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The neutropenic diet (ND) is often recommended to people with cancer to reduce infection risk despite recommendations of clinical guidelines advising against its use. While recent literature suggests the ND does not reduce infection risk, other outcomes related to health, nutrition, and lifestyle are unknown. The aim of this review is to systematically scope the literature on the ND in people with cancer for all outcomes related to clinical health, nutrition, and lifestyle. Scientific databases were systematically searched. Eligible studies were in English, people with any cancer type, consuming an ND, any age group, date, or setting. Eligible study types were randomised control trials, observational studies, systematic reviews, and meta-analyses. Twenty-one studies met the inclusion criteria. Outcomes of interest found were infection rates, fever, mortality, antibiotic use, gastrointestinal side effects, comorbidities, biochemistry, hospitalisation, nutritional status, quality of life (QoL), well-being, and financial costs. Most research has focused on infection and mortality rates with few assessing hospitalisation rates, nutritional status, financial costs, and QoL. Most included studies found no significant differences between ND and comparator diet for mortality, antibiotics use, comorbidities, and QoL; however, several studies reported the ND significantly increased the risk of infection. Gaps in the literature included effect of ND on QoL in an adult population, microbiome, lifestyle changes, and financial burden. Further research is needed regarding how the ND affects the microbiome and QoL of its consumers, but in the interim, it is important for hospitals providing an ND to their patients to liberalise the ND wherever possible., Competing Interests: None., (© The Author(s) 2024.)

Dietary intake has been associated with pain and physical function, but it is unclear if these relationships are mediated by adiposity. Data were derived from the Whyalla Intergenerational Study of Health (n = 654, 57% women). Structural equation modelling tested the hypotheses that adiposity (body mass index (BMI), waist circumference (WC), or body fat (BF, dual energy x-ray absorptiometry)) would mediate the relationship between diet quality (Dietary Guideline Index (DGI) total, core, or non-core scores) and pain (Short Form-36 bodily pain scale (SF36-BPS)), or physical function (grip-strength), overall, and by gender. Adiposity did not mediate a relationship between DGI scores and pain. Direct effects were observed between DGI total scores and SF36-BPS accounting for BMI (β = 0.170, 95% CI 0.002, 0.339), and between DGI core food scores and SF36-BPS (BMI, β = 0.278, 95% CI 0.070, 0.486; WC, β = 0.266, 95% CI 0.058, 0.474; BF, β = 0.266, 95% CI 0.060, 0.473). In women, direct effects existed between DGI scores and SF36-BPS (DGI total scores, BMI, β = 0.388, 95% CI 0.162, 0.613; WC, β = 0.372, 95% CI 0.146, 0.598; BF, β = 0.382, 95% CI 0.158, 0.605, and DGI core scores, BMI, β = 0.482, 95% CI 0.208, 0.757; WC, β = 0.472, 95% CI 0.197, 0.747; BF, β = 0.467, 95% CI 0.195, 0.739), and DGI total scores and grip-strength (BMI, β = 0.075, 95% CI 0.008, 0.142; WC, β = 0.076, 95% CI 0.009, 0.143; BF, β = 0.079, 95% CI 0.011, 0.146). Better diet quality is associated with lower bodily pain, irrespective of adiposity. Findings highlight the potential role of diet quality in pain management and function, particularly in women., Competing Interests: Author declarations The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Poor diet is a major risk factor for non-communicable disease. The aims of this study were to describe temporal patterns and seasonal changes in diet across the year in Australian adults. A total of 375 adults from a prospective cohort study conducted between 1 December 2019 and 31 December 2021 in Adelaide, Australia, were asked to complete the Dietary Questionnaire for Epidemiological Studies at eight timepoints over a year. Average intakes over the previous month of total energy, macronutrients, healthy food groups, and discretionary foods and beverages were derived. Temporal patterns in diet were analysed descriptively. Multilevel linear regression modelling was used to assess seasonal differences in diet. Of the 375 participants recruited, 358 provided sufficient data for analysis. Intake of total energy, all macronutrients, and most discretionary foods and beverages peaked in December. Total energy intake was higher in summer than in autumn, winter, and spring. Fruit intake was higher in summer than in winter. Consumption of alcoholic beverages was higher in summer than in autumn, winter, and spring. Consumption of non-alcoholic beverages was higher in summer than in autumn and winter. This study identified temporal differences in dietary intake among Australian adults. Seasonal effects appear to be driven largely by increases in consumption of foods and beverages over the December (summer) holiday period. These findings can inform the design and timing of dietary interventions.

The prevalence of overweight and obesity among adolescents has been increasing worldwide and is a significant public health challenge. Obesity is linked to several non-communicable diseases. This study aimed to determine the prevalence of overweight and obesity based on three growth references and described physical activities and dietary patterns among sixth graders in Ho Chi Minh City (HCMC). From 2018 to 2020, a cross-sectional study was conducted on 1375 students from 16 junior high schools in HCMC. We applied Probability Proportional to Size sampling to select schools. Anthropometric measurements, pubertal status assessment, and diet and physical activity data were collected through Food Frequency and Physical Activity Questionnaires. The study revealed a high prevalence of overweight and obesity among grade 6 students, with ∼45%-56% of students classified as overweight or obese using various growth references. Moreover, most students did not meet the World Health Organization's physical activity and sedentary behavior recommendations. Most students spent <60 min/day on moderate to vigorous physical activity, and over 70% spent at least 120 min/day on sedentary activities during weekdays and weekends. The diet of the students was also imbalanced, with high intakes of protein, lipids, and carbohydrates and low consumption of fruits and vegetables. Nutritionists and policymakers should inform and encourage opportunities for healthier food and more daily activity for children, starting before the sixth-grade, so they can learn how to make healthier choices and change their behavior before they reach adolescence., (© The Author(s) [2024]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Dietary and movement behaviors [physical activity (PA), sedentary behavior (SED), and sleep] occur throughout a 24-h day and involve multiple contexts. Understanding the temporal patterning of these 24-h behaviors and their contextual determinants is key to determining their combined effect on health. A scoping review was conducted to identify novel analytic methods for determining temporal behavior patterns and their contextual correlates. We searched Embase, ProQuest, and EBSCOhost databases in July 2022 to identify studies published between 1997 and 2022 on temporal patterns and their contextual correlates (e.g., locational, social, environmental, personal). We included 14 studies after title and abstract (n = 33,292) and full-text (n = 135) screening, of which 11 were published after 2018. Most studies (n = 4 in adults; n = 5 in children and adolescents), examined waking behavior patterns (i.e., both PA and SED) of which 3 also included sleep and 6 included contextual correlates. PA and diet were examined together in only 1 study of adults. Contextual correlates of dietary, PA, and sleep temporal behavior patterns were also examined. Machine learning with various clustering algorithms and model-based clustering techniques were most used to determine 24-h temporal behavior patterns. Although the included studies used a diverse range of methods, behavioral variables, and assessment periods, results showed that temporal patterns characterized by high SED and low PA were linked to poorer health outcomes, than those with low SED and high PA. This review identified temporal behavior patterns, and their contextual correlates, which were associated with adiposity and cardiometabolic disease risk, suggesting these methods hold promise for the discovery of holistic lifestyle exposures important to health. Standardized reporting of methods and patterns and multidisciplinary collaboration among nutrition, PA, and sleep researchers; statisticians; and computer scientists were identified as key pathways to advance future research on temporal behavior patterns in relation to health., Competing Interests: Conflict of interest HAE-M (Heather A Eicher-Miller) is on the editorial board of Advances in Nutrition and played no role in the Journal’s evaluation of the manuscript. RML, SEC, NDR, RM, and SAM declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal and Torres Strait Islander communities. Tool development included identifying key dietary indicators (informed by sales data from 31 stores), community consultation (19 Aboriginal and Torres Strait Islander store directors and two store managers) and a web-build. Tool evaluation involved feedback interviews with stakeholders (25 store managers and two nutritionists). Key dietary indicators aligned with Australian Dietary Guideline food groupings and recommendations. An online portal for accessing and customising reports was built. Stakeholder feedback indicated that the strengths of the reports were the visuals, ease of interpretation, providing information that was not currently available and potential to increase capacity to support healthy food retailing. Difficulties were defining healthiness classification with alignment to other nutrition guidelines used and ensuring reports reached relevant store decision makers. This tool may be valuable to support store decision makers in identifying and prioritising nutrition issues and optimising the health-enabling attributes of stores.

Objective: To determine the reach, adoption, implementation and effectiveness of an intervention to increase children's vegetable intake in long day care (LDC)., Design: A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children's vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework., Setting: Australian LDC centres., Participants: Thirty-nine centres, 120 educators and 719 children at follow-up., Results: There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34-1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40-1·32), P = 0·29). Among vegetable consumers ( n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88-1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20-1·82) and 1·40 (95 % CI 1·08-1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate ( n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres., Conclusions: The pragmatic self-delivered online intervention positively impacted educator's knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children' vegetable intake.

Objectives: Diet quality often changes as shift workers adjust to atypical work schedules, however, limited research exists examining the early effects of starting rotating shift work on diet and body composition. This study explored dietary behavior changes occurring in graduate paramedics during the first year of exposure to rotating shift work, and investigated dietary intake, diet quality and anthropometric changes over two years. Methods: Participants from a graduate paramedic cohort in Melbourne, Australia were approached after two years of shift work for study inclusion. Using a mixed method study approach, the qualitative component comprised individual in-depth interviews to explore perceived dietary behavior changes experienced over the first year of shift work. Interview transcripts were thematically analyzed and guided by the COM-B model (capability, opportunity, motivation, and behavior) and theoretical domains framework (TDF). Diet quality and dietary intake were quantitatively assessed by the Australian Eating Survey TM at baseline, one year, and two years, along with body weight, waist circumference, and body mass index (BMI) to monitor changes. Results: Eighteen participants were included in the study. From the interviews, participants reported: 1. food choices are driven by wanting to fit in with coworker food habits, 2. food choices and mealtimes are unpredictable and 3. paramedics try to make healthy food choices but give in to less healthy options. While daily energy intake and diet quality scores did not differ in the first two years of shift work, daily energy from takeaway foods significantly increased (mean difference (MD): 2.96% EI; 95% CI: 0.44 - 5.48; p  = 0.017) and increases in weight (MD: 2.96 kg; 95% CI: 0.89-5.04; p  = 0.003), BMI (MD: 1.07 kg/m 2 ; 95% CI: 0.26 - 1.87; p  = 0.006) and waist circumference (MD: 5.07 cm; 95% CI: 1.25-8.89; p  = 0.006) were also evident at two years. Conclusions: This study contributes new information on dietary changes and the current early trajectory of unintentional weight gain and takeaway reliance occurring within a graduate paramedic cohort over two years of shift work. To reduce the unintended metabolic consequences commonly observed with rotating shift schedules, workplaces could improve access to healthier food options and enable behavioral support/education to address nutrition-related health risks.

Many women of reproductive age have poor diet quality and are at higher risk of chronic diseases such as diabetes. Triglycerides are a critical risk factor for chronic diseases, and although they can be influenced by diet, there are minimal dietary intervention studies identifying key foods/food groups that reduce triglycerides. We performed data simulation modelling to estimate the potential reductions in fasting triglycerides that could be achieved by different dietary strategies in reproductive age women. The model was created using data from the 2011-2013 Australian Health Survey and incorporated various factors such as demographics, nutrient intake, and plasma biomarkers. Multiple linear regression analysis was conducted to estimate triglyceride levels, considering nutrient intake and pre-determined covariates. Dietary scenarios were developed, reducing the consumption of processed/ultra-processed foods, while increasing the intake of minimally processed foods like fruits, vegetables, fish, and nuts. A total of 606 women were included. Reducing processed foods by 50% plus increasing intakes of fruits (75-225 g/day), vegetables (75-225 g/day), or nuts (10-40 g/day) decreased triglycerides by up to 4.3%. Additionally, incorporating 80 g/day of omega 3 fish (>800 mg long-chain omega 3/100 g) decreased triglycerides by 8.2%. The clinical relevance of lowering triglycerides for cardiometabolic disease management should be tested in dietary intervention studies in women.

Objective: To inform a package of initiatives to increase children's vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum., Design: Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition ( n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children's dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability., Setting: LDC centres in metropolitan Adelaide, South Australia., Participants: 32 centres, 276 staff and 1039 children aged 2-5 years., Results: There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0-50 % completed the menu assessment, 3/5 would recommend)., Conclusion: A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children's vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Sports foods are convenient alternatives to everyday foods to fuel performance. Strong scientific evidence supports their use; however, commercial sports foods are classified by the NOVA system as ultra-processed foods (UPF). Consumption of UPF has been associated with poor mental and physical health, but little is known about athletes' consumption of and attitudes towards sports foods as a source of UPF. The aim of this cross-sectional study was to assess Australian athletes' intake of and attitudes towards sports foods and UPF. Adult athletes were recruited to complete an anonymous online survey via social media between October 2021 and February 2022. Data were analysed using descriptive statistics, and Pearson's χ test was used to assess potential relationships between categorical demographic variables and consumption of sports foods. One hundred forty Australian adults participating in recreational ( 2 test was used to assess potential relationships between categorical demographic variables and consumption of sports foods. One hundred forty Australian adults participating in recreational ( n 55), local/regional ( n 52), state ( n 11), national ( n 9) sports completed the survey. Ninety-five percent reported consuming sports foods within the past 12 months. Participants consumed sports drinks most commonly (73 %) and isolated protein supplements most frequently (40 % at least once per week). Participants reported everyday foods to be more affordable, taste better, present less risk of banned substances, but less convenient and greater risk of spoilage. Half (51 %) of participants reported concern about health effects of UPF. Participants reported regular UPF consumption despite taste and cost-related preferences for everyday foods and health concerns regarding UPF intake. Athletes may need support to identify and access safe, affordable, convenient, minimally processed alternatives to sports foods.n 9) sports completed the survey. Ninety-five percent reported consuming sports foods within the past 12 months. Participants consumed sports drinks most commonly (73 %) and isolated protein supplements most frequently (40 % at least once per week). Participants reported everyday foods to be more affordable, taste better, present less risk of banned substances, but less convenient and greater risk of spoilage. Half (51 %) of participants reported concern about health effects of UPF. Participants reported regular UPF consumption despite taste and cost-related preferences for everyday foods and health concerns regarding UPF intake. Athletes may need support to identify and access safe, affordable, convenient, minimally processed alternatives to sports foods.

Background: Evidence shows children gain more weight during the summer holidays versus the school year., Objectives: To examine within-child differences in activity and diet behaviours during the summer holidays versus the school year., Methods: Children (mean age 9.4 years; 37% male) wore accelerometers (GENEActiv; n = 133), reported activities (Multimedia Activity Recall for Children and Adolescents; n = 133) and parents reported child diet (n = 133) at five timepoints over 2 years capturing school and summer holiday values. Mixed-effects models were used to compare school and summer holiday behaviours., Results: Children spent less time in moderate- to vigorous-physical activity (-12 min/day; p = 0.001) and sleep (-12 min/day; p < 0.001) and more time sedentary (+27 min/day; p < 0.001) during summer holidays versus the school year. Screentime (+70 min/day; p < 0.001), domestic/social activities (+43 min/day; p = <0.001), self-care (+24 min/day; p < 0.001), passive transport (+22 min/day; p = 0.001) and quiet time (+16 min/day; p = 0.012) were higher during the summer holidays, compensating for less time in school-related activities (-164 min/day; p < 0.001). Diet quality was lower (-4 points; p < 0.001) and children consumed fewer serves of fruit (-0.4 serves; p < 0.001) during the summer holidays versus the school year., Conclusions: Children are displaying poorer activity and diet behaviours during the summer holidays, which may contribute to accelerated weight gain over the holiday period., (© 2023 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: Socio-economic position (SEP) in adolescence may influence diet quality over the life course. However, knowledge of whether individual and environmental determinants of diet quality mediate the longitudinal association between SEP and diet quality is limited. This study examined whether and to what extent food-related capabilities, opportunities and motivations of adolescents mediated the longitudinal association between SEP in adolescence and diet quality in early adulthood overall and by sex., Methods: Longitudinal data (annual surveys) from 774 adolescents (16.9 years at baseline; 76% female) from ProjectADAPT (T1 (baseline), T2, T3) were used. SEP in adolescence (T1) was operationalized as highest level of parental education and area-level disadvantage (based on postcode). The Capabilities, Opportunities and Motivations for Behaviour (COM-B) model was used as a framework to inform the analysis. Determinants in adolescence (T2) included food-related activities and skills (Capability), home availability of fruit and vegetables (Opportunity) and self-efficacy (Motivation). Diet quality in early adulthood (T3) was calculated using a modified version of the Australian Dietary Guidelines Index based on brief dietary questions on intake of foods from eight food groups. Structural equation modelling was used to estimate the mediating effects of adolescents' COM-B in associations between adolescent SEP and diet quality in early adulthood overall and by sex. Standardized beta coefficients (β) and robust 95% confidence intervals (CI) were generated, adjusted for confounders (T1 age, sex, diet quality, whether still at school, and living at home) and clustering by school., Results: There was evidence of an indirect effect of area-level disadvantage on diet quality via Opportunity (β: 0.021; 95% CI: 0.003 to 0.038), but limited evidence for parental education (β: 0.018; 95% CI: -0.003 to 0.039). Opportunity mediated 60.9% of the association between area-level disadvantage and diet quality. There was no evidence of an indirect effect via Capability or Motivation for either area-level disadvantage or parental education, or in males and females separately., Conclusions: Using the COM-B model, the home availability of fruit and vegetables (Opportunity) of adolescents explained a large proportion of the association between area-level disadvantage in adolescence and diet quality in early adulthood. Interventions to address poor diet quality among adolescents with a lower SEP should prioritize environmental determinants of diet quality., (© 2023. The Author(s).)

Background: Adults and children who are enterally tube-fed can experience adverse gastrointestinal symptoms (GIS). Observational data suggests that blended diets (BD) could mitigate such symptoms, with potential to improve quality of life and clinical outcomes. We present a novel systematic review examining the impact of BD, compared to commercial feeds, on GIS of adults and children who are tube-fed., Methods: The protocol was registered with PROSPERO (CRD42021261147). Four electronic databases were searched from inception to August 2021. Search terms included 'tube-fed', 'blended diet' and 'formula'. Inclusion criteria were intervention studies comparing blended and commercial feeds using quantitative measures of GIS. Heterogeneity of outcome measures precluded meta-analysis; therefore, a narrative synthesis was conducted., Results: Six papers (n = 219), including two randomised control trials (RCT) and four single arm pre-post studies, were identified. Equal numbers studied in- and out-patients, adults and children. Risk of bias was notable for all studies. Equivocal and insufficient evidence prevented consensus on outcomes of vomiting, gagging, oral intake, bloating and constipation. However, one RCT and two single arm pre-post studies suggest that diarrhoea symptoms may be improved on BD., Conclusions: Diarrhoea is prevalent in tube-fed populations and associated with adverse outcomes. Improvements in diarrhoea symptoms attributed to BD may be clinically important. Our findings are congruous with the wider observational evidence base, and support recommendations of the British Dietetic Association. BD may pose a viable alternative to commercial formula, and may mitigate symptoms of diarrhoea for adults and children who are tube-fed., (© 2022 The British Dietetic Association Ltd.)

Sales of plant-based 'meat' and 'milk'-products that mimic the visual and functional characteristics of animal-source foods-have increased rapidly during the past decade and are predicted to continue to increase. As plant-based 'meat' and 'milk' are nutritionally dissimilar to the animal-source originals, this study aimed to estimate the nutritional implications for the Australian population of substituting 'Easily Swappable' animal-source meat and dairy milk with plant-based imitation products. Computer simulation modelling was undertaken using dietary intake data collected in 2011-12 from a nationally representative survey sample. Conservative and Accelerated dietary transition scenarios were modelled in which various amounts of dairy milk and animal-source meat were replaced with plant-based 'milk' and plant-based 'meat', for the entire population and for various sub-populations. The scenarios were based on sales reports and economic projections. Modelling revealed that the intake of nutrients already at risk of inadequate intake, such as iodine and vitamin B12 (particularly for females), zinc (particularly for males) and n-3 long-chain fatty acids (for adults), would likely be adversely impacted in an Accelerated scenario. In conclusion, widespread replacement of dairy milk and animal-source meat with plant-based 'milk' and 'meat' may increase the risk of nutritional inadequacies in the Australian population. Messages and policy actions promoting the transition to more environmentally sustainable diets should be designed to avoid such adverse nutritional impacts.

Introduction: Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed. It also seeks to identify gaps in knowledge and implications for policy and practice., Methods and Analysis: This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guidelines. A search strategy was iteratively developed with two academic librarians and the research team. This strategy will be used to search six databases, including Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus and ProQuest Central. Identified citations will be screened by two independent reviewers; first, by title and abstract, and then full-text articles to identify papers eligible for inclusion. The reference lists of included studies and relevant systematic reviews will be searched to identify other papers eligible for inclusion. Two reviewers will extract information from all included studies and summarise the findings descriptively and numerically., Ethics and Dissemination: The scoping review will provide an overview of how CLDs developed by stakeholders have been elicited to understand food environments, diet and obesity, the insights gained and how the CLDs have been used. It will also highlight gaps in knowledge and implications for policy and practice. The review will be disseminated through publication in an academic journal and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pre-pregnancy, pregnancy and postpartum are critical life stages associated with higher weight gain and obesity risk. Among these women, the sociodemographic groups at highest risk for suboptimal lifestyle behaviours and core lifestyle components associated with excess adiposity are unclear. This study sought to identify subgroups of women meeting diet/physical activity (PA) recommendations in relation to sociodemographics and assess diet/PA components associated with body mass index (BMI) across these life stages. Cross-sectional data (Australian National Nutrition and Physical Activity Survey 2011-2012) were analysed for pre-pregnancy, pregnant and postpartum women. The majority (63-95%) of women did not meet dietary or PA recommendations at all life stages. Core and discretionary food intake differed by sociodemographic factors. In pre-pregnant women, BMI was inversely associated with higher whole grain intake (β = -1.58, 95% CI -2.96, -0.21; p = 0.025) and energy from alcohol (β = -0.08, -0.14, -0.005; p = 0.035). In postpartum women, BMI was inversely associated with increased fibre (β = -0.06, 95% CI -0.11, -0.004; p = 0.034) and PA (β = -0.002, 95% CI -0.004, -0.001; p = 0.013). This highlights the need for targeting whole grains, fibre and PA to prevent obesity across life stages, addressing those most socioeconomically disadvantaged.

Objectives: To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption., Design: We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing., Setting: We estimated policy effects in scenarios representing two stages of the 'social transition' in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile., Participants: A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico., Results: A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario., Conclusions: Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.

Introduction: Approximately 40% of late-life dementia may be prevented by addressing modifiable risk factors, including physical activity and diet. Yet, it is currently unknown how multiple lifestyle factors interact to influence cognition. The ACTIVate Study aims to (1) explore associations between 24-hour time-use and diet compositions with changes in cognition and brain function; and (2) identify duration of time-use behaviours and the dietary compositions to optimise cognition and brain function., Methods and Analysis: This 3-year prospective longitudinal cohort study will recruit 448 adults aged 60-70 years across Adelaide and Newcastle, Australia. Time-use data will be collected through wrist-worn activity monitors and the Multimedia Activity Recall for Children and Adults. Dietary intake will be assessed using the Australian Eating Survey food frequency questionnaire. The primary outcome will be cognitive function, assessed using the Addenbrooke's Cognitive Examination-III. Secondary outcomes include structural and functional brain measures using MRI, cerebral arterial pulse measured with diffuse optical tomography, neuroplasticity using simultaneous transcranial magnetic stimulation and electroencephalography, and electrophysiological markers of cognitive control using event-related potential and time frequency analyses. Compositional data analysis, testing for interactions between time point and compositions, will assess longitudinal associations between dependent (cognition, brain function) and independent (time-use and diet compositions) variables., Conclusions: The ACTIVate Study will be the first to examine associations between time-use and diet compositions, cognition and brain function. Our findings will inform new avenues for multidomain interventions that may more effectively account for the co-dependence between activity and diet behaviours for dementia prevention., Ethics and Dissemination: Ethics approval has been obtained from the University of South Australia's Human Research Ethics committee (202639). Findings will be disseminated through peer-reviewed manuscripts, conference presentations, targeted media releases and community engagement events., Trial Registration Number: Australia New Zealand Clinical Trials Registry (ACTRN12619001659190)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Diet-related self-identity, which includes components such as individuals' overall dietary pattern and food choice motivations, is a strong predictor of health behaviors. This study sought to assess the variation in dietary patterns reported by a sample of Australian adults and their associations with diet quality., Design: Cross-sectional survey., Participants: Australian adults (n = 2,010) VARIABLES MEASURED: The main outcome measure was diet quality relative to the Australian Dietary Guidelines, measured by the Healthy Diet Score survey. Other outcomes captured included dietary patterns (eg, unrestricted, vegetarian, flexitarian, or ketogenic diets), diet-related self-identity constructs (centrality, prosocial motivation, personal motivation, and strictness), and sociodemographic characteristics (eg, age, sex, and education level)., Analysis: Data were analyzed descriptively, and ordinary least squares regression was performed to identify significant predictors of diet quality., Results: Eighteen unique dietary patterns were reported. These were classified into 3 categories on the basis of the degree of restriction of core food groups. Diets based on restriction of animal protein were associated with the highest diet quality, including the highest consumption of fruits, vegetables, and whole grains, whereas restriction of other foods was associated with the poorest diet quality. Unrestricted diets reported the highest consumption of discretionary food (high in saturated fat, salt, or added sugar). Finally, the regression analysis found that diet quality was significantly predicted by dietary pattern and diet-related self-identity constructs (F[8, 1974] = 54.952; P < 0.0001; adjusted R 2  = 0.179)., Conclusions and Implications: Dietary pattern and diet-related self-identity constructs are key determinants of diet quality. This has implications for future interventions, including that programs and messages could be tailored to ensure they align with the target population's self-identity and overall dietary patterns., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: The 2013 Australian Dietary Guidelines (ADG) have been criticised for making only brief reference to sustainability considerations. With the ADG currently under review, the purpose of this rapid review was to determine the environmental impacts associated with food consumption in Australia and New Zealand., Recent Findings: Of the 20 articles included, greenhouse gas emissions (GHGe) were the most common environmental indicator (n = 12), followed by water use and water footprint (n = 7), and carbon footprint (n = 3). Whilst there are commonalities between different environmental indicators such as the large impact of discretionary food consumption on GHGe, cropland scarcity footprint, and water scarcity footprint, there is wide variation in these indicators for other food groups. Furthermore, modelling of current food consumption data to the recommended diet does not necessarily result in improvement of all indicators. The next iteration of the ADG should promote consumption of foods and dietary patterns that are associated with positive health and environmental outcomes., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Whilst there is considerable evidence to support the efficacy of physical activity and dietary interventions in disease and death prevention, translation of knowledge into practice remains inadequate. We aimed to examine the uptake, retention, acceptability and effectiveness on physical activity, physical function, sitting time, diet and health outcomes of a Healthy Eating Activity and Lifestyle program (HEAL TM ) delivered under real-world conditions. The program was delivered to 430 adults living across rural South Australia. Participants of the program attended weekly 2 h healthy lifestyle education and exercise group-based sessions for 8 weeks. A total of 47 programs were delivered in over 15 communities. In total, 548 referrals were received, resulting in 430 participants receiving the intervention (78% uptake). At baseline, 74.6% of participants were female, the mean age of participants was 53.7 years and 11.1% of participants identified as Aboriginal and/or Torres Strait Islander. Follow-up assessments were obtained for 265 participants. Significant improvements were observed for walking, planned physical activity, incidental physical activity, total physical activity, 30 s chair stand, 30 s arm curl, 6 min walk, fruit consumption and vegetable consumption, sitting time and diastolic blood pressure. Positive satisfaction and favourable feedback were reported. The healthy lifestyle program achieved excellent real-world uptake and effectiveness, reasonable intervention attendance and strong program acceptability amongst rural and vulnerable communities.

Co-design, the method of involving users, stakeholders, and practitioners in the process of design, may assist to improve the translation of health evidence into tangible and acceptable intervention prototypes. The primary objective of this review was to identify and describe co-design techniques used in nutrition research. The secondary objective was to identify associations between co-design techniques and intervention effectiveness. An integrative review was performed using the databases Emcare, MEDLINE, PsycINFO and Google Scholar. Eligible studies included those that: (1) utilised participatory research or co-design techniques, (2) described development and/or evaluation of interventions aimed at improving dietary behaviours or nutrition, and (3) targeted community-dwelling adults aged ≥18 years. We identified 2587 studies in the initial search and included 22 eligible studies. There were 15 studies that utilised co-design techniques, with a strong focus on engagement of multiple stakeholder types and use of participatory research techniques. No study implemented a complete co-design process. Most studies (14/15) reporting outcomes reported positive health (maximum p < 0.001) or health behaviour outcomes attributed to the intervention; hence, associations between co-design techniques and effectiveness could not be determined. Currently published intervention studies have used participatory research approaches rather than co-design methods. Future research is required to explore the effectiveness of co-design nutrition interventions.

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

The association between the consumption of ultra-processed food (UPF) with overweight/obesity in Chinese adults has not been investigated. This study included a cohort of 12,451 adults aged >20 years who participated at least twice in the China Nutrition and Health Survey (CNHS) during 1997-2011. Food intake at each survey was assessed using a 3-day 24-h dietary recall. Body weight (kg), height (m), and waist circumference (WC) were measured during the survey. UPF was defined by the NOVA classification. Mixed effect logistic regression analyses were used. The mean UPF consumption of the study population (baseline mean age 43.7 years) increased from 12.0 g in 1997 to 41.5 g in 2011 with the corresponding proportion of UPF in daily diet from 1.0% to 3.6%. The adjusted odds ratios (95% CI) for BMI ≥ 25 kg/m 2 for those with mean UPF consumption of 1-19 g/d, 20-49 g/d, and ≥50 g/d were 1.45 (1.26-1.65), 1.34 (1.15-1.57), and 1.45 (1.21-1.74), respectively ( p -trend = 0.015), compared with the non-consumers. Similarly, the corresponding adjusted ORs (95% CI) for central obesity were 1.54 (1.38-1.72), 1.35 (1.19-1.54), and 1.50 (1.29-1.74). Higher long-term UPF consumption was associated with increased risk of overweight/obesity among Chinese adults.

Background: High milk intake has been associated with cardio-metabolic risk. We conducted a Mendelian Randomization (MR) study to obtain evidence for the causal relationship between milk consumption and cardio-metabolic traits using the lactase persistence (LCT-13910 C > T, rs4988235) variant as an instrumental variable., Methods: We tested the association of LCT genotype with milk consumption (for validation) and with cardio-metabolic traits (for a possible causal association) in a meta-analysis of the data from three large-scale population-based studies (1958 British Birth Cohort, Health and Retirement study, and UK Biobank) with up to 417,236 participants and using summary statistics from consortia meta-analyses on intermediate traits (N = 123,665-697,307) and extended to cover disease endpoints (N = 86,995-149,821)., Results: In the UK Biobank, carriers of 'T' allele of LCT variant were more likely to consume milk (P = 7.02 × 10 -14 ). In meta-analysis including UK Biobank, the 1958BC, the HRS, and consortia-based studies, under an additive model, 'T' allele was associated with higher body mass index (BMI) (P meta-analysis  = 4.68 × 10 -12 ) and lower total cholesterol (TC) (P = 2.40 × 10 -36 ), low-density lipoprotein cholesterol (LDL-C) (P = 2.08 × 10 -26 ) and high-density lipoprotein cholesterol (HDL-C) (P = 9.40 × 10 -13 ). In consortia meta-analyses, 'T' allele was associated with a lower risk of coronary artery disease (OR:0.86, 95% CI:0.75-0.99) but not with type 2 diabetes (OR:1.06, 95% CI:0.97-1.16). Furthermore, the two-sample MR analysis showed a causal association between genetically instrumented milk intake and higher BMI (P = 3.60 × 10 -5 ) and body fat (total body fat, leg fat, arm fat and trunk fat; P < 1.37 × 10 -6 ) and lower LDL-C (P = 3.60 × 10 -6 ), TC (P = 1.90 × 10 -6 ) and HDL-C (P = 3.00 × 10 -5 )., Conclusions: Our large-scale MR study provides genetic evidence for the association of milk consumption with higher BMI but lower serum cholesterol levels. These data suggest no need to limit milk intakes with respect to cardiovascular disease risk, with the suggested benefits requiring confirmation in further studies., (© 2021. The Author(s).)

The association between egg consumption and diabetes is inconclusive. We aimed to examine the association between long-term egg consumption and its trajectory with diabetes in Chinese adults. A total of 8545 adults aged ≥18 years old who attended the China Health and Nutrition Survey from 1991 to 2009 were included in this analysis. Egg consumption at each survey was assessed by a 3-d 24-h recall and weighed food record methods. The consumption trajectories of eggs were modelled with the latent class group approach. Diabetes was diagnosed based on fasting blood glucose in 2009. Logistic regression was used to examine the association. The mean age of the study population was 50·9 (sd 15·1) years. About 11·1 % had diabetes in 2009. Egg consumption nearly doubled in 2009 from 16 g/d in 1991. Compared with the first quartile of egg consumption (0-9·0 g/d), the adjusted OR of diabetes for the second (9·1-20·6 g/d), third (20·7-37·5 g/d) and fourth (≥37·6 g/d) quartiles were 1·29 (95 % CI 1·03, 1·62), 1·37 (95 % CI 1·09, 1·72) and 1·25 (95 % CI 1·04, 1·64), respectively (Pfor trend = 0·029). Three trajectory groups of egg consumption were identified. Compared with group 1 (30·7 %, low baseline intake and slight increase), both group 2 (62·2 %, medium baseline intake and increase) and group 3 (7·1 %, high baseline intake and decrease) were associated with an increased OR for diabetes. The results suggested that higher egg consumption was positively associated with the risk of diabetes in Chinese adults.

Objective: To investigate associations between early-life diet trajectories and preclinical cardiovascular phenotypes and metabolic risk by age 12 years., Methods: Participants were 1861 children (51% male) from the Longitudinal Study of Australian Children. At five biennial waves from 2-3 to 10-11 years: Every 2 years from 2006 to 2014, diet quality scores were collected from brief 24-h parent/self-reported dietary recalls and then classified using group-based trajectory modeling as 'never healthy' (7%), 'becoming less healthy' (17%), 'moderately healthy' (21%), and 'always healthy' (56%). At 11-12 years: During children's physical health Child Health CheckPoint (2015-2016), we measured cardiovascular functional (resting heart rate, blood pressure, pulse wave velocity, carotid elasticity/distensibility) and structural (carotid intima-media thickness, retinal microvasculature) phenotypes, and metabolic risk score (composite of body mass index z-score, systolic blood pressure, high-density lipoproteins cholesterol, triglycerides, and glucose). Associations were estimated using linear regression models (n = 1100-1800) adjusted for age, sex, and socioeconomic position., Results: Compared to 'always healthy', the 'never healthy' trajectory had higher resting heart rate (2.6 bpm, 95% CI 0.4, 4.7) and metabolic risk score (0.23, 95% CI 0.01, 0.45), and lower arterial elasticity (-0.3% per 10 mmHg, 95% CI -0.6, -0.1) and distensibility (-1.2%, 95% CI -1.9, -0.5) (all effect sizes 0.3-0.4). Heart rate, distensibility, and diastolic blood pressure were progressively poorer for less healthy diet trajectories (linear trends p ≤ 0.02). Effects for systolic blood pressure, pulse wave velocity, and structural phenotypes were less evident., Conclusions: Children following the least healthy diet trajectory had poorer functional cardiovascular phenotypes and metabolic syndrome risk, including higher resting heart rate, one of the strongest precursors of all-cause mortality. Structural phenotypes were not associated with diet trajectories, suggesting the window to prevent permanent changes remains open to at least late childhood.

Background & Aims: Evidence regarding associations between potato consumption and type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) risks is accumulating. This study aims to synthesize the evidence by conducting a meta-analysis of available studies., Methods: PubMed, Web of Science, EMBASE and Cochrane Library were searched (up to August 2020) to retrieve all eligible studies on the associations of interest. The risk estimates with 95% confidence intervals (CIs) were summarized using random- or fixed-effects model based on heterogeneity. Meta-analyses were performed for East and West regions separately. Dose-response relationship was assessed using data from all intake categories in each study., Results: A total of 19 studies (13 for T2D; 6 for GDM) were identified, including 21,357 T2D cases among 323,475 participants and 1516 GDM cases among 29,288 pregnancies. Meta-analysis detected a significantly positive association with T2D risk for total potato (RR: 1.19 [1.06, 1.34]), baked/boiled/mashed potato (RR: 1.08 [1.00, 1.16]), and French fries/fried potato (RR: 1.33 [1.03, 1.70]) intakes among Western populations. Dose-response meta-analysis demonstrated a significantly increased T2D risk by 10% (95% CI: 1.07, 1.14; P for trend<0.001), 2% (95% CI: 1.00, 1.04; P for trend = 0.02) and 34% (95% CI: 1.24, 1.46; P for trend<0.001) for each 80 g/day (serving) increment in total potato, unfried potato, and fried potato intakes, respectively. As for GDM, summarized estimates also suggested a higher though non-significant GDM risk for total potato (RR: 1.19 [0.89, 1.58]), and French fries/fried potato (RR: 1.03 [0.97, 1.09]) intakes in Western countries. In the dose-response meta-analysis, a significantly increased GDM risk was revealed for each daily serving (80 g) intakes of total potato (RR: 1.22; 95% CI: 1.06, 1.42; P for trend = 0.007) and unfried potato (RR: 1.26; 95% CI: 1.07, 1.48; P for trend = 0.006)., Conclusions: This study suggests that higher potato intake is associated with higher T2D risk among Western populations. The positive relationship presents a significant dose-response manner. Wisely controlled potato consumption may confer potential glucometabolic benefits., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents., Methods: A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models., Discussion: Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy., Trial Registration: Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.

Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders ( n = 322) had overweight or obesity, and 34% ( n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the "5:2 diet"), but only 12% ( n = 34) had tried it. Open comments ( n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary., Competing Interests: The authors declare no conflict of interest.

Artificial intelligence virtual health assistants are a promising emerging technology. This study is a process evaluation of a 12-week pilot physical activity and diet program delivered by virtual assistant "Paola". This single-arm repeated measures study ( n = 28, aged 45-75 years) was evaluated on technical performance (accuracy of conversational exchanges), engagement (number of weekly check-ins completed), adherence (percentage of step goal and recommended food servings), and user feedback. Paola correctly asked scripted questions and responded to participants during the check-ins 97% and 96% of the time, respectively, but correctly responded to spontaneous exchanges only 21% of the time. Participants completed 63% of weekly check-ins and conducted a total of 3648 exchanges. Mean dietary adherence was 91% and was lowest for discretionary foods, grains, red meat, and vegetables. Participants met their step goal 59% of the time. Participants enjoyed the program and found Paola useful during check-ins but not for spontaneous exchanges. More in-depth knowledge, personalized advice and spontaneity were identified as important improvements. Virtual health assistants should ensure an adequate knowledge base and ability to recognize intents and entities, include personality and spontaneity, and provide ongoing technical troubleshooting of the virtual assistant to ensure the assistant remains effective.

Background: The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear., Objective: We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity., Methods: This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m 2 , and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes., Results: Among the 1298 participants, 375 (28.89%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (-1.08 kg, 95% CI -1.41 to -0.75 vs -1.57 kg, 95% CI -1.92 to -1.22 vs -0.66 kg, 95% CI -0.98 to -0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3%, 95% CI 1% to 6% vs 5%, 95% CI 2% to 8% vs -3%, 95% CI -5% to 0%) and fruits (9%, 95% CI 6% to 12% vs 6%, 95% CI 2% to 9% vs 2%, 95% CI 0% to 6%) and a larger reduction in ultraprocessed food intake (-18%, 95% CI -23% to -13% vs -25%, 95% CI -30% to -20% vs -12%, 95% CI -16% to -8%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (≥5%) weight loss (odds ratio 1.02, 95% CI 1.01 to 1.04)., Conclusions: The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss., Trial Registration: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445., International Registered Report Identifier (irrid): RR2-10.2196/10.1186/s12889-018-5882-y., (©Alline Beleigoli, Andre Q Andrade, Maria De Fatima Diniz, Antonio Luiz Ribeiro. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.11.2020.)

Background: Coffee is the most commonly consumed beverage in the world after water, however the debate as to whether coffee consumption is beneficial or detrimental to health continues. Current evidence of the link between coffee and health outcomes is predominately observational, thus subject to methodological issues such a confounding and reverse causation., Methods: This Mendelian randomisation phenome-wide association study (MR-PheWAS) used information from up to 333,214 participants of White-British ancestry in the UK Biobank to examine the causal association between genetically instrumented habitual coffee consumption and the full range of disease outcomes. We constructed a genetic risk score for habitual coffee consumption and screened for associations with disease outcomes across 1117 case-control series. All signals under false discovery rate controlled threshold (5.8 × 10 -4 ) were followed by Mendelian randomisation (MR) analyses, with replication in independent data sources where possible., Results: The initial phenome-wide association analysis identified signals for 13 outcomes representing five distinct diseases. The strongest signal was seen for gout (P = 2.3 × 10 -1 2 <0.001) and MR analyses did not support an association with habitual coffee consumption (inverse variance weighted MR OR 0.41, 95% CI 0.08 to 2.25, P = 0.31). Support for a possible causal relationship between habitual coffee consumption was only obtained for four distinct disease outcomes, including an increased odds of osteoarthrosis (OR 1.23, 95% CI 1.11 to 1.35), other arthropathies (OR 1.22, 95% CI 1.12 to 1.33) and overweight (OR 1.28, 95% CI 1.05 to 1.56), and a lower odds of postmenopausal bleeding (OR 0.72, 95% CI 0.63 to 0.82). Evidence for an association between habitual coffee consumption and these four diseases was also supported by phenotypic associations with self-reported coffee consumption.distortion <0.001) and MR analyses did not support an association with habitual coffee consumption (inverse variance weighted MR OR 0.41, 95% CI 0.08 to 2.25, P = 0.31). Support for a possible causal relationship between habitual coffee consumption was only obtained for four distinct disease outcomes, including an increased odds of osteoarthrosis (OR 1.23, 95% CI 1.11 to 1.35), other arthropathies (OR 1.22, 95% CI 1.12 to 1.33) and overweight (OR 1.28, 95% CI 1.05 to 1.56), and a lower odds of postmenopausal bleeding (OR 0.72, 95% CI 0.63 to 0.82). Evidence for an association between habitual coffee consumption and these four diseases was also supported by phenotypic associations with self-reported coffee consumption., Conclusions: This large-scale MR-PheWAS provided little evidence for notable harm or benefit with respect to higher habitual coffee consumption. The only evidence for harm was seen with respect to osteoarthrosis, other arthropathies and obesity., Competing Interests: Conflict of interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The role of the retail food environment in obesity risk is unclear, which may be due in part to the lack of consideration of individual differences in the responsivity to food cues. This cross-sectional investigation geo-temporally linked the CARTaGENE biobank (including genetic, dietary, lifestyle, and anthropometric data) with in-store retail food environment data to examine interactions between a polygenic risk score (PRS) for obesity and (1) diet quality ( n = 6807) and (2) in-store retail food measures ( n = 3718). The outcomes included adiposity-related measures and diet quality assessed using the 2010 Canadian-adapted Healthy Eating Index. A vegetable:soft drink ratio was constructed for each retail measure to assess the relative healthfulness of exposures. Generalized linear models adjusted for individual and neighborhood socio-demographic factors were used to evaluate main and interactive effects. Diet quality significantly modified the association between polygenic risk of obesity and body mass index, waist circumference, and body fat percent. A significant interaction was also observed between PRS and frequency of price discount of vegetables in relation to soft drinks on waist circumference. These results replicate previous reports of diet moderating polygenic risk of obesity and suggest that prices of low vs. high-energy density foods are an intervention target to address population obesity rates.

Naturally occurring metals and metalloids [metal(loid)s] are essential for the physiological functioning of wildlife; however, environmental contamination by metal(loid) and plastic pollutants is a health hazard. Metal(loid)s may interact with plastic in the environment and there is mixed evidence about whether plastic ingested by wildlife affects metal(loid) absorption/assimilation and concentration in the body. We examined ingested plastic and liver concentration of eleven metal(loid)s in two seabird species: fairy (Pachyptila turtur) and slender-billed prions (P. belcheri). We found significant relationships between ingested plastic and the concentrations of aluminium (Al), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu) and zinc (Zn) in the liver of prions. We investigated whether the pattern of significant relationships reflected plastic-metal(loid) associations predicted in the scientific literature, including by transfer of metals from ingested plastics or malnutrition due to dietary dilution by plastics in the gut. We found some support for both associations, suggesting that ingested plastic may be connected with dietary dilution / lack of essential nutrients, especially iron, and potential transfer of zinc. We did not find a relationship between plastic and non-essential metal(loid)s, including lead. The effect of plastic was minor compared to that of dietary exposure to metal(oid)s, and small plastic loads (< 3 items) had no discernible link with metal(loid)s. This new evidence shows a relationship between plastic ingestion and liver metal(loid) concentrations in free-living wildlife.

Poor diet and lifestyle exposures are implicated in substantial global increases in non-communicable disease burden in low-income, remote, and Indigenous communities. This observational study investigated the contribution of the fecal microbiome to influence host physiology in two Indigenous communities in the Torres Strait Islands: Mer, a remote island where a traditional diet predominates, and Waiben a more accessible island with greater access to takeaway food and alcohol. Counterintuitively, disease markers were more pronounced in Mer residents. However, island-specific differences in disease risk were explained, in part, by microbiome traits. The absence of Alistipes onderdonkii , for example, significantly (p=0.014) moderated island-specific patterns of systolic blood pressure in multivariate-adjusted models. We also report mediatory relationships between traits of the fecal metagenome, disease markers, and risk exposures. Understanding how intestinal microbiome traits influence response to disease risk exposures is critical for the development of strategies that mitigate the growing burden of cardiometabolic disease in these communities., Competing Interests: FM, LL, FT, ST, LH, JC, ST, SW, RM, KI, GR No competing interests declared, (© 2020, Mobegi et al.)

Background: The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales., Methods: In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280., Findings: Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5)., Interpretation: Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains., Funding: Australian National Health and Medical Research Council., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale., Objective: This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach., Methods: This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure., Results: Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI -0.1 to -2.5 kg) and 2.1 cm from their waist circumference (95% CI -3.5 to -0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events)., Conclusions: An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted., (©Carol Ann Maher, Courtney Rose Davis, Rachel Grace Curtis, Camille Elizabeth Short, Karen Joy Murphy. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 10.07.2020.)

Dietary advanced glycation end products (AGEs) are believed to contribute to pathogenesis of diabetes and cardiovascular disease. The objective of this study was to determine if a diet high in red and processed meat and refined grains (HMD) would elevate plasma concentrations of protein-bound AGEs compared with an energy-matched diet high in whole grain, dairy, nuts and legumes (HWD). We conducted a randomized crossover trial with two 4-week weight-stable dietary interventions in 51 participants without type 2 diabetes (15 men and 36 women aged 35.1 ± 15.6 y; body mass index (BMI), 27.7 ± 6.9 kg/m 2 ). Plasma concentrations of protein-bound Nε-(carboxymethyl) lysine (CML), Nε-(1-carboxyethyl) lysine (CEL) and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The HMD significantly increased plasma concentrations (nmol/mL) of CEL (1.367, 0.78 vs. 1.096, 0.65; p < 0.01; n = 48) compared with the HWD. No differences in CML and MG-H1 between HMD and HWD were observed. HMD increased plasma CEL concentrations compared with HWD in individuals without type 2 diabetes., Competing Interests: The authors report no conflicts of interest.

Background Dietary intake of long-chain omega 3 (n-3) polyunsaturated fatty acids (LCPUFA) represents a putative modifiable risk factor for depression, and a high ratio of omega 6 (n-6) to n-3 LCPUFA is frequently observed in patients with major depressive disorder. Recent reports suggest that the availability of fish and seafood may be associated with lower depression rates. The aim of this study was to investigate associations of fish consumption and LCPUFA levels with depressive symptoms. Methods Participants for this cross-sectional study ( n =206) were recruited at a community screening programme in two Torres Strait Islander communities (Mer and Waiben). Depressive symptoms were assessed with the adapted Patient Health Questionnaire-9 (aPHQ-9) and diet with a structured questionnaire. LCPUFA concentrations were measured with a capillary dried blood spot system (PUFAcoat). Logistic and quantile regression modelling was used to test the relationship between seafood consumption, membrane LCPUFAs and depression scores. Results A higher blood n-6/3 LCPUFA ratio was associated with moderate/severe depression scores across both study sites (OR=1.59 (95%CI 1.09-2.34), P  = .017). Seafood consumption was higher and the proportion of participants with aPHQ-9 scores above the cut-off for depression was lower on Mer ( n  = 100) compared with Waiben ( n  = 106). Higher seafood consumption was associated with lower depression scores on Waiben ( B  = -0.57 (95%CI -0.98 - -0.16), P  = .006) but not on Mer. Conclusions Our findings support an association of n-3 LCPUFA from natural sources with depressive symptoms. The availability of fresh seafood in the local diet may represent a protective factor for depression in this setting.

Background: Higher intakes of flavonoids provide health benefits, however, the importance of each flavonoid class and which population groups may receive the greatest protection from higher flavonoid intake warrants further investigation., Objective: To explore the associations of flavonoid and flavonoid-rich wholefood intakes with all-cause mortality and the moderating effects of early mortality risk factors., Design: The study included 2349 participants of The Blue Mountains Eye Study, with a mean ± SD age at baseline of 64.7 ± 9.2 years. Flavonoid intake was calculated from baseline food frequency questionnaires using US Department of Agriculture food composition databases. Associations were examined using adjusted Cox proportional hazards models., Results: After 14 years of follow-up, 677 participants died. There was a flavonoid threshold effect with the greatest risk reduction seen between low and moderate intakes of total flavonoids, flavonoid classes and flavonoid-rich foods. Amongst the whole cohort, participants in the highest tertile of anthocyanidin intake had a significantly lower risk of all-cause mortality [multivariable adjusted HR (95%CI): 0.76 (0.61, 0.94)] when compared to those in the lowest tertile. Amongst participants with at least one early mortality risk factor (smoking, high alcohol consumption, no regular exercise or obesity), risk of all-cause mortality was lower in those in the highest intake tertile for total flavonoids [adjusted HR: 0.77 (0.59, 1.00)], flavan-3-ols [0.75 (0.58, 0.98)], anthocyanidins [0.70 (0.54, 0.92)], and proanthocyanidins [0.69 (0.52, 0.92)], compared to those in the lowest tertile. No similar associations were observed among those without any risk factors. Similarly, consumption of apples, tea and the individual flavonoid compounds, quercetin and epicatechin, were associated with a lower risk of all-cause mortality among participants with at least one risk factor, but not amongst other participants., Conclusion: Moderate to high intakes of flavonoids and certain flavonoid subclasses may provide health benefits, particularly for individuals with at least one early mortality risk factor., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

In order to better understand the events that precede and precipitate the onset of type 2 diabetes (T2DM), several nutritional animal models have been developed. These models are generated by manipulating the diet of either the animal itself, or its mother during her pregnancy, and in comparison to traditional genetic and knock out models, have the advantage that they more accurately reflect the etiology of human T2DM. This chapter will discuss some of the most widely used nutritional models of T2DM: Diet-induced obesity (DIO) in adult rodents, and studies of offspring of mothers fed a low-protein, high-fat and/or high-sugar diet during pregnancy and/or lactation. Several common mechanisms have been identified through which these nutritional manipulations can lead to metabolic disease, including pancreatic beta-cell dysfunction, impaired insulin signaling in skeletal muscle, and the excess accumulation of visceral adipose tissue and consequent deposition of nonesterified fatty acids in peripheral tissues. In addition, there is an emerging concept that obesity/poor quality diets result in increased production and release of pro-inflammatory cytokines from adipose tissue leading to a state of chronic low-grade inflammation, and that this is likely to represent an important link between obesity/diet and metabolic dysfunction. The following chapter will discuss the most common nutritional models of T2DM in experimental animals, their application, and relationship to human etiology, and will highlight the important insights these models have provided into the pathogenesis of T2DM.

Aim We aimed to determine if nut consumption decreases mortality and/or the risk of cardiometabolic diseases based on updated meta-analyses of epidemiological and intervention studies., Methods: An updated electronic search was conducted in PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library databases for original meta-analyses to investigate the effects of nut consumption on cardiometabolic disease in humans., Results: Seven new meta-analyses were included in this updated review. Findings similar to our previous review were observed, showing that nut consumption significantly decreased cardiovascular disease (CVD) mortality (-19% to -25%; n = 4), coronary heart disease (CHD) mortality (-24% to -30%; n = 3), stroke mortality (-17% to -18%; n = 3), CVD incidence (-15% to -19 %; n = 4), CHD [or coronary artery disease (CAD)] incidence (-17% to -34%; n = 8), and stroke incidence (-10% to -11%; n = 6) comparing high with low categories of nut consumption. Fasting glucose levels (0.08 to 0.15 mmol/L; n = 6), total cholesterol (TC; 0.021 to 0.30 mmol/L; n = 10), and low-density lipoprotein cholesterol (LDL-C; 0.017 to 0.26 mmol/L; n = 10) were significantly decreased with nut consumption compared with control diets. Body weight and blood pressure were not significantly affected by nut consumption., Conclusion: Nut consumption appears to exert a protective effect on cardiometabolic disease, possibly through improved concentrations of fasting glucose, total cholesterol, and LDL-C.

Background & Aims: Given the enormous health, economic and societal consequences of the obesity pandemic, identifying effective primary prevention strategies represents a global priority. The aim of this study was to provide evidence on the association between adherence to a food-based score reflecting a set of targeted, well-informed, simple dietary recommendations and the incidence of overweight/obesity., Methods: A total of 11,349 initially free of overweight/obesity young adults (mean [SD] age: 34.7 y [10.7]), were followed up biennially during a median of 9.3 years. The Dietary Obesity-Prevention Score (DOS) was created based on a priori evidence of foods associated with weight changes. The DOS positively weighted the consumption of vegetables, fruits, legumes, yogurt, nuts, fish, and a ratio of vegetable to animal protein; whereas the consumption of red meat, processed meat, saturated animal fat, refined grains, ultra-processed food, sugary beverages, beer and spirits were inversely weighted. Energy-adjusted tertiles of each item were used to build the DOS, ranging from 14 (lowest adherence) to 42 points (highest adherence). Adherence to the DOS was calculated at baseline and after 10 years of follow-up. We assessed both incident overweight/obesity (BMI ≥25 kg/m 2 ) and average yearly weight changes in grams per year (g/y)., Results: During 104,887 person-years, 2153 incident cases of overweight/obesity were identified. A higher adherence to the DOS at baseline was significantly associated with lower risk of future development of overweight/obesity [multivariable-adjusted HR (95% CI) for the highest vs. lowest quintile = 0.63 (0.54-0.74)], with a significant linear dose-response relationship (p for trend < 0.001). When the analyses were updated with repeated measures, the results were similar and remained statistically significant. Consistently, increases in average yearly weight gain were significantly lower with better adherence to the DOS., Conclusions: In this Mediterranean cohort of university graduates, a higher adherence to a food-based score was significantly associated with lower risk of overweight/obesity and lower average annual weight gain. These findings may help counsel patients regarding dietary risks and raise awareness of weight gain before the onset of overweight/obesity., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Purpose: To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment., Methods: Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis. This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941)., Results: Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies., Conclusion: Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors., Implications for Cancer Survivors: At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity of research on this subject, necessitating further investigations.

(1) Background: Night shift workers have greater risks of developing cardiometabolic diseases compared to day workers due to poor sleep quality and dietary habits, exacerbated by circadian misalignment. Assessing effects of dietary interventions on health outcomes among this group will highlight gaps for future research. (2) Methods: A search of studies was conducted on PubMed, Cochrane Library, Embase, Embase Classic, Ovid Emcare, and Google Scholar, from earliest to June 2019. The population-intervention-comparator-outcomes-study design format determined inclusion criteria. (3) Results: 756 articles were retrieved; five met inclusion and exclusion criteria. Six-hundred-and-seventy night shift workers were from healthcare, industrial, and public safety industries. Dietary interventions included two longer-term nutrition programs and three shorter-term adjustments of meal composition, type, and timing. Outcome measures were varied but included weight and cardiometabolic health measures. Nutrition programs found no weight improvement at both six and 12 months; low-density lipoprotein (LDL)-cholesterol levels decreased at six months. Triglycerides peaked after meals at 7:30 pm; glucose and insulin area under the curve peaked after meals at 11:30 pm. (4) Conclusions: Weight loss was not achieved in the studies reviewed but LDL-cholesterol improved. Future studies should investigate the effects of energy reduction and altering meal timing on cardiometabolic risk factors of night shift workers in randomised controlled trials, while assessing hunger, sleepiness, and performance.

Introduction: High iron intake has been shown to be associated with poor cognition. We aimed to examine the association between iron-related dietary pattern (IDP) and cognitive function in Chinese adults., Method: Longitudinal study data from the China Health and Nutrition Survey (CHNS) during 1991-2006 were used (N = 4852, ≥55 years old). Dietary intake was obtained from a 3-day food record during home visits. Reduced rank regression was used to construct IDP with iron intake as a response variable. Cognitive function was assessed in 1997, 2000, 2004 and 2006. Multivariable mixed linear regression and logistic regression were used in the analyses., Results: IDP was characterised by high intake of fresh vegetable, wheat, legume, beverage, offal, rice and whole grain. High IDP intake was associated with poor cognition. In fully adjusted models, across the quartiles of IDP, the odds ratio (95% CI) for poor cognitive function were: 1.00, 1.06 (0.86-1.30), 1.24 (0.99-1.54), and 1.50 (1.17-1.93), respectively. There was a borderline significant interaction between IDP and meat intake (p interaction 0.085). The association between high IDP and poor cognition was only observed among those with no or low intake of meat. With the adjustment of carbohydrate or iron intake, the IDP and cognition association became non-significant. IDP was positively associated with lead intake. The association between IDP and poor cognition was partly mediated by lead intake., Conclusions: Iron-related dietary pattern is associated with poor cognition in Chinese adults, partly due to high intake of carbohydrate, iron and lead.

Parents are an ideal target to reduce children's unhealthy food intake. Motivation is one component of behavior change; however, there is a paucity of research exploring parental motivation in unhealthy food provision. This study aimed to understand the relationships between, and relative importance of, constructs of parents' reflective motivation and children's intake of unhealthy foods. An online survey captured parent-rated reflective motivation constructs based on the health action process approach (HAPA) model, and children's intake of unhealthy food using the short food survey. The HAPA model includes constructs of self-efficacy, risk perception, outcome expectancies, intention, and planning. Structural equation modelling was used to examine relationships between constructs and the HAPA model in its structural form. Four-hundred and ninety-five parents of three to seven-year olds completed the study. Model fit statistics (X 2 = 210.03, df = 83, p < 0.001; Comparative fit index (CFI) = 0.96; Tucker Lewis index (TLI) = 0.94) supported suitability of the HAPA model. The HAPA model explained 9.2% of the variance in children's unhealthy food intake. Constructs of self-efficacy (action to maintenance β = 0.69; maintenance to recovery β = 0.70; maintenance to planning β = 0.82) were found to be the most important constructs for reducing children's unhealthy food intake, followed by planning (to unhealthy food intake β = -0.32) and intention (to planning β = 0.21). This study provides an initial insight into parental motivation and identifies primary intervention targets to enhance parental motivation to reduce unhealthy food provision, and subsequently children's unhealthy food intake.