Abstract Background Poor diet quality has been associated with greater risk of people developing overweight and obesity, type 2 diabetes, cardiovascular disease, and osteoarthritis. For each of these conditions, weight management is recommended in respective guidelines. Current weight management interventions, such as the Healthy Weight for Life™ (HWFL) program that uses meal replacements, have not been assessed for impact on diet quality. Further, the role of a dietitian providing medical nutrition therapy (MNT) in conjunction with the HWFL program has not been evaluated. MNT is an evidence-based approach where dietary interventions are tailored to the individuals needs, medical history, lifestyle, and dietary preferences. Therefore, the primary aim of this pilot study is to evaluate the feasibility, acceptability and preliminary impact of adding personalised (MNT) consultations to the HWFL program on diet quality. Secondary outcomes include weight and osteoarthritis scores . Methods An 18-week randomised control trial was undertaken, with eligible HWFL program participants randomised to either usual care arm (HWFL program) or HWFL + MNT. A food frequency questionnaire was used to assess diet quality (% energy from nutrient-dense core food) and provide intervention participants with personalised feedback on food and nutrient adequacy of their dietary patterns. Weight and knee osteoarthritis outcomes using the hip and knee osteoarthritis outcome scores, were self-reported and used to assess outcomes. Project acceptability was assessed by process evaluation questionnaire. An intention-to-treat analysis was undertaken using generalised linear mixed models with post-estimations reported as mean (95% CI). Results Forty participants (75% female, 62 ± 10years, 78% osteoarthritis) enrolled in the study. Baseline diet quality was poor (34% energy from non-core foods). Post-intervention both intervention and usual care groups significantly improved their diet quality and reduced weight, but there were no significant differences between groups. Sub-scores for knee osteoarthritis function significantly improved in the intervention compared to the control group (mean between group difference 17.4, 95% CI 1.6, 33.1), though after correcting for multiple testing this was no longer significant. Overall intervention acceptability was high. Conclusion Both the intervention and usual care arms significantly improved diet quality. All intervention participants found MNT was highly acceptable. For those with knee osteoarthritis significant improvements in knee osteoarthritis function was reported in the intervention group. This should be further explored in future interventions. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12623001062617).

BackgroundPeople living with severe obesity are at an elevated risk of poor oral health. Contributing factors to poor oral health in this population group include cariogenic dietary behaviours and social determinants of health. There has been minimal discussion of the possible impacts of disordered eating behaviours on oral health particularly for those living with obesity.AimThis short communication aims to increase the awareness among dental teams of disordered eating behaviours and possible impacts on oral health particularly for patients living with obesity.MethodsA short evidence-based report was developed to highlight the relevance and importance of increasing dental professional awareness of disordered eating behaviours.ResultsData on prevalence of disordered eating behaviours in the general population and individuals living with severe obesity have been reported. Some studies have revealed there may be a higher prevalence of some forms of disordered eating behaviours among people living with obesity. Potential negative sequelae on oral health include increased risk of missing teeth, periodontal disease, and active dental caries.ConclusionsCollaboration between the disciplines of oral health and nutrition and dietetics, and with primary care providers such as general practitioners, is important to foster successful nutritional strategies for both general and oral health in patients living with obesity. Suggested approaches include joint professional society statements and increased training for the dental profession on oral health impacts of disordered eating behaviours to facilitate early identification, provision of tailored oral health care and signposting for support. The integration of the dental team into current obesity management will add to their supportive role in the overall management of people living with severe obesity.

Pregnant women are at higher risk of contracting listeriosis, which can lead to serious perinatal complications. This study evaluated associations between Listeria monocytogenes exposure, infant perinatal outcomes, and hospital resource use in a cohort of 1604 Australian mother-infant dyads. Maternal L. monocytogenes exposure was estimated from self-reported intake of foods from a validated food frequency questionnaire that potentially harbor L. monocytogenes. Infant outcomes obtained from hospital medical records included birth mode, preterm birth, birthweight, and admission to special care nursery (SCN)/neonatal intensive care unit (NICU). Infant hospital resource use was measured by infant length of stay (LOS), LOS in SCN/NICU, and days excluding SCN/NICU. Multinomial, negative binomial, and hurdle models, were performed to examine Listeria Food Exposure Score (LFES) associations with infant outcomes, total LOS, and LOS excluding and within SCN/NICU. All models were adjusted for covariates including smoking, parity, maternal age, BMI, and SEIFA IRSAD decile. Mean (SD) maternal age was 32.0 (5.0) years, and median (IQR) gestation was 39.0 (38.1, 40.0) weeks. Although adjusted results showed a statistically significant association between LFES and reduced infant LOS excluding SCN/NICU (β = 0.99; 95% CI: 0.979, 0.998, p < 0.03), the effect size was minimal, with minor clinical significance. There were no significant associations with infant birth mode, preterm birth, low birthweight, size for gestational age, macrosomia, admission to NICU/SCN, total LOS in hospital, and SCN/NICU (all p > 0.05). Future research should explore these associations among ethnically diverse women at earlier stage of pregnancy and include the assessment of food safety practices in the analyses.

BACKGROUND/OBJECTIVES:The pre-diagnosis dietary intake in newly diagnosed multi-ethnic paediatric inflammatory bowel disease (PIBD) is not well understood. This study aimed to describe the pre-diagnosis diet and environmental factors in children with newly diagnosed PIBD attending a single Australian tertiary children's hospital. METHODS:A pilot cross-sectional study was conducted from February 2022 to February 2023 involving children with newly diagnosed PIBD. RESULTS:Of 56 children confirmed with PIBD, 54% had Crohn's disease (CD)-mean ± SD age, 11.55 years ± 2.84-and 46% had Ulcerative Colitis (UC)-11.50 years ± 2.94 (45%, non-Caucasian). More Caucasians had an IBD family history (48.3% vs. 20%; p = 0.02 *). Non-Caucasian children demonstrated significantly lower mean serum vitamin D levels than Caucasian children (42.5 vs. 69 nmol/L; p ≤ 0.001 ***). Most children across ethnicities for both IBD subtypes had 'regular' intakes of red meat, whereas more Caucasian children had 'regular' intakes of processed/deli meat (72% vs. 39%; p = 0.02 *). A total of 64% of non-Caucasian children with CD reported a usual pre-diagnosis diet that differed from the traditional diet, compared to 42% with UC (p = 0.29). When eating out, fast foods were chosen regularly by most children with PIBD. Pre-diagnosis dietary intake data indicated that most with PIBD 'rarely/never' had whole-food sources of plant protein and had 'infrequent' intake of rice. Plant food diversity was low (mean 11 types/week). CONCLUSIONS:The significantly lower likelihood of IBD family history, along with relatively lower vitamin D levels, and the predominance of a Western-style dietary pattern among non-Caucasian children are compatible with the hypothesis that non-genetic factors may be important in PIBD, warranting further investigation into diet and environmental factors in this group. Further investigation of the pre-disease modifiable non-genetic factors contributing to the development of PIBD in the migrant population group is recommended. The finding across ethnicities of low pre-diagnosis plant food diversity was novel; however, due to the lack of healthy controls and the use of a novel but non-validated exposome tool, causality associations should be interpreted cautiously.

BACKGROUND:The impact of clinical trials extends beyond knowledge gained. However, broader impacts, including social, health and economic benefits to patients and communities are rarely assessed. In rural and remote regions where inclusion of local populations in clinical trials is limited, these assessments are even more rare. The Healthy Rural Hearts (HealthyRHearts) study aimed to reduce cardiovascular disease (CVD) risk in rural Australians through a medical nutrition therapy (MNT) intervention delivered via telehealth following a primary care heart health assessment. This provided an opportunity to evaluate its impacts more broadly and to guide future investment in rural clinical trials. METHODS:Data on the impacts of the HealthyRHearts study were obtained from administrative records, document analysis, relevant websites/databases and in-depth interviews using three methods within the Framework to Assess Impact from Translational Health Research (FAIT). These include (1) a modification of the Payback Framework reported as quantified metrics, (2) a cost-consequence analysis (CCA) to determine return on investment and (3) a narrative account of impact generated from the study using qualitative data. RESULTS:The modified Payback Framework identified significant knowledge advancement through publications, training materials and economic benefits from employment opportunities and leveraged funding. However, the greatest impacts were improvements in rural healthcare and research capacity through training and support offered to dietitians, project staff, general (primary care) practice staff and patients. The majority of patients had improved CVD risk scores, activation in healthcare participation, health literacy and quality of life at trial completion. The CCA demonstrated a modest return of $1.31 ($0.69-1.89) for each Australian dollar invested. Dietitians and general practice staff interviewed identified personal satisfaction as a benefit of participation, with dietitians reporting economic benefits as a result of their new skills. Patients reported that their nutrition knowledge and dietary behaviours improved, leading to perceived improvements in their health and wellbeing. CONCLUSIONS:The HealthyRHearts trial delivered significant impact in knowledge gain, while building healthcare and research capacity and capability in rural communities. Patient and community benefits were also delivered, with a potentially small but positive return on investment, suggesting that investment in rural clinical trials has broad-ranging benefits beyond research outcomes alone.

BACKGROUND:Management of diabetes in pregnancy requires input from multiple health professionals throughout the course of an individual's pregnancy. Implementing healthcare delivery that suits the local context of a metropolitan or rural region may contribute to improvements in care delivery and pregnancy and birthing outcomes. AIMS:To compare healthcare delivery for people with diabetes in pregnancy in metropolitan and rural areas of Australia. MATERIALS AND METHODS:A cross-sectional survey was conducted, with questions focused on healthcare delivery for women with diabetes in pregnancy, including the multidisciplinary care provided. Data were collected via a nationwide survey of health professionals currently involved in the healthcare management of people with diabetes in pregnancy in Australia. Survey data were analysed using descriptive and inferential statistics. RESULTS:The main aspects of healthcare delivery were similar between metropolitan and rural respondents. The proportion of health professionals offering face-to-face services was greater in rural areas (n = 38, 100%) compared to metropolitan (n = 34, 71%). Rural respondents (21%) reported they were collocated with an endocrinologist and 48% with an obstetrician. This was compared to 71% of metropolitan respondents reporting being collocated with an endocrinologist, and 63% with an obstetrician. CONCLUSIONS:This research offers direction as to potential considerations when planning and implementing models of care in rural areas. Additional research confirming the priorities within the rural context is needed to support the development of optimal care delivery for pregnant people with diabetes living in rural regions.

AIM:To synthesise evidence from RCTs investigating the effectiveness of nutrition interventions on depression, anxiety, stress, and/or diabetes distress outcomes in adults living with diabetes. METHODS:Six online databases were searched using key words between 2000 and February 2024. Included studies were conducted in adult populations (≥18 years), with Type 1 (T1D) or Type 2 Diabetes (T2D), investigating impacts of nutrition interventions on mental health outcomes. Random effects meta-analyses were undertaken for mental health outcomes. RESULTS:Thirty publications met inclusion criteria, all included adults with T2D, with one including both T1D and T2D. The most common interventions were nutrition supplements (n = 17, 57%) and altering macronutrient intakes (n = 5, 17%). Most studies reported on depression (n = 26) and anxiety (n = 14) outcomes, with fewer examining stress (n = 7) or diabetes-related distress (n = 8). Meta-analyses indicated nutrition supplementation when compared to control improved scores for depression (Beck Depression Inventory (BDI): WMD = -3.13; 95% CI: -5.09, -1.17) and anxiety (Beck Anxiety Inventory: WMD = -1.30; 95% CI: -2.08, -0.52) but not for stress. Meta-analyses confirmed that altering macronutrient composition significantly lowered diabetes-related distress (Problem Areas in Diabetes (PAID): WMD = -4.20; 95% CI: -8.18, -0.22). CONCLUSION:This review provides evidence that nutrition interventions, particularly supplement use or altered macronutrient composition, improve depression and anxiety for those with T2D. Future research should evaluate the impact of whole dietary patterns on mental health in adults with diabetes, especially T1D, to inform effective food-based nutrition advice, rather than focusing on individual supplements.

Early metabolomic and microbial markers of blood pressure (BP) dysregulation may be detectable before clinical hypertension develops. This exploratory study aimed to examine associations among dietary intake, BP, metabolomic profiles (plasma and urine), and gut microbiota composition. A secondary aim was to assess whether circulating metabolites mediate relationships between significant dietary factors and BP. This was a cross-sectional analysis of baseline data from a randomised cross-over trial. Usual dietary intake was assessed using the Australian Eating Survey (AES)® - Heart version Food Frequency Questionnaire. In-clinic BP measurements were measured and participants provided plasma, urine, and stool samples. Plasma and urine were analysed via untargeted metabolomics. Stool samples were collected for shotgun metagenomic sequencing, though metagenomic data was not included in this analysis. Associations between BP, individual metabolites, microbial taxa, and alpha diversity were assessed using linear regression with false discovery rate (FDR) correction. Causal mediation analysis was performed using nonparametric bootstrapping. Thirty-four Australian adults (mean age: 38.4 ± 18.1 years; 52.9

Current evaluation of teacher wellbeing rarely includes assessment of diet quality or influential food and nutrition (FN) constructs. Diet quality, and FN constructs such as food skills, are increasingly recognised across health research for their associations with mental health, stress regulation, and overall wellbeing, making their inclusion essential in future iterations of teacher wellbeing assessment. This study evaluates the reliability and construct validity of the teacher food and nutrition-related health wellbeing questionnaire (TFNQ) created using the online survey platform QuestionPro to measure FN constructs alongside teacher wellbeing outcomes. An intra-class correlation coefficient (ICC) ≥ 0.50 was used to establish test-retest reliability, using matched sample data with ≤ 17 days between responses, from both timepoints (dataset one and two, n = 99). Construct validity was assessed with data set one (timepoint 1, n = 438) using confirmatory factor analysis with global fit criteria (root mean square error of approximation ≤ 0.08, comparative fit index ≥ 0.90 and standardised root mean residual ≤ 0.05). Five hundred and twenty-two primary and secondary schoolteachers from across Australia completed the TFNQ at two timepoints. Six of the seven TFNQ sub-scales achieved an ICC ≥ 0.70; the remaining sub-scale, eating social norms at school achieved an ICC of 0.46. All sub-scales except social support, met at least two of the three global fit criteria for construct validity. The TFNQ is the first purpose-built evaluation tool to incorporate a set of valid and reliable sub-scales and single-item measures. The TFNQ will facilitate research that aims to explore the contribution of teacher FN practices with teacher health and wellbeing and inform the development of practical lifestyle focused solutions.

Diet is a modifiable determinant of gut microbiome composition, yet the impact of contrasting whole-dietary patterns on microbial metabolic capacity and coordinated host metabolic signatures remains incompletely characterized. In a randomized crossover feeding trial, 34 Australian adults were provided with a Healthy Australian Diet (HAD), aligned with national dietary guidelines, and a Typical Australian Diet (TAD), reflecting average population intake for two weeks each, separated by a two-week washout. Fecal microbiome composition and function were assessed using shotgun metagenomics, plasma and urine metabolites by untargeted metabolomics, with cardiometabolic markers including blood pressure, plasma lipids, and glucose quantified. HAD was associated with reduced taxonomic and functional alpha diversity relative to baseline, with no change following TAD. Species-level responses were modest, 105 functional pathways differed between diets, with 99 increasing following HAD, predominantly related to amino acid and nucleotide biosynthesis and vitamin/cofactor metabolism. Multi-omic integration using DIABLO achieved strong discrimination of dietary responses (held-out accuracy 91.7%; permutation p = 0.005). In total, 77 individual omic feature-cardiometabolic outcome associations survived FDR correction (q < 0.05), spanning microbial gene functions, plasma metabolites, and urinary metabolites linked to cholesterol, blood pressure, and triglyceride responses. These exploratory findings suggest that integrated microbiome-metabolome profiling may capture inter-individual variation in dietary cardiometabolic responses, though replication in larger, independent, robustly designed studies is needed before translational personalized nutrition strategies can be assessed.

Abstract INTRODUCTION Healthful dietary patterns may attenuate dementia risk by preserving cerebrovascular health. Prior work has focused on systemic arterial stiffness, but cerebrovascular measures may be more sensitive to neuroprotective effects of diet. We examined associations between Mediterranean diet adherence, prefrontal cortex (PFC) arterial elasticity, and cognition in older adults. METHODS Participants were 198 older adults (58% female; mean age 65.6 years) from the Newcastle ACTIVate cohort. Mediterranean Diet (MedDiet) scores were derived from the Australian Eating Survey food frequency questionnaire. Pulse Relaxation Function (PReFx), an index of PFC arterial elasticity, was measured using pulse Diffuse Optical Tomography. Cognition was assessed with CANTAB and a cued task-switching paradigm. RESULTS Higher MedDiet was associated with higher PFC arterial elasticity. MedDiet was not associated with cognition, and PReFx did not mediate diet-cognition associations. DISCUSSION Greater Mediterranean diet alignment was cross-sectionally associated with PFC arterial elasticity, suggesting a pathway through which diet may influence brain health in ageing.

Few treatment interventions for addictive eating have evaluated long-term effectiveness. This post-trial follow-up study evaluates secondary changes in addictive eating symptoms and quality of life at 12-months in a sample of individuals who participated in the TRACE (Targeted Research for Addictive and Compulsive Eating) RCT. Thirty-three adults out of possible 144 (82% female), median age 53 years, randomised to either the active intervention (five telehealth sessions delivered over 3-months), passive intervention (self-guided workbook) or control group completed an online post-trial survey. Pre- and immediate post-intervention (3-months) outcomes were compared to 12-months post-trial outcomes. Positive effects reported in the short term showed a rebound effect at post-trial follow-up in ∼50% of participants. The findings suggest that longer term support is needed to maintain changes in addictive eating behaviours and improve quality of life. Future research is needed to identify optimal intervention durations and support options for sustained change.Australian New Zealand Clinical Trials Registry (ACTRN12621001079831)

Background/Objective: Food insecurity is increasingly recognised as a concern among university students. Less is known about the interrelationships between food insecurity, psychological distress, and disordered eating risk in this population. This study aimed to examine associations between food insecurity, psychological distress, and disordered eating risk among university students, and to explore whether psychological distress mediates the association between food insecurity and disordered eating. Methods: A cross-sectional survey among university students assessed food insecurity using the USDA HFSSM. Psychological distress was assessed using the Kessler Psychological Distress Scale (K6), with disordered eating risk measured using EAT-8. Adjusted logistic regression models examined associations between food insecurity severity with psychological distress and disordered eating risk, controlling for age, living situation, and enrolment type. Mediation analysis explored whether psychological distress statistically mediated the association between food insecurity and disordered eating. Results: Overall, 63.2% of the 348 students surveyed reported some level of food insecurity, 15.8% met criteria for psychological distress and 42.0% were classified as being at high risk of disordered eating. In adjusted models, moderate (OR 2.46, 95% CI: 1.06-5.69) and severe food insecurity (OR 4.27, 95% CI: 1.83-9.97) were associated with higher odds of psychological distress. Severe food insecurity was also associated with higher odds of disordered eating risk (OR 2.07, 95% CI: 1.12-3.84). Mediation analysis indicated a statistically significant indirect association between food insecurity and disordered eating through psychological distress (B = 0.241, 95% CI: 0.065-0.418), with 43.5% of the total association statistically accounted for by psychological distress. Conclusions: Findings indicate an indirect statistical association in which food insecurity is associated with higher psychological distress, which is in turn associated with higher disordered eating risk, based on cross-sectional analysis. Longitudinal studies are needed to clarify temporality and better understand these relationships.

BACKGROUND AND AIMS:Metabolomic signatures representing a "healthy" and "unhealthy" dietary pattern have previously been constructed using data from a randomised controlled crossover feeding study (DQFS). The utility of these metabolomic signatures in other populations has not been evaluated. Here, we mapped changes in diet-derived plasma metabolites in a sample of rural adults screened as at elevated-cardiovascular disease (CVD) risk receiving medical nutrition therapy (MNT), against the DQFS dietary metabolite signature. METHODS AND RESULTS:A sub-sample of MNT participants (n = 11) received personalised MNT from a dietitian over 6-months. Plasma metabolites for DQFS and HRH were analysed using ultra-high performance liquid chromatography-tandem mass spectrometry. Restricted maximum likelihood mixed-effect models were used to evaluate change in metabolites and dietary intake across the MNT intervention. Principle component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) plots were used to compare metabolite profiles between both studies. Five metabolites significantly changed between baseline and either the 3- or 6-month, with two metabolites [Ethylmalonate and Glycosyl-N-stearoyl-sphingosine (d18:1/18:0)] significantly reduced at both 3- and 6-months. Diet quality significantly increased across the intervention (p < 0.001). PCA and PLS-DA plots identified that post MNT intervention 3- and 6-month metabolic signatures aligned more closely with the "healthy" dietary pattern signature. CONCLUSION:Findings demonstrated that the metabolomic signature identified in the controlled DQFS feeding study can be used to map changes in diet quality in response to an MNT intervention in people at an elevated CVD risk. Future studies in larger, independent cohorts are warranted.

INTRODUCTION:With the growing use of GLP-1/GIP receptor agonist medications, their impact on dietary intake and quality remains unclear. This systematic review examined how randomized controlled trials (RCT) prescribing liraglutide, semaglutide, or tirzepatide assessed and reported dietary intake and quality as outcome measures, alongside weight loss and/or glycemic control, and identified gaps in the use and methodological quality of dietary assessment methods. METHODS:Medline, Embase, Cochrane, Scopus, and CINAHL were systematically searched between January 2008-January 2025 (adults) and January 2014-January 2025 (children/adolescents). The review was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/XPNGY). RESULTS:Forty-three articles from 41 unique RCTs, comprising 50,690 participants (n = 688 children/adolescents, n = 50,002 adults) were included. Except for two studies targeting adults (one published and one unpublished data from an included study), this review found no other studies that assessed or reported dietary intake or changes in diet. Both reported a reduction in the total energy intake and altered macronutrient distribution in the medication plus diet group, although one was not significantly different from medication alone. Quality of assessment methods used was categorized as "poor" and "acceptable," respectively. These results highlight a critical gap in the literature. CONCLUSION:Only 2/41 studies (≈5%) reported or assessed dietary intake or evaluated diet changes secondary to GLP-1/GIP RA medication use. This review highlights a major gap in the evidence requiring urgent attention. More high-quality research, using validated dietary assessment methods as outcome measures in RCTs is needed to understand how these medications impact diet and diet quality, nutrient intake, and chronic disease risk.

Purpose To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth. Methods The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient’s general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability. Findings Sixteen PCPs recruited 132 eligible participants ( n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months. Conclusions Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months.

BACKGROUND:Schoolteachers' personal health and wellbeing are priority to ensure quality teaching, positive student outcomes and improving teacher retention. With limited-availability of validated tools to measure teacher food and nutrition (FN) as a component of wellbeing, this study aims to evaluate the content validity of the Teacher Food and Nutrition-related health and wellbeing Questionnaire (TFNQ) to fill this gap. METHOD:A two-round Delphi was used to refine the questionnaire and establish content validity. Round-one reviewed constructs and lifestyle covariates (LC) for inclusion. Round-two considered construct phrasing, appropriateness of scales and questionnaire order. Descriptive and thematic analyses were conducted. RESULTS:Round-one included 23 international experts, with 19 also participating in round-two. After round-one, seven constructs and three LC were removed with two constructs revised into four concise new groupings to refine the TFNQ. In round-two 83% of experts agreed with questionnaire order, and feedback indicated only minor adjustments. The final TFNQ contains 26 FN and wellbeing constructs and three LC. CONCLUSION:This Delphi study established content validity of the TFNQ to appropriately measure key aspects of FN as a component of wellbeing in schoolteachers. Future testing will evaluate the TFNQ construct validity and reliability.

Women and children are priority populations in Cambodia, however no dietary intake information exists on breastfeeding women for informing nutritional intervention. The aim was to assess nutritional adequacy of dietary intakes of Cambodian women, by breastfeeding status and locality. A cross-sectional assessment of dietary intake was conducted with non-pregnant women ≥18 years of age with at least one child under 5 years in rural, semi-rural and urban locations in Siem Reap province, Cambodia. Women used a bespoke smartphone application to capture three-day image-voice records on two occasions. Data were analysed using a semi-automated web platform incorporating a tailored Cambodian food composition database. Estimated Average Requirements were used to assess adequacy of nutrient intakes. Of 119 women included in the analysis, 58% were breastfeeding, and 63% were rural or semi-rural. Protein, carbohydrate, vitamin B12, iron, and sodium were adequate for over 65% of women. Less than 10% of women had adequate vitamin A, vitamin C, thiamine, calcium, and zinc intakes, in contrast to low deficiency rates reported for Cambodian women. Despite breastfeeding women recording higher dietary intakes, adequate intakes of protein, carbohydrate, vitamin A, thiamine, and zinc were lower than non-breastfeeding women due to higher requirements. Rural women generally had higher nutrient intakes, and urban women had inadequate folate intake. This study indicates dietary intakes of Cambodian women in Siem Reap province, particularly breastfeeding women, are not nutritionally adequate. Data collected using image-voice dietary assessment could inform nutrition interventions and policies in Cambodia to improve dietary intakes and nutrition-related health outcomes.

Adolescents with obesity may engage in dieting to facilitate weight loss (1) . However, dieting is also associated with eating disorder risk and body dissatisfaction. This study aimed to understand adolescent dieting behaviours and associations with eating disorder risk, weight bias internalisation and body appreciation. Adolescents (n = 141), median (IQR) age of 14.8 (12.9 to 17.9) years, mean (SD) BMI 35.39 (4.17) kg/m 2 , with obesity and ≥ 1 related complication were enrolled into the Fast Track to Health trial (2) , which aimed to compare two dietary intervention. At the first dietetic visit, adolescents were asked whether they had previously seen a dietitian (yes or no) and if they had previously tried any diets; the types of diets tried were categorised. Self-report questionnaires including Eating Disorder Examination Questionnaire, Binge Eating Scale, Weight Bias Internalization Scale and Body Appreciation Scale were assessed. One-way ANOVA was used to investigate the difference in questionnaire scores based on the number of diets trialled (no diets, one diet, two/three diets). Of 141 adolescents enrolled, 68 (48.2%) had previously seen a dietitian and 106 (75.2%) had tried at least one diet. Most adolescents had tried one type of diet (n = 74, 52.5%), with 29 (20.6%) having tried two or three different diets. There were no associations between sex or age and history of seeing a dietitian or attempting to diet. Adolescent with a higher BMI, expressed as a percentage of the 95th percentile, were more likely to have seen a dietitian, but there was no association between BMI and the number of diets used. Adolescents who had tried two/three diets had higher scores on the Eating Disorder Examination Questionnaire compared to those who reported not dieting (mean [SD] 2.81 [1.12] vs 1.98 [1.08], p = 0.016). There were no differences in scores on the binge eating scale, weight bias internalization scale and body appreciation scale based on the number of diets trialled (p > 0.05). Many adolescents presenting to obesity treatment will have tried one or more diets with or without the support of a dietitian. Repeated dieting attempts may be an early indicator of eating disorder risk in this population. However, further research is needed to understand the duration of dieting and specific dieting practices used. Clinicians providing nutrition education and prescribing diet interventions should be aware of this and the potential influence on adolescent perceptions of healthy and unhealthy dieting practices.

To review the impact of culinary nutrition interventions delivered online, in improving participants' cooking and/or food skills. A systematic search strategy was developed to identify eligible studies across five electronic databases. Experimental studies with an online culinary nutrition intervention were included. Study characteristics and outcomes were extracted from eligible studies by one reviewer and checked by a second. A narrative synthesis of results from eligible studies were prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 29 (15 pre-post, 5 quasi-experimental, 6 randomized controlled trials) studies were included. Significant improvements were reported in cooking and/or food skill outcomes self-efficacy (5 of 11 studies), confidence (3 of 7), cooking and/or food skills (3 of 8), knowledge (2 of 7), cooking intentions or frequency (1 of 5), and attitudes and behaviors (3 of 6). Study findings were mixed for the impact of culinary nutrition interventions on cooking and/or food skills. The precise effect of these interventions delivered online is limited by the quality and duration of the intervention. Systematic review registration OSF DOI: https://doi.org/10.17605/OSF.IO/HT29W.