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Background We piloted an educational intervention that aimed to enhance awareness about nutrition-age-related macular degeneration (AMD) links among practising and student dietitians then expanded the scope of this intervention to include general eye health, which was delivered to pharmacy students. Methods A pilot intervention was conducted in 2019 at the Dietitians Australia Conference (Gold Coast, Australia) where practising and student dietitians underwent a 2-hour small group educational workshop on nutrition and AMD links. Pre-post questionnaires were administered to participants, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcome was a change in AMD-related nutrition knowledge pre-post intervention. A larger intervention was then conducted at the University of Sydney (Sydney, Australia) where pharmacy students underwent a 4-hour educational module to improve general eye health knowledge, as well as student perceptions and attitudes towards a pharmacists’ role in low vision care. Similarly, pre-post questionnaires were administered, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcomes were changes in total knowledge, total perception and total attitude scores pre-post intervention. Results (1) Among 10 accredited and 5 student dietitians, there was significant overall knowledge improvement (mean pre-post score: 7.07 ± 1.94 vs. 10.8 ± 1.01, p = 0.001) specifically around appropriate dietary advice, food sources of key AMD-related nutrients, and awareness of supplements. (2) Among 179 second-year pharmacy students enrolled in the ‘Pharmacy Practice’ Unit of Study (Bachelor of Pharmacy, University of Sydney), total eye health knowledge (6.25 ± 1.93 vs. 6.64 ± 2.0; p = 0.011) significantly improved, along with total perception scores (41.54 ± 5.26 vs. 42.45 ± 4.95; p = 0.004). Total attitude scores were not significantly different. Conclusions The pilot intervention improved relevant nutrition-AMD knowledge among practising/student dietitians. The modified intervention for pharmacy students also significantly improved general eye health knowledge as well as students’ perception of a pharmacists’ role in low vision care.

AIMS To evaluate the nutrition knowledge of elite Australian athletes, and to obtain feedback from sports dietitians on the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaires' (PEAKS-NQ) suitability. METHODS Sports dietitians from the National Institute Network across Australia recruited athletes to complete the online, 50-item PEAKS-NQ which contained two sections (General Nutrition and Sports Nutrition). Sports dietitians provided feedback on the PEAKS-NQ using a 14-item questionnaire (with two open-ended items). The main outcome measures were nutrition knowledge score and tool suitability (usefulness, acceptability and feasibility) scores. For knowledge scores, independent t-tests, ANOVA and Chi-square tests were used to evaluate differences between groups. Suitability was evaluated using descriptive statistics. RESULTS Twelve sports dietitians from the National Institute Network in Australia recruited a convenience sample of 240 athletes (21.3 ± 4.3 years, 63.5% female, 63.3% competed internationally). Athletes scored 70.7 ± 10.5%, with better general vs sports nutrition knowledge. Females had higher overall scores (P

The Maintain Your Brain (MYB) trial is one of the largest internet-delivered multidomain randomised controlled trial designed to target modifiable risk factors for dementia. It comprises four intervention modules: physical activity, nutrition, mental health and cognitive training. This paper explains the MYB Nutrition Module, which is a fully online intervention promoting the adoption of the ‘traditional’ Mediterranean Diet (MedDiet) pattern for those participants reporting dietary intake that does not indicate adherence to a Mediterranean-type cuisine or those who have chronic diseases/risk factors for dementia known to benefit from this type of diet. Participants who were eligible for the Nutrition Module were assigned to one of the three diet streams: Main, Malnutrition and Alcohol group, according to their medical history and adherence to the MedDiet at baseline. A short dietary questionnaire was administered weekly during the first 10 weeks and then monthly during the 3-year follow-up to monitor whether participants adopted or maintained the MedDiet pattern during the intervention. As the Nutrition Module is a fully online intervention, resources that promoted self-efficacy, self-management and process of change were important elements to be included in the module development. The Nutrition Module is unique in that it is able to individualise the dietary advice according to both the medical and dietary history of each participant; the results from this unique intervention will contribute substantively to the evidence that links the Mediterranean-type diet with cognitive function and the prevention of dementia and will increase our understanding of the benefits of a MedDiet in a Western country.

BACKGROUND Longitudinal data investigating tracking of children's lifestyle behaviors and predictors of childhood obesity are limited. OBJECTIVES We examined changes in children's lifestyle behaviors (dietary, physical activity, and screen time) from ages 2-5 y to determine if maternal sociodemographic factors and BMI predict child obesity at 3.5 y and 5 y. METHODS Data were obtained from 667 first-time mothers who were recruited into the Healthy Beginnings Trial at 24-34 weeks of gestation in Sydney, Australia. Child lifestyle behaviors were assessed using face-to-face questionnaire interviews with mothers. To measure child and maternal anthropometry, BMI (in kg/m2) was calculated using measured height and weight. Children were categorized as overweight or obese based on the International Obesity Task Force criteria. We used 1-factor repeated-measures ANOVA to track preschoolers' lifestyle behaviors and multiple logistic regression to determine obesity predictors. RESULTS In children aged 2-5 y, consumption of vegetables (ηp2 = 0.06; P

Diet quality indices are a practical, cost-effective method to evaluate dietary patterns, yet few have investigated diet quality in athletes. This study describes the relative validity and reliability of the recently developed Athlete Diet Index (ADI). Participants completed the electronic ADI on two occasions, 2 weeks apart, followed by a 4-d estimated food record (4-dFR). Relative validity was evaluated by directly comparing mean scores of the two administrations (mAdm) against scores derived from 4-dFR using Spearman’s rank correlation coefficient and Bland–Altman (B–A) plots. Construct validity was investigated by comparing mAdm scores and 4-dFR-derived nutrient intakes using Spearman’s coefficient and independent t test. Test–retest reliability was assessed using paired t test, intraclass correlation coefficients (ICC) and B–A plots. Sixty-eight elite athletes (18·8 (sd 4·2) years) from an Australian sporting institute completed the ADI on both occasions. Mean score was 84·1 (sd 15·2; range 42·5–114·0). The ADI had good reliability (ICC = 0·80, 95 % CI 0·69, 0·87; P < 0·001), and B–A plots (mean 1·9; level of agreement −17·8, 21·7) showed no indication of systematic bias (y = 4·57–0·03 × x) (95 % CI −0·2, 0·1; P = 0·70). Relative validity was evaluated in fifty athletes who completed all study phases. Comparison of mAdm scores with 4-dFR-derived scores was moderate (rs 0·69; P < 0·001) with no systematic bias between methods of measurement (y = 6·90–0·04 × x) (95 % CI −0·3, 0·2; P = 0·73). Higher scores were associated with higher absolute nutrient intake consistent with a healthy dietary pattern. The ADI is a reliable tool with moderate validity, demonstrating its potential for application to investigate the diet quality of athletes.

Age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma remain the leading causes of visual impairment in developed nations, resulting in a substantial treatment burden on sufferers and health care systems. Despite significant advances in diagnostic testing and therapeutics, population-based strategies to reduce the burden of these diseases remain limited. However, there is some evidence that these diseases may share overlapping risk factors, particularly in regard to dietary intake and antioxidant status, and it is thus possible that dietary modification may reduce both the prevalence and severity of these conditions. In particular, dietary intake of green leafy vegetables, hyperglycemia/glycemia index, and omega-3 fatty acid intake, as well as overall dietary patterns, may affect risk of one or more of these conditions. In this review, we analyse the evidence for dietary intake and the association with these conditions, and provide insights into possible modifications that may thus simultaneously reduce the risk of visual impairment from multiple causes, including improving dietary intake of green leafy vegetables and reducing dietary glycemic index, both of which have been associated with a decreased risk of multiple causes of visual impairment.

AIM: Nutrition-based applications ("apps") offer enormous research potential, however evidence of their use and acceptability among older adults is limited. We compared self-reported and dietitian-adjusted dietary intake records among adults aged 55 to 75 years using the Research Food Diary (RFD) app. METHODS: Participants were recruited from the 45 and Up Study and completed a 3-day food record using the RFD. A follow-up dietetic telephone interview was performed to confirm the electronic dietary data. Independent of these interviews, a set of adjustments based on dietetic skills, nutritional database knowledge, food composition and dietary assessment was established to resolve probable reporting errors. The "adjusted" and "dietitian-assisted" records were compared to self-reported records for nutrient intakes and serves of The Five Food Groups using one-way repeated measures analysis of variance. RESULTS: Sixty-two participants were recruited, with 48 using the RFD app which included eight records without any identified errors. Reporting errors contained in the raw self-reported records included: food items with missing/implausible quantities or insufficient descriptions to allow automatic coding. After removal of unusable records, 44 records were analysed. Differences were found between the self-reported and adjusted records for protein, calcium, vitamin B12 , zinc and dairy food serves (all P

Background Research should inform clinical decision-making and evidence-based practice for all health professionals. To build research capacity among all health professionals, there is a need to measure the levels of research capacity and identify the gaps and needs of health-care professionals. The aim of the study was to better understand the research culture and capacity of health professionals (medical, nursing and allied health) in Western Sydney Local Health District, Sydney, Australia. Methods A research capacity and culture tool (RCCT) survey was electronically distributed to all health staff in WSLHD. Data were collected between November 2016 and January 2017. Participants were surveyed through a 10-point Likert scale that measured research capacity at the individual, team and organisational levels. Results A total of 393 health staff responded to the study: allied health practitioners (46.3%), nursing staff (35.4%) and medical practitioners (18.3%). Females made 76% of the sample, and 54% were aged between 35 and 54 years. Individual responses were different across professions, with an average median score for medical 6.3 (95% CI 5.8-6.9), allied health 5.3 (95% CI 4.9-5.7) and nursing 4.5 (95% CI 4.1-5.0) after adjustment for age and gender. Team responses for medical staff (average median score 5.9 95% CI 5.3-6.4) were higher than allied health (4.1 95% CI 3.7-4.6) and nursing (4.3 95% CI 3.8-4.8), after adjusting for age and gender. However, there were no differences between the three professions for the organisational responses. Allied health and nursing staff were less confident in obtaining research funding, submitting ethics applications, writing for publication and mentoring colleagues about research. Conclusion This study demonstrates the individual research capacity for medical, allied health and nursing professionals are different. Research capacity building needs to be individually tailored to the specific needs of each profession. This research will inform future capacity building activities and training for health professionals in a large public health organisation of Sydney, Australia.

Mediterranean diet interventions have demonstrated positive effects in the prevention and management of several chronic conditions in older adults. Understanding the effective components of behavioural interventions is essential for long-term health behaviour change and translating evidence-based interventions into practice. The aim of this scoping review is to provide an overview of the current Mediterranean diet interventions for older adults (≥55 years) and describe the behaviour change techniques used as part of the interventions. A scoping review systematically searched Medline, Embase, CINAHL, Web of Science, Scopus, and PsycINFO from inception until August 2022. Eligible studies were randomized and non-randomized experimental studies involving a Mediterranean or anti-inflammatory diet intervention in older adults (average age > 55 years). Screening was conducted independently by two authors, with discrepancies being resolved by the senior author. Behaviour change techniques were assessed using the Behaviour Change Technique Taxonomy (version 1), which details 93 hierarchical techniques grouped into 16 categories. From 2385 articles, 31 studies were included in the final synthesis. Ten behaviour change taxonomy groupings and 19 techniques were reported across the 31 interventions. The mean number of techniques used was 5, with a range from 2 to 9. Common techniques included instruction on how to perform the behaviour (n = 31), social support (n = 24), providing information from a credible source (n = 16), information about health consequences (n = 15), and adding objects to the environment (n = 12). Although behaviour change techniques are commonly reported across interventions, the use of the Behaviour Change Technique Taxonomy for intervention development is rare, and more than 80% of the available techniques are not being utilised. Integrating behaviour change techniques in the development and reporting of nutrition interventions for older adults is essential for effectively targeting behaviours in both research and practice.

While athletes’ nutrient intakes have been widely reported, few studies have assessed the diet quality of athletes. This is the first study to evaluate the diet quality of athletes using the purpose-built Athlete Diet Index (ADI). A convenience sample of 165 elite athletes from Australian sporting institutions completed the ADI online, with subsequent automated results provided to their respective accredited sports dietitians (ASDs). At the completion of athlete participation, ASDs (n = 12) responded to a range of survey items using a Likert scale (i.e., 1 = strongly agree to 5 = strongly disagree) to determine the suitability of the ADI in practice. Differences in ADI scores for demographics and sport-specific variables were investigated using independent t-tests, analysis of variance (ANOVA) and Bonferroni multiple comparisons. Spearman’s rank correlation was used to assess the association between total scores and demographics. The mean total ADI score was 91.4 ± 12.2 (range 53–117, out of a possible 125). While there was no difference in total scores based on demographics or sport-specific variables, team sport athletes scored higher than individual sport athletes (92.7 vs. 88.5, P &lt, 0.05). Athletes training fewer hours (i.e., 0–11 h/week) scored higher on Dietary Habits sub-scores compared with athletes training more hours (&gt, 12 h/week, P &lt, 0.05), suggesting that athletes who train longer may be at risk of a compromised dietary pattern or less than optimal nutrition practices that support training. Most (75%) ASDs surveyed strongly agreed with the perceived utility of the ADI for screening athletes and identifying areas for nutrition support, confirming its suitability for use in practice.

IntroductionGestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet.Methods and analysisThis multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome.Ethics and disseminationEthics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.Trial registration numberACTRN12620000615987; Pre-results.

This systematic review investigated the effects of weight-loss diets before elective surgery on preoperative weight loss and postoperative outcomes in people with obesity. Electronic databases were searched from inception to May 2021. Inclusion criteria were prospective cohort or randomised controlled studies that compared effects of weight-loss diets to standard care on postoperative outcomes in adults with obesity awaiting surgery. Participants with cancer or undergoing bariatric surgery were excluded. Data on preoperative weight change, length of stay, postoperative complications and patient-reported outcome measures were extracted and synthesised in meta-analyses. One randomised controlled trial involving total knee arthroplasty and two that investigated general surgery were eligible that included 173 participants overall. Each study compared low-calorie diets using meal replacement formulas to usual care. There is very-low-quality evidence of a statistically significant difference favouring the intervention for preoperative weight loss (mean difference [MD] -6.67 kg, 95% confidence interval [CI] -12.09 to -1.26 kg; p = 0.02) and low-quality evidence that preoperative weight-loss diets do not reduce postoperative complications to 30 days (odds ratio [OR] 0.34, 95% CI 0.08-1.42; p = 0.14) or length of stay (MD -3.72 h, 95% CI -10.76 to 3.32; p = 0.30). From the limited data that is of low quality, weight loss diets before elective surgery do not reduce postoperative complications.

The Mediterranean diet (MD) has significant benefits for cardiovascular disease (CVD), yet clinicians lack reliable tools to measure patient knowledge. This study aimed to develop a short tool to test knowledge of MD related to cardiac health. Themes included foods to reduce CVD risk factors, quantification of servings, and common MD dietary patterns, a maximum score of 42 was determined for correct responses. Content validity was assessed through expert consensus in a Delphi survey. A 70% level of agreement was set for each domain tested. Repeatability was assessed via a test-retest protocol in a sample with self-reported CVD, advertised through social media and administered online. Ten and six of twenty-five invited experts responded to round one and two of the Delphi survey respectively. All items achieved greater than 70% consensus. Twenty people completed the repeatability study. A paired t-test found no significant difference in mean scores between the two test periods (Test one, 28 (standard deviation (SD) 5.4). Test two 29.5, (SD 5.5), p = 0.174) and a Bland-Altman Plot indicated no bias between the two surveys. The Med-NKQ demonstrated good content validity and reliability in people with CVD, and is short and easy to administer, making it practical in clinical and research settings.

Food-based diet indices provide a practical, rapid, and inexpensive way of evaluating dietary intake. Rather than nutrients, diet indices assess the intake of whole foods and dietary patterns, and compare these with nutrition guidelines. An athlete-specific diet index would offer an efficient and practical way to assess the quality of athletes’ diets, guide nutrition interventions, and focus sport nutrition support. This study describes the development and validation of an Athlete Diet Index (ADI). Item development was informed by a review of existing diet indices, relevant literature, and in-depth focus groups with 20 sports nutritionists (median of 11 years’ professional experience) from four elite athlete sporting institutes. Focus group data were analyzed (NVivo 11 Pro; QSR International Pty. Ltd., 2017, Melbourne, Australia), and key themes were identified to guide the development of athlete-relevant items. A modified Delphi survey in a subgroup of sports nutritionists (n = 9) supported item content validation. Pilot testing with athletes (n = 15) subsequently informed face validity. The final ADI (n = 68 items) was categorized into three sections. Section A (n = 45 items) evaluated usual intake, special diets or intolerances, dietary habits, and culinary skills. Section B (n = 15 items) assessed training load, nutrition supporting training, and sports supplement use. Section C (n = 8 items) captured the demographic details, sporting type, and caliber. All of the athletes reported the ADI as easy (40%) or very easy (60% of participants) to use and rated the tool as relevant (37%) or very relevant (63% of participants) to athletes. Further evaluation of the ADI, including the development of a scoring matrix and validation compared with established dietary methodology, is warranted.

Background The obesity-cataract association has been inconsistently reported. The fat mass and obesity-related (FTO) single-nucleotide polymorphism (SNP) rs9939609 is a major SNP associated with obesity and has been used as an instrumental variable for obesity in a Mendelian randomization (MR) approach. An interaction between the FTO SNP and macronutrient intake for obesity was suggested previously. Objective The aim of this study was to assess the associations between obesity and cataract, using FTO SNP rs9939609 as an instrumental variable in an MR approach, and explore interactions of this SNP with macronutrient intake in relation to risk of cataract in a population-based cohort. Methods The Blue Mountains Eye Study (BMES) is a longitudinal population-based study of common eye disease. Of 3654 baseline participants of the BMES (1992-1994), 2334 (75.8% of survivors) and 1952 (76.7% of survivors) were followed 5 and 10 y later. During the 5-y follow-up, 1174 new participants were examined. Cumulative cataract was defined as the presence of cortical, nuclear, or posterior subcapsular (PSC) cataract at any visit, following the Wisconsin Cataract Grading System. Imputed dosage of the FTO SNP rs9939609 was used. Quintiles of macronutrient intake (carbohydrates, protein, fats) were derived from an FFQ. ORs and 95% CIs were estimated using multivariable-adjusted logistic regression models. Results After multivariable adjustment, there were no associations between BMI and any cataract types in MR models using rs9939609 as an instrumental variable. However, an interaction between rs9939609 and protein intake for PSC cataract risk was suggested (P = 0.03). In analyses stratified by quintiles of protein intake, each minor allele of rs9939609 was associated with increased odds of PSC (OR: 2.14; 95% CI: 1.27, 3.60) in the lowest quintile subgroup only. Conclusions Obesity was not causally associated with age-related cataract. However, among persons in the lowest quintile of protein intake, obesity may be associated with PSC cataract.

Objective: To determine the impact of a peer-led, school-based programme (Students As LifeStyle Activists; SALSA) on energy balance–related behaviours (EBRBs) in Grade 8 students, and the cost of implementing the programme. Design: Pre–post test Setting: High schools in New South Wales, Australia. Methods: Grade 10 students (15- to 16-year-olds) were trained by university students to deliver four lessons on healthy eating and physical activity to Grade 8 students (13- to 14-year-olds). Students completed an online questionnaire pre–post lessons on EBRBs and intentions to change EBRBs over the next month. Items included fruit, vegetable and sugar-sweetened beverage (SSB) intake, frequency of eating breakfast, participation in moderate-to-vigorous physical activity (MVPA) and school-day recreational screen-time. Pre–post changes were analysed using generalised estimating equations, adjusted for clustering. Standard methods were used to estimate implementation costs. Results: In total, 2,056 Grade 8 students from 23 high schools participated. Significant changes included 5.2% increase in eating >2 fruit serves/day ( p 4 vegetable serves/day ( p Conclusion: The SALSA peer education programme had a positive impact on most of the dietary EBRBs examined. The cost evaluation showed that it is a relatively low-cost programme to implement.

This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)). A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject’s diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment. Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was − 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p

We reviewed the literature to evaluate potential associations between vitamins, nutrients, nutritional status or nutritional interventions and presence or healing of foot ulceration in diabetes. Embase, Medline, PubMed, and the Cochrane Library were searched for studies published prior to September 2020. We assessed eligible studies for the association between nutritional status or interventions and foot ulcers. Fifteen studies met the inclusion criteria and were included in this review. Overall, there is a correlation between poor nutritional status and the presence of foot ulceration or a delay in healing. However, there is not enough data to reach conclusions about whether the relationships are causal or only association. Further research is required to test whether any forms of nutritional supplementation improve foot ulcer healing.

An inclusive research culture is vital towards the maturity of Health and Education Precincts into an active innovation ecosystem. To date, substantial investments have been made in 13 upcoming Health and Education Precincts in varying stages of development in the Greater Sydney region, New South Wales. The political commitment to create an innovative environment for teaching and a vibrant research culture is noticeable. However, it is unclear to what extent government policy engages the breadth of clinical personnel in teaching and research-related activities and contributes towards improving research culture. Based on a study conducted at the central river district of the Greater Sydney region, we argue that better engagement of clinical personnel in teaching/research-related activities and inclusion of research-related roles within the job description of clinical personnel can substantially drive a positive research culture and thereby contribute towards the overall development of Health and Education Precincts. Opportunities for continued education and training of clinical personnel and involvement in graduate research programs also substantially drives research culture. We argue that future policy and practice solutions for upcoming Health and Education Precincts need to foster an inclusive research culture and should be tailored to meet the needs of an innovative ecosystem. Future solutions will need to contribute towards improving research culture as well as the health and wellbeing of people in the region.

AIM To systematically examine the longitudinal observational evidence between diet and the incidence of depression in adults aged 45 years and older. METHOD Three electronic databases were searched for cohort studies published up to December 2020 that investigated the association between baseline dietary intake and incidence of depression in community-dwelling adults aged 45+years. Combined odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Random-effects models were used. RESULTS In total 33 articles were included, with 21 combined in meta-analyses. Both the Dietary Inflammatory Index and the Western diet were associated with an increased odds of incident depression (Dietary Inflammatory Index: OR 1.33; 95%CI 1.04, 1.70; P = 0.02; Western: OR 1.15 95%CI 1.04, 1.26; P = 0.005). Higher fruit and vegetable intakes were associated with a reduced risk of incident depression (vegetables: OR 0.91; 95%CI 0.87, 0.96; P < 0.001; fruit: OR 0.85; 95%CI 0.81, 0.90; P < 0.001). No association was observed between the Mediterranean diet, "healthy" diet, fish intake and incident depression. CONCLUSIONS Results suggest an association between higher consumption of pro-inflammatory diets and Western diets and increased incidence of depression, while higher intake of fruit and vegetables was associated with decreased incidence of depression. These results are limited by the observational nature of the evidence (results may reflect residual confounding) and the limited number of studies. More high-quality intervention and cohort studies are needed to confirm these associations and to extend this work to other food groups and dietary patterns.

Background Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs. Methods An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios. Results In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%). Conclusions This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.

Background: The evidence regarding the association between added sugar (AS) intake and obesity remains inconsistent. The aim of this study was to investigate the association between changes in the percentage of energy intake from AS (EAS%) and changes in body weight in a cohort study of older Australians during 15 years of follow-up. In addition, associations were assessed according to whether EAS% intake was provided from beverage or non-beverage sources.Methods: Data were analyzed from the participants of the Blue Mountains Eye Study Cohort. Dietary data were collected at baseline (1992–94) and three five-yearly intervals using a 145-item food frequency questionnaire. Participants' body weight was measured at each time point. Five-yearly changes in EAS% intake and body weight were calculated (n = 1,713 at baseline). A generalized estimating equation (GEE) model was used to examine the relationship between the overall five-yearly changes in EAS% intake and body weight, adjusted for dietary and lifestyle variables.Results: In each time interval, the EAS% intake decreased by ~5% in the lowest quartile (Q1) and increased by ~5% in the highest quartile (Q4). The mean (SD) body weight change in Q1 and Q4 were 1.24 (8.10) kg and 1.57 (7.50) kg (first time interval), 0.08 (6.86) kg and −0.19 (5.63) kg (second time interval), and −1.22 (5.16) kg and −0.37 (5.47) kg (third time interval), respectively. In GEE analyses, the overall five-yearly change in EAS% intake was not significantly associated with body weight change (Ptrend = 0.837). Furthermore, no significant associations were observed between changes in EAS% intake from either beverage or non-beverage sources and changes in body weight (Ptrend for beverage sources = 0.621 and Ptrend for non-beverage sources = 0.626).Conclusion: The findings of this older Australian cohort do not support the association between changes in EAS% intake and body weight, regardless of AS food sources (beverage or non-beverage).

Objectives: There is limited information about the dietary habits of patients with Parkinson's Disease (PD), or associations of diet with clinical PD features. We report on nutritional intake in an Australian PD cohort.Methods: 103 PD patients and 81 healthy controls (HCs) completed a validated, semi-quantitative food frequency questionnaire. Food and nutrient intake was quantified, with consideration of micronutrients and macronutrients (energy, protein, carbohydrate, fat, fibre, and added sugar). Participants also completed PD-validated non-motor symptom questionnaires to determine any relationships between dietary intake and clinical disease features.Results: Mean daily energy intake did not differ considerably between PD patients and HCs (11,131 kJ/day vs. 10,188 kJ/day, p = 0.241). However, PD patients reported greater total carbohydrate intake (279 g/day vs. 232 g/day, p = 0.034). This was largely attributable to increased daily sugar intake (153 g/day vs. 119 g/day, p = 0.003) and in particular free sugars (61 g/day vs. 41 g/day, p = 0.001). PD patients who (1) experienced chronic pain, (2) were depressed, or (3) reported an impulse control disorder, consumed more total sugars than HCs (all p < 0.05). Increased sugar consumption was associated with an increase in non-motor symptoms, including poorer quality of life, increased constipation severity and greater daily levodopa dose requirement.Conclusions: We provide clinically important insights into the dietary habits of PD patients that may inform simple dietary modifications that could alleviate disease symptoms and severity. The results of this study support clinician led promotion of healthy eating and careful management of patient nutrition as part of routine care.

Reliable and valid assessment of sports nutrition knowledge can inform athlete nutrition education to address knowledge gaps. This study aimed to test the reliability and validity of an electronically administered sports nutrition knowledge tool – Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire (PEAKS-NQ). A 94-item PEAKS-NQ was piloted to 149 developmental athletes (DA) in New Zealand, with a subset invited to complete the PEAKS-NQ again to assess reliability. Reliability was evaluated using sign test, intraclass correlation and Cronbach’s α. Accredited sports dietitians (ASD; n 255) completed the PEAKS-NQ to establish construct validity via known-groups methodology and provided relevance scores to determine the scale content validity index (S-CVI). Rasch analysis was conducted to identify potentially problematic items and test reliability. Score differences between DA and ASD were analysed using independent t or non-parametric tests. DA (n 88) were 17·8 (sd 1·4) years, 61·4 % female and mostly in high school (94·3 %). ASD (n 45) were 37·8 (sd 7·6) years, 82·2 % female, with >5 years of dietetic experience (59·1 %). ASD scored higher than DA in all sections and overall (91·5 (sd 3·4) v. 67·1 (sd 10·5) %) (P < 0·001). There were no differences between retests (n 18; P = 0·14). Cronbach’s α was 0·86. S-CVI indicated good content validity (0·88). Rasch analysis resulted in a fifty-item PEAKS-NQ with high item (0·91) and person (0·92) reliability. The PEAKS-NQ is reliable and valid for assessing sports nutrition knowledge which could assist practitioners effectively tailor and evaluate nutrition education.

IntroductionProviding effective nutritional rehabilitation to patients hospitalised with anorexia nervosa (AN) is challenging, partly due to conservative recommendations that advocate feeding patients at low energy intakes. An ‘underfeeding syndrome’ can develop when patients are not provided with adequate nutrition during treatment, whereby malnourished patients fail to restore weight in a timely matter, and even lose weight. Of particular concern, the reintroduction of carbohydrate in a starved patient can increase the risk of developing electrolyte, metabolic and organ dysfunction. The proposed trial assesses the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in adolescent and young adult patients (aged 15–25 years), hospitalised with AN.Methods and analysisThe study employs a double-blind randomised controlled trial design. At admission to hospital, malnourished adolescent and young adults with AN will be randomly allocated to commence feeding on a standard enteral feeding formula (1.5 kcal/mL, 54% carbohydrate) or a lower carbohydrate isocaloric enteral feeding formula (1.5 kcal/mL, 28% carbohydrate). Assessments of nutritional intake, weight and biochemistry (phosphate, magnesium, potassium) will be conducted at baseline and during the first 3 weeks of hospital admission. The primary outcome measure will be incidence of hypophosphatemia. Secondary outcomes include weight gain, oedema, other electrolyte distortion, length of hospital admission, admission to the Intensive Care Unit (ICU) and number of days to reach medical stability, using defined parameters.Ethics and disseminationThe protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee and institutional research governance approvals were granted. Written informed consent will be sought prior to study enrolment. Study findings will be widely disseminated through peer-reviewed publications and conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617000342314); Pre-results.

There is an evidence&ndash, practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 &plusmn, 8 years, control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar&rsquo, s test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings &plusmn, SE) of total vegetables (primary outcome) and other key food groups, however, there was a significantly higher intake of nuts (secondary outcome) (3.96 &plusmn, 0.51 vs. 2.71 &plusmn, 0.32, p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 &plusmn, 0.17 vs. 1.71 &plusmn, 0.22, p = 0.003) and legumes (0.69 &plusmn, 0.10 vs. 1.12 &plusmn, 0.16, p = 0.02) and intake of sweets and processed/prepared foods (8.31 &plusmn, 0.76 vs. 6.54 &plusmn, 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.

Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30 %. We conducted a randomised, inactive-placebo controlled, double-blind trial of 500 mg of slow-release vitamin C in sixteen people with foot ulcers in the Foot Wound Clinic at Westmead Hospital. Nine were randomised to control and seven to vitamin C. When serum vitamin C results become available at 4 weeks, all people with deficiency were offered both vitamin C and glucosamine tablets for the next 4 weeks. Patients without baseline deficiency continued their original assigned treatment. The primary outcome was percentage ulcer healing (reduction in ulcer size) at 8 weeks. Fifty percentage of subjects had baseline vitamin C deficiency, half having undetectable levels. Healing at 8 weeks was significantly better in the vitamin C group (median 100 v. –14 %, P = 0·041). Healing without amputation occurred in all patients in the vitamin C group. In contrast, 44 % of controls had not healed their ulcer at the end of the study period. Vitamin C improved healing of foot ulcers. Further studies are needed to determine whether there is a threshold effect for serum vitamin C above which therapy is ineffective and whether there are better or lesser responding subgroups. Because of its low cost and ease of access and administration, we recommend offering vitamin C therapy to all people who have chronic foot ulcers and potentially suboptimal vitamin C intake. Trial registration number: ACTRN12617001142325.

Background: Periodontal disease is the leading cause of tooth loss worldwide. Current periodontal treatment is limited by its dependency on patients learning and maintaining good dental habits, and repeated visits to oral health physicians. Vitamin C&rsquo, s role in collagen synthesis and immune function makes it important in wound healing and possibly periodontal healing. Therefore, if some patients are deficient, this may worsen patient outcomes. Methods: Patients were invited to participate following assessment and treatment at the Westmead Centre of Oral Health Periodontic Clinic, regardless of current disease stage or treatment. Adults were eligible if they gave informed consent and had current periodontal disease. Study involvement consisted of periodontal assessment and care followed by an interview and measurement of serum vitamin C and C-reactive protein (CRP). Results: A total of 6 out of 20 patients had vitamin C levels less than the institutional normal range, of whom 2 had levels &lt, 11.4 &mu, mol/L and one &lt, 28 &mu, mol/L. Low vitamin C was associated with higher periodontal disease stage (p = 0.03). Elevated CRP was found in 2/3 of people with low vitamin C and CRP was negatively correlated with vitamin C (p &lt, 0.01). Vitamin C did not correlate with patient-reported fruit or vegetable consumption, but high processed meat intake was associated with lower vitamin C. Conclusion: Although a small study, this rate of vitamin C deficiency in the periodontal clinic is clinically important and correlations with disease severity and CRP suggests biological importance. This warrants further studies to assess vitamin C and whether supplementation improves periodontal outcomes, particularly in deficient subjects.

To assess contributions of dietary and genetic factors to ethnic differences in AMD prevalence.Population-based analytical study.In the Blue Mountains Eye Study, Australia (European ancestry n = 2826) and Multi-Ethnic Cohort Study, Singapore (Asian ancestry, n = 1900), AMD was assessed from retinal photographs. Patterns of dietary composition and scores of the Alternative Healthy Eating Index were computed using food frequency questionnaire data. Genetic susceptibility to AMD was determined using either single nucleotide polymorphisms (SNPs) of the cAge-standardized prevalence of any (early or late) AMD was higher in the European (16%) compared to Asian samples (9%,Genetic susceptibility to AMD was higher in European compared to Chinese samples and explained more of the AMD risk difference between the two samples than the dietary factors investigated.

ISSUE ADDRESSED Low health literacy disproportionately affects adults from culturally and linguistically diverse backgrounds. This study investigated the health literacy of adults attending outpatient allied health services in western Sydney, a highly diverse region in Sydney with residents from a range of cultural and linguistic backgrounds. METHODS A cross-sectional survey was undertaken between March and April 2017 using the Health Literacy Questionnaire (HLQ). Participants, aged over 18 years and with a primary language of English, Arabic, Chinese or Hindi, were recruited from outpatient allied health clinics at Westmead Hospital. Means (standard deviation) for each of the nine HLQ domains were calculated and associations with demographic variables were investigated using analysis of variance (ANOVA). RESULTS Two hundred and thirty people were included with mean age of 45.1 years (SD = 19.0), the majority were female (75.5%), over half were born overseas (55.7%) and 77.6% reported speaking English at home. The highest mean score on a HLQ domain (out of 5) was "Understanding health information well enough to know what to do" (M = 4.19; SD = 0.67), and the lowest mean score (out of 4) was "Appraisal of health information" (M = 2.97; SD = 0.54). Participants who did not speak English at home had significantly lower scores on seven of the nine HLQ domains. CONCLUSIONS Important health literacy strengths and limitations of a diverse sample of adults attending outpatient allied health services in western Sydney were identified. Findings should be considered in the light of the cross-sectional survey methodology with non-random sampling. SO WHAT Data will inform future interventions to improve health literacy and health outcomes among vulnerable population groups in western Sydney.