Discretionary Food Intake Research Articles

How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial.

The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption. Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS. Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia. Analyses included 225 women (116 intervention and 109 control). Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects. The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.

Investigating the mediators and moderators of child body mass index change in the Time2bHealthy childhood obesity prevention program for parents of preschool-aged children

ObjectivesThe aim of this study was to explore factors which mediated or moderated the effect of the Time2bHealthy online program for parents of preschool-aged children on body mass index (BMI) change. Study designMediation and moderation analyses of data from a two-arm parallel randomised controlled trial. MethodsRandomisation was conducted after baseline measures. The intervention group received an 11-week online program, and the comparison group received emailed links to information from an evidence-based parenting website. Data on the primary outcome (child BMI), potential mediators (energy intake, fruit and vegetable intake, discretionary food intake, physical activity, screen-time, sleep, child feeding, parent self-efficacy or parent role-modelling) and potential moderators (child age, parent age, parent income, parent education or parent living situation) were collected at baseline, 3 months and 6 months. PROCESS macro for SPSS was used to analyse possible mediators and moderators on BMI outcomes. ResultsDespite significant food-related outcomes in the main analysis of this trial, no significant mediating or moderating effects were found for any hypothesised mediators or moderators. ConclusionsThis study's null results could be explained by the high proportion of children in the healthy weight range, the study period not being long enough to detect change, the multicomponent nature of the intervention or the relatively small number of outcomes measured. Future childhood obesity interventions should continue to explore the effects of mediators and moderators on BMI and consider collecting data on a wide range of mediating and moderating factors to allow for comparison between studies to develop a better understanding of the factors contributing to successful interventions.

Modelling the Association between Core and Discretionary Energy Intake in Adults with and without Obesity.

Background: Many dietary recommendations for weight control rely on the assumption that greater core food intake will displace intake of energy-dense discretionary foods and beverages. However, there is little evidence to support these assumptions. This study examined the naturalistic relationship between daily core and discretionary energy intake, and with discretionary food and discretionary beverage intake, separately. The impact of weight status on these associations was also examined. Method: One hundred participants completed a four-day (non-consecutive) estimated food diary. Discretionary foods and beverages were identified by reference to the Australian Dietary Guidelines. Non-discretionary items were considered core items. Simultaneous-equation random effects models using disaggregated dietary data controlling for sociodemographic variables were used to determine the association between various dietary components. Result: Core energy intake correlated negatively with discretionary energy intake (cross-equation correlation, ρ = −0.49 (95% CI: −0.57, −0.39)). Its correlation with discretionary foods (−0.47 (−0.56, −0.37)) was stronger than that with discretionary beverages (−0.19 (−0.30, −0.07)) The correlation between core energy intake and discretionary energy intake was significantly stronger in participants who did not have obesity (−0.67 (−0.71, −0.50)) than those with obesity (−0.32 (−0.46, −0.17)) (p = 0.0002). Conclusions: Core and discretionary energy intake share an inverse and potentially bidirectional, relationship that appears to be stronger with discretionary foods than discretionary beverages. These relationships were significantly weaker in participants with obesity which may indicate less precise dietary compensation in these individuals. While strategies that promote greater intake of core foods may assist with weight maintenance in individuals of healthy weight, its impact in individuals with obesity may be limited. These strategies should be accompanied by direct messages to reduce commensurately the intake of discretionary items, with special attention paid to discretionary beverage consumption.

An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial.

BackgroundElectronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children.ObjectiveThis study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy.MethodsThe Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection.ResultsA total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.ConclusionsThe trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).

Breakfast Choice Is Associated with Nutrient, Food Group and Discretionary Intakes in Australian Adults at Both Breakfast and the Rest of the Day.

Breakfast choice is correlated with daily nutrient intakes, but this association may not be solely explained by the breakfast meal. We profiled breakfast consumer groups among Australian adults and compared the role that breakfast versus the rest of the day had on daily intakes of the Five Food Groups, discretionary foods, and nutrients. Breakfast groups were breakfast cereal consumers, non-cereal breakfast consumers, and breakfast skippers. One-day dietary recall data from the 2011–2012 National Nutrition and Physical Activity Survey were analysed (n = 9341, ≥19 years), as well as socio-demographic and anthropometric measures. Twelve per cent of adults were breakfast skippers, 41% were breakfast cereal consumers, and 47% were non-cereal breakfast consumers. Females were more likely to have a non-cereal breakfast than males, and the non-cereal breakfast was predominantly bread-based. Breakfast skipping decreased with age (p < 0.001), while breakfast cereal consumption increased with age (p < 0.001). Breakfast skippers were more likely to be male, had a lower socio-economic status, and lower physical activity levels (p < 0.001). Breakfast skippers had the highest mean body mass index (BMI) and waist circumference (p < 0.001), the lowest intake of wholegrain foods, fruits and vegetables, and the highest intake of discretionary foods (p < 0.001). Breakfast cereal consumers had the lowest mean BMI and waist circumference (p < 0.001) and had healthier diets at both breakfast and throughout the rest of the day. They were the most likely to meet the daily recommended serves for grain foods, fruit, dairy, and vegetables, had the highest wholegrain food intake, and the lowest discretionary intake (p < 0.001). Additionally, breakfast cereal consumers had the most favourable daily nutrient intakes, including the lowest added sugars intakes. Differences in daily diet between breakfast groups were attributed to differences in food choices both at breakfast and throughout the rest of the day.

Is Obesity in Young People With Psychosis a Foregone Conclusion? Markedly Excessive Energy Intake Is Evident Soon After Antipsychotic Initiation.

Introduction: Antipsychotic medication (APM) initiation is associated with rapid and substantial weight-gain and high rates of obesity. Obesity leads to premature onset of cardiometabolic diseases and contributes to the 15–20 year shortfall in life expectancy in those experiencing severe mental illness. Dietary energy intake excess is critical to weight management but is yet to be quantified in youth with first episode psychosis (FEP) receiving APM. This study aimed to describe the degree of energy overconsumption and the food sources contributing to this in youth with FEP.Materials and Methods: People aged 15–30 years with FEP receiving APM completed diet histories through qualified dietitians to assess energy imbalance and food sources. Outcome measures were: (i) energy balance; and (ii) intake of core and discretionary foods.Results: Participants (n = 93) were aged 15–29 years (mean = 21.4 ± 2.9 years) and exposed to APMs for a median for 8 months (Interquartile Range (IQR) 11 months). Energy balance was exceeded by 26%, by a median 1,837 kJ per day (IQR 5,365 kJ). APM polypharmacy and olanzapine were linked to larger excesses in dietary energy intake. The greatest contributors to energy intake were refined grain foods (33%) and discretionary foods (31%).Conclusion: Young people with FEP receiving APMs appear to have markedly excessive energy consumption, likely contributing to rapid weight-gain, and thereby seeding future poor physical health. Larger, prospective studies are needed to gain a greater understanding of dietary intake, and its effects on health, in people with FEP.

Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: Relationships with clinical impairment, comorbidity, and self-reported food choices

BackgroundOrthorexia nervosa (ON) is characterized by obsessions about eating healthily and rigid adherence to a perceived healthy diet. This study uses the Eating Habits Questionnaire to investigate the relationship of ON symptoms with self-reported food intake, eating-related impairment, obsessive compulsive disorder symptoms (OCD), gender, and BMI while controlling for other eating disordered symptoms. The aim of this study is to provide further evidence for the construct of ON as distinct from other forms of disordered eating. MethodsThe sample consisted of 449 adults recruited on Amazon's Mechanical Turk. Self-reported symptoms of currently recognized eating disorders (anorexia and bulimia nervosa, AN/BN, avoidant/restrictive food intake disorder, ARFID) were statistically controlled in correlational analyses and MANCOVA exploring the relationship of ON domains to comorbidity, eating behavior, gender, and weight. ResultsConfirmatory factor analysis supported a three-factor solution for the EHQ, with factors representing normative healthy eating behaviors (“behaviors”), positive feelings associated with healthy eating (“feelings”), and interference/problems from rigid healthy eating (“problems”). Overall ON symptoms were more strongly related to AN/BN than to ARFID. Of the subscales, only Problems was related to other eating disorder symptomatology. Controlling for other eating disorder symptoms, overall ON symptomatology was not related to clinical impairment from eating or OCD, although it was related to higher self-reported intake of fruits/vegetables and lower intake of discretionary foods. When other eating disordered symptoms and ON domains were statistically controlled, Problems was related to clinical eating impairment, OCD symptoms, and higher intake of both fruits/vegetables and discretionary foods. ConclusionsThe Problems scale of the EHQ appears to capture disordered eating symptomatology that is distinct from other eating disorders and from normative healthy eating behaviors, consistent with descriptions of ON.

Maternal feeding practices in relation to dietary intakes and BMI in 5 year-olds in a multi-ethnic Asian population.

BackgroundIn Asia, little is known about how maternal feeding practices are associated with dietary intakes and body mass index (BMI) in preschoolers.ObjectiveTo assess the relationships between maternal feeding practices with dietary intakes and BMI in preschoolers in Asia using cross-sectional analysis in the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort.Participant settingsMothers (n = 511) who completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and a semi-quantitative Food Frequency Questionnaire (FFQ) when children were 5 years old.Statistical analysisAssociations between 12 maternal feeding practices (mean scores divided into tertiles) and children’s dietary intakes of seven food groups and BMI z-scores were examined using the general linear regression model. Weight and height of the child were measured, and dietary intakes derived from the FFQ.ResultsCompared to those in the low tertile, mothers in the high tertile of modelling healthy food intakes had children with higher intakes of vegetables[+20.0g/day (95%CI:11.6,29.5)] and wholegrains[+ 20.9g/day (9.67,31.1)] but lower intakes of sweet snacks[-10.1g/day (-16.3,-4.94)] and fast-foods[-5.84g/day (-10.2,-1.48)]. Conversely, children of mothers in the high tertile for allowing child control (lack of parental control) had lower intake of vegetables[-15.2g/day (-26.6,-5.21)] and wholegrains[-13.6g/day (-22.9,-5.27)], but higher intakes of sweet snacks[+13.7g/day (7.7, 19.8)] and fast-foods[+6.63g/day (3.55,9.72)]. In relation to BMI at 5 years, food restrictions for weight was associated with higher BMI z-scores [0.86SD (0.61,1.21)], while use of pressure was associated with lower BMI z-scores[-0.49SD(-0.78,-0.21)].Conclusions and implicationsModelling healthy food intakes by mothers was the key feeding practice associated with higher intakes of healthy foods and lower intakes of discretionary foods. The converse was true for allowing child control. Only food restrictions for weight and use of pressure were associated with BMI z-scores.

Intake of free sugar and micronutrient dilution in Australian children and adolescents.

This cross-sectional analysis aimed to investigate the association between free sugar intake and micronutrient intake in Australian children and adolescents and to assess the effectiveness of the cut-off of < 10% energy intake from free sugar (%EFS) as recommended by the World Health Organization (WHO). Dietary data of children and adolescents from the Australian Health Survey 2011-12 were analyzed (n = 1466). Free sugar intake was estimated using a published methodology with modification to suit the definition of free sugar. Six cut-offs for %EFS were created in 5% increments. Participants' mean intakes of 18 micronutrients, as well as their intakes of core (healthy) and discretionary (unhealthy) foods, at different cut-offs were compared using ANCOVA, with age, sex, and socioeconomic status measures as covariates. The odds ratios of not meeting the nutrient reference values (NRVs) for Australia and New Zealand of each micronutrient were calculated using logistic regression. Micronutrient intake decreased with increasing %EFS and the peak intakes of most micronutrients appeared between 0-15%EFS. The absolute intakes of most micronutrients were not significantly different between participants who consumed < 10%EFS and ≥ 10%EFS. Those with > 20%EFS were less likely to meet the NRVs of more than half of the micronutrients. Additionally, as %EFS increased, intakes of core food groups decreased, while intakes of discretionary food groups increased. The dilution effect in micronutrient intake with increasing free sugar intake was evident in Australian children and adolescents. However, meeting the WHO cut-off was associated with limited improvement in micronutrient adequacy.

Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument

BackgroundMethods to address misreporting associated with short dietary assessment instruments are needed. ObjectiveOur objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake. DesignValidation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls. Participants/settingThree population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013–2014). The indirect validation compared data from the 2011–2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015–2016). Main outcome measuresFood group intake (in servings) was measured. Statistical analyses performedDescriptive and inferential statistical analyses were conducted. ResultsDirect validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from –0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat. ConclusionsAdjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.

Mother-child dietary behaviours and their observed associations with socio-demographic factors: findings from the Healthy Beginnings Trial.

Few studies have investigated the effect of maternal factors on child eating practices. Our study aimed to explore mother-child dietary behaviours and their associations with socio-demographic factors. A cross-sectional analysis was conducted using data from control participants (n 243) in the Healthy Beginnings Trial, which involved first-time mothers and their 2-year-old children. Mother-child dietary behaviours were assessed using short dietary questions (short FFQ) and their associations with socio-demographic factors were examined using binary logistic regression. The dietary intake of 2-year-old children was characterised by low vegetable consumption and high discretionary food intake. In multivariate analysis, lower-income mothers (0·5 cups/d) AOR 2·93 (95 % CI 1·03, 8·35), compared with older mothers (≥25 years). Non-Australian-born mothers reported their child consumed more fruit juice (>0·5 cups/d) AOR 2·04 (95 % CI 1·02, 4·05), sweet snacks AOR 1·96 (95 % CI 1·02, 3·76) and fast food (≥2 times/week) AOR 3·67 (95 % CI 1·29, 10·43) compared with Australian-born mothers. Significant positive correlations between maternal and child dietary intake were observed for all dietary variables except milk, with the largest association for fast foods (Pearson's r 0·52, P<0·001). This study shows that maternal factors are associated with child dietary behaviours. Targeting young mothers (<25 years) of potential disadvantage, before commencement of early feeding practices, has the potential to improve children's diets.

Cross-sectional and prospective mediating effects of dietary intake on the relationship between sedentary behaviour and body mass index in adolescents

BackgroundCross-sectional evidence suggests TV viewing, but not objectively-measured sedentary time or bouts of sedentary time, is consistently associated with body mass index (BMI) in adolescents. However, it is unclear whether dietary intake is a potential mediator of these relationships. The aim of this study was to explore the cross-sectional and prospective mediating effects of dietary intake on the association of sedentary behaviour with BMI z-score (zBMI) in a cohort of Australian adolescents.MethodsCross-sectional and prospective analyses were conducted in adolescents aged 12–15 years participating in the 2002/03 (baseline) and 2004/05 (follow-up) Nepean Growing Up Study. The independent variables were television (TV) viewing, an objective measure of total sedentary time and average sedentary bout duration, and the outcome variable zBMI. Using the Sobel-Goodman method with bootstrapping, mediation analyses were conducted examining three dietary components (discretionary foods, sugar-sweetened beverages [SSB] and takeaway foods) as mediators of associations between TV viewing and zBMI (n = 259) and between total sedentary time and average sedentary bout duration with zBMI (n = 140).ResultsNo significant cross-sectional or prospective total or direct associations were observed for TV viewing, total sedentary time and average sedentary bout duration with zBMI. However, TV viewing was positively associated with consumption of takeaway foods cross-sectionally (β = 0.06; 95% CI 0.01 to 0.12), prospectively at baseline (β = 0.07; 95% CI 0.01 to 0.12) and prospectively at follow-up (β = 0.10; 95% CI 0.04, 0.16), and average sedentary bout duration was inversely associated with SSB consumption both cross-sectionally (β = −0.36; 95% CI -0.69 to −0.02) and prospectively at baseline (β = −0.36; 95% CI -0.70 to −0.02). No mediation effects were identified.ConclusionsTV viewing, total sedentary time and bouts of sedentary time were not associated cross-sectionally or prospectively with adolescents’ zBMI, and three elements of dietary intake (e.g. intake of discretionary foods, SSB and takeaway foods) did not mediate this relationship. The role of dietary intake and sedentary behaviour in relation to adolescent health requires further clarification.

Personal and situational predictors of everyday snacking: An application of temporal self-regulation theory.

This study aims at testing predictions derived from temporal self-regulation theory (TST) in relation to discretionary food choices (snacks). TST combines a motivational sphere of influence (cognitions and temporal valuations resulting in intentions) with a momentary sphere (encompassing social and physical environmental cues). This dual approach differs from current health behaviour theories, but can potentially improve our understanding of the interplay of personal and environmental factors in health behaviour self-regulation. A mixed event-based and time-based (Ecological Momentary Assessment) study in 61 adults aged between 18 and 64, with a BMI range between 18.34 and 39.78 (M=25.66, SD=4.82) over two weeks. Participants recorded their food and drink intake for two weeks in real time using electronic diaries. Participants also responded to non-consumption assessments at random intervals throughout each day. Momentary cues (individual, situational, and environmental factors) were assessed both during food logs and non-consumption assessments. Motivational factors, past behaviour, and trait self-regulation were assessed during baseline. Multilevel logistic regression analyses showed that across all snack types, environmental cues and negative affect were associated with an increased likelihood of snacking. Perceiving a cost of healthy eating to occur before eating was associated with an increased likelihood of snacking, whereas intentions and self-regulation were not. Discretionary food intake is largely guided by momentary cues, and motivational-level factors, such as intention and self-regulation, are less important in the initiation of discretionary food intake. Statement of contribution What is already known on this subject? Overweight and obesity are a result of prolonged periods of energy imbalance between energy intake and expenditure (Hill & Peters, ). One of the key behavioural determinants of energy imbalances results from food intake, specifically from discretionary food choices (snacking). Temporal self-regulation theory (Hall & Fong, ) takes into account both deliberate and momentary influences on health behaviour, which is especially relevant to exploring the drivers of snacking. What does this study add? Offers new insight into the application of TST in explaining momentary eating behaviours. Snacking initiation is guided by momentary cues, not person-level factors. Dietary interventions should acknowledge the momentary cues that are associated with snacking.

Discrepancy in socioeconomic status does not fully explain the variation in diet quality between consumers of different coffee types.

Habitual consumers of different coffee types may vary in socioeconomic status (SES), which is an important determinant of diet quality. Nonetheless, research on diet quality among coffee consumers was scarce. We aimed to compare the diet quality of coffee consumers with different preferences towards coffee type and additive usage. In this cross-sectional analysis, intake data of food, coffee, and additive usage from the adult respondents of the 2011-2012 Australian Health Survey were used. Participants were grouped according to the type of coffee (espresso and ground coffee, E&G; coffee made from coffee mixes and instant coffee, M&I; non-consumers, NC) and additives (milk, sugar, and intense sweetener) consumed. Adjusted food group intake was compared between consumption groups using general linear model. E&G drinkers had better SES than M&I and NC. After adjusting for covariates, the mean dairy intake of E&G drinkers was 22.2% higher than M&I drinkers (p<0.001) and 33.1% higher than NC (p<0.001). Mean discretionary food intake of E&G drinkers was 12.1% lower than M&I (p=0.003) and 12.3% lower than NC (p=0.001). In terms of additive usage, non-users of coffee additive had the lowest dairy food intake and the highest discretionary food intake. Coffee consumers' different preferences towards coffee type and additive usages reflected significant variations in their diet quality, even after adjustment of SES. Therefore, future epidemiological studies should consider separating coffee drinkers according to their habitual consumption of different types of coffee.

Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents.

Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14–18 years old in the 2011–2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.

Older Australians Can Achieve High Adherence to the Mediterranean Diet during a 6 Month Randomised Intervention; Results from the Medley Study.

Adherence to a Mediterranean diet (MedDiet) is thought to be achievable in non-Mediterranean regions, but this has yet to be investigated. We aimed to determine if an older Australian population could adhere to a MedDiet for six months. We conducted a randomised, parallel dietary intervention trial with two dietary arms: the Mediterranean diet (MedDiet) group and the habitual diet (HabDiet) control group. A 15-point Mediterranean diet adherence score and food and nutrient intakes were estimated from three-day weighed food records collected at baseline, two and four months. Erythrocyte fatty acids, serum carotenoids and urinary metabolites were assessed at baseline, three and six months. We enrolled 166 participants; 152 commenced and 137 completed the study (70 in the MedDiet group, 67 in the HabDiet group). Adherence scores were significantly higher in the MedDiet group at two months (between group difference 2.2, 95% CI 1.3, 2.9) and four months (between group difference 2.6, 95% CI 1.9, 3.3). Consumption of vegetables, fruits, fish, legumes, nuts and olive oil significantly increased in the MedDiet group compared to the control, and discretionary food intake decreased (p < 0.01). Measures of compliance including serum β-carotene, lycopene and erythrocyte monounsaturated fatty acids were significantly higher in the MedDiet group at three and six months (p < 0.05). Our results indicate that a population of older Australians can adopt a Mediterranean diet over a six month period.

Adherence to a Mediterranean Diet (MedDiet) for 6 months improves dietary quality and dietary inflammatory index in a western population: results from the Mediterranean diet for cognition and cardiovascular health in the elderly (MedLey) study

Inflammation is thought to be an underlying pathophysiological cause of a range of chronic diseases including cardiovascular disease (CVD). Diet is a modifiable risk factor for CVD and can influence the inflammatory process depending on the quality of the diet. Western diets, typically characterised by processed foods, red and processed meats, refined carbohydrates and added sugars, have been shown to be positively associated with inflammatory markers, while a Mediterranean diet, rich in plant foods and low in processed foods, has been shown to have a contrasting effect. The dietary inflammatory index (DII) was developed to determine the inflammatory potential of a dietary pattern. Positive DII scores indicate a pro‐inflammatory diet and negative scores indicate an anti‐inflammatory diet. This opportunistic study sought to evaluate the change in dietary quality and dietary inflammatory index following the administration of a traditional MedDiet in older Australian adults.152 Australian men and women (mean age 71±5yrs) were recruited for the MedLey study. Participants were randomly allocated either a MedDiet (n=80) or continue their habitual diet (HabDiet) (n=72) for 6 months. Volunteers followed a prescribed MedDiet plan under dietetic supervision. All volunteers attended the clinic on a fortnightly basis to have their weight measured, discuss the intervention and receive study foods. Dietary intake was calculated using 3‐day weighed food records. Data was analysed using linear regression.137 volunteers completed the trial (MedDiet n=70, HabDiet n=67). Our volunteers were able to comply with the MedDiet throughout the intervention (92% compliance rate) according to daily monitoring of food intake. At baseline, 14% of the population were meeting recommended intakes for vegetables and 54.9% for fruits, and 5.1% for dairy foods.. With administration of a traditional MedDiet, the MedDiet group increased their mean daily intake of vegetables (+60g), fruit (+123g), dairy (+98g), fish (+42g), nuts (+33g), legumes (29g,) and decreased their intake of meat (−21g) and discretionary foods (−168g). The HabDiet achieved only minor changes at 4 months, although decreased their intake of discretionary foods 95g but in contrast also decreased their mean daily intake of dairy foods (−19g) and fish (−12g). The baseline DII was −0.10±1.71 (mean±SD) for our Australian population (n=152). For the MedDiet group the DII score was −1.40±0.20 and −1.47±0.20 at 2 and 4 months of the intervention, respectively, whilst the HabDiet DII score did not change significantly (0.47±0.21 at 2 months and 0.54±0.21 at 4 months).This dietary pattern was sustainable to follow for 6 months as evident by the high compliance rate and facilitated improves in the quality of the diet by increases plant based foods and decreases in discretionary food. This resulted in changes in the DII promoting a low inflammatory diet which could be beneficial for healthy ageing and the avoidance of chronic disease.Support or Funding InformationThis project was supported by a grant from the National Health Medical Research Council of Australia.

Temporal eating patterns: associations with nutrient intakes, diet quality, and measures of adiposity

Background: Some evidence suggests that higher energy intake (EI) later in the day is associated with poor diet quality and obesity. However, EI at one eating occasion (EO) is also dependent on EI at surrounding EOs. Studies that examine the distribution of EOs across the day are rare.Objective: The aim of this study was to examine associations between temporal eating patterns, nutrient intakes, diet quality, and measures of adiposity in a representative sample of Australian adults.Design: Dietary data from two 24-h recalls collected during the cross-sectional 2011-2012 Australian National Nutrition and Physical Activity Survey were analyzed (n = 4544 adults, aged ≥19 y). Temporal eating patterns, based on the distribution of EOs across the day, were determined by using latent class analysis. Diet quality estimated adherence to healthy eating recommendations and was assessed by using the 2013 Dietary Guidelines Index (DGI). Multivariate regression models assessed associations between temporal eating patterns, nutrient intakes, diet quality, and adiposity (body mass index, waist circumference, weight status, and central weight status). Models were adjusted for potential confounders and energy misreporting.Results: Three patterns, labeled "conventional," "later lunch," and "grazing," were identified. Compared with a "conventional" or "later lunch" pattern, men and women with a "grazing" pattern had lower DGI scores and higher intakes of discretionary (noncore) foods (P < 0.05). Among women, the "grazing" pattern was associated with overweight or obesity (OR: 1.57; 95% CI: 1.15, 2.13) and central overweight or obesity (OR: 1.73; 95% CI: 1.19, 2.50). These associations were attenuated after the exclusion of energy misreporters and adjustment for total EI.Conclusions: This study found that a "grazing" temporal eating pattern was modestly but significantly associated with poorer diet quality and adiposity among women, after adjustment for covariates and energy misreporting. Future research should consider the impact of energy misreporting on the relation between temporal eating patterns and adiposity. This secondary analysis was registered at anzctr.org.au as ACTRN12617001029381.

58 - A Hox Family-Based Scoring System Predicts the Clinical Outcome of Myelodysplastic Syndromes

Orthorexia nervosa (ON) is characterized by obsessions about eating healthily and rigid adherence to a perceived healthy diet. This study uses the Eating Habits Questionnaire to investigate the relationship of ON symptoms with self-reported food intake, eating-related impairment, obsessive compulsive disorder symptoms (OCD), gender, and BMI while controlling for other eating disordered symptoms. The aim of this study is to provide further evidence for the construct of ON as distinct from other forms of disordered eating.The sample consisted of 449 adults recruited on Amazon's Mechanical Turk. Self-reported symptoms of currently recognized eating disorders (anorexia and bulimia nervosa, AN/BN, avoidant/restrictive food intake disorder, ARFID) were statistically controlled in correlational analyses and MANCOVA exploring the relationship of ON domains to comorbidity, eating behavior, gender, and weight.Confirmatory factor analysis supported a three-factor solution for the EHQ, with factors representing normative healthy eating behaviors (“behaviors”), positive feelings associated with healthy eating (“feelings”), and interference/problems from rigid healthy eating (“problems”). Overall ON symptoms were more strongly related to AN/BN than to ARFID. Of the subscales, only Problems was related to other eating disorder symptomatology. Controlling for other eating disorder symptoms, overall ON symptomatology was not related to clinical impairment from eating or OCD, although it was related to higher self-reported intake of fruits/vegetables and lower intake of discretionary foods. When other eating disordered symptoms and ON domains were statistically controlled, Problems was related to clinical eating impairment, OCD symptoms, and higher intake of both fruits/vegetables and discretionary foods.The Problems scale of the EHQ appears to capture disordered eating symptomatology that is distinct from other eating disorders and from normative healthy eating behaviors, consistent with descriptions of ON.

Overview of the Dietary Intakes of the Mexican Population: Results from the National Health and Nutrition Survey 2012

Background:Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in young children, iron deficiency in pregnant women, and widespread obesity across age groups.Objective:The aim was to summarize and discuss findings published in this supplement on dietary intakes and the eating habits of the Mexican population.Methods:A 24-h recall questionnaire that used the multiple-pass method with a repeated measure in a fraction of the sample was applied in a nationally representative sample. We estimated mean intakes and percentages of inadequacy for macronutrients and micronutrients; mean intakes and percentages of the population who adhere to dietary recommendations for food groups; sources of added sugars; intakes of discretionary foods by mealtime, place, and activity; and mean dietary intakes in children <2 y old.Results:Infant formula was consumed by almost half of infants aged <6 mo and sugar-sweetened beverages were consumed by two-thirds of children aged 12–23 mo. In the different age groups, a high proportion of the population had excessive intakes of added sugars (58–85%) and saturated fats (54–92%), whereas a high prevalence of insufficient intakes was found for fiber (65–87%), vitamin A (8–70%), folates (13–69%), calcium (26–88%), and iron (46–89%). Discretionary foods (nonbasic foods high in saturated fats and/or added sugars) contributed 26% of the population’s total energy intake, whereas only 1–23% met recommendations for legumes, seafood, fruit, vegetables, and dairy foods.Conclusions:High proportions of Mexicans consume diets that do not meet recommendations. Breastfeeding and complementary feeding diverged from recommendations, intakes of discretionary foods were high, and the prevalence of nutrient inadequacies and age groups not meeting intake recommendations of basic food groups were also high. The results are consistent with the high prevalence of the double burden of malnutrition and are useful to design food and nutrition policies.