Energy-dense Nutrient-poor Research Articles

Physical activity, sleep quality, energy dense nutrient-poor (EDNP) foods intake, with blood pressure among obese teachers

Profession teachers with obesity nutritional status encourage hypertension because they have light physical activity, poor sleep quality, and high energy-dense, nutrient-poor food (EDNP) intake caused by potential occupational risks. This study sought to examine the relationship between physical activity, sleep quality, EDNP intake, and systolic and diastolic blood pressure. This was a study with a consecutive sampling design among female teachers aged 35-54 years in Kudus in March 2022. The total number of respondents with direct offline interviews was 59. Rank Spearman or Pearson test for bivariate analysis, followed by the linear regression test for multivariate analysis. Bivariate tests showed that physical activity (p=0,039) and EDNP intake (p=0,001) showed a noteworthy correlated with systolic blood pressure. The relationship between sleep quality (p=0,039) and EDNP intake (p=0,028) was significant for diastolic blood pressure but not for systolic blood pressure. The results of the multivariate test indicated a substantial correlation between physical activity, sleep quality, and EDNP intake on systolic BP (p=0,001) and diastolic BP (p=0,006) blood pressure. In conclusion, physical activity, sleep quality, and EDNP intake were significantly associated with systolic and diastolic blood pressure.

A Qualitative Process Evaluation of Participant Experiences in a Feasibility Randomised Controlled Trial to Reduce Indulgent Foods and Beverages

There is a growing interest in the effects of ultra-processed/energy-dense nutrient-poor foods on health outcomes, and few interventions to reduce their consumption have been tested. We tested a simple intervention to help people reduce the indulgences they consume (energy-dense nutrient-poor (EDNP) foods). Herein, we report the qualitative findings to understand how participants reduced their consumption by exploring intervention fidelity and the factors affecting consumption. We conducted a qualitative descriptive study of 23 adults who had taken part in a feasibility randomised controlled trial that asked participants to say no to seven indulgences/week and record what they said no to. Data were collected using face-to-face semi-structured interviews and analysed thematically. A total of 23 adults with an average BMI of 30.8 kg/m2 took part. Participants liked the term indulgence, as they could apply it to their normal dietary intake and make small changes. They found self-monitoring what they said no to helpful and reported that emotional eating and habits affected consumption. They had difficulty overcoming these. As most people are consuming too many foods that are EDNP, this simple intervention of "Say No" seven times/week has the potential to be developed as a public health campaign.

Emotional Eating and Diet-related Self-Efficacy, Motivation, and Norms in Adolescents

The objective of the current study was to examine the association between emotional eating and self-efficacy, motivation, and social norms for consumption of fruits and vegetables (F/V) and energy-dense, nutrient-poor (EDNP) foods and beverages, as well as interactions with body mass index-z score (BMI-z). Adolescents completed self-report measures of demographics, emotional eating, and dietary health behavior theory constructs. Emotional eating was associated with lower self-efficacy for consumption of F/V and for limiting EDNP foods/beverages; greater motivation for limiting of EDNP foods/beverages; lower social norms for consumption of F/V; and greater social norms for consumption of EDNP foods/beverages. There were no interactions with BMI-z. Evidence-based nutrition programs that leverage health behavior theories should be tailored to adolescents’ emotional eating.

Eating Behaviors and Diet Quality: A National Survey of Australian Young Adults

ObjectiveTo investigate associations between eating behavior constructs (social eating, perceived competence, habit automaticity, self-determined motivation) and diet quality among young adults. DesignCross-sectional analysis. ParticipantsYoung adults (n = 1,005; mean age, 21.7 ± 2.0 years; 85% female) enrolled in the Advice, Ideas, and Motivation for My Eating (Aim4Me) study. Main outcome measuresFour eating behavior measures collected via online surveys: Social Eating Scale, Perceived Competence in Healthy Eating Scale, Self-Report Behavioral Automaticity Index, and Regulation of Eating Behaviors scales. Diet quality was assessed using the Australian Recommended Food Score (ARFS) and percentage energy from energy-dense, nutrient-poor (EDNP) foods. AnalysisMultivariate linear regression investigating associations between eating behavior measures (independent variables) and ARFS and EDNP foods (dependent variables), adjusting for sociodemographic and lifestyle confounders. ResultsGreater perceived competence in healthy eating and behavioral automaticity for consuming healthy foods, limiting EDNP food intake, and higher intrinsic motivation, integrated regulation, and identified regulation of eating behaviors were associated with higher ARFS and lower percentage energy EDNP foods (P < 0.001). Greater self-reported social influence on eating behaviors was associated with higher ARFS (P = 0.01). Higher amotivation was associated with greater % energy from EDNP foods (P < 0.001). Conclusions and ImplicationsPerceived competence, habit automaticity, and self-determined motivation are determinants of diet quality in young adults. These findings support the development of interventions that promote healthy eating habits by focusing on eating behavior constructs and evaluating their use in improving diet quality.

Defining Energy-Dense, Nutrient-Poor Food and Drinks and Estimating the Amount of Discretionary Energy.

Overconsumption of energy provided by energy-dense, nutrient-poor (EDNP) food and drinks increases the risk of unhealthy weight gain and of obesity-related health outcomes. The aim of this study was to develop a nutrient profiling model for classifying EDNP food and drinks and to estimate the amount of discretionary energy for EDNP food and drinks in a recommended diet. A stepwise approach was used first to develop a nutrient profiling model for classifying EDNP food and drinks and then to estimate the amount of discretionary energy in a recommended diet using diet modeling. The nutrition profiling model comprised 24 macro- and micronutrients and energy density. The model classified 67% of 1482 foods and 73% of 161 drinks correctly as EDNP food and drinks compared with an expert-adjusted model. Sweets, chocolate, cake, cookies and biscuits, sweet and salty snacks, sugar-sweetened and artificially sweetened drinks, and alcoholic drinks were classified as EDNP food and drinks. The estimated amount of discretionary energy for EDNP food and drinks was 4–6% of the energy requirements for 4–75-year-old Danes. It seems prudent to have special attention on EDNP food and drinks in dietary guidelines and future public health initiatives to avoid overconsumption of energy.

The Impact of the COVID-19 Pandemic on Young Australian Adults’ Food Practices

ABSTRACTBackgroundYoung Australian adults exhibit poor food behaviors. These include increased consumption of Energy-Dense, Nutrient-Poor (EDNP) foods, sugar-sweetened beverages, and low consumption of fruit and vegetables. However, little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected young Australian adults’ pre-existing adverse food behaviors.ObjectivesThe present study aimed to understand the impact of the COVID-19 pandemic on food practices by exploring views of young adults living in Australia.MethodsThrough qualitative descriptive methods, data gathered through individual interviews were thematically analyzed. Participants included 38 young adults aged 18–30 y with a mean age of 24.1 y (76% female).ResultsFive themes emerged: 1) disruption of routines, 2) increased flexibility, 3) changes in food practices, 4) heightened psychological distress, and 5) impact on future behaviors. Disruption of routines and increased flexibility associated with working/learning from home resulted in both positive and negative changes in food practices. Negative changes included increased consumption of EDNP foods, increased consumption of foods prepared outside of home, decreased purchases and consumption of fresh foods, meal skipping, and a lack of meal planning. Positive changes included an increase in home cooking; consistent weekly eating patterns; decreased consumption of EDNP foods; smaller, more frequent meals; and decreased consumption of foods prepared outside of home.ConclusionsYoung Australian adults reported more negative and fewer positive changes in food practices. The observed negative changes in food practices are likely to have accentuated young Australian adults’ previously known poor food behaviors. This study adds to the international literature by reporting ways that young adults implemented positive changes during the pandemic and future directions of their food practices.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions-A Scoping Review.

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

Dietary Outcomes of the 'Healthy Youngsters, Healthy Dads' Randomised Controlled Trial.

(1) Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father–child dietary intakes. (2) Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen’s d determined effect sizes, while correlation tests determined associations in father–child dietary intakes. (3) Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father–child dietary intakes for some of the dietary variables. (4) Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

P14 Factors that Influence the Snacking Behaviors of Adolescents from Low Socioeconomic Status Backgrounds in New York City: Preliminary Findings

BackgroundU.S. adolescents from racial/ethnic minority and low socioeconomic status (SES) backgrounds consume energy-dense, nutrient-poor (EDNP) snacks, and this is associated with poor overall diet quality and obesity. What remains less clear are factors that influence snacking behaviors among this population.ObjectiveTo qualitatively explore factors that influence the snacking behaviors of adolescents from low SES backgrounds in New York City (NYC).Study Design, Setting, ParticipantsAdolescents (12-18 years) were recruited from a NYC Boys & Girls Club (proxy for low SES) to participate in a semi-structured, qualitative phone interview. The Social Cognitive Theory (SCT) informed the development of the interview guide, such that adolescents were asked about personal cognitive, environmental (social and physical), and behavioral factors that influence snacking.Measurable Outcome/AnalysisInterviews were audio-recorded, transcribed, and analyzed in NVivo 12® using the thematic analysis approach. Emergent themes were categorized into a priori categories based on SCT constructs.ResultsParticipants (n = 16) were predominantly male (63%) and Black (81%), with a mean age of 14.9 years. Regarding personal cognitive factors, adolescents’ snacking was influenced by preference (eg, taste, brand), health benefits (eg, more energy), and health concerns (eg, fear of weight gain/diabetes). Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking with family promoted healthier snacking. Adolescents also discussed how their physical environment fostered unhealthy snacking. One adolescent stated, “The amount of bodegas compared to the amount of supermarkets that are in my community, the ratio is completely unbalanced...there's a lot of unhealthy choices in my community.” Concerning behavioral factors, adolescents referenced having high purchasing power and autonomy to choose snacks: “I have my own money, so I would go out to the grocery store [to buy snacks].”ConclusionThere is a need for culturally tailored interventions targeting snacking behaviors of adolescents from low SES backgrounds that acknowledge personal cognitive, environmental, and behavioral factors. U.S. adolescents from racial/ethnic minority and low socioeconomic status (SES) backgrounds consume energy-dense, nutrient-poor (EDNP) snacks, and this is associated with poor overall diet quality and obesity. What remains less clear are factors that influence snacking behaviors among this population. To qualitatively explore factors that influence the snacking behaviors of adolescents from low SES backgrounds in New York City (NYC). Adolescents (12-18 years) were recruited from a NYC Boys & Girls Club (proxy for low SES) to participate in a semi-structured, qualitative phone interview. The Social Cognitive Theory (SCT) informed the development of the interview guide, such that adolescents were asked about personal cognitive, environmental (social and physical), and behavioral factors that influence snacking. Interviews were audio-recorded, transcribed, and analyzed in NVivo 12® using the thematic analysis approach. Emergent themes were categorized into a priori categories based on SCT constructs. Participants (n = 16) were predominantly male (63%) and Black (81%), with a mean age of 14.9 years. Regarding personal cognitive factors, adolescents’ snacking was influenced by preference (eg, taste, brand), health benefits (eg, more energy), and health concerns (eg, fear of weight gain/diabetes). Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking with family promoted healthier snacking. Adolescents also discussed how their physical environment fostered unhealthy snacking. One adolescent stated, “The amount of bodegas compared to the amount of supermarkets that are in my community, the ratio is completely unbalanced...there's a lot of unhealthy choices in my community.” Concerning behavioral factors, adolescents referenced having high purchasing power and autonomy to choose snacks: “I have my own money, so I would go out to the grocery store [to buy snacks].” There is a need for culturally tailored interventions targeting snacking behaviors of adolescents from low SES backgrounds that acknowledge personal cognitive, environmental, and behavioral factors.

Healthy Eating in Low-Income Rural Louisiana Parishes: Formative Research for Future Social Marketing Campaigns.

High rates of obesity and chronic disease exist in the southeastern United States (US). Knowledge about the attitudes, beliefs, and barriers of the rural low-income Louisiana population regarding healthy eating is limited. Focus Group discussions based on the Theory of Planned Behavior (TPB) were conducted in rural parishes (N = 3) with low-income residents of Louisiana (N = 29). Grounded Theory methods and cross-case analysis were used. The participants were primarily single Black females of age 18–30 years who earned a high school diploma, were employed, and had children. Beliefs included healthy eating was physically beneficial, yet financial impacts and the low palatability of healthy foods were barriers. Professional resources for nutrition education were limited which led to reliance on friends, family, and the internet. Friends and family were positive and negative influences on eating choices. Control beliefs included the high prices and low palatability of healthy foods, the wide availability of Energy Dense Nutrient Poor (EDNP) foods, and low motivation to sustain eating behavior changes. Formative research to optimize campaign distribution channels may improve accessibility to social marketing support and healthy eating resources. Persuasive messages that address control beliefs are needed in social marketing campaigns for rural low-income Louisiana environments.

University Students Purchasing Food on Campus More Frequently Consume More Energy-Dense, Nutrient-Poor Foods: A Cross-Sectional Survey.

University food environments are typically dominated by unhealthy food choices. The aim was to investigate associations between on-campus food purchasing behaviours and dietary intake in an Australian university student sample. An online cross-sectional survey was conducted in 2017–2018 with students (n = 362, 71.0% female, mean age 27.5 ± 10.5 years) from the University of Newcastle, Australia. On-campus food purchasing behaviours (purchasing frequency and weekly expenditure), dietary intake (diet quality and percentage energy/day from energy-dense, nutrient-poor (EDNP) foods) and sociodemographic and student characteristics (e.g., time spent on campus) were measured. Linear regression was used to explore associations between food purchasing behaviours and dietary intake, adjusted for potential confounders. Mean percentage energy/day from EDNP foods was 31.7 ± 14.4. Mean diet quality score was 32.6 ± 10.2 out of 73. Higher percentage energy/day from EDNP foods was associated with higher weekly expenditure (β = 0.203, p < 0.001) and more frequent purchase (β = 18.041, p < 0.001 for ≥4 times a week vs. never) of food/drinks on campus. Diet quality was not significantly associated with purchase frequency or expenditure (p > 0.05). Findings are supportive of changes being made to university food environments, as a strategy to improve dietary intake among university students.

Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort.

Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.

Consumption of Fruits, Vegetables, and Nuts Can Be Increased When Multitasking with Screen Devices

ABSTRACT Past research shows that people overconsume energy-dense, nutrient-poor (EDNP) foods when they are not paying attention to environmental cues that encourage consumption. Very little is known about the mindless consumption of nutritious foods (herein referred to as preferred foods). Using dual-processing, limited capacity, and mood management models and theories, this study explored whether people misreport the selection of preferred and EDNP foods under differing levels of distraction created by screen media device use. Participants freely grazed on EDNP and preferred snacks while either watching TV (one screen) or multitasking with two or three screens (TV, iPod, laptop computer). Participants under-reported the number of preferred foods they selected for consumption in the three-screen multitasking conditions more than in one- and two-screen conditions. They under-reported the selection of preferred snacks more than EDNP snacks in the three-screen conditions. The under-reporting of snack selection was greater in one three-screen condition (TV+texting+online shopping) (which was evaluated as highly arousing and pleasant), than in the other three-screen condition (TV+texting+online reading) (which was rated as highly arousing but less pleasant). Compared to participants with weaker health beliefs, those with stronger beliefs about healthy lifestyle said they were more rational in selecting preferred snacks. Findings show that people sometimes eat greater amounts of preferred foods than they realize, when they are multitasking with screen devices. By surrounding oneself with snack-size fruits, vegetables, and nuts in multitasking situations, mindless eating could be a powerful nudge to facilitate greater consumption of preferred foods to combat health concerns.

Energy-dense, nutrient-poor food and beverage sales in Australia: where and when products are sold, and how sales are changing over time.

To quantify sales trends for key energy-dense, nutrient-poor (EDNP) foods and beverages over 5 years in Australia. The Euromonitor Global Market Information Database and linear regression models were used to estimate average annual change in sales per capita of thirteen EDNP food categories and two EDNP beverage categories (defined using Australian Dietary Guidelines) over 5 years (2012-2017 for foods and 2011-2016 for beverages). The average annual change in sales was divided by the observed sales in 2012 (foods) or 2011 (beverages) to estimate the average percentage-change in sales per capita per annum. All major retail outlets in Australia. Euromonitor Global Market Information Database sales data. Between 2012 and 2017, sales per capita per annum of frozen pizza (6 %), pastries (5 %), potato chips (crisps) (5 %), tortilla chips (3 %), chocolate confectionery (2 %), frozen processed potatoes (2 %), ice cream (2 %) and sugar confectionery (0·2 %) increased. There were no changes in sales of sweet biscuits, chocolate spreads and cakes, and sales of savoury biscuits and processed meat decreased (-2 and -1 %, respectively). Between 2011 and 2016, sales per capita per annum of sports and energy drinks increased (4 %), sales of regular (sugar-sweetened) cola (-6 %) and all non-cola soft drinks (-1 %) decreased and sales of diet cola did not change. Sales of EDNP foods and beverages generally increased or remained stable relative to population growth. Our results demonstrate the need for public health policies to reduce sales of EDNP foods and beverages.

High consumption of energy-dense nutrient-poor foods among low-income groups in the Mississippi Delta and Alabama.

To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years. We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10-17 years with parental consent. Retail food outlets in Mississippi and Alabama, USA. Adults (n 11 311) and adolescents (n 3460). The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male - female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings. SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.

Me'akai in Tonga: Exploring the Nature and Context of the Food Tongan Children Eat in Ha'apai Using Wearable Cameras.

Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me’akai (food) consumed by Tongan children in Ha’apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids’Cam Tonga project. Images were analysed to assess the participants’ food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.

Higher diet quality in university students is associated with higher academic achievement: a cross-sectional study.

Unhealthy diets are typical of university students and the effects may be wider reaching than health. The present study aimed to describe the association between dietary intake and academic achievement in a sample of Australian university students. A cross-sectional analysis of data from an online survey of 278 students from the University of Newcastle (UON), Australia [mean (SD) age 26.9(10.5)years; 70.9% female] was conducted. Dietary intake, in terms of diet quality score [Australian Recommended Food Score (ARFS)], including individual sub-scales, and percentage energy per day from energy-dense nutrient poor (EDNP) foods, including individual sub-groups, was assessed using the validated Australian Eating Survey Food Frequency Questionnaire, and academic achievement was assessed as self-reported grade point average (GPA). The association between GPA and dietary intake was explored using linear regression, with adjustment for socio-demographic and student characteristics. Higher GPA was associated with higher diet quality (ARFS) (β=0.02, P=0.011), higher sub-scale scores for vegetables (β=0.03, P=0.026) and fruit (β=0.05, P=0.029) and with lower percentage energy per day from EDNP foods overall (β=-0.01, P=0.047) and also from sweetened drinks (β=-0.06, P<0.001). The results of the present study demonstrate small associations between a healthier dietary intake and higher academic achievement, as well as vice versa. Given that the associations were small, they may not be particularly meaningful. However, this evidence could be used as a motivator for efforts aiming to improve dietary intake among university students.

Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial.

BackgroundExcess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed.ObjectiveThis 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter).MethodsAll eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness.ResultsEnrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019.ConclusionsTailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=trueInternational Registered Report Identifier (IRRID)DERR1-10.2196/12782

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults.

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults’ experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Do the contemporary dietary patterns of children align with national food and nutrient recommendations?

Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4-8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age-specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent-reported 24-h recall dietary data were disaggregated into five core food groups, along with energy-dense, nutrient-poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi-squared and t-tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy-dense, nutrient-poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day-1 ] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub-categories of EDNP foods.