depression in people with MS, and the association was independent of diet quality. Following a diet in line with national guidelines to include at least two servings of fish (particularly oily fish) per week could be beneficial for people with MS.

Ultra-processed food (UPF) consumption is growing nearly everywhere, including in Australia(1). Ultra-processed dietary patterns are associated with chronic disease and contribute to environmental degradation(2,3). The UPF concept is novel and has gained increased media and public attention in recent years. Despite this, research investigating the public’s perceptions regarding UPFs is limited. Therefore, this study aimed to explore Reddit forum discussions about UPFs to identify the main topics of discussion and examine how UPFs are portrayed. A qualitative content analysis was used to analyse the ‘top’ threads from the r/ultraprocessedfood subreddit, a global Reddit community dedicated to discussing UPFs, with over 34,000 subscribers. Data were collected in January 2025. A coding framework was developed deductively, and codes were informed by literature that uses a food systems lens to discuss UPFs(2–4) to capture a comprehensive range of issues related to UPF, including their impacts and causal mechanisms. The framework included codes to represent UPF-related topics that were discussed: health; planetary health; social inequities; culture; political economy; food system; dietary patterns; food; and nutri-biochemical. Coding was undertaken by two researchers in NVivo. Fifty threads comprised of a total of 2,730 comments were collected and analysed. The most frequently discussed topic was food (n = 45 (90%) threads, n = 1188 (43.5%) comments), followed by dietary patterns (n = 37 (74%) threads, n = 415 (15.2%) comments), health (n = 43 (86%) threads, n = 404 (14.8%) comments), food system (n = 34 (68%) threads, n = 323 (11.8%) comments) and nutri-biochemical (n = 34 (68%) threads, n = 322 (11.8%) comments). The least discussed topic was planetary health, which was coded to 13 (26%) threads and 25 (0.9%) comments. Comments under the most coded topic, food, often contained information or questions about specific foods being UPF or non-UPF, tips and food swaps for avoiding UPFs. Discussion of ‘UPF-free’ or ‘low UPF’ cooking, food preparation, meal ideas and grocery shopping was also common, with users sharing helpful information and offering support. Comments under the second-most coded topic, dietary patterns, discussed the practicalities of consuming a diet with no or minimal UPFs, with many users stating that it is unfeasible to consume a diet completely free of UPFs. The third-most common topic, health, often discussed health impacts linked to ultra-processed dietary patterns or described personal health outcomes users attributed to their UPF intake. Overall, Reddit posts discussed a broad range of topics related to UPFs. Support forums and promotion of cooking may be a useful tool to support reductions in UPF consumption. Environmental health was rarely discussed and is an important facet of ultra-processed dietary patterns for future public health messaging to address.

Adequate protein intake is essential for maintaining muscle and bone health(1). In the context of an ageing population, it is not only the amount of protein that matters, but also its source and quality, which are increasingly recognised as factors in preserving musculoskeletal function. With the growing shift towards a more plant-based diet, driven largely by sustainability concerns, understanding protein source intake and quality becomes even more crucial(2). However, despite growing awareness of protein’s importance, there is a lack of evidence for the current protein intake, source intake and quality in the Australian population. The aim of this study was to assess protein intake, source and quality in a nationally representative sample of Australian older adults. This study is a cross-sectional secondary data analysis including n = 2819 participants aged 55 years and over from the Australian National Nutrition and Physical Activity Survey (S), part of the 2011–13 Australian Health Survey (AHS). Dietary data (two 24-hour recalls) were used to derive total protein intake (g/day and g/kg/day) as well as protein intake from either animal or plant-based protein sources (g/day and percentage of total protein intake). Protein quality per meal was derived using the alpha tool(3), and expressed as a meal protein quality score ranging from 0–100, with a score of 100 being the highest protein quality. Of the n = 2819 participants (mean age 67 ± 9), n = 1520 were female, and n = 1299 were male. The daily protein intake was 83.7 g/day, with 64.4% from animal-based protein sources and 35.7% from plant-based protein sources. Breakfast had the highest proportion of plant-based protein sources (55.4%), followed by lunch (32.3%) and dinner (21.6%). In contrast, animal-based protein sources were highest at dinner (78.4%), followed by lunch (67.7%) and breakfast (24.5%). Protein quality scores (daily and per meal) will be assessed. The study will provide insight into the older Australians’ daily protein intake, source intake and distribution as well as protein quality. This is essential for effectively identifying nutritional strategies to manage age-related diseases such as sarcopenia and osteoporosis, and as such, support healthy ageing.

According to one influential line of thought, quasi-realism is faced with a dilemma. On the one hand, if the quasi-realist project of saying everything the realist wants to say is successful, quasi-realism collapses into realism. On the other hand, if the quasi-realist stops short of saying everything the realist wants to say, quasi-realism fails to realize its explanatory ambitions. In a recent paper, Bart Streumer argues that there is a way for the quasi-realist to avoid this problem by endorsing the first horn of the dilemma. More specifically, Streumer argues that quasi-realism could be true although we are unable to believe it, and that our inability to believe it could be evidence for its truth. In this paper, we first argue that Streumer’s argument is unsuccessful. We then argue that Streumer’s argument is unsuccessful for an interesting reason; namely for how it invites the exploration of an underappreciated theoretical alternative along broadly pragmatist lines, which we outline in the final section of the paper. What hinges on this invitation is nothing less than the question of what contemporary debates in metaethics and metanormativity are all about.

Intestinal glucose absorption is predominantly mediated by sodium-dependent glucose transporter 1 (SGLT1) and glucose transporter 2 (GLUT2). Expression of these glucose transporters is influenced by diet, inflammation and insulin sensitivity, and is increased in patients with type 2 diabetes(1). Overexpression may increase intestinal glucose absorption and exacerbate postprandial hyperglycaemia. Chronic low-grade inflammation, common in metabolic diseases, upregulates these transporters(2) and the SARS-CoV-2 receptors, angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS2)(3), potentially worsening glucose metabolism and increasing susceptibility to COVID-19. We hypothesised that dietary phytochemicals, known to regulate glucose metabolism and inflammation, may counteract high glucose- and inflammation-induced changes in transporter and viral receptor expression. We initially screened various phytochemicals, pharmaceuticals and plant extracts for their effects on the expression of ACE2 or TMPRSS2 in differentiated Caco-2/TC7 human intestinal epithelial cells. Genistein, apigenin, artemisinin and sulforaphane were the most promising compounds for downregulating TMPRSS2, and thus were used in subsequent experiments. The cells were stimulated with glucose or pro-inflammatory cytokines interleukin-1 beta (IL-1β) and tumour necrosis factor-alpha (TNF-α), with and without the phytochemicals. ACE2, TMPRSS2, SGLT1 and GLUT2 mRNA was measured by droplet digital PCR, while interleukin-8 (IL-8) and ACE2 proteins were assessed using ELISA, with significant changes detected by ANOVA. To assess whether effects observed in Caco-2/TC7 cells were relevant to human tissues, we examined gene expression in human gut tissues from patients with and without inflammatory bowel disease using transcriptomic datasets. In Caco-2/TC7 cells, high glucose (25 mM) increased expression of SGLT1 (p < 0.05) and TMPRSS2 (p < 0.01), while exposure to pro-inflammatory cytokines upregulated ACE2 (p < 0.001), TMPRSS2 (p < 0.001) and SGLT1 (p < 0.001). Although none of the phytochemicals decreased inflammation-induced IL-8 secretion, genistein normalised inflammation-induced increases in SGLT1 (p < 0.01) and TMPRSS2 (p < 0.001). The regulation of SGLT1 gene expression followed the same pattern as TMPRSS2, implying a common mechanism. In the human transcriptome data, we observed a correlation between TMPRSS2 and SGLT1 (r > 0.5, p < 0.05), which was enhanced by inflammation. High glucose and inflammation upregulate ACE2, SGLT1 and TMPRSS2 in intestinal cells, potentially increasing the risk of type 2 diabetes and SARS-CoV-2 infection in humans via a gut-mediated mechanism. The association between TMPRSS2 and SGLT1 gene expression, which is particularly evident in inflammatory conditions, suggests a common regulatory pathway that warrants further investigation. These findings suggest a possible relationship between elevated SGLT1 and new-onset diabetes in COVID-19 patients and may help to explain why individuals with metabolic diseases are more likely to develop severe COVID-19. Furthermore, our results provide mechanistic evidence for nutrition-based interventions, such as genistein, to potentially alleviate postprandial glycaemic response and COVID-19 pathophysiology.

Distance running offers many health benefits, yet injuries are common. In long-distance runners (> 20 km/week), a previous running-related injury (RRI) is the strongest predictor of injury(1). In females, menstrual dysfunction and low bone mineral density (BMD) increases bone stress injury (BSI) risk(2). A recent meta-analysis of diet-related risk factors found lower total energy and fat intakes in injured female runners, and a lower fibre intake in both sexes combined with a BSI(3). Of the four studies contributing to these findings, all involved younger trained or highly trained athletes, with only one including females up to 53 years. Older runners may be at increased risk due to age-related physiological changes and nutrient deficiencies, but prospective studies are lacking. This study aimed to evaluate the relationship between bone health, diet, and RRI in masters distance runners. Male and female masters athletes (≥ 35 years) running ≥ 30 km/week enrolled in a 6-month prospective study. Baseline measures included demographics, diet (energy, macro- and micronutrients), and BMD (total body and site-specific). Dietary intake was compared to Australian nutrient reference values or sports recommendations. Weekly running mileage and injury occurrence were tracked for six months. Analyses were conducted for the whole cohort and by sex. Of 100 runners (n = 56 male) completing the study, 26 sustained a soft tissue injury (with one combined soft tissue and BSI). Injured runners (both sexes combined) had lower dual femoral neck BMD (Hedge’s g = −0.51, p = 0.028), Z-score (Hedge’s g = −0.52, p = 0.032), and T-score (Hedge’s g = 0.40, p = 0.040) compared to uninjured runners. Injured females had lower dual femoral neck BMD (Hedge’s g = −0.64, p = 0.049) compared to uninjured females, and females with whole-body T-score ≤ 1 had higher injury risk (OR = 6.4, p = 0.030). Few runners met their estimated energy requirements (24% females, 29% of males), with no difference in intake between injured and uninjured runners. Similarly, no significant relationships were observed for macronutrients. Males not meeting calcium recommendations had higher injury risk (OR = 4.0, p = 0.03). Females not meeting iron recommendations had lower injury risk (OR = 0.21, p = 0.038). Findings suggest bone health may influence soft tissue injury risk in masters distance runners, as shown by sex-specific associations between BMD and injury. No associations for energy and macronutrients may reflect overall inadequate intake. Inadequate calcium intake in males may impair soft tissue integrity and repair, increasing injury risk. The protective effect of low iron intake in females may relate to poor overall intake or use of age-based recommendations that overlook menstrual status. Larger, long-term studies using age-appropriate assessments are warranted.

Globally, approximately 2.9 million people live with multiple sclerosis (MS). The prevalence of depression and anxiety is significantly higher in people with MS than in the general population, contributing to a lower quality of life(1). A high-quality diet has been shown to have beneficial effects on MS symptoms, including mental health outcomes. Despite emerging evidence on the association between a high-quality diet and mental health outcomes in people with MS, there is a lack of evidence supporting the specific effects of dietary quality on depression and anxiety in MS. Adults with MS gather information from a range of resources to improve their diet and mental health. However, little is known about the development sources and nature of diet-focused resources aimed at improving mental health outcomes in adults with MS. We conducted a scoping review to identify and map the content, accessibility, acceptability, and usefulness of diet-focused resources aimed at improving depression and anxiety in adults with MS. The review was conducted according to the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist(2). Resources eligible for inclusion could be of any type (e.g., web article, blog, dietary modification program) and in any format (e.g., online, telehealth, in-person). Included resources featured diet, food, or nutrition as a mechanism to improve depression and anxiety in adults with MS. A comprehensive search was conducted to identify published (MEDLINE, CINAHL Ultimate, PsycINFO, Emcare, Scopus, ProQuest Central, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) and unpublished resources (ProQuest Dissertations and Theses Global, Google Scholar, websites, and organisations). From 949 resources screened (n = 834 articles and other resources retrieved from databases; n = 98 resources retrieved from websites; n = 17 resources retrieved from organisations), 64 were included (n = 42 organisational or web-based resources, e.g., podcast episodes, blog posts, web articles; n = 20 published journal articles; n = 1 mobile application in development; n = 1 book). Resources mentioned an extensive range of dietary and nutritional information (e.g., macronutrients, food groups, micronutrients, MS-specific diets) linked to depression and anxiety for people with MS; however, 6 resources were based solely on lived experience, while other resources involved a combination of input from experts (n = 54), organisations (n = 23), authors or journalists (n = 5), or co-design (n = 1). Furthermore, some resources (n = 20) were only available in certain countries or regions due to recruitment restrictions, making them inaccessible for many people with MS. Developing evidence-based mental health and dietary resources tailored for people with multiple sclerosis will address the current gap in credible, co-designed resources accessible to the multiple sclerosis community.

Skin yellowness has been found to positively associate with carotenoid intake, and fruit and vegetable intake in young Caucasians(1–3). Carotenoids are lipid soluble pigments found predominantly in fruit and vegetables. After absorption, a proportion of carotenoids are deposited in the skin, where they contribute to skin yellowness, which can be measured using reflectance spectroscopy, raising its potential as an objective, non-invasive measure of carotenoid, or fruit and vegetable intake. Studies measuring skin yellowness and its association with carotenoid or fruit and vegetable intake are generally cross-sectional in nature and overrepresented by younger populations. In this study we investigated whether a two-week vegetable soup intervention, adding 4 daily serves of either high-carotenoid (14.9 mg/d), or low-carotenoid (6.4 mg/d) vegetables per day, altered skin yellowness and serum carotenoid concentrations in older adults (n = 18, 83% female, average age = 66 years, BMI = 27.4 kg/m2). Participants were randomised into either a high carotenoid soup (20% carrot, 40% potato, 30% pumpkin, 10% sweet potato) or low-carotenoid soup (40% broccoli, 25% cabbage, 25% cauliflower, 10% kale) intervention, both with equal serves of vegetables. Participants consumed the provided soups and standard frozen meals for lunch and dinner, but breakfast and snacks were ad libitum. Total fruit and vegetable intake was determined using an interview-based food frequency questionnaire (baseline) and a two-week food record (during intervention). Total carotenoid intake from fruits and vegetables was calculated using data from either the Australian Food Composition Database, or the US Department of Agriculture Database. Skin yellowness was assessed using skin reflectance spectroscopy (CIE Lab l*a*b*) where b* represents the degree of yellowness, and serum carotenoid concentrations determined using high performance liquid chromatography. There were no significant changes in total fruit and vegetable intake in either group, but participants randomised to the high-carotenoid soup intervention, had a significant increase over the intervention period in carotenoid intake (+113.2 mg (high) vs. −62.8 mg (low), p < 0.01), total serum carotenoid concentrations (+1.56 µg/mL (high) vs. +0.4 µg/mL (low), p < 0.05) and skin yellowness at multiple skin sites (shoulder, biceps, palm, and sole of foot, all p < 0.05) compared to those randomised to the low-carotenoid soup intervention. Changes in serum carotenoid concentrations during the intervention were strongly associated with changes in skin yellowness (biceps, palm, sole of foot, all p < 0.05), but not with changes in total fruit and vegetable intake, which remained generally unchanged. In summary, changes in skin yellowness were detected following a 2 week high carotenoid soup intervention, compared to participants on a low-carotenoid soup intervention in the absence of changes to total fruit and vegetable intake. These findings emphasise the importance of carotenoid-rich fruit and vegetables when using skin colour to predict fruit and vegetable consumption.

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

Food and nutrition insecurity in high‑income countries is increasingly persistent, driven by intersecting economic, social and environmental disruptions. In Australia, acute shocks such as the COVID‑19 pandemic, floods and bushfires, alongside chronic pressures including rising food prices, housing stress and concentrated corporate power, have exposed structural weaknesses in food access, governance and system resilience. This review examines how community‑led responses to food and nutrition insecurity function during disruption, whether they buffer short-term hardship or contribute to adaptive capacity and redistribution of agency. Guided by the six‑pillar food security framework and a socio-ecological model, responses are examined across household, community, organisational and governance levels. A continuum of responses is identified, ranging from downstream emergency food relief that buffers immediate hardship through to community and organisational food infrastructure that strengthens local resilience and governance‑level responses with greater transformative potential. Drawing on this synthesis, we propose the SEEDS (Socio-Ecological Enablers of Dietary Security) Model, which conceptualises how food system responses across socio-ecological levels and over time can progress from buffering (acute) to adaptation (medium‑term) and ultimately transformation (long‑term). Central to this framework is a shift in decision‑making power, accountability and participation. While many initiatives improve food access and short‑term stability during crises, the greatest potential for transformation lies where responses are embedded within governance structures, enable meaningful community participation and influence policy, procurement and resource allocation. Implications for public health nutrition practice include expanded roles in systems leadership, cross‑sector governance and advocacy for upstream policy reform.

The Nutrition Science Competencies for use in undergraduate degrees in Australia were last developed and released in 2019(1). Since then, new priorities affecting nutrition science have emerged, such as an increased emphasis on planetary health, Australia’s food supply chain, changing population demographics, priority groups and digital transformation(2). Simultaneously, the higher education sector is navigating the ethical use of Generative AI and has an increased focus on cultural awareness and career readiness(3,4). Nutrition Science Competencies inform the review and development of undergraduate nutrition programs and nutrition majors in Australian universities. Competencies guide university curriculum to train graduates to fill roles in the contemporary Australian labour market that are currently in demand, and to potentially foresee emerging nutrition roles, in health care, science, food, education or otherwise. The 2019 National Nutrition Science Competencies are due to be updated and the planned 2025/2026 update is being conducted by Nutrition Society of Australia’s Special Interest Group Nutrition Education and Tertiary Teaching (SIGNETT). This presentation will share plans and a timeline for the update. The multiple-methods project will comprise of two stages. Stage 1 will involve a scoping review of published and grey literature to identify advances relevant to nutrition competency updates. Stage 2 will derive the updated structure and set of nutrition science competencies through a Delphi process. The Delphi Panel will comprise approximately 100 nutrition experts from academia, industry and the community. A reference group comprising highly regarded nutrition experts will oversee and provide advice to the working group. We will further invite interested Nutrition Society members to contribute to this update. This work proposes the process for developing a contemporary set of competencies to support the alignment of curriculum and training with evolving professional standards in nutrition. Given that these competencies will be developed through consultation with industry stakeholders, academic experts, and community representatives, they will provide a robust foundation for curriculum design. The inclusive development process will ensure their credibility and give confidence for endorsement as a formal SIGNETT position statement. By embedding these competencies into university programs, institutions can reinforce the evidence-based nature of nutrition education, strengthen graduates’ professional identity, and contribute to the National Trusted Voice in Nutrition.

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

Unhealthy food consumption is rising in rural South Asia, yet food environments in the region remain understudied. To address this gap, we characterised rural food environments and assessed how food affordability, accessibility, availability, and desirability are associated with dietary patterns and quality in Bangladesh, India, and Nepal. We used household (N=9711) and markets (N=1646) data from the Transforming Agrifood Systems in South Asia (TAFSSA) survey conducted in five rural districts in 2023: Nalanda (India), Surkhet and Banke (Nepal), and Rangpur and Rajshahi (Bangladesh). Participants included adult women, men, and adolescents. Primary outcomes included weekly consumption of 25 food items and Global Diet Quality Scores (GDQS): GDQS-plus (0–32) and GDQS-minus (0–17). Predictors included proximity to markets, food prices, vendor density, food availability, and exposure to advertising or nutrition messaging. Multivariate regressions were used to assess associations and were adjusted for sociodemographic and household characteristics. Diets in these settings were characterised by low healthy food intake (GDQS-plus scores ranged from 6.6 to 7.7), and high unhealthy food intake (GDQS-minus scores from 9.3 to 11.7). Ultra-processed food vendors were present in >80% of villages. Snacking was the strongest predictor of both higher healthy (+1.11 GDQS-plus) and unhealthy (−0.67 GDQS-minus) food intake (P<0.001), indicating that snacking increases overall dietary intake. Key predictors of suboptimal diets include low affordability of nutritious foods, alongside the widespread availability and desirability of inexpensive ultra-processed products. These findings highlight structural and behavioural drivers of rural dietary transitions and provide evidence to guide food system interventions aimed at improving nutrition in underserved populations.