AbstractObjective:To understand how healthy menu labelling information is used by parents/caregivers and where it fits within predictors of healthy meal choices when eating out.Design:Parents were recruited to complete a 15-min observational, online survey regarding their experiences and hypothetical choices when eating out with their child/ren.Setting:Australia.Participants:Eligible participants had one or more child/ren aged between 2 and 12 years and attended cafes, restaurants, hotels and clubs (CRHC) for lunch or dinner at least four times a year. Of initial respondents (n 1802), 92·5 % provided complete and valid data. Participants were 84·7 % female, ranging from 18 to 68 years old.Results:98·3 % believed that healthier alternatives should be available for children in CRHC. For general food choices, health was a strong motivator (45·7 %); however, parents reported eating at CRHC mainly for pleasure or a treat (61·2 %) and being driven by children’s taste preferences (85·9 %) when selecting menu items. 59·0 % of orders included a combination of healthy and traditional items. 42·0 % of the sample were influenced by the healthy choice (HC) labelling. Multiple regression revealed that, in addition to some demographic variables, the percent of HC ordered was positively associated with self-reported parent vegetable consumption, making food choices for the children for health reasons, familiarity with HC items and making order choices due to dietary needs and good nutrition.Conclusions:Despite a preference for availability of healthier children’s menu choices in CRHC, menu labelling highlighting healthy options may have limited impact relative to child preferences.

Regular almond consumption has been shown to improve body weight management, lipid profile and blood glucose control. We hypothesized that almond consumption would alter fecal microbiota composition, including increased abundance and activity of potentially beneficial bacterial taxa in adults who are overweight and obese with elevated fasting blood glucose. A total of 69 adults who were overweight or obese with an elevated plasma glucose (age: 60.8 ± 7.4, BMI ≥27 kg/m2, fasting plasma glucose ≥5.6 to <7.0 mmol/L) were randomized to daily consumption of either 2 servings of almonds (AS:56 g/day) or an isocaloric, high carbohydrate biscuit snack for 8 weeks. AS but not biscuit snack experienced significant changes in microbiota composition (P= .011) and increases in bacterial richness, evenness, and diversity (P< .01). Increases in both the relative and absolute abundance of operational taxonomic units in the Ruminococcaceae family, including Ruminiclostridium (false discovery rate P = .002), Ruminococcaceae NK4A214 (P = .002) and Ruminococcaceae UCG-003 (P = .002) were the principal drivers of microbiota-level changes. No changes in fecal short chain fatty acid levels, or in the carriage of the gene encoding butyryl-CoA:acetate CoA-transferase (an enzyme involved in butyrate synthesis) occurred. Almond consumption was not associated with reduced gut permeability, but fecal pH (P= .0006) and moisture content (P = .027) decreased significantly in AS when compared to BS. Regular almond consumption increased the abundance of potentially beneficial ruminococci in the fecal microbiota in individuals with elevated blood glucose. However, fecal short-chain fatty acid levels remained unaltered and the capacity for such microbiological effects to precipitate host benefit is not known.

Background: Almonds are a rich source of bioactive components. This study examined the effects of daily almond consumption on glycaemic regulation, liver fat concentration and function, adiposity, systemic inflammation and cardiometabolic health. Methods: 76 adults with elevated risk of type 2 diabetes (T2D) or T2D (age: 60.7 +/- 7.7 years, body mass index: 33.8 +/- 5.6 kg/m(2)) were randomly assigned to daily consumption of either 2 servings of almonds (AS:56 g/day) or an isocaloric, higher carbohydrate biscuit snack (BS) for 8 weeks. Glycosylated haemoglobin (HbAlc), glycaemic variability (GV), liver fat, serum aminotransferases, body weight and composition, markers of cardio-metabolic risk and systemic inflammation were assessed at baseline and week 8. Results: No group differential effects were observed on HbA1c, GV, body weight and composition, liver fat and aminotransferases, cardio-metabolic health and inflammatory markers (all P> 0.05). For serum TC/HDL-C ratio a significant gender x treatment x time interaction occurred (P < 0.01), such that in women TC/HDL-C ratio was significantly reduced after AS compared to BS (-0.36 [0.26] mmol/L [n = 14] vs. -0.14 [0.32] mmol/L [n = 17]; P = 0.05), but not in men (P = 0.52). Conclusions: Compared to BS, AS consumed between meals did not substantially alter glycaemic regulation, liver fat or function, adiposity, and metabolic health and inflammatory markers. Serum TC/HDL-C ratio improved in women, but not in men with AS; but as this sub-analysis was not defined a priori the results should be interpreted with caution. Further research should examine the longer-term health effects of regular almond consumption and differential gender responses. (C) 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Background: Populations worldwide do not meet recommended vegetable intakes, yet significant amounts of vegetables are wasted, including carrots. Aim: To investigate whether advice to consume carrot powder is an effective strategy to supplement vegetable intake, compared to advice to consume more vegetables. Design: Healthy adults (n = 42) were randomly assigned to either two servings carrot powder/day (CP) [5.2 mg/day carotenoids] or carotenoid-rich vegetables (VEG) [11.4 mg/day carotenoids] for four weeks. Plasma carotenoids were assessed pre- and post-intervention, and consumer attitudes surveyed weekly. Results: Total plasma carotenoids increased similarly between groups (median[interquartile range], CP: +0.31[0.09, 0.42]mu g/mL; VEG: +0.33[0.23, 0.48]mu g/mL, P = 0.40). 'Liking' and 'desire to eat' were lower and 'boredom' higher (P < 0.05) with CP versus VEG. 'Effort to consume' CP remained constant but decreased for VEG after four weeks. Conclusions: Carrot powder effectively boosts vegetable intake, however greater consumer understanding of the product and how it may be used is required for improved consumer acceptance.

Higher-protein diets, meal replacements, and greater early weight loss have separately been associated with greater weight loss. We compared a high-protein, meal replacement program with daily energy restriction (DER) to one which provided greater energy restriction adding alternate day fasting (ADF + DER; alternating days of modified-fasting and DER plus 1 ad libitum day/week) on retention, weight loss, physiological, nutritional, and behavioral markers. Participants were randomized to ADF + DER or DER for 16 weeks (n = 162, age 40 ± 8 years BMI 36 ± 6 kg/m2 (Mean ± SD)) plus 8 weeks weight maintenance. At week 16 weight change was −10.7 ± 0.5 kg and −11.2 ± 0.6 kg in ADF + DER and DER groups (treatment NS). Fat mass, visceral adipose tissue, and lean mass (p < 0.05) were similarly reduced between treatments. Weight loss was sustained to 24 weeks (treatment NS). Fasting LDL-cholesterol, triglycerides, insulin, hsCRP, glucose, and blood pressure all improved (p < 0.05; treatment NS). Transferrin saturation, ferritin, serum zinc, folate, and B12 improved (p < 0.05; treatment NS). Plasma thiamine and vitamin D levels decreased, reflecting lower carbohydrate intakes and seasonal changes, respectively. Food cravings, quality of life, and mood improved (treatment NS). Energy, fatigue, and pain improved slightly more in DER (p < 0.05). This study supports the use of higher protein, meal replacement programs with or without ADF in weight management.

A systematic review was undertaken to identify intervention characteristics associated with increasing consumption of vegetables in children (2-12 years). PubMed, PsychINFO and CABabstracts were used to identify studies published between 2004-2014 that had measures of vegetable consumption, a minimum of 3-month follow-up and were conducted in home and community settings (outside of schools). Twenty-two studies were included in the review. Details of the study design, population, setting, intervention characteristics, target behaviour, behaviour change techniques used and vegetable intake were extracted. Study quality and intensity were scored. Overall, 12/22 studies were effective short-term, and 6/10 were effective long-term (6 + months); mean short-term change in vegetable intake was 29%, equating to an increase of a quarter to a half of a serving of vegetables. Intervention effectiveness was associated with number of settings targeted and frequency of contact but not length of intervention. Planning for social support, vegetable exposure and provision of staff training were commonly used behaviour change techniques in effective interventions. This review has identified strategies that may optimise effectiveness of future home-based and community-based interventions aiming to increase vegetable intake in young children.

Background: For many decades, Australia has required a Nutrient Information Panel to be included on food packaging, usually on the back of products. Recently, two regulated, voluntary systems were introduced for use on food packaging in Australia: the Health Star Rating system and nutrient content and health claims. Nonetheless, the scope and potential for these new initiatives to achieve their purpose is partly depdendant on their perception by consumers. This report describes the results of a population based survey of South Australian adults about how various elements of food labels are used to inform their purchase decisions. Methods: A survey was conducted using a random stratified sampling technique in people aged 15 years and older in the Australian state of South Australia. All surveys were administered face-to-face to 3005 people between September 2015 and December 2015. Data was weighted by the inverse of the individual’s probability of selection, as well as the response rate in metropolitan and country regions and then reweighted to benchmarks from the June 2014 Estimated Resident Population calculated by the Australian Bureau of Statistics. Results: The response rate for the survey was 57.3%. Most respondents to the survey rated their own dietary intake as ‘healthy’ (61.5%) or ‘extremely healthy’ (9.1%). Aside from price, country of origin was nominated as the most important information on the food label of a food bought for the first time (by 35.0%), followed by the ingredient list (21.6%) and claims about nutrition (20.9%). The response to this question was markedly different by age group, with almost half (48.3%) of those aged 55 years or over considering that country of origin was the most important information to look for. For the youngest age group (15-34 yrs), 28.4% considered the ingredient list was the most important information, 26.5% considered claims about nutrition to be most important, and 22.2% considered country of origin to be the most important information on the food label. The Nutrition Information Panel was used to guide the purchase decision for a new breakfast cereal by more than half of respondents (50.8%), while a statement on the front of the pack about how the food effects health was used to guide the purchase decision of only 8.9%. While only 22.1% disagreed (16.4% disagreed somewhat, 5.7% disagreed completely) with the statement that ‘the Nutrient Information Panel on food packaging is a trustworthy source of information,’ almost double the amount of subjects at 44.0% disagreed (36.1% disagreed somewhat, 17.9% disagreed completely) that ‘statements about health on food packaging are a trustworthy source of information.’ Conclusion: For South Australian adults, statements about health benefits of food on food packaging are viewed with much greater suspicion than the nutrient information panel. Attitudes towards food packaging varied more by age group than by sex of the respondent. For an unfamiliar food, country of origin is considered the most important information on food packaging by more than a third of adults. Keywords: Food packaging, Nutrition label, Front of Pack, Health Star, South Australia

Reducing glycaemic index (GI) and glycaemic load (GL) inconsistently improves aspects of cognitive function and appetite in children. Whether altering the GL by lowering carbohydrate relative to protein and fat has a role in these effects is unknown. Therefore, we assessed the differential effects of beverages varying in GL and dairy composition on appetite, energy intake and cognitive function in children. A total of forty children (10–12 years) completed a double-blind, randomised, crossover trial, receiving three isoenergetic drinks (approximately 1100 kJ): a glucose beverage (GI 100, GL 65), a full milk beverage (GI 27, GL 5) and a half milk/glucose beverage (GI 84, GL 35). For 3 h post-consumption, subjective appetite and cognitive performance (speed of processing, memory, attention and perceptual speed) were measured hourly. At completion, each child was provided a buffet-style lunch and energy intake was calculated. Blood glucose was objectively measured using the Continuous Glucose Monitoring System. Blood glucose AUC values were significantly different between the drinks ( P < 0·001), but did not sustain above the baseline for 3 h for any drink. Mixed modelling revealed no effect of beverage on subjective appetite or energy intake. Participant sex and drink GL significantly interacted for short-term memory ( P < 0·001). When girls consumed either milk-containing beverage, they recalled 0·7–0·8 more words compared with 0·5 less words after the glucose drink ( P ≤ 0·014). Altering GL of drinks by reducing carbohydrate and increasing protein did not affect appetite or cognition in children. Girls may demonstrate improved short-term memory after consuming beverages with higher protein and lower GL.

Aim To describe reported consumption of meat for children using the 2007 Australian National Children's Nutrition and Physical Activity Survey. Methods One-day, weighted data are described for consumption of meat, poultry and fish consumed as cuts and from mixed dishes. Data are presented for all children by age groups (23 years, 48 years, 913years, 1416 years) and gender. Trimming practices, time and place of consumption, and nutrient contributions are described. Results Ninety per cent of children reported consuming meat, poultry or fish on the day surveyed. Reported mean consumption of all beef/veal/lamb, pork/ham/bacon, poultry and fish ranged from 52?g in 2 to 3-year-old boys to 161?g in 14 to 16-year-old boys; and was lower in 9 to 16-year-olds girls; 98?g. Mean reported consumption of beef/veal/lamb was 2164?g for boys and 2336?g for girls, depending on age group. For meals where the meat, poultry or fish were identified individually, meals with beef/veal/lamb contained more vegetables (159?g) than pork/ham/bacon (50?g) and poultry (110?g). The beef/veal/lamb was fully (20%) or semi-trimmed (58%), and 49% of minced beef/veal/lamb was lean. Sixty-eight per cent of respondents reported eating poultry with the skin removed. Across all age groups, beef/veal/lamb in cuts and mixed dishes contributed 4% of total energy, 6% of total fat, 5% of saturated fat, 46% of haem iron, 18% of zinc and 21% of long-chain omega-3 fatty acid intake. Conclusions These findings help to inform evidence-based individual or population-level recommendations.

Abstract Objective Dairy food consumption is important for Australian children as it contributes key nutrients such as protein and Ca. The aim of the present paper is to describe dietary intake from dairy foods for Australian children aged 2–16 years in 2007. Design Secondary analysis of a quota-sampled survey using population-weighted, 1 d (24 h) dietary recall data. Setting Australian national survey conducted from February to August 2007. Subjects Children (n 4487) aged 2–16 years. Results Most Australian children consumed dairy foods (84–98 %), with the proportion consuming tending to decrease with age and males consuming significantly more than females from the age of 4 years. Milk was the most commonly consumed dairy food (58–88 %) and consumed in the greatest amount (243–384 g/d). Most children consumed regular-fat dairy products. The contribution of dairy foods to total energy intake decreased with age; from 22 % of total energy at age 2–3 years to 11 % at age 14–16 years. This trend was similar for all nutrients analysed. Dairy food intake peaked between 06.00 and 10.00 hours (typical breakfast hours) corresponding with the peak in dairy Ca intake. Australian children (older than 4 years) did not reach recommendations for dairy food intake, consuming ≤2 servings/d. Conclusions The under-consumption of dairy foods by Australian children has important implications for intake of key nutrients and should be addressed by multiple strategies.

OBJECTIVE:To identify parents' concerns and attitudes towards children's diets, activity habits and weight status.DESIGN:Computer-assisted telephone interviewing administration of a 37-item survey. Data were weighted for parental education level. Descriptive results are presented, and comparisons are made by the age, gender and parental characteristics of the child.SETTING:Online research panel of Australian parents.SUBJECTS:A total of 1202 randomly selected parents of children aged 2-16 years, broadly representative of the Australian population.RESULTS:Parents were concerned about their child's education (reported by 35 % of respondents), child's health and well-being (25 %), and violence, drugs and alcohol (20 %). Concern about nutrition was indicated by 14 % of respondents and concern about fitness/exercise was indicated by 3 % of the sample. Factors perceived as making a healthy diet difficult to achieve for their child were child resistance (89 %), the availability of healthy food (72 %), a busy lifestyle (67 %) and the influence of food advertising (63 %). Ninety-two per cent of parents thought that it was realistic for their child to be active for at least 1 h/d, with 75 % of parents feeling that it was realistic for their child to have less than 2 h recreational screen time per d. Despite this, common barriers to achieving the activity guidelines were lack of time, weather and keeping children occupied.CONCLUSIONS:Insights into parental concerns from the current study may be useful in guiding development of interventions to improve children's nutrition and physical activity habits by framing messages in a way that are most likely to resonate with parents.

Dietary protein induces greater satiety compared with carbohydrate in lean subjects, which may involve appetite-regulatory gut hormones. Little is known about the duration of effect, influence of protein and carbohydrate source and relevance to non-lean individuals. We compared the effect of various dietary proteins and carbohydrates on post-prandial appetite ratings, ad libitum energy intake (El) and appetite hormones in lean and overweight men. Three randomised double-blinded cross-over studies examined appetite response (appetite ratings, ghrelin, glucagon-like peptide-1 (GLP-1) and cholecystokinin) to liquid preloads over three to four hours followed by a buffet meal to assess ad libitum El. The 1-MJ preloads contained similar to 55 g of protein (whey, casein, soy and gluten), carbohydrate (glucose, lactose and fructose) or combined whey/fructose. El was 10% higher following glucose preloads compared with protein preloads, observed at three hours but not four hours. Protein ingestion was followed by prolonged elevation of cholecystokinin and GLP-1 (two hours) and suppression of ghrelin (three to four hours) compared with glucose and independent of protein type. Replacing some whey with fructose attenuated the effect of protein on these hormones. Treatment effects on El and appetite hormones were independent of bodyweight status, despite higher GLP-1 and lower ghrelin in overweight subjects. Protein-rich liquid preloads reduce El over three hours in overweight men compared with glucose. These findings suggest a potential application for protein-rich drinks and/or foods to facilitate reduced El. Future studies should explore additional dietary manipulations that may enhance this relationship, and confirm these effects within the context of energy-restricted dietary patterns.

The aim of the study was to comprehensively assess foods differing in protein type (whey vs casein) relative to a low glycaemic index (GI) and high GI carbohydrate (CHO) food for their effects on DNA damage, DNA repair and mitogen response in peripheral blood lymphocytes using the cytokinesis-block micronucleus assay two hours after consumption. We also studied the relationship of these parameters with plasma folate, vitamin B12, zinc, magnesium and selenium immediately before the intervention and change in plasma glucose and plasma insulin during the two-hour period after consumption. There was no effect of protein, CHO or GI on genome damage or immune responsiveness except for a small but significant improvement in resistance to radiation-induced DNA damage in the high-GI CHO food relative to the casein food. Mitogen response was significantly and positively correlated with plasma zinc, magnesium, selenium and folate and baseline genome damage significantly negatively correlated with plasma folate and vitamin B12. There was no significant correlation between plasma micronutrients and change in plasma glucose or insulin except for a positive and significant correlation between change in plasma insulin and plasma selenium. The correlation between change in plasma insulin and change in plasma glucose was weaker. It is apparent from these preliminary data that micronutrient status may have a profound effect on genome stability and immune responsiveness while the effects of short-term changes in glycemia and dietary intake of carbohydrate or protein may have only minor effects on these parameters.

CONTEXTAlthough dietary protein produces higher acute satiety relative to carbohydrate, the influence of protein source and body mass index (BMI) has not been clearly described.OBJECTIVEThe objective of the study was to assess postprandial responses to different protein sources, compared with glucose, in males with normal and high BMI.DESIGNThis was a randomized, crossover study of four preloads followed by blood sampling (+15, 30, 45, 60, 90, 120, 180 min) and buffet meal.SETTINGThe study was conducted at an outpatient clinic.PARTICIPANTSThe study population included 72 men, with a BMI range 20.6-39.9 kg/m(2).INTERVENTIONSInterventions consisted of liquid preloads (1.1 MJ, 450 ml) containing 50 g whey, soy, gluten, or glucose.MAIN OUTCOME MEASURESFasting and postprandial plasma glucose, insulin, ghrelin, glucagon-like peptide-1 (GLP-1) and cholecystokinin (n = 38), ad libitum energy intake, and appetite ratings were measured.RESULTSEnergy intake was 10% lower after all protein preloads, compared with the glucose treatment (P < 0.05), independent of BMI status and protein type. All protein loads prolonged the postprandial suppression of ghrelin (P < 0.01) and elevation of GLP-1 (P < 0.01) and cholecystokinin (P < 0.05). Fasting GLP-1 concentrations [overweight, 17.5 +/- 1.3; lean, 14.7 +/- 0.1 pg/ml (5.2 +/- 0.4 and 4.4 +/- 0.1 pmol/liter, respectively); P < 0.001] and postprandial responses (P = 0.038) were higher in overweight subjects.CONCLUSIONSWhey, soy, and gluten similarly tend to reduce ad libitum food intake 3 h later in lean and overweight males relative to glucose. Postprandial ghrelin, GLP-1, insulin, and cholecystokinin may contribute to this higher satiety after protein consumption. GLP-1 concentrations are increased in overweight subjects, which may affect satiety responses in this group.