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Background To inform the interpretation of dietary data in the context of sex differences in diet–disease relations, it is important to understand whether there are any sex differences in accuracy of dietary reporting. Objective To quantify sex differences in self-reported total energy intake (TEI) compared with a reference measure of total energy expenditure (TEE). Methods Six electronic databases were systematically searched for published original research articles between 1980 and April 2020. Studies were included if they were conducted in adult populations with measures for both females and males of self-reported TEI and TEE from doubly labeled water (DLW). Studies were screened and quality assessed independently by 2 authors. Random-effects meta-analyses were conducted to pool the mean differences between TEI and TEE for, and between, females and males, by method of dietary assessment. Results From 1313 identified studies, 31 met the inclusion criteria. The studies collectively included information on 4518 individuals (54% females). Dietary assessment methods included 24-h recalls (n  = 12, 2 with supplemental photos of food items consumed), estimated food records (EFRs; n  = 11), FFQs (n  = 10), weighed food records (WFRs, n  = 5), and diet histories (n  = 2). Meta-analyses identified underestimation of TEI by females and males, ranging from −1318 kJ/d (95% CI: −1967, −669) for FFQ to −2650 kJ/d (95% CI: −3492, −1807) for 24-h recalls for females, and from −1764 kJ/d (95% CI: −2285, −1242) for FFQ to −3438 kJ/d (95% CI: −5382, −1494) for WFR for males. There was no difference in the level of underestimation by sex, except when using EFR, for which males underestimated energy intake more than females (by 590 kJ/d, 95% CI: 35, 1,146). Conclusion Substantial underestimation of TEI across a range of dietary assessment methods was identified, similar by sex. These underestimations should be considered when assessing TEI and interpreting diet–disease relations. [ABSTRACT FROM AUTHOR]

Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55–85 years. A prospective cohort study of adults in Newcastle, New South Wales, Australia. Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Higher step count (HR: 0.93, 95%CI: 0.88–0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74–0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78–1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures. [ABSTRACT FROM AUTHOR]

Intermittent energy restriction (IER) has shown early success in adolescents with obesity, however efficacy trials are needed. This study aims to determine if IER results in lower body mass index (BMI) z-score after 52 weeks in metabolically unhealthy adolescents with obesity compared with continuous energy restriction (CER). This is a prospective, randomised, multi-centre trial conducted in tertiary care settings, with three phases: jumpstart (weeks 0–4); intensive intervention (weeks 5–16); continued intervention and/or maintenance (weeks 17–52). During the jumpstart phase, all participants follow a very low energy diet (∼800 kcal/3350 kJ/day), then transition to their allocated intervention: IER or CER. IER involves three energy-restricted days/week, consuming one-third of daily energy requirements (∼600−700 kcal/2500−2950 kJ/day), and four days/week of a healthy meal plan. The CER, which is current standard care, has individually tailored energy prescription based on age and sex (13–14 years, 1430−1670 kcal/6000−7000 kJ/day; 15–17 years, 1670−1900 kcal/7000−8000 kJ/day). The study will recruit 186 (93 per arm) treatment-seeking adolescents aged 13–17 years with obesity and at least one metabolic co-morbidity. The primary outcome is change in BMI z-score at 52 weeks. Secondary outcomes are changes at 4, 16 and 52 weeks in: body composition; diet quality, food choices and food patterns; cardio-metabolic risk factors; physical activity and sedentary behaviour; sleep and psycho-behavioural measures. This study challenges existing clinical paradigms that CER is the only method for weight management in metabolically unhealthy adolescents. If successful, IER may offer an alternate medical nutrition therapy approach for those seeking treatment in tertiary settings. ACTRN12617001630303. [ABSTRACT FROM AUTHOR]

to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression. few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian. [ABSTRACT FROM AUTHOR]

Poor diet is a major public health issue requiring strategies to support improvements. Nutrition knowledge influences eating behaviours, yet few studies have examined relationships with diet quality. The current study aimed to explore relationships between demographic characteristics, nutrition knowledge, and diet quality using the Australian Recommended Food Score (measuring diet variety). Adults 18–60 years completed a 210-item survey including questions on demographics, health, nutrition knowledge, and diet. Statistical analysis used chi-square tests, linear and multiple regression, adjusted for covariates. 480 respondents with a mean (SD) age 39.1 ± 11.6 years (18% male) completed all questions. Overall diet quality scores were high (ARFS 39.5 ± 9 points). Nutrition knowledge (p < 0.001) and BMI (p < 0.001) were positively associated with ARFS. ARFS scores were higher for those with higher nutrition knowledge scores (ARFS 42 ± 8 points) and of lower BMI (ARFS 40 ± 8 points) compared to those with lower knowledge (ARFS 37 ± 11) and higher BMI (ARFS 35 ± 10 points). Those with BMI ≥ 40 kg·m−2 and weight loss surgery reported the lowest diet quality (ARFS 31 ± 10 points). Diet quality was highest among those with high nutrition knowledge and lower BMI. Those with a BMI ≥ 40 kg·m−2, particularly those with past weight loss surgery reported the lowest diet quality, despite comparable levels of nutrition knowledge. It remains unclear which factors explain the variation in diet quality in the weight loss surgery group and this deserves further attention given the growing popularity of weight loss surgery. [ABSTRACT FROM AUTHOR]

Objective to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. Design analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. Setting women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. Participants 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. Measurements and findings measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. Conclusions few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. Implications for practice a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian. [ABSTRACT FROM AUTHOR]

Objective to explore motivations for weight change, weight loss methods used and factors perceived to influence healthy eating and physical activity for weight management following childbirth, and to evaluate differences by socio-demographic, weight status and pregnancy characteristics. Design cross-sectional online survey completed from May to August 2013. Participants Australian women ( n =874, aged 32.8±4.5 years, pre-pregnancy Body Mass Index 25.6±5.7 kg/m 2 ) aged 18–40 years who had given birth in the previous 5 years Measurements women self-reported socio-demographic, weight status and pregnancy characteristics. Those who reported being unhappy at their current weight ranked their most to least important reasons for wanting to change their weight from a list of nine options. Weight control methods used in the previous two years were reported from a list of 12 options. Perceived healthy eating and physical activity factors influencing weight management were assessed across 20 items using a five-point Likert scale. Findings the most prevalent motivators reported for weight change were to improve health (26.1%) and lift mood (20.3%). Three-quarters (75.7%) of women reported having used at least one weight loss method in the previous two years. Time constraints due to family commitments, enjoyment of physical activity and healthy eating, motivation and cost were factors most commonly reported to influence weight management. Body mass index, parity, education, household income and time since last birth were related to motivations for weight change, weight loss methods used and/or factors perceived to influence weight management. Implications for practice weight management support provided by health professionals should consider women's expressed motivators and factors influencing weight management, along with differences in sociodemographic, pregnancy and weight status characteristics, in order to engage women at this life-stage and facilitate adoption of healthy lifestyle behaviours. [ABSTRACT FROM AUTHOR]

Changes in snacking habits in developed countries are a growing cause for concern, since foods and beverages commonly consumed as snacks, tend to be both energy dense and nutrient poor. Adolescents are characterised by frequent snack consumption. Therefore, promoting more healthful snack choices to adolescents is important for optimising nutrient intake and lowering the risk of chronic disease. The ability to evaluate the healthiness of snacks is essential to making healthy choices. Previous research has shown that health claims can influence consumers’ perceptions of food products. However, little is yet known about consumers’ perceptions of how nutritious or healthy specific foods or beverages are. This knowledge is important for planning successful interventions and designing healthy snacks that will also appeal to population groups with a higher dietary risk, including adolescents. The aim was to investigate how adolescents evaluate the healthiness of snacks currently available for consumption in school environments. Seventy-five adolescents participated in a sorting task and evaluated the healthiness of 37 representative snacks. The data were analysed using hierarchical multiple regression and cluster analysis. The sugar ( β = −.51, P < .001), fruit ( β = .49, P < .001), total fat ( β = −.41, P = .002) and nut content ( β = .35, P = .002) were significant predictors of snacks’ perceived healthiness. The findings of this study are important for tailoring future interventions to promote healthy eating and setting priorities for nutrition education. [ABSTRACT FROM AUTHOR]

Background Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia. Aims To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs). Methods Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m2, females 41.3 years, 24.0 kg/m2. Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance. Results Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars). Conclusions Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM. Methods: Participants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes. Results: Of 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p =0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p =0.061). Those diagnosed with GDM in a previous pregnancy (p =0.034) and younger women (p =0.054) were less likely to view the diagnosis as an opportunity to improve their health. Conclusions: This study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction. [Copyright &y& Elsevier]

Abstract: Despite short-term efficacy, many weight loss studies demonstrate poor long-term results and have difficulty recruiting men. Cost-effective treatments that help men achieve long-term weight loss are required. Using a two-phase, assessor-blinded, parallel-group randomised controlled trial design this study will test the effectiveness and cost-effectiveness of a male-only weight loss maintenance intervention. In Phase I (3months) 209 men received the SHED-IT Weight Loss Program. In Phase II (12months) 92 men who lost 4kg or more were randomised to either (i) a maintenance group who received the 6-month, gender-tailored SHED-IT Weight Loss Maintenance Program, which included no face-to-face contact (n=47), or (ii) a self-help control group (n=45). Randomisation was stratified by weight loss (4kg–7.4kg, ≥7.5kg) and BMI (<30kg/m2, ≥30kg/m2). Assessments occurred at 'study entry' (start of Phase I), 'baseline' (start of Phase II), '6 months' (post-test) and will occur at '12 months' (follow-up; primary endpoint). The primary outcome is weight change in Phase II (i.e. from 'baseline' at 12months after randomization). Secondary outcomes include waist circumference (umbilicus and narrowest), blood pressure, body composition, objectively measured physical activity, sedentary time, portion size, dietary intake, quality of life, depressive symptoms, and behavioural cognitions. Costing data will be collected for cost-effectiveness analysis. Generalised linear mixed models (intention-to-treat) will assess outcomes for treatment (maintenance vs. control), time (baseline, 6-month and 12-month) and the treatment-by-time interaction. This will be the first study to evaluate a male-only, gender-targeted weight loss maintenance program. Results will provide evidence regarding feasible and theoretically-driven obesity treatments for men with potential for long-term impact and widespread dissemination. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12612000749808). [Copyright &y& Elsevier]

Abstract: The ability of parents to accurately report energy intake in toddlers has rarely been validated using the gold-standard doubly labeled water (DLW) method to assess total energy expenditure (TEE). The aim of the study was to evaluate the accuracy of toddler energy intake (EI), estimated using the Australian Child and Adolescent Eating Survey (ACAES) food frequency questionnaire (FFQ) by parent report compared with a weighed food record (WFR) and TEE measured by DLW. Twelve toddlers had TEE assessed over 10 days using DLW. Usual energy intake was estimated by the primary caregiver, using standard toddler portions in ACAES-FFQ and a 4-day WFR and daily EI (in kilocalories) derived using national nutrient databases. Accuracy of reporting was calculated from absolute (EI-TEE) and percentage (EI/TEE×100) differences between EI and TEE and Pearson correlations and limits of agreement from Bland-Altman plots. Toddlers (n=12, 7 boys) had a mean age of 3.2±0.5 years, body mass index 16.2±0.9 kg, body mass index z score 0.1±0.8, EI from ACAES-FFQ 1,183±281kcal/day, and WFR 1,179±278 kcal/day and DLW TEE 1,251±149 kcal/day. The mean difference and limits of agreement (±2 standard deviations) compared with DLW was −68 (−623, 488) kcal/day for the FFQ and for the WFR −72 (−499, 354) kcal/day. Although both a semiquantitative FFQ and WFR can adequately estimate toddler energy intake at the group level in this population, toddler-specific portion size estimates should be assigned to foods listed in the FFQ. Choice of method is likely to depend on practical issues, including cost and burden. [Copyright &y& Elsevier]

Background: The prenatal environment can induce permanent changes in offspring phenotype. Thinness at birth is associated with adult risk of cardiometabolic disease. Objective: The objective was to investigate the association between maternal nutrition during pregnancy and intrauterine development of fetal body composition. Design: We used prospective data from 179 Australian women with singleton pregnancies from the Women and Their Children's Health Study. A validated food-frequency questionnaire was used at 18-24 wk and 36-40 wk of gestation to quantify maternal diet during the previous 3 mo of pregnancy. Fetal body-composition measurements were ascertained from abdominal and midthigh sites by ultrasound performed at 19, 25, 30, and 36 wk. The subcutaneous fat area at each site was calculated by subtracting the lean/visceral area from the total area. Results: In linear mixed-model regressions, maternal intakes of protein (b = -0.13; P = 0.04) and starch (b = 0.10; P = 0.02) and the proteinxarbohydrate ratio (b = -3.61; P = 0.02) were associated with the percentage of abdominal fat, whereas SFA (b = 0.27; P = 0.04) and PUFA (b = -0.48; P = 0.03) were associated with the percentage of midthigh fat. Response surfaces for fetal adiposity were maximized at different macronutrient intakes. Abdominal fat was highest with low protein intakes (<16% of energy), and midthigh fat was highest at intermediate protein (18- 21% of energy), high fat (>40% of energy), and low carbohydrate (<40% of energy) intakes. Conclusion: Fetal body composition may be modifiable via nutritional intervention in the mother and thus may play an important role in influencing the offspring's risk of future disease. [ABSTRACT FROM AUTHOR]

Abstract: Parental dietary intake, lifestyle behavior, and parenting style influence a child''s weight status. Few studies have examined associations between parent–child dietary intake, or specific father–child associations. This cross-sectional study examined associations between father–child dietary intakes of fruit, vegetables, and selected energy-dense nutrient-poor foods. The study population consisted of overweight fathers with 50 father–child dyads included in the analysis; median (interquartile range) age of fathers was 39±8.0 years; body mass index was 32.7±5.3; and their primary school–aged children (n=50) (54% boys aged 8.5±3.0 years, body mass index z score 0.6±1.6) who had been targeted to participate in the Healthy Dads, Healthy Kids pilot trial in the Hunter region, New South Wales, Australia in 2008. Dietary intakes of fathers and children were assessed using validated food frequency questionnaires, with mothers reporting their child''s food intake. Descriptive statistics were reported and Spearman''s rank order correlations used to test the strength of associations between father–child intakes. Fathers'' median (interquartile range) daily fruit and vegetable intakes were 0.9 (1.5) and 2.2 (1.3) servings/day, respectively, whereas children consumed 2.1 (2.4) fruit and 2.9 (2.1) vegetable servings/day. Moderately-strong positive correlations were found between father–child fruit intakes (r=0.40, P<0.01), cookies (r=0.54, P<0.001), and potato chips (r=0.33, P<0.05). There were no associations between intakes of vegetables, ice cream, chocolate, or french fries (P>0.05). Children''s intakes of fruit and some energy-dense nutrient-poor foods but not vegetables were related to their father''s intakes. The targeting of fathers should be tested in experimental studies as a potential strategy to improve child and family eating habits. [Copyright &y& Elsevier]

Purpose: The objective of this investigation was to examine the mechanisms of physical activity and dietary behavior change in the Program X intervention. Methods: Program X involved a clustered randomized controlled design with six schools (N=124 participants, mean age=14.1±0.8 years) randomized to intervention or control conditions for the 6-month study period. Physical activity and fruit and vegetable consumption were assessed using pedometers and questionnaires, respectively. The theoretical framework of the intervention was assessed using structural equation modeling, mediation, and moderation analyses. Results: The model explained 56% of the variance in physical activity at 6-months, but did not represent a good fit to the data, χ2 =87.43, df =19, p < .001. The model explaining fruit and vegetable consumption explained 31% of the variance and provided a good fit to the data, χ2 =12.40, df =10, p =.259. None of the variables satisfied the criteria for mediation or moderation in the physical activity model, but gender moderated the effects of intervention on fruit and vegetable consumption. Conclusions: None of the hypothesized mediators were responsible for behavior change in the Program X intervention. Future studies should address the limitations of existing psychosocial scales and continue to explore the mechanisms of behavior change using model testing, mediation, and moderation analyses. [Copyright &y& Elsevier]

Abstract: Purpose: The objective of this study was to evaluate the impact of a school-based intervention (Program X) incorporating pedometers and e-mail support on physical activity, sedentary behavior, and healthy eating in adolescents. Methods: A randomized control trial was used to evaluate the impact of the Program X intervention. Six schools (N = 124 participants; mean age 14.1 ± .8 years) were randomized to intervention or control conditions for the 6-month study period. Objectively recorded physical activity (mean steps/day), self-reported sedentary behavior, and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated-measures analysis of variance and χ2 tests. Results: Participants in the intervention group increased their step counts by 956 ± 4107 steps/day (boys) and 999 ± 1999 (girls). Repeated-measures analysis of variance revealed significant group-by-time interactions for boys (F = 7.4, p = .01, d = .80) and girls (F = 29.6, p <.001, d = 1.27) for mean steps/day. The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys (χ2 = 4.0, p = .043) and increased the number of fruit serves among girls (χ2 = 4.8, p = .028). The intervention did not have a statistically significant effect on sedentary behavior. Conclusion: A school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls. [Copyright &y& Elsevier]

Abstract: Data on the immunogenicity and memory induction of pneumococcal conjugate vaccines in very preterm infants is limited. We vaccinated 69 full term and 68 preterm infants (median gestational age (GA) 30 weeks) with a 7-valent pneumococcal conjugate vaccine (PCV7) at 2/3/4 months of age, followed by a plain polysaccharide booster at 12 months of age. IgG-GMC (ELISA) was significantly lower in preterm infants to six vaccine serotypes (ST) at 2 months and 5 months of age, to five ST at 12 months of age and to three ST at 13 months of age. A significantly lower proportion of preterm infants achieved IgG levels ≥0.35μg/ml to ST 4, 6B and 9V at 5 months and to ST 4, 6B, 18C, 19F and 23F at 12 months of age. Fold rises following the polysaccharide booster were comparable to those of term infants. At least 93% of both cohorts achieved IgG ≥0.35μg/ml to all STs following booster vaccination. Pneumococcal conjugate vaccine at an accelerated schedule of 2/3/4 months of age is likely to provide protection against pneumococcal disease for preterm infants. Antibody concentrations wane over the first year of life in both preterm and term infants and booster vaccination is therefore likely to be important. [Copyright &y& Elsevier]

Abstract: Objective: The objective was to determine whether provision of oral nutritional supplements, delivered by community nurses, could improve nutritional status and wound healing in home-nursed elderly. Methods: This was a double-blind, randomized trial in 50 elderly patients referred for wound management. Patients received 237 mL/d of 4 or 8 kJ/mL of an oral nutritional supplement for 4 wk. Nutritional status was measured with the Subjective Global Assessment and the Mini-Mental State Examination questionnaire to determine cognitive function and wound characteristics to assess healing. Differences between variables were examined with the Mann-Whitney or Student''s t test for comparing two groups, one-way analysis of variance when there was more than two groups, and chi-square analysis for comparing two categorical variables. Associations between variables were examined with Pearson''s correlation and regression analysis. Results: At baseline, 34% subjects were moderately malnourished and 8% were severely malnourished. In both groups, there was significantly greater improvement in Mini-Mental State Examination scores at week 4 (95% confidence interval −2.0 to −0.001, P = 0.04) and a greater decrease in the wound effusion score (95% confidence interval −2.0 to 0.0, P = 0.045). Median length of stay did not differ between groups (P > 0.05). Conclusions: Malnutrition is common in elderly patients who are nursed at home for wound management. Provision of energy- and protein-dense oral supplements by community nurses is effective in improving some indices of wound healing and cognitive function in this group. Although further study is needed to determine the effect on length of stay, the nutritional needs of this vulnerable group should not be overlooked. [Copyright &y& Elsevier]

The prevalence of Gestational Diabetes Mellitus (GDM) increased from 7% to 13.1% between 2013 and 2017 in NSW, Australia. Limited detail has been reported on dietary patterns prior to GDM diagnosis. To evaluate adequacy of micronutrient intakes and contribution of nutrient-dense versus energy-dense, nutrient-poor food groups to total energy. Dietary intake of women with GDM was assessed over the six months prior to attending the first outpatient nutrition education group using the Australian Eating Survey: food frequency questionnaire with food group serves compared to the Australian Guide to Healthy Eating recommendations. Nutrient intakes compared to Estimated Average Requirements (EARs). Diet quality was evaluated using the Australian Recommended Food Score diet quality index. Fifty women with a mean age of 30.8±4.6 years completed the Australian Eating Survey. Mean percentage (SD) energy intake derived from nutrient-dense versus energy-dense, nutrient-poor foods was 66.6% (12.4) and 33.4% (12.4); respectively. Median intakes of iron, calcium, fibre, iodine and folate were below EARs. Median (IQR) total Australian Recommended Food Score was 31(15) from a maximum 73 points. Adherence to the Australian Guide to Healthy Eating recommendations was low, with no participants meeting recommendations for serves of bread and cereals, 92% below dairy and dairy alternatives and 82% below vegetable intake recommendations. Before being diagnosed with GDM, women derive a high percentage of total energy from energy-dense, nutrient-poor foods, have low dietary variety amongst nutrient-dense foods, and sub-optimal intakes of key pregnancy micronutrients. Poor dietary patterns require attention within medical nutrition therapy for GDM in order to optimise nutrition-related health outcomes. [ABSTRACT FROM AUTHOR]

As decision-making shifts more into digital environments, understanding how consumers assess and select foods, particularly healthy foods, in these environments is becoming increasingly important. Online services offer opportunities to improve consumer wellbeing through promoting healthier food choices and positively impacting purchasing behaviours. This scoping review presents a structured overview of the literature published up to February 2022 regarding the use of nudging strategies in online grocery stores. A systematic search of eight databases resulted in 2312 records for the title and abstract screening, with 138 relevant articles assessed for eligibility through full-text screening. Studies were included if they applied digital nudging strategies in online grocery stores and reported food choices. Fifteen records met the inclusion criteria and four common nudging strategies were identified in these studies: i) applying different (already established) label(s) (n = 6), ii) healthier swap suggestions (n = 3), iii) default options (n = 2), iv) increasing the salience (n = 1) or a combination of strategies (n = 3). While multiple studies identified improved nutritional contents outcomes due to nudging, overall, studies frequently lack of a clear explanation and description of the implemented visual UI features, limiting insights into which factors attracts consumer's attention, and therefore further predicts consumer behaviours and decision making. Furthermore, gaining insights into which nudging strategies are ineffective could inform the design of online food choice environments. Lastly, theoretical frameworks that structure nudging interventions should also consider the digital environments. • Food choices conducted in digital settings are becoming more common. • A review on digital nudging in grocery stores identified 4 nudging strategies used. • Inconsistencies in describing 'digital nudging' call for a unified terminology. • Investigating personalized nudging strategies is warranted. • Insights into which digital nudging approaches are not effective is lacking. [ABSTRACT FROM AUTHOR]

The authors reflect on the developmental adaptations that maternal diet during pregnancy can cause, referencing the article "Maternal protein intake during pregnancy and offspring overweight 20 years later" by E. Maslova and colleagues which appeared on page 1,139 within the issue. Topics discussed include the connections between higher maternal intakes of animal protein when replaced for carbohydrate and researches evaluating low-protein (LP) diets and high-protein (HP) diets during pregnancy.

Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques. To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context. A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 – 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation. Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened. Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool. [ABSTRACT FROM AUTHOR]

This paper provides an overview of nutrition recommendations for dietary intakes necessary to support normal growth and development of children from birth to 18 years and to promote long-term health and quality of life. Key nutrients and food-based dietary recommendations have been examined from international evidence-based child dietary and feeding guidelines from the World Health Organization and a convenience sample of countries. The paper also reviews key issues relating to the environmental impacts of child diets. Fundamental gaps are identified in defining optimal intakes for children at specific ages and for those living in different geographical regions and food environments. • Optimal dietary intake is essential for normal child growth and long term health. • Child dietary patterns are important contributors to the health of our planet. • Globally child dietary intakes are sub-optimal compared to dietary recommendations. • A nutritious and sustainable food system for all children must be a global priority. • Strategies to optimize child nutrition should support environmental sustainability. [ABSTRACT FROM AUTHOR]

To provide an overview of the qualifications of nurses working in antenatal clinics, and to identify current nutrition services and information provided to pregnant women. To explore barriers and enablers to the provision of nutrition services by nurses to pregnant women attending antenatal clinics mapped against the Theoretical Domains Framework. Cross-sectional qualitative study, conducted in three municipal hospitals (Temeke, Mwananyamala and Ilala) in Dar es Salaam, Tanzania. Fourteen nurses currently providing health services to pregnant women, with at least two months' work experience within in the selected facility were purposively selected. In-depth interviews were carried out with the participants by three trained research assistants using guides prepared in Swahili. Transcripts were translated into English and imported to NVivo 12 software. Data was analysed using qualitative content analysis principles. Five nutrition services commonly provided to pregnant women at antenatal clinics were nutrition education, iron and folic acid supplementation, weight measurements, dietary assessment and haemoglobin level monitoring. Domains included knowledge, skills, beliefs about capabilities, in addition to memory, attention and decision processes, and the environmental context and resources domains had both barriers and enablers identified by participants. The three remaining domains of the social/professional role and identity, optimism, and beliefs about consequences had only enablers reported. Nurses deliver nutrition care to pregnant women during routine antenatal clinic visits. However, the information delivered to pregnant women varied among nurses, and a number of barriers and enablers to provision of nutrition care to pregnant women were identified. This data can inform future improvement to strategies for implementing nutrition services to pregnant women attending antenatal clinics. In-service training to nurses working with pregnant women and availability of tailored nutrition education materials, such as a food guide in these health facilities could improve nutrition care during this important period. [ABSTRACT FROM AUTHOR]

Objectives: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55-85 years.Design: A prospective cohort study of adults in Newcastle, New South Wales, Australia.Method: Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years).Results: Higher step count (HR: 0.93, 95%CI: 0.88-0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74-0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78-1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates.Conclusions: Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures. [ABSTRACT FROM AUTHOR]