Objectives To examine the association between HGS and physical function, quality of life (QoL), and cardiometabolic risk markers in midlife women, and verify potential discrepancies between absolute and relative HGS on these relationships. Study design This cross-sectional study enrolled 83 participants (50.7±5.3y) who completed handgrip (hydraulic dynamometer), knee extensor and plantar flexor (isokinetic dynamometry) strength tests, and body composition evaluations (DXA). A variety of physical function tests, QoL (SF-36) and cardiometabolic blood markers were also measured. Results Participants below the cutoff for HGS/body mass (0.34) did not differ in height but were significantly (P<0.01) heavier (80.8±12.8 vs. 68.6±11.4 kg), had higher BMI (30.0±4.2 vs. 25.4±4.0 kg/m2) and body fat (39.9±4.4 vs. 35.1±5.6 %). All strength measures were significantly lower in those below the cutoff (all P<0.05), and performances in the physical function tests were poorer (all P<0.01). They also presented significantly (P<0.02) lower QoL scores in the physical functioning (87.9±11.2 vs. 92.8±6.5), role physical (83.7±21.6 vs. 94.3±12.5), role emotional (84.8±24.3 vs. 94.4±12.4), social functioning (87.1±20.4 vs. 95.2±13.4), and general health (65.0±15.0 vs. 75.1±14.3) domains, and significantly higher total cholesterol (5.7±0.8 vs. 5.3±0.8 mmol/L), LDL-cholesterol (3.6 ± 0.8 vs. 3.2±0.6 mmol/L), total/HDL-cholesterol ratio 3.7±0.8 vs. 3.4 ± 0.8), and triglycerides (1.2±0.5 vs. 1.0±0.4 mmol/L). Absolute HGS was not significantly correlated with physical function outcomes. Conclusions Body mass-normalized HGS is a better discriminator of physical function, QoL and cardiometabolic risk than absolute HGS, indicating its relevance in the clinical evaluation of middle-aged women.

PURPOSE:Adequate fruit and vegetable (FV) intake is the foundation of a healthy diet; however, intake is especially low among stroke survivors. This study explores barriers and motivators to FV intake in female stroke survivors and informs strategies to improve well-being. METHODS:Female stroke survivors completed questionnaires and attended either a focus group or an interview, with the resulting transcripts analysed using reflexive thematic analysis. RESULTS:Ten female stroke survivors aged (mean [SD]) 66.3 [17.1] years completed the study. Across the focus groups (n = 3) and interviews (n = 2), three themes emerged: (1) "Navigating alone," reported that survivors felt left to fend for themselves for dietary support and education. (2) "If it's good for me" identified a willingness to improve FV intake and nutrition literacy. (3) "Make it easy" highlighted the need for compensatory strategies to raise FV intake. Barriers to FV intake included physical impairments, fatigue, and memory loss. These barriers impacted food shopping, preparation, and consumption, necessitating reliance on family and compensatory strategies. Motivators included education, simplified recipes, reminders, and pre-prepared options. CONCLUSION:Female stroke survivors wanted more dietary education, FV knowledge, support, and practical stroke-appropriate resources. Incorporating these findings into rehabilitation planning may improve the well-being of female stroke survivors.

Introduction The provision of abdominal aortic calcification (AAC) imaging results can elicit cardiovascular disease (CVD)-risk reducing behaviours. However, its impact on psychosocial, mental and suboptimal health measures is less clear. Methods Secondary analyses of a previously reported 12-week, single-blind, randomised controlled trial (RCT) including 240 community-dwelling older Australian men and women. Participants were provided with AAC imaging results and CVD risk-reducing educational resources (AAC+Ed, n=121) or education alone (Control+Ed, n=119). Psychosocial distress, mental health score and suboptimal health status were estimated using validated questionnaires. Linear mixed models were used to compare changes between groups across 12 weeks. Results 240 participants (mean ± SD, age 67.8 ± 5.0 years, 57.5% females) were randomised and 227 (95%) completed the study. Approximately 57% had evidence of AAC (≥1 on a 24-point scale) at baseline. Providing AAC imaging results to older men and women did not affect psychosocial health, mental health and suboptimal health (all p>0.05) measures compared to Control+Ed. The mean net differences for change (95%CI) for depression, anxiety and stress were -0.50 (-1.42, 0.42), -0.20 (-0.81, 0.41) and -0.21 (-1.18, 0.76), respectively; the mean net difference for change (95%CI) for mental health component score was 1.69 (-1.29, 4.67) and for total suboptimal health status was -0.84 (-2.08, 0.39). Conclusions In older men and women, the provision of AAC results with education on CVD risk factors did not alter measures of psychosocial, mental, and suboptimal health status over 12 weeks compared to education alone. The study was registered at www.anzctr.org.au ACTRN12618001087246.

Health literacy is a determinant of health that should be promoted and measured in early childhood. In the era of digitalization, this could involve digital platforms. However, little knowledge exists on the extent, range, and nature of literature on digital tools for promoting or measuring young children's health literacy. Addressing this gap, a scoping review was undertaken to explore what digital health literacy tools for children aged 3-5 years could be identified in the literature, what their key features were, how they were designed, whether children were codesigners, and whether the tools had been evaluated. Eligibility criteria included the literature being peer-reviewed, published between 2013 and 2024, and in English. Nine health and education databases were searched, and 19 articles met the inclusion criteria. Few of the reported tools covered the core dimensions of health literacy, underlying the need for digital tools that promote and/or measure young children's health-related knowledge and information-related skills. There was sparse description of design approaches, and little evidence children were engaged as active design partners, which is critical to address. Encouragingly, some evidence was usually provided to rationalize choices around specific digital technologies and/or design features, which could be further bolstered with evidence from the field of educational technology for children. There is strength in the literature's reporting of evaluation studies using well-respected design approaches; however, sample sizes were sometimes small, long-term follow-up did not often occur, and the influence of contextual factors on children's use of the tools was not explored.

ISSUE ADDRESSED:This work aimed to understand the ways in which local organisations were working in partnership to support food security action in rural, regional, and remote areas. METHODS:Semi-structured interviews were conducted with 101 food security initiative leaders, representing 148 food initiatives within Australia's largest state, Western Australia (WA). A thematic analysis was undertaken using NVivo that indicated a total of 378 partnering organisations worked on the food security initiatives. RESULTS:Organisations partnered to address food security in their regions through coordinated action; community consultation; food/financial donations; funding and grants; on-ground programme and service delivery and physical and human resources. Initiatives need to be documented, where appropriate, in formal partnership agreements to increase the sustainability of initiatives yet allow for some adaptability to respond to the changing nature of wicked issues such as food security. CONCLUSION:This study's findings increase understanding about how rural, regional, and remote Australian organisations are collaborating to drive food security action and identify areas where partnerships could be enhanced to maximise impact on food security. Although this study was undertaken in WA, the recommendations are relevant to all rural, regional, and remote food security initiatives and include helping organisations to identify clear partnership purposes, partner roles, and actions. SO WHAT?: Providing a qualitative analysis of food security partnerships offers insight into the nature, purpose, and experiential phenomena of these partnerships, to determine what, how and why organisations work together.

INTRODUCTION:This study explores the collaborative co-design process for developing a weekly meal box tailored for individuals with neurological conditions. Recognising the critical role of nutrition for this community, the research addresses the challenges posed by cognitive and physical impairments in meal preparation. METHODS:Through two co-design workshops involving consumers, healthcare providers and industry experts, insights were gathered on dietary preferences, nutritional needs and practical challenges. RESULTS:The workshops emphasised the importance of convenient, easy-to-prepare meals with simple instructions, flexibility and customisability. Consumers expressed preferences for convenient, easy-to-prepare meals with simple, easy-to-follow recipe instructions that align with optimal dietary patterns and taste preferences. Health and industry experts emphasised the importance of flexibility/customisability, ease of access and meal preparation. A prototype meal box was developed and tested in a simulation event, revealing positive feedback and areas for improvement. Participants appreciated the pre-prepared ingredients and reported increased confidence in cooking. CONCLUSION:By involving both consumers and health and industry experts in the design process, this study contributes to the design of meal box solutions that have real potential to improve the quality of life for those managing neurological conditions through nutrition. The co-design approach ensured the meal box met the specific needs of the target group, promoting sustainability and practical application. Future research will focus on refining the prototype and evaluating its effectiveness in a broader pilot study. This study underscores the importance of user-centred design in creating viable nutritional solutions for individuals with neurological impairments. PATIENT AND PUBLIC CONTRIBUTION:People with lived experience of a neurological condition, their carers, health providers and industry experts contributed throughout the design process and the preliminary simulation event. Our thematic analysis was conducted by someone with lived experience of a neurological condition, who also contributed to the writing and reviewing of the manuscript.

BACKGROUND:In Australia, there are concerns that unrestricted junk food advertising during sports broadcasts increases short-term junk food consumption among viewers. Therefore, the present study aimed to estimate the impact of junk food and anti-junk food advertising on consumption inclinations. METHODS:We conducted a content analysis across a sample (N = 16) of Australian Football League (AFL) and National Rugby League (NRL) matches to determine the prevalence of junk food and anti-junk food advertising video clips. We also exposed participants (N = 428) to a single randomly selected junk food advertisement or a single anti-junk food advertisement and measured the immediate impact on craving and consumption intentions for both healthy weight and high body mass index (BMI) participants. RESULTS:Junk food and anti-junk food advertising video clips comprised 10.85% and .003% of all advertisements across the broadcasts, respectively. For both healthy and overweight participants, junk food advertisement exposure did not increase immediate craving or consumption intentions. However, decreases were observed in craving and consumption intentions following an anti-junk food advertisement. CONCLUSIONS:Junk food advertising prevalence across national sports was high. Junk food advertisements did not increase immediate inclinations to consume junk food, but an anti-junk food advertisement was effective in reducing immediate craving and consumption intentions, particularly for healthy BMI participants. SO WHAT?: Given the potential efficacy of health promotion adverts, governments should consider investing in a higher frequency of health messages during broadcasts that are known to readily promote junk food, such as national sports.

ISSUE ADDRESSED:To understand community and stakeholder perceptions of food supply chains in regional and remote Western Australia (WA). METHODS:This qualitative study used 19 focus groups with 61 food system stakeholders and 31 community members to understand barriers to and enablers of food supply and perspectives of what good food supply chains look like. A thematic analysis of focus group transcripts was conducted. RESULTS:Barriers included regulatory hurdles, lack of local facilities, limited food delivery, high food costs and lack of skill-sharing. Enablers included employment options, individual food processing skills, quality local food, local food awareness and emergency food relief. Participants envisioned a sustainable, affordable, adaptable and efficient food supply chain with local food access, food literacy, home food growing, culturally appropriate food, strong food supply actor relationships, waste management and food supply chain career opportunities. CONCLUSIONS AND IMPLICATIONS:Recommendations include establishing Food Action Groups (also known as Food Policy Councils) in WA, to facilitate more opportunities for regionally-produced food to be sold within regional WA communities to increase food availability, quality and reduce price; and enhance food literacy in schools, workplaces and communities using evidence-based programs. SO WHAT?: This article provides lived experience perspectives of regional and remote food supply, illuminating key issues across each step of the food supply chain.

BackgroundInvasive meningococcal disease (IMD) is a serious, vaccine-preventable infectious disease that can be life-threatening. Teaching adolescents about the early detection and prevention of IMD can be challenging in a school environment, with educators reporting they lack confidence or expertise to cover this in the classroom environment. Professional guest educators are an alternative to cover specialist topics such as IMD; however, time and resourcing constraints can mean that these educators are not always available. Serious games may be an alternative to face-to-face education, where complex health information may be delivered via self-directed gameplay. ObjectiveThis study aims to develop a serious game that can replace a face-to-face educator in a classroom setting to educate adolescents aged 12 years to 15 years. This study evaluates the efficacy of the Meningococcal Immunisation Awareness, Prevention and Protection app (MIApp), a serious game designed to replicate the information provided in a 30-minute face-to-face presentation provided by a trained educator. MethodsThis clustered, randomized controlled equivalence trial involved students (Years 7-10) from 6 secondary schools across metropolitan Western Australia who completed pre- and postintervention questionnaires with a follow-up at 3 months postintervention to measure the primary outcome of IMD knowledge acquisition following this self-guided intervention. The findings were compared with changes in an active control (comparison) group who received an in-class educational presentation about IMD transmission and protection. A questionnaire was developed to assess 9 key areas of knowledge. Median scores for knowledge pre- and postintervention were collected from a self-administered assessment of this questionnaire and, at 3 months postintervention, were compared between groups. A knowledge score of +/–2/16 was determined a priori to meet the criteria for equivalence. Participants who used MIApp were also asked a series of questions to assess the enjoyment of and engagement with the game. ResultsOf the 788 participating students, the median postintervention correct score in both the MIApp and control cohorts was 14/16 (87.5% correct responses), compared with the median pre-intervention correct score of 6/16 (37.5% correct responses), representing a significant (P<.001) increase in IMD knowledge in both groups. Improvements were retained in both groups 3 months after the initial intervention (median correct score: 11/16 in the intervention group; 12/16 in the control group; P=.86), demonstrating the efficacy of MIApp to deliver health education about IMD transmission and protection, although response rates in the follow-up cohort were low (255/788, 32.4%). ConclusionsMIApp met the predetermined threshold for equivalence, demonstrating similar improvements in knowledge posttrial and at the 3-month follow-up. Participating adolescents considered the MIApp game more enjoyable than a presentation, with equivalent improvements in knowledge. Serious games could represent a constructive tool to help teachers impart specialized health education.

A rapid transformation to sustainable agricultural production systems is necessary, requiring on-farm monitoring and measurements of key agricultural sustainability indicators. While many assessment methods for agricultural sustainability incorporate a three-pillar model of sustainability: environment, economic, and social, a step beyond this is required to support both human and planetary health. This review takes the position that a more nuanced, yet broader framing of agricultural sustainability is warranted, and identifies the measurement of additional pillars including health and nutrition, production, and responsible governance, plus overlooked aspects including Indigenous cultures. A peer-reviewed and grey literature search was conducted identifying articles (n = 8) discussing comprehensive, more than three-pillar, on-farm sustainability assessment instruments (n = 7). These seven instruments were analysed against an a priori framework of adaptability, modularity, practicality and scalability. Also explored was the usage of the broader sustainability pillars and common themes within the literature. Limited literature was found which encompassed the complexity of the requirements for measuring agricultural sustainability on-farm. A scalable and practical approach to the construction and use of on-farm agricultural sustainability assessment instruments is nascent. This review recommends the examination of instruments in a participatory and transdisciplinary manner to ensure effective operationalisation, acknowledge place-based nuance, and support farmers as potential end-users. Moving forward, the application and design of sustainable agriculture assessment instruments needs to encompass the full range of externalities created by agricultural production systems to actualise sustainability.

BACKGROUND:The term sarcopenia was introduced to describe the age-related decline in muscle mass, but current definitions also include measures of muscle strength and function. Menopause increases sarcopenia risk and may exacerbate the adverse effects of physical inactivity. Exercise training is a potent stimulus to restore muscle health, and nutritional supplementation can further improve the outcomes. The purposes of this study were to examine the changes in a set of sarcopenia-related phenotypes induced by a 14-day step-reduction period followed by a 12-week exercise training programme, with or without fortified milk supplementation in healthy 40-60-year-old females, and to determine whether menopausal status interacted with these changes. METHODS:In this double-blind, placebo-controlled randomized trial, females aged 40-60 years were evaluated before and after 2 weeks of reduced activity monitored through pedometer and after a subsequent 12-week exercise + nutrition programme with ingestion of a fortified milk product (FMP) or placebo. Muscle volume (dual-energy X-ray absorptiometry [DXA] and peripheral quantitative computed tomography), handgrip (hydraulic handheld dynamometer), knee extensor and plantar flexor strength (isokinetic dynamometer) and a variety of physical function measures were assessed at all timepoints. RESULTS:Eighty-three self-reported healthy females (50.7 ± 5.3 years; 52 postmenopausal) completed the reduced-activity period, and 67 completed the subsequent exercise training + nutrition phase. At baseline, participants averaged 8323 ± 3077 daily steps and then decreased to 1876 ± 729 during the reduced-activity period. Mean sarcopenia outcomes declined after 2 weeks of activity restriction, with significant changes (p < 0.05) in shank muscle cross-sectional area (CSA) (67.7 ± 9.9 to 66.5 ± 9.9 cm2), handgrip strength (25.3 ± 5.0 to 24.0 ± 5.3 kg), knee extensor peak torque (134.7 ± 36.2 to 122.7 ± 34.5 Nm) and stair ascending time (3.6 ± 0.6 to 3.7 ± 0.6 s) and power (367.6 ± 67.6 to 356.7 ± 67.7 W), with no significant time × menopause interactions (p > 0.05 for all variables). All muscle mass, strength and function outcomes were not only improved after exercise training + nutrition but also significantly increased compared to preintervention baseline (all p < 0.05). No training × menopause or training × supplementation interactions were observed for any variable (both p > 0.05). CONCLUSIONS:Two weeks of step reduction negatively affected muscle mass, strength and physical function in 40-60-year-old females. A 12-week training programme including strength exercises and dietary supplementation not only recovered muscular health but also promoted improvements above the baseline before the physical activity restriction. Menopause status did not influence changes in response to step reduction or exercise, and the addition of a fortified milk product during the training period did not influence the induced adaptations.

Building health literacy in early childhood is essential for lifelong health and underpins children’s learning and developmental trajectories. This study assessed the efficacy of the Little Aussie Bugs books, designed to enhance health literacy in Australian Early Childhood Education and Care (ECEC) centres. The books, featuring inclusive characters and key health literacy catchphrases, were distributed to >1200 early learning settings Australia-wide. Exploratory research design used online surveys (n = 110) and in-depth interviews with ECEC teacher participants (n = 8) to determine the compatibility of the books with ECEC contexts and practices to facilitate the delivery of health literacy education. The findings were conceptualized through a socioecological lens, using the process, person, and context over time model. Participants reported high overall satisfaction with the books, alongside increased confidence to deliver health literacy messages. Key advantages included the dialogic nature of the books, children’s familiarity with catchphrases and characters, and children’s understanding of otherwise abstract concepts, such as ‘invisible germs’. However, these benefits were limited for less experienced educators who may not have understood the dialogic nature of the books, subsequently not utilizing them to their full capacity. These limitations indicate the need for further support to accompany the resources and maximize their impact. Further research is planned to inform the design of effective and appropriate professional learning to complement the resources, supporting educators to optimize their use of the books and promoting sustained delivery of health literacy messaging in ECEC settings.

Food security(FS) refers to having sufficient physical, social, and economic food access at all times. People living in rural, regional, and remote (RRR) locations often face distinctive challenges to FS. Existing solutions, that aim to enhance FS, themselves face challenges when addressing these issues. This paper outlines the application of an adapted Systemic Innovation Lab (SIL) approach to enhance the function of existing community and government-led, -run or -operated initiatives (programs, interventions) in RRR Western Australia. It examines which systems change characteristics participating initiatives possess, to identify opportunities to support their transition to newer and more effective ways of addressing FS in their region. A six-stage SIL process was enacted, with four of the stages focused on identifying which systems change characteristics, across nine Focus Areas (FAs), the participating initiatives possessed. Data representing 148 initiatives were analysed to map the initiatives’ support of FS systems change in their region and identify the FAs systems change characteristics least possessed by initiatives. This delivered insights necessary to strengthen these characteristics and enhance participating initiatives’ capacity to better support RRR FS. Initiatives were least likely to possess systems change characteristics relating to two-way communication between government and community, which, if adopted, would support the achievement of holistic, effective, and sustainable outcomes for FS in RRR locations.

ISSUE ADDRESSED:Food systems strongly influence food security outcomes. Food Action Groups (often termed Food Policy Councils/Coalitions/Networks internationally) offer a co-ordinated and collaborative approach to local food system issues. Their organisational structure and stakeholder membership significantly impact their focus and impact. Therefore, it is imperative to understanding community member and food system stakeholders' perspectives on how regional and remote Australian Food Action Groups should be structured to maximise their impact on local food systems, and identify the most appropriate stakeholders to facilitate and drive their action. METHODS:A qualitative study using focus groups, was conducted in regional and remote townships across Western Australian regions of Peel, South West, Great Southern, Wheatbelt, Midwest (including Gascoyne), Goldfields, Pilbara, and Kimberley. Participants were community members and food system stakeholders. Focus group transcript data were thematically analysed. RESULTS:A formal structure with sustainable funding was important for Food Action Groups, as was adopting a bottom-up approach with local community needs driving the agenda, supported by an adaptable and responsive work plan. Involving community members and ensuring a diverse membership were viewed as critical to their success. CONCLUSIONS:To effectively address local needs, Food Action Groups should adopt a formal structure with clear processes and involve a diverse group of community stakeholders. This would leverage local knowledge and evidence to guide actions and set well-informed priorities. SO WHAT:The establishment of Australian Food Action Groups in regional and remote Australia has potential to follow suit of their US, Canada and UK predecessors, improve regional food systems and influence government policies.

Food security is a particular challenge in rural, regional and remote locations due to complexities associated with food availability, access, utilisation, stability, agency and sustainability dimensions. Existing approaches, such as emergency food relief, have been found to inadequately address these challenges, suggesting that a comprehensive portfolio of solutions could be more effective. Understanding what food security initiative leaders operating in these areas consider important will help establish a shared goal to guide the development of a portfolio approach. This paper aimed to determine government and community-led food security initiative leaders' visions of a food secure regional Australia. This qualitative study was conducted across inner regional, outer regional, remote and very remote townships in Western Australia. Participants' perspectives of a food secure region were sought through semi-structured interviews. A total of 101 participants provided evidence for 148 food security initiatives. Many initiative leaders' visions focused on improved access to food and education programs such as food growing and food literacy programs. Less emphasis was placed on solutions such as community-led food security action and advocacy for increased government support and funding. Participants typically described existing and siloed solutions that, despite their widespread implementation, have been critiqued for their inability to adequately address the complexities of food security. This suggests a disconnect between participants' visions and a more effective portfolio approach. More time should be invested in enhancing community and interest holder' understanding of systems change and a portfolio approach to bridge this gap.

School -based nutrition education (NE) has an important role in promoting healthy eating habits and helping prevent chronic diseases - particularly among disadvantaged children and youth who are more likely to experience poor diet quality. However, teachers report being underprepared or time -poor in delivering NE and there is a growing trend for schools to outsource health -related content to external providers. This study evaluated the effect of an experiential NE session on Years 3-12 students (N=1,714) and teachers (N=178), developed and facilitated by a hunger relief charity for low socioeconomic schools that access a school breakfast program. The results showed significant increases (p<0.001) in student knowledge and attitudes towards healthy eating. Teachers indicated they improved their knowledge of how to teach children about healthy eating and were motivated to include more NE in their teaching programs. The study shows that targeted, experiential NE sessions delivered by external experts can improve students' knowledge and attitudes toward healthy eating post -intervention and may reduce barriers to the provision of ongoing teacher -led NE. The opportunities for sustained impact in the context of a school breakfast program are discussed.

Meningococcal disease (MD) is a severe, vaccine-preventable infectious disease that can be life-threatening. This study evaluated the efficacy of the Meningococcal Infection Awareness, Prevention and Protection app (MIApp), a serious game to deliver health education for adolescents about MD. This study evaluated the efficacy of the Meningococcal Infection Awareness, Prevention and Protection app (MIApp), a novel serious game to deliver health education for adolescents about MD. Participating high school students (Years 7-10) from six secondary schools across metropolitan Western Australia completed a pre- and post-intervention questionnaire to measure primary outcomes. The findings were compared to changes in an active control (comparison) group that received an in-class educational presentation about MD transmission and protection. Of the 788 participating high school students, the median post-intervention correct score in both the MIApp and control cohorts was 14/16 (87.5% correct responses), compared to the median pre-intervention correct score of 6/16 (37.5% correct responses), representing a significant (p<0.01) increase in MD knowledge. Improvements were retained in both groups three months after the initial intervention, demonstrating the efficacy of MIApp to deliver health education about MD transmission and protection. Participating adolescents considered this digital game more enjoyable than a presentation. Serious games represent a constructive tool to help teachers impart knowledge about risk-avoidance behaviours, vaccination uptake, and early symptom identification of MD.

Abstract Background Higher cruciferous vegetable intake is associated with lower cardiovascular disease risk in observational studies. The pathways involved remain uncertain. We aimed to determine whether cruciferous vegetable intake (active) lowers 24-h brachial systolic blood pressure (SBP; primary outcome) compared to root and squash vegetables (control) in Australian adults with mildly elevated BP (SBP 120–160 mmHg inclusive). Methods In this randomized, controlled, crossover trial, participants completed two 2-week dietary interventions separated by a 2-week washout. Cruciferous vegetables were compared to root and squash vegetables (~ 300 g/day) consumed with lunch and dinner meals. Participants were blinded to which interventions were the active and control. Adherence was assessed using food diaries and biomarkers (S-methyl cysteine sulfoxide (SMCSO, active) and carotenoids (control)). Twenty-four-hour brachial ambulatory SBP and secondary outcomes were assessed pre- and post each intervention. Differences were tested using linear mixed effects regression. Results Eighteen participants were recruited (median (IQR) age: 68 (66–70); female: n = 16/18; mean ± SD clinic SBP: 135.9 ± 10.0 mmHg). For both interventions, 72% participants had 100% adherence (IQR: 96.4–100%). SMCSO and carotenoids were significantly different between interventions (mean difference active vs. control SMCSO: 22.93 mg/mL, 95%CI 15.62, 30.23, P < 0.0001; carotenoids: − 0.974 mg/mL, 95%CI − 1.525, − 0.423, P = 0.001). Twenty-four-hour brachial SBP was significantly reduced following the active vs. control (mean difference − 2.5 mmHg, 95%CI − 4.2, − 0.9, P = 0.002; active pre: 126.8 ± 12.6 mmHg, post: 124.4 ± 11.8 mmHg; control pre: 125.5 ± 12.1 mmHg, post: 124.8 ± 13.1 mmHg, n = 17), driven by daytime SBP (mean difference − 3.6 mmHg, 95%CI − 5.4, − 1.7, P < 0.001). Serum triglycerides were significantly lower following the active vs. control (mean difference − 0.2 mmol/L, 95%CI − 0.4, − 0.0, P = 0.047). Conclusions Increased intake of cruciferous vegetables resulted in reduced SBP compared to root and squash vegetables. Future research is needed to determine whether targeted recommendations for increasing cruciferous vegetable intake benefits population health. Trial registration Clinical trial registry ACTRN12619001294145. https://www.anzctr.org.au

Provision of non-invasive vascular imaging results to individuals has been shown to improve cardiovascular disease risk factor control: its impact on diet remains uncertain. In this two-arm, single-blind, parallel, 12-week randomized controlled trial, 240 participants, 57.5% females aged 60-80 y had abdominal aortic calcification and clinical assessments performed at a hospital clinic. Participants were randomized 1:1 to receive (intervention n = 121) or not (control n = 119) their calcification results. Both groups received educational resources on cardiovascular disease risk control and were unblinded to the intervention. Outcome measures were performed at baseline and 12 weeks. The primary outcomes of the study were changes in fruit and vegetable intake measures over 12 weeks assessed using plasma carotenoid concentrations (biomarkers of FV intake) and a food frequency questionnaire. Secondary outcomes included 12-week changes in other aspects of the diet, physical activity, body weight, blood pressure, heart rate, lipid profile, glucose concentrations, estimated cardiovascular disease risk score, and medication use. Between-group differences were tested using linear mixed-effects regression. There were no between-group differences in the primary outcomes at 12 weeks: plasma carotenoids (mean difference +0.03 mu g/mL [95%CI -0.06, 0.13]) and fruit and vegetable intakes (+18 g/d [-37, 72]). However, the provision of calcification results led to between-group differences in serum total (-0.22 mmol/L [-0.41, -0.04]) and non-HDL (-0.19 mmol/L [-0.35, -0.03]) cholesterol, and estimated cardiovascular disease risk score (-0.24% [-0.47, -0.02]). No between-group differences were seen for other secondary outcomes. In this work, providing vascular imaging results did not improve diet but did improve some cardiovascular disease risk factors (Australian and New Zealand Clinical Trials Registry ACTRN12618001087246). It is unclear whether providing the results of abdominal aortic calcification imaging to patients improves diet parameters. This randomized trial shows that this intervention does not lead to improvements in fruit and vegetable intake, while showing an effect on some cardiovascular disease risk factors used as secondary outcomes.