Non-Communicable Diseases (NCDs) constitute the most notable single killer of the population of Pacific Small Island Developing States (SIDS). It is therefore not surprising that the leaders of Pacific SIDS recognize NCDs as a crisis(1). But just as it is in many parts of the world, addressing NCDs in the Pacific is a complex challenge for many reasons. For example, and in the midst of recurrent climate change disasters, it would be fair to wonder if Pacific SIDs and development stakeholders – and academia included - have not become overwhelmed in obtaining more clarity about the main causes of NCDs, and tackling them with the relevant prioritization, policy environments that address economic and market forces, coordinated interventions, good examples from leaders, actions driven leadership, not blaming the victims, and a lot more. Maybe it is too uncritical and simplistic to continue to make the historical argument that the population of Pacific SIDS are obese, overweight, suffer from micronutrient deficiencies, stunting, and so forth because they choose poor diets and physical inactivity, or simply because all of this is cultural.

The foregoing context demands more criticality and contributes to the rise of several philosopher kings who so easily describe NCDs as a disease that requires a health approach in absolutism. But if we were to invest more into obtaining deeper insights about the causes of NCDs in the Pacific, there could be a possibility for stakeholders to increasingly advocate for a systems approach to addressing NCDs in the Pacific. A systems approach would for example, recognize that as economic development receives more investments, people will conversely reduce walking in favor of vehicle transportation, children will spend less time playing outside in favor of watching television, more highly processed food of high salt, sugar and fat contents will be marketed and affordable than locally grown food, people will work in the service sector to the detriment of traditional gardening. A systems approach would account for a combination of biomedical, food systems, educational, religious, socio-cultural, recreational, etc… approaches.

As one of the development stakeholders, the Food And Agriculture Organization of the United Nations (FAO) joins efforts with others to address NCDs in the Pacific(2). The entry point for FAO is through promoting the production and consumption fresh, safe, nutritious and healthy foods. My intervention at the 2023 Joint Conference of the Nutrition Societies of New Zealand will provide insights into FAO’s work from this vantage point.

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.

Cerebral palsy (CP), or to use the Te Reo term “Hōkai Nukurangi”, is an umbrella name for a group of permanent neurodevelopmental disorders, affecting movement and posture(1), and is the most common childhood onset physical disability globally. The available literature on the nutritional status of children with CP describes high rates of malnutrition, however data appears to be skewed towards children of higher levels of impairment impacting functional independence. Less is known about the nutritional status of children with lower levels of impairment. The aim of the “Eat, Sleep, Play-CP” study was to evaluate total energy intake, total protein intake and the timing of protein intake in relation to physical activity for children with CP across all functional levels living in Aotearoa New Zealand. Children with CP aged 5-12 years were invited to participate in an observational assessment of dietary intake using parent reported 24-hour dietary recall (Intake 24) on three non-consecutive days, accompanied by a questionnaire capturing self-reported sleep and physical activity patterns. Body composition was assessed via whole body dual energy X-ray absorptiometry scan. Nine participants (6 males, median age: 10 years, n = 2 Māori), across Gross Motor Function Classification System levels I-IV, and Eating and Drinking Classification System levels I-III took part in the study. The median total energy intake was 7267kJ/d (range 5355-10731.96kJ/d), and median protein intake was 67g/d (range 49-111g/d). According to the Nutrient Reference Values for Australia and New Zealand (NRV)(2), 3 of the 9 participants (33%) were within the recommended range for energy intake according to their age and reported physical activity levels. Of the other 6, 4 were below and 2 were above the recommended ranges. All 9 met the recommended protein intake (NRV). Participants had a median percentage body fat of 40% (range 20-46%), and non-fat mass of 58% (range 52-76%). Five participants fell within the overweight or obese range for their age and sex, three of whom were within the recommended range of total energy daily intake according to NRVs. This outcome may indicate that for some children with CP, recommendations could be over-estimating the actual requirements. These early results may bring in to question current practice around guidance for energy intake requirements for children with CP and their whānau to support healthy body composition. Further investigations are needed to establish whether specific energy intake guidelines are required for children with CP.

Childhood obesity and overweight rates in New Zealand are considerably higher than that globally with one in three children aged between 2-14 years being overweight or obese(1). Children’s dietary knowledge and food preferences are influenced by various factors including the food environment. Schools are an excellent setting to influence children’s dietary behaviours since they have the potential to reach almost all children during the first two decades of their lives. However, previous analyses indicate many school canteens and food providers do not supply foods that promote healthy eating and nutrition behaviours (2,3). The Ministry of Health (MoH) recently implemented a ‘Food and Drink Guidance for Schools’ which utilises a traffic-light framework dividing foods into three categories: ‘green’, ‘amber’, and ‘red’(4). The aim of this study was to assess primary school canteen food menus against the newly implemented MoH Guidance. A convenience sample of 133 primary school canteen menus were collected in 2020 as part of the baseline evaluation of the Healthy Active Learning initiative across New Zealand. Four researchers (three nutritionists and one dietitian) developed a menu analysis toolkit to undertake the analysis of all menus collected. The toolkit provided a breakdown of commonly packaged foods and meals/menu items available to purchase within schools based on Health Star Ratings, ingredients, and/or standard recipes. Assumptions were created for menu items requiring additional detail to be categorised according to the guidance through consensus by all four researchers. Primary school menus were coded by two researchers, and intercoder reliability was ensured by independent coding and cross-checking of 10% of menus. Descriptive and inferential analyses were conducted using IBM SPSS and P<0.05 denoted significance. Analyses of canteen menus revealed that most menu items belonged to the less healthy amber (41.0%) and red (40%) food categories. Low decile schools had a lower percentage of green food items (8.6%) and a higher percentage of red food items (48.3%) compared to high decile schools (p = 0.028). Similarly, schools in low deprivation areas had a significantly higher percentage of green food items (14.2%) compared to high deprivation areas (8.6%) (p = 0.031). Sandwiches, filled rolls, and wraps were the most commonly available items (86%) followed by baked foods and foods with pastry (71%). Sugar-sweetened beverages were just as prevalent as water on school food menus (54% each). Over half of in-house catered canteen menu items were classified as 'red’ foods (55.3%). This study highlights that most school canteens were not meeting the guidelines for healthy food and drink provision outlined by the MoH. Improving school food availability for children in socioeconomically deprived areas needs to be prioritised to reduce inequities. Findings suggest the need for more robust national policies and mandated school guidance to improve the food environments in New Zealand schools.

Centenarians represent a phenomenon of successful aging, yet little is known about their lifestyle and health practices, including diet/nutrition, medication use, and health conditions. A protocol for this systematic review was registered previously(1). We systematically searched Medline, CINAHL, Scopus, and grey literature from 2000 to 2022, limited to quantitative studies published in English among adults aged 95 years or above. Two reviewers independently screened 3,392 records and identified and extracted data from 34 eligible studies. Additionally, they independently assessed the study quality using the Modified Newcastle-Ottawa Scale (mNOS)(2). Any disagreement was discussed and resolved with a third reviewer. In analysis, pooled prevalence was provided for categorical variables on demographics, lifestyles, medications, and diseases using % (95%CI); mean or median was provided for continuous variables. Due to study heterogeneity, we conducted a narrative synthesis for the associations between the exposures and outcomes. Over 70% of the included studies met 6/8 criteria based on the mNOS; nearly half did not mention or control for confounders in statistical analyses. The age ranged from 95-118y (32 studies: 100y+; 2 studies: mean age 97-98 y); the majority were females (75%; 95%CI: 71%,78%). Most centenarians did not smoke or drink [current smokers: 7% (5%, 9%); former smokers:16% (12%, 19%); daily drinkers: 27% (20%, 34%); former drinkers:21% (13%, 30%)]. Most centenarians were physically inactive (23%; 20%, 26%). Over 50% had normal weight (52%; 42%, 61%), 33% (14%, 52%) underweight, and 14% (8%, 20%) overweight. Regarding nutrition, the narrative synthesis suggests that centenarians had normal levels of albumin (3.8g/dL), total triglycerides (111mg/dL), total (188mg/dL), and HDL cholesterol (54mg/dL) but high levels of LDL cholesterol (109mg/dL). Regarding medications, nearly 50% took antihypertensive medications (49%; 14%, 84%) or other cardiovascular drugs (48%; 24%, 71%); they took a median of 5 (range: 2-7) drugs. Common conditions included impairment of basic activities of daily living (ADL) (54%; 33%, 74%), hypertension (43%; 21%, 65%), and diabetes (22%; 9%, 52%). In regression analyses among centenarians, high dietary diversity, lower salt preference, and weight status were significant factors for more independence in basic ADL, lower mortality, and greater longevity. For example, a high dietary diversity score was associated with a low mortality risk [0.93 (0.92, 0.94) per unit increase]; those who preferred salty food versus those who did not had a 3.6-fold risk of impaired ADL [adj.OR: 3.59 (1.14, 11.25)]. Being overweight vs. normal weight reduced the risk of ADL impairment [adj.OR: 0.84 (0.78, 0.91] while underweight increased this risk [adj.OR:1.34 (1.28, 1.41)]. Also, overweight [adj.OR: 0.92 (0.90, 0.94)] or abdominal obesity [adj.OR: 0.72 (0.52, 0.996)] reduced the likelihood of longevity per kg increase. This systematic review suggests a healthy lifestyle, good nutrition, and normal body weight may contribute to extreme longevity. Interpreting these summary findings should be cautious due to potential recall bias and heterogeneity of the included studies.

Aging is associated with increasing oxidative stress and declining antioxidant defences, making the body susceptible to various chronic conditions. Cruciferous vegetables contain glucoraphanin, which is metabolised into sulforaphane (SFN) in the gut(1). SFN activates a mechanism enhancing antioxidant defences that may contribute to a reduction in risk of age-related chronic diseases. Our hypothesis proposes that consuming cruciferous vegetables releases hepatic extracellular vesicles (EVs), which carry with a cargo of antioxidant proteins, into the systemic circulation(2) that are transported to ‘at risk’ tissues. We seek to characterise the antioxidant protein content of EVs from blood samples of healthy human volunteers from a prospective dietary intervention study trial called (GLOBE). The GLOBE study employs a randomised, single-blind, two-arm crossover design and involves 12 healthy male or female adults aged >55 years, at the time of enrolment, have a BMI in the range of 18.5-30 kg/m2, and have self-reported healthy (are not suffering from current illness like cancer, and gastrointestinal diseases including coeliac, Crohn’s, colitis, and irritable bowel syndrome) and not using any medications like antacids, laxatives and antibiotics which can interfere with normal digestive or metabolic processes. The dietary intervention consists of two commercially available treatments, one of which is a glucoraphanin-rich vegetable soup, while the other vegetable soup lacks glucoraphanin. Our initial focus lies in optimizing and standardizing a method for routinely characterizing EVs derived from healthy volunteers participating in dietary intervention studies. We specifically aim to extract EVs from a minimal plasma volume (2ml) using size exclusion chromatography (SEC). Subsequently, we intend to employ this method to analyse EVs obtained from 161 plasma samples collected from 12 participants during the GLOBE study for different time points like 0, 120, 240, 360, 480 min, 24 and 48 hr. Our goal is to gain insight into the role of EVs as part of the mechanisms by which consuming a moderate quantity of cruciferous vegetables may confer health benefits. Our research carries the potential to establish a standardised approach to the characterisation of EVs from healthy individuals which has several applications in nutrition research.

Malnutrition affects over half the world’s population, manifesting in myriad forms. Nearly 1 in 4 children never reach their full growth potential, while 1 in 2 lack key micronutrients essential for health and development.1 Furthermore, 1 in 3 women suffer from anemia, and 2 in 3 do not get enough vital micronutrients. At the same time, over 2 in 5 adults are overweight or obese, and 1 in 5 live with high blood pressure. These various forms of malnutrition lead to physical and cognitive impairments, increased susceptibility to infections and chronic diseases, and reduced quality and length of life. They also impose immense economic, social, and health burdens. In addition to harming human health, our food system damages the planet, generating greenhouse gas emissions that drive climate change and depleting freshwater reserves. It also causes deforestation and habitat destruction which drive species to extinction. These grave harms to both human and environmental wellbeing demand urgent action. Transforming our food systems is imperative to promote nutritious diets that deliver adequate nutrition and protect against noncommunicable diseases, while simultaneously protecting our planet, its biodiversity, and natural resources. As a response, many call for drastically limiting consumption of animal source foods like meat, eggs, and dairy. They argue that these foods jeopardize both human health and environmental sustainability. However, is it possible to meet the nutritional needs of the global population with few animal source foods? What are the full impacts, both positive and negative, of animal source foods on human health and the environment? In this presentation, I will review the latest scientific evidence surrounding these questions. I will examine whether mindfully produced and consumed animal source foods can be part of the solution. Join me to explore these critical issues concerning sustainable nutrition and the role of animal source foods in our food system transformation.

Food-related infrastructure in primary schools can be used to deliver healthy and sustainable food education from a young age(1), though little is known about the presence and use of such infrastructure in primary schools. The aim of this study is to explore the use of physical infrastructure in healthy and sustainable food education in Australian primary schools. A quantitative cross-sectional online survey of primary school teachers undertaken between August 2022-July 2023 collected data about the presence and teaching-related use of food gardens, cooking facilities and food waste management systems in primary schools. Descriptive statistics were generated using Stata 17.0 statistical software. Participants were 239 teachers recruited via social media advertising and education/nutrition networks. The majority of teachers agreed that primary schools should have a food garden (n = 194, 81%), cooking facilities (n = 196, 82%) and a food waste system (n = 205, 86%) that can be used for teaching. Whilst three quarters of participants stated their school had a food garden (n = 181, 76%), just over half reported their school had cooking facilities (n = 130, 54%) or a food waste system (n = 131, 55%) that could be used for teaching purposes. More than 60% of participants reported they used such infrastructure within their teaching when it was available. Food waste systems were most commonly reported to be used more than once a week (n = 30, 33%) to teach students about food waste (n = 69, 77%), food sustainability (n = 65, 72%) and the environment (n = 63, 60%). Food gardens were most commonly reported to be used once a week (n = 33, 30%) to teach students about gardening skills (n = 97, 87%), the environment (n = 77, 69%), healthy eating (n = 67, 60%) and food sustainability (n = 67, 60%). Cooking facilities were most commonly reported to be used once or twice a term (n = 21, 23%) to teach students about food preparation and cooking (n = 71, 84%) and healthy eating (n = 62, 73%) and for tasting food (n = 55, 64%). From these findings we conclude that primary school teachers consider food gardens, cooking facilities and food waste systems to be important for delivering healthy and sustainable food education. Whilst food gardens appear to be common in Australian primary schools, there is variability in their use as an educational resource. Further variability exists regarding the presence and use of cooking facilities and food waste systems in primary school settings. There is future scope to (1) extend the presence of food-related infrastructure in primary schools; and (2) develop resources and training opportunities for teachers to support their use of such infrastructure in delivering healthy and sustainable food education for primary school students.

Poor menstrual health literacy is a factor that contributes to females not seeking medical help for abnormal menstrual symptoms that may impact their mental, social, and physical health(1). Few studies have focused on testing baseline functional knowledge of the menstrual cycle (MC) outside the context of pregnancy and menopause. The primary objective of this study was to investigate MC knowledge levels of physically active females residing in New Zealand. A secondary objective was to understand where females get their MC information from, what sources they consider to be trustworthy and what information on the MC they would like to know more about. A MC knowledge questionnaire was developed by the research team (n = 3), and reviewed by academics (n = 4), medical experts (n = 4), sporting organisation staff (n = 5), and target population (n = 10) to ensure content validity. Active females (n = 203) between the ages of 16-40 years completed an online questionnaire. The questionnaire included a total of 25 knowledge questions and was split into four categories: menstrual cycle (Q = 9), menstruation (Q = 7), symptoms (Q = 5), and health outcomes (Q = 6). Responses (single and multiple answer multi-choice questions) were analysed using descriptive statistics which were presented as mean, SD and frequency (%). The overall knowledge score was 51.8% (22.8 ± 3.4). The highest knowledge scores were noted for symptoms (80.5%), followed by menstruation (79.8%), and the menstrual cycle (64.2%). Females scored poorly when asked about health outcomes related to the MC (20.4%). 61.5% of participants (n = 123) identified the internet as their main source of MC information. Friends (n = 82, 41%), school sex education (n = 73, 36.5%) and social media (n = 73, 36.5%) were the next most common sources of MC information. The most trustworthy sources of information were doctors/GPs (n = 96, 48%) and healthcare professionals (n = 70, 35%). The most common topics that females wanted to know more about were diet and the MC (n = 115, 57.5%), training and the MC (n = 115, 57.5%), MC tracking (n = 78, 39%), MC and mood (n = 75, 37.5%) and RED-S/LEA/Female athlete triad (n = 71, 35.5%). Overall functional knowledge levels of the MC and associated health outcomes is low in active females. Healthcare professionals and doctors are the most trustworthy sources of information; however, they are not the most common sources of information that females will engage with. Developing online educational resources on the MC, associated health outcomes and lifestyle factors (diet, physical activity) with medical and healthcare professionals may be considered in future female health education.

Fruit and vegetable intakes are major modifiable determinants of risk for non-communicable disease(1), yet intake levels remain low(2) and multiple barriers (cost, access, perishability, preparation skills) exist(3,4). 100% fruit and vegetable juices contain key micronutrients and bioactive compounds (5–7) and may help circumvent these barriers to consumption(6,7). However, their role in dietary guidelines and models of healthy eating remains controversial due to their free sugars and reduced dietary fibre content, relative to whole fruits and vegetables(6,7). Therefore, we conducted a systematic umbrella review of systematic literature reviews (SLRs) with meta-analyses assessing the relationships between 100% juice consumption and human health outcomes. Four databases (Medline, Cochrane Library, EMBASE, and CINAHL) were systematically searched for SLRs with meta-analyses of human prospective cohort, case-control, and intervention studies examining the relationship between 100% juice and any health outcome through to 20th October 2022. Screening (Covidence), quality (GRADE)(8), risk of bias (ROBIS)(9) and content overlap (corrected covered area(10)) tools were applied, and extracted data were narratively synthesised. The protocol was pre-registered (PROSPERO) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists. 15 SLRs on 100% fruit juice including 51 primary meta-analyses, 6 dose-response analyses, and 87 sub-analyses were eligible for inclusion. No eligible studies on vegetable juice were found. Included studies represented data from almost 2 million subjects with a range of doses (50-1200mL/day) and timeframes (hours to years). Significant improvements in health outcomes were found in 19.6% of included meta-analyses (blood pressure, flow-mediated dilation, IL-6, c-reactive protein, and stroke mortality), and increased disease risks were found in 5.9% of included meta-analyses (CVD mortality, prostate cancer, and type II diabetes). The remainder (74.5%) found no significant difference (blood lipids, weight, liver function, metabolic markers, colorectal and breast cancers, and multiple inflammatory markers). The ROBIS quality assessment rated nine SLRs as low risk of bias, three as unclear and three as high. Using GRADE, confidence in the body of evidence ranged from very low (27 primary and 79 secondary meta-analyses) to low (19 primary and 13 secondary meta-analyses), and medium (4 primary and one secondary meta-analyses.) Findings show 100% juice consumption has limited risks of harm and some potential benefits, over a broad range of doses, including some that are relatively high, and time periods. The positive associations between 100% juice consumption and specific health outcomes relevant to population health may be explained by multiple mechanisms, including the vitamin, mineral, and bioactive contents. The balance of evidence suggests that 100% may have a neutral or beneficial place in general, population-level dietary guidelines.

Apples consumption is associated with improved health and reduced risk of cancer which is attributed to its phytochemical content(1). Evidence suggests that apple phytochemicals affect different Hallmarks of cancer and reduce oxidative stress, which is involved in the pathology of cancer(2). The limiting factor to obtain these effects in the human body is apple phytochemicals’ low bioavailability. Our study is focused on a heritage apple cultivar discovered in New Zealand - Monty’s Surprise. Based on our previous liquid chromatography–mass spectrometry (LC-MS) analysis this apple contains high phytochemical (mainly flavonoids) concentrations when compared to some other commercial apple cultivars available in New Zealand. This study aims to evaluate the bioavailability of Monty’s Surprise apple phytochemicals in humans and Monty’s Surprise phytochemicals’ effects on blood total antioxidant capacity and lung, and breast cancer cell proliferation. Twelve healthy participants received either apple puree or a placebo as a control in a randomised crossover human study. Blood samples were collected after overnight fasting and at regular intervals up to eight hours post-meal consumption. The main phytochemical metabolites in the participant’s plasma were evaluated by LC-MS-MS. Plasma total antioxidant capacity was evaluated by Ferric Reducing Antioxidant Power. Based on the results from the metabolomics analysis we then created a synthetic mixture of the Monty’s Surprise apple phytochemical metabolites and evaluated their effects on cell proliferation using SYBR green assay in vitro. We were able to detect twenty-seven different phytochemical metabolites in the participant’s plasma after consumption of Monty’s Surprise apple puree. The main metabolites detected were metabolites of phenolic acids, and phase II metabolites, but also phloretin metabolites. Moreover, Monty’s Surprise apple puree consumption significantly increased (p < 0.001) plasma total antioxidant capacity 30 minutes post-meal intake (from the baseline to 170.76 µmol/L ± 34.58), when compared to the placebo consumption. In addition, Monty’s Surprise apple phytochemical metabolites inhibited lung and breast cancer cell proliferation at different concentrations. Results from this study demonstrated that Monty’s Surprise apple phenolic compounds are absorbed and enter the systemic circulation after apple puree ingestion and their absorption improves plasma antioxidant status. Moreover, Monty’s Surprise apple blood metabolites inhibit lung and breast cancer cell growth in vitro. These findings suggest that incorporating Monty’s Surprise apple into the diet may improve human health and prevent cancer development.

Preconception diet is a proposed modifiable risk factor for infertility(1). However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility. A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evidence gaps, and to provide information for nutritional recommendations for couples planning a pregnancy. In this systematic scoping review, four electronic databases (Medline and EMBASE via Ovid processing, CAB Direct, and CINAHL via EBSCO) were searched for observational studies (prospective and retrospective cohort, cross-sectional, and case–control studies) from inception to 27 September 2021. Eligible studies included women of reproductive age during the preconception period, and evaluated exposures related to preconception diet and outcomes related to fertility. Results were synthesised using a descriptive approach. A total of 36 studies were eligible for inclusion (31 prospective, 3 cross-sectional, and 2 case–control studies) and were published between 2007 and 2022. Of the assessed dietary exposures, increased adherence to the Mediterranean diet displayed the strongest and most consistent association with improved clinical pregnancy rates. Reducing trans fatty acids (TFAs), saturated fatty acids, and discretionary food intake (fast food and sugar-sweetened beverages) were associated with improvements in live birth, clinical pregnancy rates, and related ART outcomes. The dietary components of seafood, dairy, and soy demonstrated inconsistent findings across the few included studies. Due to heterogeneity and the limited available literature on most exposures, there is insufficient evidence to support any specific dietary approach for improving fertility. However, following some of the dietary approaches outlined in this review (anti-inflammatory diets, reducing TFA, and discretionary food intake) are consistent with broad healthy eating guidelines, have little to no associated risk, and offer a plausible set of possible benefits. This warrants further exploration in randomised controlled trials.

Olfaction, the sense of smell, is under recognised and underappreciated despite being vital in wellbeing. It confers a major influence on the feeding process being the major contributor of flavour and has a direct involvement in the cephalic phase responses. Along with its influence on food and nutrition, olfaction is directly associated with cognitive function and impacts social communication and safety(1). Loss of olfactory acuity, commonly occurring in aging and frailty, significantly influences dietary behaviour and food selection(2). Unlike the senses of vision and audition, interventions are lacking. We propose in a proof-of-concept that crossmodal integration of olfaction and audition could inhibit olfactory decline in lifelong musicians through encouraging neuroplasticity of the olfactory brain centres. Ethical approval was obtained from The University of Adelaide Human Research Ethics Committee. Male musicians with a lifetime experience of music (ME) and naïve non-musicians (NM) aged 55 years and over were recruited through music organisations and controls through the Australian Men’s Shed network. The initial target sample size was twenty per cohort. Olfactory acuity was assessed with Sniffin’ sticks® (Odofin, Groningen, The Netherlands), a well validated system of a battery of three tests regimes. Sniffin’ sticks represent ‘felt tipped pens’ impregnated with odourants presented 20mm below the nose of participants who were then prompted to ‘sniff’. Assays determined participant ‘Threshold’, ‘Discrimination’ and ‘Identification’ of test odours (3). Measurement of Threshold and Discrimination were undertaken in triplet fifteen seconds apart with eyes closed; measurement of Threshold being conducted in an ascending ‘staircase’ to detect lowest odour concentration detectable, whereas measurement of Discrimination selected the ‘odd-man-out’ of a triplet comprising two identical and one different odour. Measurement of Identification, with eyes open, selected the odour of a single ‘pen’ from a prompt list of four. All tests demanded selection. Each of the test batteries were scored out of sixteen along with total aggregate of Threshold, Discrimination, and Identification (TDI). Twenty-six participants completed the study (18 ME and 8 NM); numbers were limited owing to active COVID-19. Mean and standard deviations (SD) of Threshold, Discrimination, Identification and TDI were derived and compared between groups using ‘t’-test. For ME, Threshold, Discrimination, and Identification values were 6.2 (SD ± 3.7), 10.6 (SD ± 1.9), and 12.9 (SD ± 1.6). The respective values for NM were 5.0 (SD ± 2.3), 8.8(SD ± 2.9), and 10.8 (SD ± 2.5). The ME group showed a significantly higher Discrimination (p = 0.164). Significant differences were not seen for Threshold, Identification, and overall TDI scores, however the small sample size may have accounted for this. Based on this proof-of-concept, further exploration of music is warranted as an intervention to enhance olfactory acuity to potentially improve the intake of food and nutrition, and enrich pleasure of eating and drinking, and quality of life.

Teacher food and nutrition (FN) related factors include diet quality, health perceptions and FN attitudes. These factors are associated with both personal health and wellbeing, and teacher classroom FN practices. With Australian schoolteachers currently experiencing high levels of stress, anxiety and burnout, measuring and understanding the status of teacher FN-related health and wellbeing is needed. However, first there needs to be a comprehensive and validated tool to collect these data. This study aims to evaluate content validity of a new tool, the Teacher Food and Nutrition Questionnaire (TFNQ), to measure FN-related health and wellbeing of Australian schoolteachers. The TFNQ was developed following an extensive literature review of FN data collection methods previously used in schoolteacher populations internationally. It initially included 16 FN-related constructs alongside six constructs of wellbeing and mental health, and seven lifestyle covariates identified from the literature review. A two-round e-Delphi methodology was implemented using a mix of structured, rank-order and qualitative questions administered to an international, multidisciplinary group of experts via an online survey1. Descriptive statistics were used to derive a consensus vote (set at 75%) of constructs and covariates to be prioritised for inclusion. Qualitative feedback was analysed to identify areas of potential change. Twenty-three experts participated in round-one from Australia (n = 15), Switzerland (n = 3), The United Kingdom (n = 2), Canada (n = 1), The United States of America (n = 1) and New Zealand (n = 1). Of the 29 constructs and covariates evaluated in round-one of the e-Delphi, all achieved above 75% consensus, yet qualitative feedback indicated potential to reduce and streamline the number of constructs. Rank order questions and qualitative feedback resulted in the removal of four FN and two wellbeing constructs along with four lifestyle covariates. Round-two included 19 (83%) experts from round-one, with 83% (n = 15) in agreement regarding question order. Final feedback indicated only minor adjustments to question item phrasing. The e-Delphi process modified the TNFQ and established content validity. Further construct validity and reliability testing is required to produce a robust tool for measuring FN-related health and wellbeing of contemporary Australian schoolteachers.

Circadian clocks play a key role in metabolic homeostasis, and disruption of circadian rhythms is inextricably intertwined with metabolic disorders [1]. Emerging evidence in the literature suggests that polyphenols possess the potential to modulate metabolic processes associated with circadian rhythms. This review aims to evaluate the effects of polyphenols on metabolic homeostasis via circadian rhythms and their potential mechanism(s) of action on circadian rhythmicity of clock components and linked metabolic processes, by critically assessing the literature on mammalian cells in vitro. To ensure that all relevant studies in this area were included, a systematic search protocol was developed by defining the inclusion and exclusion criteria based on the population, intervention, comparator and outcome framework, along with limiting the source of evidence to original research written in English. Three databases (Ovid Medline, Web of Science, and Scopus) were searched with no time constraints. The search identified 5842 studies and, after duplicate removal and initial screening, 48 studies were reviewed in full. Of those, 38 were eligible for inclusion. The included studies were published between 2008-2023, with a notable surge in publications after 2016, which is indicative of the growing attention towards polyphenols and circadian biology. 33 polyphenols were examined for their effects on circadian cellular processes (n = 16 papers), expression of clock genes and/or proteins (n = 26), or circadian rhythm features of clock genes (n = 10). A handful of studies examined the role of polyphenols in regulating disrupted glucose and lipid metabolism through clock components. The findings suggested that the underlying mechanisms were BMAL1-dependent. It must be noted that the effects of the reported polyphenols were elucidated at concentrations exceeding the normal range found in human plasma and target tissues (˃ 10 μM). However, a single study revealed that (−)-epigallocatechin-3-gallate (EGCG) at a physiologically-relevant concentration (10 μM), improved hepatic glucose metabolism [2]. Further, the polyphenols reported in this review exhibited the potential to influence numerous clock components, mainly BMAL1, PER2 and RORα/γ, at mRNA and/or protein levels when administered at physiologically-relevant concentrations. These polyphenols include nobiletin, tangeretin, curcumin, bavachalcone, cinnamic acid, (−)-epigallocatechin-3-gallate, resveratrol and Urolithin A. Polyphenols have the potential to regulate circadian oscillators and associated metabolic processes in various types of cells. However, there is significant methodological heterogeneity among the studies, which makes it difficult to compare outcomes. Thus, this review will help future research in the field of circadian impacts of polyphenols to integrate standardised approaches, in aspects such as utilisation of a synchronisation method and physiologically-relevant concentrations of polyphenols (≤ 10 μM) in cultured cells. This is critical for understanding how polyphenols might modulate circadian-metabolic health in humans.

Mentoring is an established method of promoting networking, professional growth and learning, and career development in many health professions(1). For a non-vocational profession such as nutrition with a diverse scope of practice, the impact of mentoring remains unclear. In 2020, the Nutrition Society of Australia (NSA) developed and implemented a mentoring program for registered nutritionists. The individually matched mentoring facilitates a 12-month relationship between nutritionists who opted-in to the program. This qualitative case study research aimed to understand the conceptualisation and development of the NSA mentoring program and explore the experience from the viewpoints of both mentors and mentees in the program. First, a 60-minute focus group was conducted with the NSA program organising committee to explore the initial conceptualisation, objectives of the program, expected outcomes, and related training provided to mentors and mentees. Then, a 34-item questionnaire was sent to 63 participants from the first three program cohorts to collect their demographic information as well as expectations, perception and experience of the mentoring. Twenty-one questionnaire responses from 10 mentors and 11 mentees were collected. Participants were from a range of nutrition professions across NSW, VIC, QLD, and WA. Ten questionnaire participants (four mentors and six mentees) further participated in in-depth interviews to provide narratives of their experience. Thematic analysis was conducted with employment of theory-building structure within the case study(2). Our findings indicated that despite an explicit discussion of mentoring focus on employability skills, e.g. communication, professionalism, advocacy, etc., many mentees perceived mentoring as a gateway to employment and career pathway development. The perceived benefits of mentoring were highly dependent on matching of mentor/mentee, which was complicated by the diversity of practice within the profession, and unstated expectations of individual mentees. Regardless of the perceived quality of their mentoring experience, participants reported that the NSA mentoring program added value to the society’s membership and were supportive of program continuity. In conclusion, the NSA mentoring program was a value-adding strategy to the society membership and it could play an important role in career pathway support into the diverse areas of practice in the nutrition profession. More explicit discussion of expectations between mentors and mentees at the beginning of mentoring could enhance the mentoring experience.

Monitoring indicators of children`s diet quality at the national level is imperative to examine if a country is on track to achieving children`s global nutrition targets and fulfilling the related Sustainable Development Goals. Despite the importance of diet quality in early life and its impact in health and wellbeing throughout the life course, Aotearoa New Zealand has limited information that is nationally representative or generalizable on children`s diet quality, especially among children under 5 years old. The only national child nutrition survey conducted to date took place two decades ago and involved children 5 years of age and older. We have previously used data collected by the Growing in Up in New Zealand cohort study, which is nationally generalizable, to partially fill historic gaps in knowledge of children`s diet and feeding practices in the first five years of life. Information on breastfeeding initiation, duration and exclusivity, timing of food introduction and whole-of-diet adherence to National Food and Nutrition Guidelines have been previously published 1–3. This work intends to complement information on NZ children`s diet quality by examining the cohort`s dietary patterns (DPs) at 9- (n = 6,259), 24- (n = 6,292), and 54-months (n = 6,131) and their maternal sociodemographic and health behaviour determinants. At all time-points, children`s DPs were identified using principal components analyses. Multivariate linear regressions were performed to examine the associations between each DP and the maternal variables. At 9-, 24- and 54-months two distinct DPs were identified, explaining, 36.4%, 35.3% and 33.6% of children`s intake variability, respectively. The Refined high in sugar and salt DP, at all time-points, was characterised by high positive loadings in white/refined breads and cereals and items with high content of sugar, sodium, and fat. At 24-months, the Refined high in sugar and salt DP also had high positive loading in the protein group. The Fruit/Vegetables DP, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). The Fruit/Vegetables DP had high loading in whole grain options of breads and cereals at 24-months and positive loading in the protein group at 9- and 54-months. High scores on the Refined high in sugar and salt DP at the three time-points were associated with maternal smoking habits, maternal education level, ethnicity, and maternal scores in the “Junk” and “Traditional/White bread” DPs (obtained at the antenatal maternal interview). High children’s scores on the Fruit/Vegetables DP, at all time-points, were associated with the maternal antenatal score in the “Health Conscious” DP. Findings support that policies and interventions aiming to improve early life diets in NZ should be culturally safe and support mothers’ access to formal education, healthy diets, and smoking cessation.

A growing body of research has identified interactions between microorganisms and nutrients within the gut, collectively referred to as the ‘gut microbiome’(1). Alongside this, distinct structural characteristics/components of dietary fibre have been recognised to exhibit various physiological effects on the body(1). These inherent physiological properties have the potential to result in diverse health benefits through the consumption of resistant starch, a specific form of dietary fibre(2). It is important to note that the laboratory-based techniques employed to assess resistant starch content from current Australian dietary composition data are antiquated and have not been conducted using updated testing methods(3). Results from updated testing methods may contribute to and inform nutritional recommendations to support and improve health outcomes. To assess the resistant starch content of starch-containing Australian foods using the updated Association of Analytical Chemists (AOAC) 2002.02 testing methods approved by Food Standards Australia New Zealand(3). Standardised kits (K-RSTAR) and control flours were used for assaying. Forty commonly consumed and available Australian foods were tested in duplicate for their resistant starch content. Calculated resistant starch values (in grams) were recorded using calculation tools provided by Megazyme. Means, standard deviations, and coefficient of variations between duplicate samples were recorded in a Microsoft Excel spreadsheet. The resistant starch content of foods varied from 0-13.72g/100g for rice crackers, beetroot, and hi-maize pancakes, respectively. Foods with the highest resistant starch were hi-maize flour pancakes, red kidney beans, Lebanese bread, and Cornflakes cereal, which ranged from 2.30-13.72g/100g. The lowest resistant starch foods included beetroot, rice crackers, All Bran cereal, and Nutri-grain cereal, ranging from 0-0.04g/100g. Changes in the foods’ natural chemical, physical, and enzymatic qualities may have led to slight batch variations and deviations from the literature available. This study is the first known Australian study to investigate the resistant starch content of selected Australian foods using the AOAC 2002.02 assay method. This data can be used to assess resistant starch consumption in the Australian population, inform gut microbiome research, and guide clinical practice recommendations for fibre intake.

Food environments around secondary schools are a strong influence on adolescents’ food purchasing habits1. We conducted a repeat cross-sectional study using Google Street View to examine school food environments in regional and metropolitan NSW, Australia over 17-years. Findings showed that unhealthful food outlets such as fast-food franchises, consistently dominated school food environments over 2007-2023. Increasing levels of poor nutrition among youth has been raised as a concern2 by the Health Advisory Panel for Youth at the University of Sydney [HAPYUS] - an established group of 16 adolescents aged 13-18 years residing in NSW3. To gain further insight into the study findings and how it may impact adolescents’ health, it is critical to include voices of adolescents in this research. The aim of this sub-study was to engage with members of our youth advisory group and conduct a consultation exercise on these study findings, drawing upon their lived experiences of school food environments. In Aug-2023, we engaged four youth advisors from HAPYUS. Study authors provided an overview of the study and its findings to the youth advisors via a Zoom call. Youth advisors formulated a 500-word statement on their perspectives and lived experiences of food environments surrounding their high schools over the subsequent 4 weeks. Adolescents agreed that physical proximity to unhealthy food outlets around schools was a key contributor to unhealthy eating habits however also recognised social and economic factors which play a significant role in shaping poor diets. The following quotes from their combined statement reflect social and economic concerns: i) “[We] observed on a daily basis young people were opting to travel to the closest food court for fast food, or in some extreme cases, even order fast food via a meal delivery app, to be delivered to the school - as opposed to choosing the closest outlet” ii) “Overpriced foods in schools with some drinks costing 2x more than a heavily discounted KFC meal, no meaningful difference between foods sold at canteens and those sold at fast food outlets - heavily processed, packaged snacks, pre-made reheated foods” iii) “Most unhealthy food outlets choose a location that is not only close to schools but also close to major shopping centres and food courts… ideal for an after-school social catchup as it appears to accommodate the needs of a large group of people.” Consultation findings revealed the importance of social and economic factors that must be analysed in addition to adolescents’ physical proximity to food outlets around their schools. Youth advisors call for governments to take immediate action to implement policies that ensure schools have cheap and healthy foods at canteens to mitigate against the purchase of foods from nearby unhealthy food outlets.

Home enteral nutrition (HEN) is a long-term, life-sustaining nutrition therapy for patients unable to consume sufficient food orally. Patients rely on a prescribed, manufactured product to provide their full nutrient requirements, although some patients may have supplementary oral intake. Prescribed enteral nutrition is used as a treatment for malnutrition, but may, in the long-term, cause poor nutrition status. This study aimed to investigate the nutrition status (energy, protein, vitamin D, and selenium) and malnutrition incidence in long-term HEN patients in the Counties Manukau region. In this cross-sectional study, 42 adults on HEN for 4+ weeks under the care of Te Whatu Ora Health New Zealand were analysed. Participants’ enteral and oral feeding regimes were tracked using patient records and five non-consecutive 24-hour recalls. Biochemical markers, body mass index (BMI), body composition (BIA), and nutrition focussed physical findings were evaluated using reference standards and the Global Leadership Initiative on Malnutrition (GLIM) malnutrition criteria(1). Independent t-tests and Mann-Whitney tests compared participants based on their enteral and supplementary oral intakes and adherence to their enteral prescription. Dependent t-tests and Wilcoxon tests evaluated nutrients contributions from various feeding methods and sources. Over half (54.7%, n = 23) relied exclusively on enteral nutrition, but 60% did not achieve their full energy prescription. Compared to requirements based on the Oxford equation and 1g/kg of body weight, energy and protein intake was low in 20% of all participants, mean intake of these participants was 1,242 ± 183 kcal and 57.5 ± 13.5 g respectively. Participants with full enteral intake had a significantly higher vitamin D intake (14.9 µg, P<0.05) than those with supplementary oral intake (11.2 µg, P<0.05). However, those with oral intake had significantly higher intake of selenium, energy, and all the macronutrients than those with sole enteral intake. Vitamin D and selenium intakes were significantly greater in participants obtaining their full prescription than those that did not. No participants had low vitamin D or selenium blood concentrations, however 40% and 38.1% respectively were high. There was a significant relationship between meeting their energy prescription and high plasma selenium. Low BMI, mid arm muscle circumference, and fat free mass index were observed in 47.5%, 40.5%, and 44.8% of participants respectively. This was not statistically significant between groups. Fat mass and waist circumference were significantly higher in participants on full enteral nutrition. According to the GLIM malnutrition criteria, 62.5% (n = 25) of all participants were malnourished. In conclusion, while HEN patients maintain good vitamin D and selenium status, energy and protein malnutrition are evident. The types of food consumed by those with oral intake may be responsible for the differences in nutritional status. Further attention to prescription adherence and nutritional balance from HEN and oral intake is necessary for this vulnerable group.