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Childhood trauma is a well-established risk factor for psychosis, paranoia, and substance use, with cannabis being a modifiable environmental factor that exacerbates these vulnerabilities. This study examines the interplay between childhood trauma, cannabis use, and paranoia using standard tetrahydrocannabinol (THC) units as a comprehensive measure of cannabis exposure.
Methods
Data were derived from the Cannabis&Me study, an observational, cross-sectional, online survey of 4,736 participants. Childhood trauma was assessed using a modified Childhood Trauma Screen Questionnaire, while paranoia was measured via the Green Paranoid Thoughts Scale. Cannabis use was quantified using weekly standard THC units. Structural equation modeling (SEM) was employed to evaluate direct and indirect pathways between trauma, cannabis use, and paranoia.
Results
Childhood trauma was strongly associated with paranoia, particularly emotional, and physical abuse (β = 16.10, q < 0.001; β = 16.40, q < 0.001). Cannabis use significantly predicted paranoia (β = 0.009, q < 0.001). Interactions emerged between standard THC units and both emotional abuse (β = 0.011, q < 0.001) and household discord (β = 0.011, q < 0.001). SEM revealed a small but significant indirect effect of trauma on paranoia via cannabis use (β = 0.004, p = 0.017).
Conclusions
These findings highlight childhood trauma as a primary driver of paranoia, with cannabis use amplifying its effects. While trauma had a strong direct impact, cannabis played a significant mediating role. Integrating standard THC units into psychiatric research and clinical assessments may enhance risk detection and refine intervention strategies, particularly for childhood trauma-exposed individuals.
Preclinical evidence suggests that diazepam enhances hippocampal γ-aminobutyric acid (GABA) signalling and normalises a psychosis-relevant cortico-limbic-striatal circuit. Hippocampal network dysconnectivity, particularly from the CA1 subfield, is evident in people at clinical high-risk for psychosis (CHR-P), representing a potential treatment target. This study aimed to forward-translate this preclinical evidence.
Methods
In this randomised, double-blind, placebo-controlled study, 18 CHR-P individuals underwent resting-state functional magnetic resonance imaging twice, once following a 5 mg dose of diazepam and once following a placebo. They were compared to 20 healthy controls (HC) who did not receive diazepam/placebo. Functional connectivity (FC) between the hippocampal CA1 subfield and the nucleus accumbens (NAc), amygdala, and ventromedial prefrontal cortex (vmPFC) was calculated. Mixed-effects models investigated the effect of group (CHR-P placebo/diazepam vs. HC) and condition (CHR-P diazepam vs. placebo) on CA1-to-region FC.
Results
In the placebo condition, CHR-P individuals showed significantly lower CA1-vmPFC (Z = 3.17, PFWE = 0.002) and CA1-NAc (Z = 2.94, PFWE = 0.005) FC compared to HC. In the diazepam condition, CA1-vmPFC FC was significantly increased (Z = 4.13, PFWE = 0.008) compared to placebo in CHR-P individuals, and both CA1-vmPFC and CA1-NAc FC were normalised to HC levels. In contrast, compared to HC, CA1-amygdala FC was significantly lower contralaterally and higher ipsilaterally in CHR-P individuals in both the placebo and diazepam conditions (lower: placebo Z = 3.46, PFWE = 0.002, diazepam Z = 3.33, PFWE = 0.003; higher: placebo Z = 4.48, PFWE < 0.001, diazepam Z = 4.22, PFWE < 0.001).
Conclusions
This study demonstrates that diazepam can partially restore hippocampal CA1 dysconnectivity in CHR-P individuals, suggesting that modulation of GABAergic function might be useful in the treatment of this clinical group.
Physical inactivity is a leading cause globally of noncommunicable diseases such as diabetes, heart attacks, and strokes. Here, we present the results from a 4-week-long experimental test of a nudge designed to promote physical activity among 206 seniors in Abu Dhabi, United Arab Emirates—a population with one of the highest rates of physical inactivity in the world. We find that the “Forever Fit” nudge—a booklet containing a simple exercise program and information about the health benefits of physical activity—has a large positive effect on 93 previously inactive seniors. The nudge increases the time previously inactive participants spend being physically active from about 5 to about 15 minutes per day.
We present the serendipitous radio-continuum discovery of a likely Galactic supernova remnant (SNR) G305.4–2.2. This object displays a remarkable circular symmetry in shape, making it one of the most circular Galactic SNRs known. Nicknamed Teleios due to its symmetry, it was detected in the new Australian Square Kilometre Array Pathfinder (ASKAP) Evolutionary Map of the Universe (EMU) radio–continuum images with an angular size of 1 320$^{\prime\prime}$$\times$1 260$^{\prime\prime}$ and PA = 0$^\circ$. While there is a hint of possible H$\alpha$ and gamma-ray emission, Teleios is exclusively seen at radio–continuum frequencies. Interestingly, Teleios is not only almost perfectly symmetric, but it also has one of the lowest surface brightnesses discovered among Galactic SNRs and a steep spectral index of $\alpha$=–0.6$\pm$0.3. Our best estimates from Hi studies and the $\Sigma$–D relation place Teleios as a type Ia SNR at a distance of either $\sim$2.2 kpc (near-side) or $\sim$7.7 kpc (far-side). This indicates two possible scenarios, either a young (under 1 000 yr) or a somewhat older SNR (over 10 000 yr). With a corresponding diameter of 14/48 pc, our evolutionary studies place Teleios at the either early or late Sedov phase, depending on the distance/diameter estimate. However, our modelling also predicts X-ray emission, which we do not see in the present generation of eROSITA images. We also explored a type Iax explosion scenario that would point to a much closer distance of $\lt$1 kpc and Teleios size of only $\sim$3.3 pc, which would be similar to the only known type Iax remnant SN1181. Unfortunately, all examined scenarios have their challenges, and no definitive Supernova (SN) origin type can be established at this stage. Remarkably, Teleios has retained its symmetrical shape as it aged even to such a diameter, suggesting expansion into a rarefied and isotropic ambient medium. The low radio surface brightness and the lack of pronounced polarisation can be explained by a high level of ambient rotation measure (RM), with the largest RM being observed at Teleios’s centre.
Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.
Methods
In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores from the Patient Health Questionnaire-9 (depression symptoms), Generalized Anxiety Disorder-7 (anxiety symptoms), and Work and Social Adjustment Scale (functional impairment). Genome-wide association analyses were performed with REGENIE. Heritability was estimated using GCTA-GREML and genetic correlations with bivariate-GREML.
Results
The phenotypic correlations were moderate across the three measures (Pearson’s r = 0.50–0.69). All three scales were found to be under low but significant genetic influence (single-nucleotide polymorphism-based heritability [h2SNP] = 0.11–0.19) with high genetic correlations between them (rg = 0.79–0.87).
Conclusions
Among individuals with lifetime depression or anxiety from the GLAD Study, the genetic variants that underlie symptom severity largely overlap with those influencing functional impairment. This suggests that self-reported functional impairment, while clinically relevant for diagnosis and treatment outcomes, does not reflect substantial additional genetic liability beyond that captured by symptom-based measures of depression or anxiety.
The perinatal period has gained increasing attention from developmental psychopathologists; however, experiences during birth have been minimally examined using this framework. The current study aimed to evaluate longitudinal associations between childhood maltreatment, negative birth experiences, and postpartum mental health across levels of self-reported emotion dysregulation and respiratory sinus arrhythmia (RSA). Expectant mothers (N = 223) participated in a longitudinal study from the third trimester of pregnancy to 7 months postpartum. Participants contributed prenatal resting RSA and completed questionnaires prenatally, 24 hours after birth, and 7 months postpartum. Results indicated that more childhood maltreatment was associated with higher birth fear and postpartum anxiety and depressive symptoms. Resting RSA moderated the association between childhood maltreatment and birth fear, such that more childhood maltreatment and higher resting RSA were associated with increased birth fear. Additionally, self-reported prenatal emotion dysregulation moderated the association between childhood maltreatment and postpartum depressive symptoms, such that more childhood maltreatment and higher emotion dysregulation were associated with increased depressive symptoms. Emotion dysregulation across multiple levels may amplify vulnerability to negative birth experiences and postpartum psychopathology among individuals with childhood maltreatment histories. Thus, emotion dysregulation in the context of trauma-informed care may be worthwhile intervention targets during the perinatal period.
Chapter 10 on International Atmospheric Trust cases investigates the application of the public trust doctrine in climate litigation. Historically, under this doctrine courts have maintained that certain natural and cultural resources should be held in trust for the public, with the government acting as a trustee. The authors explain the practical application and interpretation of this doctrine in climate litigation, examining key cases (through 2022) across various jurisdictions, including the United States, Canada, India, Pakistan, and Uganda. The effect is to produce a Restatement of best practices in climate litigation revealing the successes and challenges encountered when invoking the public trust doctrine in climate litigation. This review of the case law reveals an emerging distinction between the U.S., which has seen the erection of procedural barriers in federal and state courts to avoid deciding cases on the merits, and international courts, who have reached the merits of several cases, ordering remedial actions. The chapter underscores the potential of this doctrine to induce more robust climate action among the political branches of government, reflecting a growing recognition among courts outside the U.S. of their own role in safeguarding the atmosphere.
Falls account for 95 percent of hip fractures in older adults. Wearable hip protectors reduce hip fracture risk in long-term care settings, but their use is low among community-dwelling older adults. We conducted interviews to explore how hip protectors are perceived by 27 community-dwelling older adults who visited the Fraser Health Fall Prevention Mobile Clinic in British Columbia. Directed content analysis focused on perceived benefits, design preferences, and cost as a barrier to use of hip protectors. Most participants acknowledged the benefits of hip protectors in reducing the risk of hip fracture, enhancing physical activity, and reducing the fear of falling. However, most participants did not perceive they were at high enough risk to warrant the use of hip protectors. Participants also discussed how willingness to wear depended on design features, including style, pad thickness, appearance, ease of use, fit, comfort, and laundering. Participants also noted the cost, ranging from $60 to $120, as a barrier.
This paper explores the transformative potential of artificial intelligence (AI), particularly generative AI (GenAI), in supporting the teaching, learning, and assessment of second language (L2) listening and speaking. It examines how AI technologies, such as spoken dialogue systems and intelligent personal assistants, can refine existing practices, offer innovative solutions, and address challenges related to spoken language competencies, as well as drawbacks they present. It highlights the role of GenAI, explores its capabilities and limitations, and offers insights into the evolving role of GenAI in language education. This paper discusses actionable insights for educators and researchers, outlining practical considerations and future research directions for optimizing GenAI integration in the learning and assessment of listening and speaking.
About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA).
Methods
In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD.
Results
Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7–0.9) at 6 weeks to 5.5% (5.3–5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14–3.85]), preterm delivery (1.47 [1.30–1.66]), PCOS (1.37 [1.09–1.72]), hyperemesis gravidarum (1.32 [1.11–1.57]), gestational hypertension (1.30 [1.03–1.66]) and postpartum haemorrhage (1.29 [0.91–1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD.
Conclusions
The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA’s private sector. Identified risk factors could inform targeted PPD screening strategies.
Conduct disorder is a psychological condition marked by persistent patterns of rule-breaking, aggression and disregard for societal norms. As pornography consumption becomes increasingly prevalent among young adults, concerns have emerged regarding its potential psychological and social implications. This study explores how pornography consumption may contribute to conduct disorder symptoms among young adults through an in-depth qualitative analysis. Using a case-study approach, four individuals with a history of frequent pornography consumption and behavioural issues linked to conduct disorder were selected. Data were collected through detailed interviews, focusing on their experiences, behavioural patterns and psychological effects. The analysis revealed that prolonged exposure to certain types of pornography was associated with increased impulsivity, aggression and rule-breaking tendencies. Participants also reported social and emotional challenges, further reinforcing conduct disorder symptoms. This study suggests that specific patterns of pornography consumption may play a role in the development or worsening of conduct disorder symptoms. Recognizing these behavioural links is crucial for creating effective prevention and intervention strategies, especially for young adults at risk of engaging in deviant or criminal behaviour.
A novel entomopathogenic nematode (EPN) species, Steinernema tarimense n. sp., was isolated from soil samples collected in a Populus euphratica forest located in Yuli County within the Tarim Basin of Xinjiang, China. Integrated morphological and molecular analyses consistently place S. tarimense n. sp. within the ‘kushidai-clade’. The infective juvenile (IJ) of new species is characterized by a body length of 674–1010 μm, excretory pore located 53–80 μm from anterior end, nerve ring positioned 85–131 μm from anterior end, pharynx base situated 111–162 μm from anterior end, a tail length of 41–56 μm, and the ratios D% = 42.0–66.6, E% = 116.2–184.4, and H% = 25.5–45.1. The first-generation male of the new species is characterized by a curved spicule length of 61–89 μm, gubernaculum length of 41–58 μm, and ratios D% = 36.8–66.2, SW% = 117.0–206.1, and GS% = 54.8–82.0. Additionally, the tail of first-generation female is conoid with a minute mucron. Phylogenetic analyses of ITS, 28S, and mt12S sequences demonstrated that the three isolates of S. tarimense n. sp. are conspecific and form a sister clade to members of the ‘kushidai-clade’ including S. akhursti, S. anantnagense, S. kushidai, and S. populi. Notably, the IJs of the new species exhibited faster development at 25°C compared to other Steinernema species. This represents the first described of an indigenous EPN species from Xinjiang, suggesting its potential as a novel biocontrol agent against local pests.
Type 2 diabetes mellitus (T2DM) is a major disease worldwide, causing significant mortality and morbidity. Currently, in Aotearoa, New Zealand, there is a high prevalence of T2DM, with a disproportionate impact on Māori and Pacific populations(1). Moreover, it has been predicted that the prevalence will continually increase. Research has shown that insulin resistance (IR) has been reported to play a critical role in the development of T2DM and other related cardiometabolic diseases(2). Therefore, managing IR is crucial to reducing the development of T2DM. Notably, bioactive compounds in various diets are known to modify the risk of T2DM by regulating IR. Among such dietary compounds include kawakawa (Piper excelsum), an indigenous species used by Māori in traditional medicine (Rongoā). Kawakawa is shown to contain several bioactive compounds that are shown to have insulin-sensitising effects. Research by our group has recently shown kawakawa to have potential anti-diabetic and anti-inflammatory effects in healthy human volunteers(3,4). However, how Kawakawa exerts these effects on insulin signalling and glucose uptake remains unknown. We hypothesise that kawakawa will enhance the glucose uptake in the treated cells and will differentially regulate key genes involved in insulin signalling pathways, including GLUT2, IRS-1, PPAR-γ, and PI3K/Akt, across various tissues. To test our hypothesis, we aim to investigate the mechanistic action of kawakawa extract on insulin signalling pathways in different cell models from metabolically active organs. We will use the same kawakawa powder sample shown to improve postprandial insulin in a healthy population. Cell models representing different insulin-responsive organs: liver (HepG2), skeletal muscle (L6-GLUT4myc), pancreas (MIN6), and adipose (3T3-L1) will be used. The cells will be treated with different doses of kawakawa extract, and glucose uptake will be measured. Key signalling pathways, including GLUT2, IRS-1, PPAR-γ, and PI3K/Akt, will be monitored using western blot and quantitative polymerase chain reaction (qPCR) analysis. The findings of this study have the potential to identify key targets of kawakawa action on insulin signalling in metabolically active organs. These outcomes will inform future research with kawakawa in clinical settings in people with cardiometabolic diseases such as T2DM and can form the basis for developing a dietary intervention for individuals at risk of these diseases. Additionally, Rongoā is an acceptable intervention by Māori, integrating this knowledge with evidence-based scientific interventions would aid in creating a holistic health paradigm that resonates within Māori communities.
Globally, food waste from school lunch programmes varies considerably, ranging from 33 to 116 g/student/day, with vegetables the most wasted food category(2). In New Zealand, the Ka Ora Ka Ako school lunch programme provides free healthy lunches to schools whose communities face greater socio-economic barriers. The programme has been criticised with claims that large quantities of food is wasted, although there is no available data available to support these comments. The aim of this study was to measure the quantity and destinations of food waste from the Ka Ora, Ka Ako school lunch programme in Dunedin schools. A total of eight primary schools in Dunedin participated. At each school, data was collected over four days: the first day was an observation day and on the remaining three consecutive days food waste was measured. Equipment (e.g., measuring scales, buckets and containers) was used for direct weighing and to carry out the waste composition analysis (i.e., manually sorting waste by type). Data was recorded and analysed using Microsoft Excel software. School rolls ranged from 17 to 353 students. Across the seven schools, the total amount of food waste from leftovers was 5274 g/day, with a mean of 32 g/student/day. Destinations of food waste from leftovers varied, ranging from returning to the supplier to being disposed in school rubbish bins (to landfill). Using the Target, Measure, Act approach recommended for food waste, the ‘Target’ is to halve per capita global food waste at the retail and consumer levels by 2030(2). This study contributes to the second step, which is to ‘Measure’ food waste. The findings from this study may be used for the third step, ‘Act’, to reduce food waste from the Ka Ora, Ka Ako school lunch programme, diverting this from landfill.
Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.
Food security constitutes a worldwide concern closely correlated with population growth. By 2050, the global population is expected to reach 9.3 billion(1). The rising population, along with increasing life expectancy and shifts toward Western dietary patterns, is expected to drive higher food demand and contribute to a rise in metabolic conditions(2). In this context, looking for alternative and sustainable food and protein sources is imperative. Pasture legumes including lucerne (Medicago sativa) and red clover (Trifolium pratense) are becoming popular as they can be used as an alternative protein and functional food source. Both crops play an important role in New Zealand’s agriculture. Their seeds can be used in human nutrition as alternative food and protein options; however, the presence of anti-nutritional factors (ANF) and their distinct taste make them less favourable for human consumption. Fermentation can be used as a possible strategy to mitigate these limitations. Lactobacillus fermentation was conducted using Lactocillus plantarum, Lactobacillus. acidophilus and Lactobacillus. casei. Proximate composition and mineral content were determined following Association of Official Analytical Chemists (AOAC) methods. Total phenol content (TPC), total flavonoid content (TFC) and antioxidant activity (2,2-Diphenyl-1-picrylhydrazyl and 2,2′-azino-bis-(3-ethylbenzothiazoline-6-sulfonic) acid) and ANF including phytic acid, trypsin, and chymotrypsin inhibition were assessed using colourimetric techniques. For the enzyme inhibition assays, enzyme-substrate reactions were performed with sample extracts before measurement. All the experiments were replicated three times, and the results were expressed as mean ± SD. A factorial analysis of variance (ANOVA) was conducted (4 legume seed samples × 3 LAB cultures) with a Tukey’s post-hoc test for mean comparison at P < 0.05 using IBM SPSS Statistics 29.0. All the legume seeds demonstrated high nutritional content, with crude protein and fibre levels around 40 and 16% respectively. The seeds were also rich in minerals, particularly magnesium, phosphorus, iron and zinc. In addition, fermentation led to an increase (P < 0.05) in TPC, TFC and antioxidant activity, while significantly reducing ANF. For instance, fermentation led to an increase in TPC (18.8 to 47.1% increase), TFC (9.6 to 34.5% increase) and AOA via DPPH and ABTS. Lactobacillus fermentation has proven to be an effective processing technique to enhance the nutritional value of lucerne and red clover seeds. These findings support the potential of using fermentation to develop novel and sustainable protein sources, contributing to improved dietary quality and nutrition. Moreover, further work to study the effect of fermentation on the nutrient digestibility of lucerne and red clover seeds is warranted.
New Zealand and Australian governments rely heavily on voluntary industry initiatives to improve population nutrition, such as voluntary front-of-pack nutrition labelling (Health Star Rating [HSR]), industry-led food advertising standards, and optional food reformulation programmes. Research in both countries has shown that food companies vary considerably in their policies and practices on nutrition(1). We aimed to determine if a tailored nutrition support programme for food companies improved their nutrition policies and practices compared with control companies who were not offered the programme. REFORM was a 24-month, two-country, cluster-randomised controlled trial. 132 major packaged food/drink manufacturers (n=96) and fast-food companies (n=36) were randomly assigned (2:1 ratio) to receive a 12-month tailored support programme or to the control group (no intervention). The intervention group was offered a programme designed and delivered by public health academics comprising regular meetings, tailored company reports, and recommendations and resources to improve product composition (e.g., reducing nutrients of concern through reformulation), nutrition labelling (e.g., adoption of HSR labels), marketing to children (reducing the exposure of children to unhealthy products and brands) and improved nutrition policy and corporate sustainability reporting. The primary outcome was the nutrient profile (measured using HSR) of company food and drink products at 24 months. Secondary outcomes were the nutrient content (energy, sodium, total sugar, and saturated fat) of company products, display of HSR labels on packaged products, company nutrition-related policies and commitments, and engagement with the intervention. Eighty-eight eligible intervention companies (9,235 products at baseline) were invited to participate, of whom 21 accepted and were enrolled in the REFORM programme (delivered between September 2021 and December 2022). Forty-four companies (3,551 products at baseline) were randomised to the control arm. At 24 months, the model-adjusted mean HSR of intervention company products was 2.58 compared to 2.68 for control companies, with no significant difference between groups (mean difference -0.10, 95% CI -0.40 to 0.21, p-value 0.53). A per protocol analysis of intervention companies who enrolled in the programme compared to control companies with no major protocol violation also found no significant difference (2.93 vs 2.64, mean difference 0.29, 95% CI -0.13 to 0.72, p-value 0.18). We found no significant differences between the intervention and control groups in any secondary outcome, except in total sugar (g/100g) where the sugar content of intervention company products was higher than that of control companies (12.32 vs 6.98, mean difference 5.34, 95% CI 1.73 to 8.96, p-value 0.004). The per-protocol analysis for sugar did not show a significant difference (10.47 vs 7.44, mean difference 3.03, 95% CI -0.48 to 6.53, p-value 0.09).In conclusion, a 12-month tailored nutrition support for food companies did not improve the nutrient profile of company products.
Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was MetSSS after 12 weeks. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 2.1), p<0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (-1.9 kg (-2.0 to -0.34)), p=0.006 and wellbeing, assessed by the SF-36 quality of life questionnaire, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.