Flavonoids, found in plant foods, are becoming increasingly recognised for their health benefits(1). A valid, reliable and short dietary assessment tool is necessary to assess flavonoid intake, as current methods are burdensome for researchers and participants. This study aimed to evaluate the validity and reproducibility of a flavonoid food frequency questionnaire (Flav-Q), which was derived from the Kent & Charlton Flavonoid Food Frequency Questionnaire (FFQ)(2). The Flav-Q contains 23 items and was validated against repeated 24-hour dietary recalls in an Australian adult population (18y+). The Flav-Q was administered at four time-points over 12 months period (n = 80). At each time-point, two 24-hour dietary recall surveys were completed using Intake-24(3). Usual flavonoid intake was assessed by cross-referencing food lists with the Phenol-Explorer database and averaged using the multiple source method (MSM) for participants who had at least 4 recalls. The criterion validity of the Flav-Q at baseline was compared against the usual intake using the Wilcoxon signed-rank test, Spearman’s correlation coefficient, Bland-Altman plots, and Cohen’s kappa (κ)(4). The reproducibility of the baseline Flav-Q (Flav_Q1) was compared with time points 2, 3, and 4. Mean total flavonoid intake was higher for Flav-Q1 compared to usual intake (443.2 mg/day vs 234.4 mg/day, p < 0.001) and overestimated subclass intake except for flavanones. Moderate to strong correlations were found between Flav-Q1 and usual intake for total flavonoids (r = 0.66, p < 0.001; κ = 0.45, p < 0.001) and subclasses flavan-3-ols (r = 0.72, p < 0.001; κ = 0.53; p < 0.001)), flavonols (r = 0.55, p < 0.001; κ = 0.40, p < 0.001), flavanones (r = 0.49, p < 0.001; κ = 0.30, p = 0.007), and a weaker non-significant correlation for anthocyanin (r = 0.38, p < 0.001; κ = 0.15, p = 0.18) and flavones (r = 0.34, p < 0.001; κ = 20, p = 0.07). Bland-Altman plots showed a large bias and wide limits of agreement (61.64%) for total flavonoid intake. Flav-Q demonstrated high reproducibility across all timepoints (Flav-Q1 vs Flav-Q2 r = 0.82, p < 0.001; κ = 0.70, p < 0.001), Flav-Q1 vs Flav-Q3 (r = 0.68, p < 0.001; κ = 0.47, p < 0.001), Flav-Q1 vs Flav-Q4 (r = 0.63, p < 0.001; κ = 0.47, p < 0.001). Mean percentage differences between repeated timepoints for total flavonoid ranged from 19% to 31%, with Bland-Altman plots showing good levels of agreement. Overall, the Flav-Q tool was reproducible and demonstrated some agreement for assessing the intake of total flavonoid and its subclasses. However, further validation to determine reasons for over-estimation is necessary.

Food insecurity has been associated with poorer dietary quality in Australian adults(1). Understanding the relationship between food insecurity and healthy lifestyle behaviours is crucial for developing effective personalised nutrition interventions. This study aimed to investigate differences in healthy lifestyle and food choice behaviours like food shopping, food preparation skills, and nutrition knowledge between food-secure and insecure adults. An online, cross-sectional survey using a convenience sample of Australian adults measured food insecurity using a single-item food insecurity screening tool(2). Healthy lifestyle and food choice behaviours were measured through the validated psycho-behavioural living and eating for health segments (LEHS) survey(3). Differences in survey responses between food-secure and food-insecure respondents were explored using Chi-square tests and t-tests. Among respondents (n = 148; 68% female; 92% tertiary educated; mean age 34.4 ± 10.9 years), 22% were classified as food insecure. According to the LEHS, food-secure participants are predominantly ‘Balanced All Rounders’ (n = 39; 33.6%) who try to live a balanced lifestyle and ‘Health Conscious’ (n = 36; 31.0%), who prioritise healthy eating. Food-insecure participants had a higher percentage identifying as ‘Lifestyle Mavens’ (n = 6; 18.8%) compared to the food-secure group (n = 4; 3.4%); who are passionate about healthy eating and use social media to follow active lifestyles. Both groups have similar proportions of ‘Aspirational Healthy Eaters’ (n = 32; 27.6% food-secure vs n = 8; 25.0% food insecure), who aspire to eat healthily but find it challenging, and ‘Contemplating Another Day’ (food insecure group n = 2; 6.3% compared to the food-secure group n = 5; 4.3%); who acknowledge the importance of healthy eating but do not prioritise it. Between group differences are statistically significant (p = 0.042). Regardless of food insecurity status, most respondents considered themselves highly skilled at various aspects of food preparation, food shopping and nutrition knowledge. A higher proportion of food-insecure individuals reported that people sought them out for healthy eating advice (43% vs 29%; p = 0.026). On average, food-insecure respondents reported being more knowledgeable about food budgeting (mean score difference on 5-point Likert scale = 0.5; p = 0.048) and buying cheaper cuts of meat to save money (mean score difference = 0.7; p < 0.001). However, food-insecure respondents reported being less able to keep basic pantry ingredients stocked for meal preparation (mean score difference = −0.6; p < 0.001). Unlike other Australian research(4), food insecurity in this convenience sample of Australian adults does not appear to be associated with a lack of food skills, and food-insecure people may be more health conscious, and better at food budgeting despite more limited resources. The LEHS survey may offer a valuable framework for tailoring personalised nutrition interventions in a manner that respects and supports the dignity of food-insecure individuals.

The role of flavonoids on cognitive performance in older adults has been intensively studied, with the subclass of anthocyanins showing promising outcomes(1). However, there is conflicting evidence in the case of individuals at high risk of developing dementia, namely those with mild cognitive impairment (MCI). A recent study has suggested that cognitive scores in people with MCI were higher in those who had higher anthocyanin intake (>10 mg)(2). Baseline data from 65 participants of an ongoing clinical trial that had an MIS (Memory Index Score) score ≤ 13 with self-reported subjective memory complaints, (mean age 69.1y ± 6.2) were used to investigate the relationship between dietary anthocyanin intake and indices of mood and cognitive performance. Repeated 24-hour dietary intake was recorded through Intake24 (a computer-based program) for three days (2Xweekday and 1Xweekend day) and anthocyanin intake was quantified using the PhenolExplorer food composition database. The primary outcome of interest was the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall (FCSRT+IR) (assesses auditory anterograde memory functioning), while other cognitive functions assessed included: Spot the Word-2 (assessing premorbid estimate); Oral Symbol Digit Test (speed of processing); List Sorting (working memory); Trail Making Test A & B (speed of processing/executive function); and Verbal Fluency (language/semantic memory). Subjective memory complaints were assessed using the Memory Assessment Clinic-Q (MAC-Q) and mood was assessed using the Geriatric Depression Scale (GDS). Independent t-tests were used to compare differences in cognitive tasks and mood scores between high (>10 mg/d) and low consumers of anthocyanins (<10 mg/d). There was a trend for high anthocyanin consumers (n = 35, median = 44.87 (10.01, 177.83)) to score better on FCSRT-Delayed Free Recall scores (16.57 ± 3.74) compared to lower consumers (n = 30, median = 0.01 (0, 9.51)), (15.97 ± 0.18) with a mean difference (SE) of −1.06 (0.58) (p = 0.06) suggesting recall of 1.06 more words after a 20-30 minute delay. Higher consumers had a lower GDS score (1.77 ± 3.73) compared to lower consumers (3.73 ± 1.77), p = 0.01. Spot the word test scores (assesses premorbid verbal abilities using a robust lexical decision task) were higher for high anthocyanin consumers (53.06 ± 4.38) compared to lower consumers (50.40 ± 4.38), mean difference (SE) = −2.66 (1.10), p = 0.01, meaning participants with higher intake of dietary anthocyanin were able to point at 2.7 more real words than low consumers. Dietary consumption of anthocyanin in older adults with MIS is associated with beneficial effects on depressive scores and the ability to retrieve words. Further research is warranted to identify optimal dosage for recommended intake. This cross-sectional study used baseline data from a randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ANZCTR):12622000065796.