Australian Dietary Guidelines Research Articles

Predicting food consumption using contextual factors: An application of machine learning models

Abstract Background Improving diet quality relies on making manageable adjustments to eating behaviours. Personalised nutrition interventions hold promise for modifying behaviour. Machine learning (ML) offers a novel approach to examining dietary behaviours in personalised nutrition by leveraging data on past behaviours and environmental contexts. This study aims to investigate whether contextual factors at eating occasions (EO) can predict food consumption to enhance diet quality. Methods Cross sectional data from the Measuring Eating in Everyday Life Study (MEALS) were analysed (n = 675, 18-35y). A smartphone food diary app recorded dietary intakes at EO for 3-4 non-consecutive days, also capturing social-environmental (e.g., activity) and physical-environmental factors (e.g., consumption location). Participant characteristics were collected via an online survey. Food groups intake (servings per EO) followed Australian Dietary Guidelines. This study benchmarked two established models, gradient boost decision tree and random forest, which have previously shown high performance in similar tasks. Performance was evaluated using 10-fold cross-validation, measuring mean absolute error (MEA), root mean square error (RMSE), and R squared. Feature importance analysis identified key variables for predicting food consumption. Results ML predicts most food groups at EO using contextual factors, with slight differences between actual and predicted consumption (<1 serving per EO). For fruits, dairy, and meat, MEA values were 0.35, 0.34, and 0.56 servings, respectively (RMSE values: 0.61, 0.50, and 0.80 servings). Self-efficacy, age and consumption location were influential in most ML models. Conclusions ML offers insights into contextual factors and food consumption, suggesting directions for precision nutrition interventions. Future research should identify positive influences of contextual factors on dietary behaviours and incorporate these insights into interventions. Key messages • Machine learning can effectively predict food consumption based on contextual factors at eating occasions. • Understanding the influence of contextual factors such as consumption location on food consumption can inform the development of precision nutrition interventions aimed at improving diet quality.

Contextual factors influence food intake at eating occasions in young adults: A mixed effect analysis

Understanding eating behaviours of young adults is crucial for developing strategies to improve their diet quality. Factors that influence eating behaviours are often multifaceted and highly contextual, with little research focused on young adults. This study examined contextual factors influencing food intake at eating occasions among young adults. Participants (n = 675, 18–30 years) recorded dietary intake and contextual characteristics at eating occasions (n = 27,513) using a smartphone food diary (“FoodNow”) over three to four non-consecutive days. Food and beverage intakes were classified into six groups according to the Australian Dietary Guidelines. Eating occasion-level contextual factors, such as consumption location, purchase location, activity, and social context, were recorded via the app, while person-level contextual factors were collected through an online survey. Generalised mixed models with random intercepts were used to investigate effects of contextual factors on food group consumption at meals and snacks. Eating location was associated with vegetable and discretionary food intake; meals that were eaten while in transit were 0.59 serves lower in vegetables (95% CI: −0.93, −0.38; p < 0.001) and 0.31 serves higher in discretionary foods (95% CI: 0.03, 0.54; p = 0.014), compared meals eaten at home. Higher intakes of discretionary foods were observed when friends were present at meals and snacks (0.66 and 0.57 serves, 95% CI: 0.56, 0.88; 0.36, 0.77, p < 0.001). Meals purchased from convenience stores were higher in grain and discretionary foods than meals from other locations (p < 0.001). Majority of person-level factors showed minimal effects on food group consumption. Addressing factors such as purchase location and social contexts during meals and snacks may improve food choices, as small changes at eating occasions can significantly impact overall diet quality over time.

A gut-focused perinatal dietary intervention is associated with lower alpha diversity of the infant gut microbiota: results from a randomised controlled trial

ABSTRACT Objectives: In experimental models, the prenatal diet influences gut microbiota composition in mothers and offspring; however, it is unclear whether this occurs in humans. We investigated the effects of a gut-focused perinatal dietary intervention on maternal and infant gut microbiota composition four weeks after birth. Methods: This randomised controlled trial randomised pregnant women to receive dietary advice as part of standard care, or additionally receive a dietary intervention focused on the Australian Dietary Guidelines and increasing prebiotic and probiotic/fermented food intakes (ACTRN12616000936426). Study assessments occurred from gestation week 26 (baseline) to four weeks postpartum (follow-up). Faecal samples, collected at baseline for mothers, and follow-up for mothers and infants, underwent 16SrRNA sequencing. The primary outcome was a between-group mean difference in infant faecal Shannon index. Secondary outcomes included between-group differences in other microbiota measures, including maternal change from baseline CLR-transformed Prevotella abundance. Results: Forty-four women and 45 infants completed the study. The mean Shannon index of infants in the intervention group was −0.35 (95% CI: −0.64, −0.06, SD: 0.52) units lower than control group infants, corresponding to a medium effect size (Cohen’s D: −0.74, 95% CI: −1.34, −0.13). The findings were similar using other metrics of α-diversity. There were no between-group differences in β-diversity, nor any differentially abundant taxa in infants. The intervention increased abundances of the genus Prevotella in mothers compared to controls. Discussion: This gut-focused perinatal dietary intervention was associated with differences in the maternal and infant gut microbiota composition. Larger studies are required to replicate and extend these findings.

Food intake in an Australian Aboriginal rural community facing food and water security challenges: A cross-sectional survey.

Researchers were invited by Aboriginal leaders to collaborate on this study which aimed to assess food intake in the Walgett Aboriginal community to inform long-term community-led efforts to improve food and water security and nutrition. Aboriginal adults living in or near Walgett, a remote community in north-west NSW, Australia, completed an adapted Menzies Remote Short-item Dietary Assessment Tool, which was administered verbally and face-to-face in early 2022. Aboriginal people were involved in the survey design, training and collection, and analysis of data. Descriptive statistics were tabulated, overall and by gender, age, and location. Differences by sex, age group (18-44 years versus ≥45 years), and location (Walgett town or other) were determined using a chi-square test. A total of 242 participants completed the survey; 55% were female. Three-quarters of participants reported meeting the recommendations for discretionary foods (73%); however, more than half (56%) exceeded the recommended maximum serves of sugar-sweetened beverages. The proportion of participants meeting core food group guidelines was 72% for meat, 36% for fruit, 20% for bread and cereals, 6% for dairy, and 3% for vegetables. Overall, none of the participants met the recommended serves of all food groups outlined in the Australian Dietary Guidelines. Findings show that Walgett Aboriginal community members surveyed were consuming a healthier diet than national data reported for Aboriginal and Torres Strait Islander people in Australia. However, none of the participants were meeting all of the national dietary guidelines, placing them at increased risk of diet-related chronic disease. Local Aboriginal community-led efforts to improve food and water security should include specific strategies to improve nutrition.

Effect of time restricted eating versus current practice in dietetics on glycaemic control and cardio-metabolic outcomes in individuals at risk of developing type 2 diabetes: Protocol for a multi-centre, parallel group, non-inferiority, randomised controlled trial

BackgroundTime restricted eating (TRE) is a dietary strategy that may improve metabolic health. However, no studies have compared TRE with current practice (CP) in dietetics. HypothesisTRE will not be inferior to CP to improve glycaemic control in individuals at risk of type 2 diabetes (T2D). MethodsThis parallel group, randomised, non-inferiority, controlled trial randomised 247 participants by site and glycated haemoglobin (HbA1c) into TRE or CP (1:1) for 12 months. Participants were aged 35–70 years, with a body mass index (BMI) >25 but <45 kg/m2, and score ≥15 on the Australian type 2 diabetes risk (AUSDRISK) assessment, without a diagnosis of T2D. Study visits were balanced between groups and all participants received five consultations at 0, 0.5, 1, 2 and 3 months. TRE followed a self-selected 9 h eating window (≥0600 and ≤1900), whereas CP followed Australian dietary guidelines. OutcomesThe primary endpoint is the estimate of group mean difference (TRE vs CP) of HbA1c at 4 months in a covariate linear regression adjusting for stratification factors and sex. Secondary efficacy outcomes at 4 and 12 months are changes in fasting glucose, fasting insulin, HOMA-IR and nocturnal glucose by continuous glucose monitor incremental area under the curve and change in HbA1c at 12 months. Other endpoints are exploratory and will not be adjusted for multiplicity. ConclusionsWe will determine whether TRE is an alternate strategy to current practice in dietetics to improve glucose control.Trial registration:NCT04762251; 21 Feb 2021.

Modifying the Health Star Rating nutrient profiling algorithm to account for ultra-processing.

To modifythe Australian and New Zealand Health Star Rating to account for ultra-processing and compare the alignment of the modified ratings with NOVA classifications and the current Australian Dietary Guidelines classifications of core (recommended foods) and discretionary (foods to limit). Data was cross-sectionally analysed for 25 486 products. Four approaches were compared to the original Health Star Rating: (1) five 'negative' points added to ultra-processed products (modification 1; inclusion approach); (2) ultra-processed products restricted to a maximum of 3.0 Health Stars (modification 2; capping approach); (3 and 4) same approach used for modifications 1 and 2 but only applied to products that already exceeded 10 'negative' points from existing Health Star Rating attributes (modifications 3 and 4, respectively; hybrid approaches). Alignment occurred when products (i) received <3.5 Health Stars and were NOVA group 4 (for NOVA comparison) or discretionary (for Dietary Guidelines comparison), or (ii) received ≥3.5 Health Stars and were NOVA groups 1-3 or core. All Health Star Rating modifications resulted in greater alignment with NOVA (ranging from 69% to 88%) compared to the original Health Star Rating (66%). None of the modifications resulted in greater alignment to the Dietary Guidelines classifications overall (69% to 76%, compared with 77% for the original Health Star Rating), but alignment varied considerably by food category. If ultra-processing were incorporated into the Australian and New Zealand Health Star Rating, consideration of ultra-processing within the broader dietary guidance framework would be essential to ensure coherent dietary messaging to Australians.

Beyond the lunchbox: Menu development guidelines for the Tasmanian School Lunch Project.

Universal school lunches hold the potential to improve student nutritional intake and access to food, but to do so menus must be nutritionally adequate. There is growing interest in school lunch programs (SLPs) in Australia, and one is currently being trialled in Tasmania. No nutrition guidelines currently exist for menu development in Australian schools. A desktop review of international SLPs was completed, and findings analysed in the context of Australian Nutrient Reference Values and Australian Dietary Guidelines to inform the development of Tasmanian SLP guidelines. Globally, SLPs are guided by portion sizes and/or nutrient criteria. SLPs (many of which address food insecurity) must provide children the opportunity to meet energy and nutrient needs, while minimising food waste. We propose energy-based nutrient criteria and qualitative recommendations for menu development. SO WHAT?: We have developed guidelines to inform the development of Tasmanian SLP menus. These guidelines may be applicable to other states and territories piloting similar programs.

Exploring reasons for high levels of food insecurity and low fruit and vegetable consumption among university students post-COVID-19

High rates of food insecurity and low consumption of fruit and vegetables among university students have been observed prior to the COVID-19 pandemic and intensified during the pandemic. This study aimed to investigate food insecurity among university students and its associations with sociodemographic factors, fruit and vegetable consumption behaviours, and preferred campus programs to address these issues. A convenience sample of 237 Australian university students completed a cross-sectional online survey from October to December 2022. Food insecurity was assessed using the 10-item US Adult Food Security Module, applying the Canadian classification scheme. Sociodemographic variables, fruit and vegetable consumption behaviours, and perceptions of fruit and vegetable access and their affordability were included in the survey. Students were also asked to select the most suitable program(s) and provide reasons for their choice using open-ended questions. Approximately half of respondents (46.4%) were identified as food insecure. The proportion of students meeting the recommended intake of vegetables as specified in the Australian Dietary Guidelines was very low (5.1%) compared with fruit (46.2%). Low fruit consumption was significantly associated with food insecurity (OR = 1.81; 95%CI 1.03, 3.18, p = 0.038). Factors such as the perceived lower accessibility and higher price of fruit and vegetables were significantly associated with higher odds of food insecurity. In terms of potential programs, a free fruit and vegetable campaign was the most popular program, with affordability and physical access being the most frequently cited reasons. These findings suggest that food insecurity is associated with low fruit and vegetable consumption in university students. Therefore, transforming campus food environments and developing food policies at the university level must be considered to address food and nutrition security in university students.

Extent of alignment between the Australian Dietary Guidelines and the NOVA classification system across the Australian packaged food supply.

The Australian Dietary Guidelines are currently being revised and ultra-processed foods have been identified as a high priority action area. To better understand how well the current Dietary Guidelines align with level of processing classifications, the aim of this study was to assess the alignment between the Australian Dietary Guidelines and the NOVA classification system for classifying the healthiness of packaged foods. Data were sourced from the Australian FoodSwitch dataset, which included 28 071 packaged food and beverage products available in major Australian supermarkets in 2022. Products were classified as (i) core or discretionary (Australian Dietary Guidelines) and (ii) non-ultra-processed or ultra-processed (NOVA). Agreement between the two systems (core vs. non-ultra-processed and discretionary vs. ultra-processed) was evaluated using the kappa statistic. There was 'moderate' agreement (κ = 0.41, 95% CI: 0.40-0.42) between the Australian Dietary Guidelines and the NOVA system, with 69.8% of products aligned across the two systems. Alignment was more common for discretionary foods (80.6% were ultra-processed) than core foods (59.9% aligned were not-ultra-processed). Food categories exhibiting the strongest levels of alignment included confectionary, foods for specific dietary use, and egg and egg products. Discordance was most common for convenience foods, sugars, honey and related products, and cereal and grain products. Despite moderate alignment between the Australian Dietary Guidelines and NOVA, the discordance observed for almost one-third of products highlights the opportunity to develop recommendations for ultra-processed foods within the guidelines to advise Australians how these foods should be considered as part of a healthy diet.

Adherence to dietary guidelines and associated factors among rural Australian cancer survivors: a cross-sectional study

PurposeThis study aimed to explore levels of adherence to dietary guidelines, and factors associated with dietary guideline adherence, among rural Australian cancer survivors.MethodsA cross-sectional study was undertaken. We recruited a convenience sample of adults with cancer who attended the chemotherapy day unit or allied health appointments at a rural hospital in Baw Baw Shire, Victoria, Australia, between August 2017 and December 2021. Dietary guideline adherence was assessed by cross-referencing participants’ responses to an adapted version of the Dietary Questionnaire for Epidemiological Studies with dietary recommendations in Australian dietary guidelines. Binary logistic regression was used to assess factors associated with dietary guideline adherence for fruits and whole red meats.ResultsThere were 107 rural cancer survivors (median age, 67 years). Dietary guideline adherence was highest for alcohol (88%) followed by whole red meats (63%), fruits (56%), processed red meats (24%), cereals/breads/grains (7%), and vegetables (4%). Relative to those aged < 65 years, 65–74-year-olds had 5.7-fold greater odds (adjusted odds ratio (aOR) = 5.74, 95% confidence interval (CI) = 1.91–17.17) of adhering to the dietary guideline for fruits. Relative to those who had completed/ceased treatment, participants who were currently receiving treatment had 78% lower odds (aOR = 0.22, 95% CI = 0.09–0.59) of adhering to the dietary guideline for fruits.ConclusionThis study contributes preliminary data on adherence to dietary guidelines and associated factors among rural Australian cancer survivors. Dietary guideline adherence varied across food groups and was mostly low, albeit not markedly worse than Australia’s national population for the fruits and vegetables groups. The mostly low adherence in our sample suggests a potential need to increase provision of dietary information, supportive care screening, and, wherever necessary, dietetics referrals, assessments, and interventions among rural cancer survivors. Larger, longitudinal studies of adherence to dietary guidelines and/or tailored, cancer-specific dietary recommendations should be undertaken in future.

Using the Australian Dietary Guidelines 2&5 education message in supermarket shopping trolleys to nudge shoppers to purchase more fruit and vegetables: A feasibility study using an intervention design.

Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing chronic diseases; however, only one in 16 Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test the feasibility of modifying shopper purchasing behaviour to purchase more F&Vs using the Australian Dietary Guidelines 2&5 education message covering one-half of the base of shopping trolleys. Placards giving the message that eating 2 fruits and 5 vegetables every day for good health were placed at the base of shopping trolleys as an educational nudge. Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting paper sales receipts to measure the weight (kg), total spending and F&V-specific spending (Australian dollars) for intervention versus control trolleys for one Saturday. We also conducted a short intercept survey that was administered independently from the research study day on non-trial shoppers. Shoppers who selected trolleys with the 2&5 education nudge placards (n = 101) purchased 1.66 kg less weight of F&Vs (Intervention: mean = 3.89 kg, SD = 3.40 kg, 95% CI = 3.21 kg, 4.56 kg, vs. Control: mean 5.55 kg, SD = 4.16 kg, 95% CI = 4.73 kg, 6.37 kg, p = 0.002) and spent less on F&Vs compared to shoppers in the control group (n = 102; Intervention: mean = $26.00, SD = $21.60, 95% CI = $21.78, $30.32 vs. Control: mean $36.00, SD = $27.00, 95% CI = $30.72, $42.36, p = 0.004). Intervention group shoppers also spent less in total spending between groups (Intervention: mean = $115.40, SD = $68.30, 95% CI = $101.95, $128.95 vs. Control: mean $151.30, SD = $79.40, 95% CI = $135.73, $166.93, p = 0.001). The 2&5 education nudge placard had the opposite effect as intended on shoppers' purchases to buy more F&Vs, although there may have been other differences between the intervention and the control groups since they were not randomised. Larger studies are required to elucidate and confirm these findings over the longer term.

Development of a Tool for Reporting Key Dietary Indicators from Sales Data in Remote Australian Aboriginal and Torres Strait Islander Community Stores.

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.

Perceived food intolerances and its impact on diet quality in patients with an ileoanal pouch

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically-refractory ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Whilst quality of life is generally good, as many as 83% of patients associate dietary factors with the onset of symptoms(1) and around two-thirds employ some form of dietary restriction post-pouch creation(2,3). There is growing interest to understand the role of diet (as a whole) on pouch function and how it can be used therapeutically. It is imperative that we know the dietary characteristics of pouch patients before attempting to introduce strategies altering their food choice. Since there is good rationale to assess overall diet quality to identify potential avenues for targeting dietary strategies, this study aimed to examine the frequency of perceived food intolerances and diet quality in patients with an ileoanal pouch and the relationship between these two indices. In this cross-sectional study, patients with an ileoanal pouch completed a food intolerance questionnaire and a validated 297-item semi-quantitative food frequency questionnaire (Monash Comprehensive Nutritional Assessment Questionnaire). Dietary data was used to score diet quality using the 2013 Dietary Guidelines Index (DGI), a scoring system which compares how closely an individual’s dietary intake aligns with the Australian Dietary Guidelines (ADG). The DGI also comprises of 11 subcomponents (scored out of 10 respectively) based on each of the ADG guidelines and provides a total score of 110, with higher scores reflecting greater compliance to the ADG. In order to determine if perceived dietary intolerances was negatively associated with the intake of specific dietary factors, univariable and multivariable linear regression analysis of the correlation of intolerance and diet quality was performed. Of the 58 (10 FAP and 48 UC) patients studied, 81% of UC and 80% of FAP patients reported dietary intolerances. Mean total DGI score was 78 (95% CI: 74-80) of 110 in the overall pouch cohort with no differences across pouch sub-groups. However, only 5% of patients achieved a full score for food variety. Both uni- [OR −0.94 (−1.7,-0.10); p = 0.02] and multivariable analysis (adjusting for age and sex) showed that only intolerances to dairy products were associated with reduced intake of lactose-containing dairy [OR −0.29 (−1.8,-0.08); p=0.03]. No other significant correlations were found for overall or subcomponents of DGI scores. High rates of perceived food intolerances were observed in patients with an ileoanal pouch. However, only those with perceived dairy intolerances restricted their intake of lactose-containing dairy products. Additionally, patients with ileoanal pouch scored highly for overall diet quality but specific gaps in achieving better diet quality, particularly for diet variety were observed. These results provide some starting points for targeted dietary counselling to optimise nutritional health and potentially to improve pouch function these patients.

Nutritional composition of plant-based meat and dairy alternatives: comparison of supermarket products to the Australian Food Composition Database

Consumer interest in plant-based diets has increased, alongside significant growth in the availability of plant-based meat and dairy alternatives in supermarkets(1). The nutritional profile of these products is likely to vary due to the broad range of ingredients used(2). Food composition databases, such as the Australian Food Composition Database (AFCD), are used extensively in research, practice, and policy, including by nutrition and dietetics researchers and health professionals to identify the nutrient content of foods. However, it is unclear if, and to what extent, the AFCD data on plant-based alternatives reflects the current food supply. This study aimed to examine the range and composition of plant-based meat and dairy alternatives available in Australian supermarkets and compare this with the AFCD. Data on core plant-based meat and dairy alternatives were collected from eight Melbourne supermarkets between June and October 2022 using the CSIRO FoodTrackTM database methodology(3). Products were included if they were i) meat or dairy substitutes outlined in the AFCD; or ii) plant-based alternatives for core meat and dairy included in the Australian Dietary Guidelines. Product images were taken, and data was transcribed. Products collected in supermarkets were then ‘matched’ to the most appropriate reference item in the AFCD. In total, 455 meat alternatives (n = 219 legumes/pulses; n = 178 meat substitutes; n = 38 tofu/tempeh; n = 20 sausages) and 249 dairy alternatives (n = 157 milk; n = 52 cheese; n = 40 yoghurt) were identified. Over half of the plant-based meat substitutes (n = 102; 57%) were made from a soy/wheat/pea base protein. Of the dairy alternatives, just over half of the cheese substitutes had coconut as their main ingredient (n = 28; 54%), and almost two-thirds of yoghurts were coconut-based (n = 28; 70%). The majority of the 157 milks were oat-based (n = 57; 37%), followed by almond (n = 45; 29%), and soy (n = 27; 17%). Many supermarket products were not reflected in the AFCD, including over two-thirds of dairy alternatives (n = 159; 67%), and one-third of meat alternatives (n = 150; 33%). This was due to more product options within categories, such as the variety of canned beans/legumes (n = 96) and flavoured milk substitutes (n = 34) available in supermarkets, and a greater variety of main ingredients used, most notably for cheese substitutes (n = 52). This study highlights that the range of plant-based meat and dairy alternatives available in Australian supermarkets is diverse, with many different base ingredients used, and a great range of products available in-store than in the AFCD. Findings highlight the challenges of food composition databases in keeping up to date with the fast-growing plant-based sector. Outcomes from this study have implications for the monitoring of the food supply and population level dietary data.

Nourished@Deakin – can an online cooking program inspire university students to cook and eat healthier?

University students are a unique population subgroup, who experience a life transition into adulthood, often marked by the establishment of unhealthy eating behaviours(1) which are associated with chronic disease risk factors, poor mental health and lower academic achievement(2). Data regarding the food skills/behaviours of university students is limited, but low cooking self- efficacy and food skills are potential barriers to healthy meal preparation(1). Nourished@Deakin is an online cooking program, co-designed by Deakin University students, that aims to inspire students to cook and eat healthier. It commenced in November 2021 and includes a series of blogs, recipes, and cooking videos, available to all Deakin students via a Deakin University blog site. To determine if accessing Nourished@Deakin improves food skill confidence, food intake, and nutrition knowledge, participants completed a short online survey before accessing Nourished@Deakin materials and then again four weeks after their first engagement. The survey included 31 questions regarding confidence related to a variety of food skills (eg. recipe following, reading food labels, meal planning); 2 questions regarding fruit/vegetable intake; 11 knowledge questions regarding the Australian Dietary Guidelines (ADGs); and 16 demographic questions. Pre/post surveys were compared using paired t tests (knowledge scores, fruit/veg serves) or McNemar extact test (proportions). A total of 108 students completed the pre-survey and 41 (mean (SD) age 27.0 (8.4) years; 63% female) also completed the post-survey. Of the 41 participants who completed both surveys, 42% were studying within the Faculty of Health and 16 (39%) were living in the family home with parents. Most (68%) were studying full time and 59% were employed part-time/casually. Three-quarters were domestic students, and 59% were undergraduate students. Following completion of Nourished@Deakin, there was a significant increase in the proportion of participants feeling confident in two of the 31 food skills (namely ‘meal planning’: 44% pre vs 63% post, P&lt;0.05; and ‘growing fruit and/or vegetables at home’: 22% pre vs 44% post, P&lt;0.05). Fruit intake increased from 1.6 serves/day pre-program to 1.9 serves/day post-program (P&lt;0.05), but vegetable intake remained stable (2.5 serves/day pre and 2.6 serves/day post, P = 0.287). Before participating in Nourished@Deakin, 56% of participants correctly reported the recommended daily serves of fruit and 66% correctly reported it for vegetables. The mean ADG knowledge score was 8.2/9 and 49% of participants got all nine questions correct. There were no significant changes in any of the knowledge markers post-program. Over a relatively short period, Nourished@Deakin produced modest improvements in the self-reported confidence in some food skills and self-reported fruit intake. A revised program (incorporating a greater variety of recipes, additional blogs, and new videos) may encourage greater engagement and result in increased confidence and knowledge in other targeted areas.

Parents’ perceptions of the Tasmanian School Lunch Project - interim findings

Most Australian school students take a packed lunch to school(1). However, parents have reported many barriers to packing a healthy lunch(2). Subsequently, foods eaten during school hours are not consistent with the Australian Dietary Guidelines, with discretionary foods providing about 44% of energy consumed during this time(3). In addition, some children go to school without any food for lunch or money to buy lunch. The Tasmanian School Lunch Project provides free nutritious cooked lunches for Kinder to Year 10 students attending 30 government schools (15 commenced 2022, 15 commenced 2023) in areas of high socioeconomic disadvantage. The lunches were provided 1-3 days/week. The menu and recipes were designed by dietitians. This analysis aimed to describe parents’ perceptions of the School Lunch Project during the first year. Six of the 15 schools that commenced in term 2 2022 were invited, and agreed, to participate in the evaluation. During term 3 or 4 2022, parents completed online or written surveys (n = 159) and/or participated in discussion groups (n = 26) to share their thoughts on the menu, their concerns, likes, and willingness to pay. Survey data were analysed descriptively and open-ended survey responses and discussion group data thematically. During 2022, 78,832 nutritious cooked lunches were provided to 1,678 students. Most parents felt there was enough variety on the menu (66%) and the right amount of food was served (69%). Most students (79%) ate the lunches every day they were provided yet 52% of parents continued to provide a packed lunch. Parents enjoyed that their child was having a healthy lunch (66%) and trying new foods (74%). Some parents in the discussion groups indicated positive flow on effects at home with students trying new foods and sitting down together as a family to eat the evening meal. Half the parents (50%) had no concerns about the school providing lunches. The most commonly reported concerns were their child might not like the food (36%) or their child does not try new foods (8.6%). These concerns were also raised in the discussion groups. Most parents (93%) were prepared to pay for the lunches in future (median $3, range $1-$12) and 85% thought there should be a family discount. Parents acknowledged some payment was necessary for the sustainability of the program but some expressed concern for those who may struggle to pay. More direct communication with families about the meals offered, the availability of bread (from term 4 2022) for students who choose not to eat the cooked lunch or want more to eat, and allowing families time to adjust to the new lunch system, may address some of the concerns raised. Further data on parents’ perceptions of the school lunches will be collected during term 3 2023.

Monitoring Australian Foods and Diets

Monitoring the food supply including composition and what people are eating is an important aspect of maintaining public health and safety. The Food Composition Program at Food Standards Australia New Zealand (FSANZ) is responsible for generating, compiling and publishing data on the nutrient content of Australian foods to support FSANZ standards development work and monitoring activities. This work also supports broader Government public health policies and initiatives such as National Nutrition Surveys, Front of Pack labelling and reformulation. Having robust up to date food composition and dietary intake data that represents the current food supply and consumption patterns provides the strong evidence base needed to support FSANZ activities(1). FSANZ has been working with the Australian Bureau of Statistics since 2019 to support their work on the 2023 National Nutrition and Physical Activity Survey (NNPAS)(2). Our role has been to assist in customising the survey instrument Intake24 used to collect the 24-hour recall data from the NNPAS and to generate the datasets required to allow food, dietary supplement and nutrient intakes to be estimated from the survey and enable reporting against the Australian Dietary Guidelines. This presentation will discuss FSANZ role in monitoring foods and healthy diets in Australia, with a particular focus on the methods and tools for generating and reporting data for the 2023 NNPAS.

Short-term impact of a healthy and typical Australian dietary pattern on cardiometabolic outcomes: insights from a randomised, cross-over feeding study

Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305 Australia.Cardiovascular disease (CVD) remains a major cause of global mortality. Poor diet quality, characterised by excessive consumption of energy-dense, nutrient-poor foods and insufficient intake of fruits, vegetables, and whole grains, is associated with an increased risk of CVD(1). This study compares the impact of two short-term dietary interventions, a Healthy Australian Diet adhering to national guidelines and a Typical Australian Diet representing current national consumption patterns, on several cardiometabolic outcomes. These outcomes include body weight, waist circumference (WC), body fat percentage (BFP), blood pressure (BP), fasting blood lipids and glucose concentrations. Data from an eight-week randomised, cross-over feeding study involving 34 adults (53% female, age 38.4 ± 18.1 years) were analysed, with participants randomly assigned to consume each diet for two weeks, separated by a two-week washout period. During each feeding phase, all food items were provided to ensure compliance. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3), with saturated fat limited to ≤10% of energy. The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4), setting total fat intake at 40% of energy and total saturated fat at 15% of energy. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Trained personnel measured WC using a tensible tape, while body weight and BFP measurements were obtained using bioimpedance analysis (Inbody 270; Biospace Co, Seoul, Korea). Blood pressure was recorded using the Uscom BP+ supra-systolic oscillometric central blood pressure device. Blood glucose and lipid (triglycerides, total-, low-density lipoprotein- [LDL] and high-density lipoprotein- [HDL] cholesterol) concentrations were measured after a 12-hour fast by an accredited pathology service. Differential changes in cardiometabolic variables between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. There were no significant differences between the Healthy Australian Diet and the Typical Australian Diet with respect to weight, BFP, WC, blood triglycerides, systolic and diastolic BP. However, the Healthy Australian Diet led to a significantly greater decrease in total-, LDL-, HDL- and non-HDL cholesterol, and fasting blood glucose relative to the Typical Australian Diet (p&lt;0.001). The results underscore the importance of promoting dietary intakes that align with Australian Dietary Guidelines for optimising the risk of CVD and impaired glucose tolerance. Conversely, the Typical Australian Dietary pattern demonstrated detrimental cardiometabolic effects over a short period of just two weeks.

Comparison of snack characteristics by diet quality: findings from a nationally representative sample of Australian adolescents

Snacking is a common eating behaviour among adolescents accounting for more than a quarter of their total energy intake but the relationship between snacks and overall diet quality remains unclear(1). Hence, the aim of this study was to examine characteristics of snacks among Australian adolescents (12-18 years) according to their level of diet quality. This secondary analysis uses one day of 24-hour dietary recall data from the 2011 - 2012 National Nutrition and Physical Activity Survey (n = 935). Snacks were defined based on participant-identified eating occasions(2). The Dietary Guideline Index for Children and Adolescents (DGI-CA) was used to assessed adherence to the Australian Dietary Guidelines(3), with the highest tertile of the DGI-CA score indicating high adherence. The means (95% confidence intervals [CI]) for daily snack frequency and snack energy density (ED; kJ/g) were estimated for boys and girls, using linear regression, adjusted for age, area-level disadvantage, and energy misreporting. The differences in means and proportions across tertiles of DGI-CA scores were tested by using F- and Chi square-tests, respectively. The results show no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores in either boys (lowest tertile mean = 2.2, 95% CI [2.0, 2.4] snacks/day, highest tertile = 2.1 [1.9, 2.3]) or girls (lowest tertile = 1.9 [1.7, 2.1] snacks/day, highest tertile = 2.2 [1.9, 2.4]). The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.42, 95% CI [7.1, 10] kJ/g, highest tertile = 6.32 [5.4, 7.4] kJ/g) and girls (lowest tertile = 8.99 [7.8, 10.3] kJ/g, highest tertile = 5.92 [5.1, 6.9] kJ/g). As DGI-CA scores increased, the proportion of both boys and girls consuming discretionary foods at snacks (such as soft drinks) decreased, while foods from the five food groups (such as apples) increased (p-values &lt; 0.05). In conclusion, snack ED, but not frequency, and the types of foods consumed by adolescents at snacks varied by a level of diet quality. Snack ED decreased with increasing diet quality and adolescents with higher diet quality had higher intakes of foods from the five food groups and lower intakes of discretionary foods at snacks. Encouraging the consumption of lower-ED foods from the five food groups at snacks presents an opportunity to enhance adolescent diet quality. Future studies should explore snack-specific strategies to improve overall diet quality of adolescents.

Short-term skin carotenoid changes following consumption of a typical Australian diet versus a healthy Australian diet: findings from a randomised crossover feeding trial

Carotenoids, a group of phytochemicals found in plant-based foods with yellow, red, or orange pigments, have been shown to be stored in the skin upon consumption of carotenoid-rich foods(1). Skin carotenoid levels can be measured using skin reflectance spectroscopy, which assesses skin lightness (L*), redness (a*), and yellowness (b*)(2). Previous research has demonstrated significant increases in skin yellowness (b*) after a 4-week high-carotenoid diet(2). The aim was to examine shorter-term changes (two weeks) in skin yellowness following the consumption of a Healthy Australian Diet rich in carotenoids compared to a Typical Australian Diet with low carotenoid content. The study analysed data from an eight-week randomised, cross-over feeding trial involving 34 adults (53% female, aged 38.44 ± 18.05 years). Participants were randomly assigned to each diet for two weeks, separated by a two-week washout period. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(3), emphasising the consumption of carotenoid-rich fruits and vegetables such as carrots, pumpkin, tomatoes, red capsicum, and sweet potatoes. In contrast, the Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4) and emphasised the intake of fruits and vegetables low in beta-carotene, such as white potatoes, onions, cauliflower, and pears. Skin carotenoids were measured using skin reflectance spectroscopy at three sites (palm, inner and outer arm), and each measurement was taken thrice. Overall skin yellowness (b*) was calculated as the average of all three measurements at all three sites. Measurements were conducted at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout; baseline 2), and week 8 (post-feeding phase 2). Differential changes in skin carotenoid levels between intervention groups were assessed using linear mixed-effect models, adjusting for diet sequence, feeding phase, body fat percentage, total fat intake, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to evaluate the relative effects of each diet. Although there was a trend towards higher skin yellowness (0.215 ± 0.517; p = 0.41) following consumption of the Healthy Australian diet relative to baseline, and an inverse trend following the Typical Australian Diet (−0.118 ± 0.539, p = 0.56), the difference in change between the two diets was not statistically significant (p = 0.32). Notably, baseline values within this participant cohort were higher than previously reported at b* = 16.7(1) (baseline 1 b*: 17.57 ± 2.23, baseline 2 b*: 17.71 ± 2.26), which may influence the magnitude of observable change. The findings suggest that the two-week intervention duration may be insufficient to achieve statistically significant changes in skin carotenoid levels. Future investigations into whether plasma carotenoids increase first, with skin changes occurring later, could offer valuable insights into the potential utility of this as a biomarker validation of change in fruit and vegetable intake.