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Background Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities. Methods A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes. Results The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities. Conclusions Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally. Electronic supplementary material The online version of this article (10.1186/s12889-017-4795-5) contains supplementary material, which is available to authorized users.

Background/Objectives: To describe the development of a single-frequency bioimpedance prediction equation for fat-free mass (FFM) suitable for adult Aboriginal and Torres Strait Islander peoples with and without diabetes or indicators of chronic kidney disease (CKD). Subjects/Methods: FFM was measured by whole-body dual-energy X-ray absorptiometry in 147 adult Indigenous Australians. Height, weight, body circumference and resistance were also measured. Adults with and without diabetes and indicators of CKD were examined. A random split sample with internal cross-validation approach was used to predict and subsequently validate FFM using resistance, height, weight, age and gender against measured FFM. Results: Among 147 adults with a median body mass index of 31 kg/m2, the final model of FFM was FFM (kg)=0.432 (height, cm2/resistance, ohm)-0.086 (age, years)+0.269 (weight, kg)-6.422 (if female)+16.429. Adjusted R2 was 0.94 and the root mean square error was 3.33 kg. The concordance was high (rc =0.97) between measured and predicted FFM across a wide range of FFM (31-85 kg). Conclusions: In the context of the high burden of diabetes and CKD among adult Indigenous Australians, this new equation for FFM was both accurate and precise and based on easily acquired variables (height, weight, age, gender and resistance) among a heterogeneous adult cohort. Refereed/Peer-reviewed

Objectives: To examine associations between dietary patterns identified by factor analysis, and successful ageing. Design: Prospective cohort study with diet measured in 1990-4, and successful ageing in 2003-7. Ordered logistic regression with outcome determined as dead/usual ageing/successful ageing was used to examine associations with quintile groups of dietary factor scores. Participants: Men and women (n=6308), without history of major illness at baseline, and aged >70 years at follow-up, or who had died before follow-up but would have been aged >70 at the commencement of follow-up, from the Melbourne Collaborative Cohort Study. Measurements: Frequencies of intake of 121 foods at baseline were collected in a food frequency questionnaire. Anthropometry and other health and lifestyle data were collected. At follow-up, questionnaire data relating to mental health, physical function and medical history were used to define successful ageing. Results: Four dietary factors were identified, characterized by higher loadings for (1) vegetables; (2) fruit, (3) feta, legumes, salad, olive oil, and inverse loadings for tea, margarine, cake, sweet biscuits and puddings; (4) meat, white bread, savoury pastry dishes and fried foods. In models excluding body size, the second factor ‘Fruit’ was positively associated with successful ageing (OR in top 20% vs lowest 20% of score 1.31, 95%CI (1.05-1.63), p trend across quintile groups 0.001); while the fourth factor ‘Meat/fatty foods’ was inversely associated (OR in top 20% vs lowest 20% of score 0.69, 95%CI (0.55-0.86), p trend across quintile groups 0.001). Factors 1 and 3 did not show significant associations with successful ageing. The association for ‘Fruit’ was little altered after adjustment for body size, while for ‘Meat/fatty foods’ the association was somewhat attenuated. Conclusion: A dietary pattern including plenty of fruit while limiting meat and fried foods may improve the likelihood of ageing successfully. Refereed/Peer-reviewed

Background: Modern diets, characterised by excess consumption of processed foods, are accompanied by an epidemic of chronic diseases. Cardiovascular disease and depression carry a large burden of disease and often occur together. Poor dietary patterns have been identified as an independent risk factor for depression while healthy diets with minimally processed food are protective. Traditional Mediterranean diets have been shown to reduce risk of cardiovascular disease; however there is a need for clinical trials in people with depression. This paper reports the study protocol of a Mediterranean-style diet intervention conducted in adults with self-reported depression. Methods/design: HELFIMED is a parallel 6-month randomised controlled trial investigating whether dietary patterns can be improved in people with depressive symptoms and whether healthier diet combined with fish oil supplementation can improve mental and cardiometabolic health and quality of life. Adults aged 18-65 years with self-reported depressive symptoms over the previous two months (N = 163) were block-randomised on age and gender between May 2014 and June 2015 to receive nutrition education, food hampers, fortnightly cooking workshops based on Mediterranean-style dietary principles for 3 months and fish oil supplementation for 6 months, or to attend fortnightly social groups (control group) for 3 months. All participants completed mental health (DASS and PANAS), quality of life, dietary and shopping and budgeting questionnaires and provided anthropometric measurements, blood and urine samples at baseline, 3 and 6 months. Additionally the treatment group attended focus groups at 3 and 6 months. Primary and secondary outcomes will be analysed using linear mixed modelling and correlations will investigate associations between improved health outcomes and subjective/objective measures of improved diet/nutritional status. Discussion: This study will contribute causal evidence to prior observational and longitudinal studies that have shown associations between Mediterranean diet and mental health. The results will inform public health and clinical strategies for treatment of depression and comorbid cardiometabolic risk factors.Trial registration: Australian New Zealand Clinical Trials Register (ACTRN12614000438651). Trial registration date: 23rd April 2014. Refereed/Peer-reviewed

This study explored urinary cadmium levels among Torres Strait Islanders in response to concerns about potential health impact of high levels of cadmium in some traditional seafood (dugong and turtle liver and kidney). Cadmium levels were measured by inductively coupled mass spectrometry in de-identified urine samples collected during general screening programs in 1996 in two communities with varying dugong and turtle catch statistics. Statistical analysis was performed to identify links between cadmium levels and demographic and background health information. Geometric mean cadmium level among the sample group was 0.83 mug/g creatinine with 12% containing over 2 microg/g creatinine. Cadmium level was most strongly associated with age (46% of variation), followed by sex (females >males, 7%) and current smoking status (smokers >non-smokers, 4.7%). Adjusting model conditions suggested further positive associations between cadmium level and diabetes (p=0.05) and residence in the predicted higher exposure community (p=0.07). Positive correlations between cadmium and body fat in bivariate analysis were eliminated by control for age and sex. This study found only suggestive differences in cadmium levels between two communities with predicted variation in exposure from traditional foods. However, the data indicate that factors linked with higher cadmium accumulation overlap with those of renal disease risk (i.e. older, females, smokers, diabetes) and suggest that levels may be sufficient to contribute to renal pathology. More direct assessment of exposure and health risks of cadmium to Torres Strait Islanders is needed given the disproportionate level of diet-related disease and the cultural importance of dugong and turtle. This study highlights the need to consider social and cultural variation in exposure and to define "safe" cadmium levels during diabetes given its rising global prevalence.

To examine the relationship between C-reactive protein (CRP), adiposity and other metabolic abnormalities in an Aboriginal community in Northern Australia.Cross-sectional analysis of data obtained between 2001 and 2003 from 379 Aboriginal people residing in a geographically isolated community.Mean (95% CI) CRP in women and men was 4.06 cholesterol (3.53, 4.66) mg/l and 3.42 (2.94, 3.97) mg/l, respectively (P=NS). The prevalence of the metabolic syndrome (US National Cholesterol Education [corrected] Program (NCEP) definition) was significantly higher for women than men (41 vs 18%, chi (2)=20.94, P0.001). C-reactive protein correlated strongly with adiposity in women (waist circumference, waist to hip ratio and body mass index; r/=0.514, P0.01) but much less strongly in men (r/=0.221, P0.05). In a multivariate stepwise linear regression model, waist circumference was the strongest independent predictor explaining 35% of CRP concentration variance in women, but only 5.4% in men (WHR). Incremental increases in CRP concentration across four BMI categories were significant in women (P (linear trend)0.001) but not in men.High CRP levels in the surveyed population are consistent with the high prevalence of vascular disease morbidity and mortality in Aboriginal Australians. The relationship of CRP with increasing body fat was strong and consistent in women but not in men. Prospective studies are needed to elucidate the role of CRP (if any) as a predictive marker for cardiovascular events in this high-risk population.

Heavy kava use has been associated with sudden death in Aboriginal Australians in Arnhem Land (Northern Territory, Australia) where poor diets and a high incidence of premature coronary heart disease are known. Heavy kava users may suffer additional risk if further malnourished. Among 98 people (62 males, 36 females) in one community, 36 never used kava, 26 were past users, and 36 were continuing users. Across kava-using groups skinfold thickness, body mass index and body fat decreased. Total- and LDL-cholesterol were elevated in kava users compared to both former users and never users. HDL-cholesterol was higher in current users vs never users. Across kava-using groups, triglycerides, homocysteine and diet-derived antioxidant vitamins alpha-tocopherol and retinol, did not vary. Plasma carotenoid levels (indicative of vegetable and fruit intake) were very low, but when adjusted for plasma cholesterol, did not vary between kava-using groups. An obsession for kava drinking may mediate kava's direct effects on nutritional status.

Objective: To compare effects of a high carbohydrate (high-CHO) and a monounsaturated fat diet (high-MUFA) on body fat distribution and sex hormones in post-menopausal women with Type 2 diabetes. Design: Randomised cross-over with no washout. Setting: Geelong Hospital outpatient. Subjects: Thirty four women were recruited, 30 completed the study, and data are presented for 21 women compliant to the high-CHO diet. Interventions: Women followed a high-CHO diet (20% energy (%E) from fat, 60%E from carbohydrate and a high-MUFA diet (40%E from fat, half as monounsaturated fat, 40%E from carbohydrate) in random order for 12 weeks each. Main outcome measures: Dietary compliance was measured by change in linoleic acid (C18:2, ω-6) in plasma cholesteryl esters. Body composition was measured by dual-energy X-ray absorptiometry. Fasting concentrations of glucose and insulin were measured in plasma. Steroid hormones and sex hormone binding globulin (SHBG) were measured in serum. Results: On the high-CHO diet C18:2, ω-6 in plasma cholesteryl esters declined by 5.4% (95% confidence intervals (CI), −2.5% to −8.4%, P=0.0015). Fat was lost mainly from the lower body (lower body loss −0.71 kg, 95% CI, −0.43 to −1.00 kg, P=0.001; upper body loss −0.15 kg, 95% CI, −0.76 to +0.46 kg, P=0.6). Yet on the high-MUFA diet, lower body fat loss was minimal (−0.22 kg, 95%CI, +0.11 to −0.55 kg, P=0.2). By general linear modelling (GLM), differences in lower body fat loss were significantly related to diet (P=0.04). After adjustment for age, dehydroepiandrosterone sulphate (DHEAS) concentrations after the high-CHO diet were related to levels of lower body fat (r=0.394, P=0.04). Conclusions: In women with Type 2 diabetes following a high-CHO diet for 12 weeks the disproportionate loss of lower body fat is related to a decline in DHEAS. Sponsorship: Supported by grant 950921 from the National Health and Medical Research Council of Australia.

To describe ethnic differences in the relationship between body size and body composition. Knowledge about such differences is important when studying obesity-related complications, such as hypertension and non-insulin dependent diabetes, because it may not be possible to generalize results from one study population to other populations.Cross-sectional study.Four groups of different ethnic identity (2987 Caucasians (Danes), 243 predominantly Melanesian (Torres Strait Islanders from northern Australia), 206 Australian Aborigines and 146 Polynesians (New Zealand Samoans), aged 30-70 y, were studied.We examined associations between body weight and bioelectrical impedance, as a measure of body composition.Except for Australian Aborigines, associations (slopes) between body weight and resistance were generally constant in the different ethnic groups, once height and age differences had been considered, indicating that this relationship may involve a certain universality, that is independent of the population specificity for impedance measurement. Systematic differences in instrument readings or electrodes did not seem to be responsible for the differences found.With the exception of Australian Aborigines, there may be a constant relation between body size and body composition (total body water or fat free mass) of different ethnic groups, that depends on gender and age category only.

Objectives: To assess the accuracy of the Schofield, Schofield & James (1985) equations and those of Hayter & Henry (1994) for the prediction of the basal metabolic rate (BMR), of young Australians. Design: BMR was measured by indirect calorimetry, while fat free mass (FFM) and fat mass (FM) were measured by bioelectric impendence analysis (BIA) in 128 volunteers (39 men and 89 women), aged between 18 and 30 y. Setting: Deakin Institute of Human Nutrition, Deakin University, Melbourne, Australia. Results: The measured BMR of Australian men and women were significantly lower (P≤0.001) than the predicted BMR using the Schofield et al (1985) equation, with a mean (s.d.) bias (bias=measured−predicted BMR) of −406 (513) kJ/d in men and −124 (348) kJ/d in women. The measured BMR of Australian men and women were similar to the predicted BMR using the equations of Hayter & Henry (1994) and bias was unrelated to body weight. BMR adjusted for FFM and FM was significantly higher by three percent in women on oral contraceptive agents (OCA) as compared to those not on OCA. Conclusions: The Schofield et al (1985) equations are not valid for the prediction of BMR of young Australian men and women. The equations of Hayter & Henry (1994) for North Europeans and Americans, provide an accurate estimate of the BMR of Australian men and women at the group level. However, in young women not using OCA a correction factor of 0.97 applied to the predicted BMR provides a better estimate. Sponsorship: Deakin University, Australia.

Background Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions. This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. Methods/Design We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. Discussion This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613000694718

The aim of this study was to examine whole-body glucose turnover and glucose uptake into individual tissues in Psammomys obesus. The animals were classified according to the level of circulating glucose and insulin in the fed state: group A was normoglycaemic and normoinsulinaemic (glucose8.0 mmol/l), insulin150 mU/l), group B was normoglycaemic and hyperinsulinaemic (glucose8.0 mmol/l, insulinor = 150 mU/l), and group C was hyperglycaemic and hyperinsulinaemic (glucoseor = 8.0 mmol/l, insulin 150 mU/l). The animals were deprived of food for 6 h, after which they were anaesthetized and cannulated, using the jugular vein for infusions and the carotid artery for blood sampling. Whole-body glucose turnover was measured using a primed-continuous infusion of 6-[3H]-glucose and saline to quantitatively assess hepatic glucose production (HGP), glucose disposal (Rd), and the metabolic clearance rate of glucose (MCR). Following the 2-h infusion period, the glucose metabolic index (Rg') of individual tissues was measured using a fixed-dose bolus of 2-deoxy-[14C] glucose. Under the steady-state conditions of the experiment, HGP was assumed to be equal to Rd, and both variables were found to be significantly correlated to the fasting glucose concentration (r=0.534, P0.05, n=19). On the other hand, MCR was found to be inversely correlated to the fasting plasma glucose concentration (r=0.670 P0.01, n=19). When the animals were divided into three groups as described above, HGP in group C animals was significantly elevated compared with group A (20.8 +/- 2.6 vs 12.7 +/- 0.6 mg.kg-1.min-1; P0.05), and MCR showed a tendency to be lower in group C than group A, although the difference was not statistically significant. HGP and MCR were not significantly different between groups A and B. Measurement of the glucose metabolic index in individual tissues showed that group C animals had significantly higher Rg' values in muscles and adipose tissues compared with those in group A (P0.05). In addition, Rg' in group B white gastrocnemius and soleus were significantly higher than in group A despite similar rates of HGP and levels of glycaemia. These findings suggest that an early increase in skeletal muscle glucose uptake and hyperinsulinaemia can be demonstrated in group B Psammomysobesus before significant hyperglycaemia.

Background Indigenous Australians have an incidence of end stage kidney disease 8-10 times higher than non-Indigenous Australians. The majority of research studies concerning Indigenous Australians have been performed in rural or remote regions, whilst the majority of Indigenous Australians actually live in urban settings. We studied prevalence and factors associated with markers of kidney disease in an urban Indigenous Australian cohort, and compared results with those for the general Australian population. Methods 860 Indigenous adult participants of the Darwin Region Urban Indigenous Diabetes (DRUID) Study were assessed for albuminuria (urine albumin-creatinine ratio≥2.5 mg/mmol males, ≥3.5 mg/mmol females) and low eGFR (estimated glomular filtration rate < 60 mls/min/1.73 m2). Associations between risk factors and kidney disease markers were explored. Comparison was made with the AusDiab cohort (n = 8,936 aged 25-64 years), representative of the general Australian adult population. Results A high prevalence of albuminuria (14.8%) was found in DRUID, whilst prevalence of low eGFR was 2.4%. Older age, higher HbA1c, hypertension, higher C-reactive protein and current smoking were independently associated with albuminuria on multiple regression. Low eGFR was independently associated with older age, hypertension, albuminuria and higher triglycerides. Compared to AusDiab participants, DRUID participants had a 3-fold higher adjusted risk of albuminuria but not of low eGFR. Conclusions Given the significant excess of ESKD observed in Indigenous versus non-Indigenous Australians, these findings could suggest either: albuminuria may be a better prognostic marker of kidney disease than low eGFR; that eGFR equations may be inaccurate in the Indigenous population; a less marked differential between Indigenous and non-Indigenous Australians for ESKD rates in urban compared to remote regions; or that differences in the pathophysiology of chronic kidney disease exist between Indigenous and non-Indigenous populations.

Background There is an overwhelming burden of cardiovascular disease, type 2 diabetes and chronic kidney disease among Indigenous Australians. In this high risk population, it is vital that we are able to measure accurately kidney function. Glomerular filtration rate is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that creatinine-based estimates of glomerular filtration rate derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, and there is significant heterogeneity in body build and composition within and amongst these groups. This heterogeneity might differentially affect the accuracy of estimation of glomerular filtration rate between different Indigenous groups. By assessing kidney function in Indigenous Australians from Northern Queensland, Northern Territory and Western Australia, we aim to determine a validated and practical measure of glomerular filtration rate suitable for use in all Indigenous Australians. Methods/Design A cross-sectional study of Indigenous Australian adults (target n = 600, 50% male) across 4 sites: Top End, Northern Territory; Central Australia; Far North Queensland and Western Australia. The reference measure of glomerular filtration rate was the plasma disappearance rate of iohexol over 4 hours. We will compare the accuracy of the following glomerular filtration rate measures with the reference measure: Modification of Diet in Renal Disease 4-variable formula, Chronic Kidney Disease Epidemiology Collaboration equation, Cockcroft-Gault formula and cystatin C- derived estimates. Detailed assessment of body build and composition was performed using anthropometric measurements, skinfold thicknesses, bioelectrical impedance and a sub-study used dual-energy X-ray absorptiometry. A questionnaire was performed for socio-economic status and medical history. Discussion We have successfully managed several operational challenges within this multi-centre complex clinical research project performed across remote North, Western and Central Australia. It seems unlikely that a single correction factor (similar to that for African-Americans) to the equation for estimated glomerular filtration rate will prove appropriate or practical for Indigenous Australians. However, it may be that a modification of the equation in Indigenous Australians would be to include a measure of fat-free mass.