University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32–35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12–2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Technology has increased the availability of mobile health (mHealth) apps for dietary assessment. The 24 hour recall (24 HR) is the current preferred method to monitor population diet related health and nutritional status to inform public health nutrition policies. A novel labelled image assisted 24 HR has potential to enhance engagement with consumers but needs to be evaluated for acceptability and accuracy. 1. To identify features of an image-assisted mobile 24 HR (mFR24) that are enablers or barriers to its acceptable use in adult dietary assessment. Controlled feeding study participants recorded before and after images of food and beverages consumed at three meals in a single day using the mobile app. The next day, they labelled the items in their images from a food list in the app linked to a food composition database; before an interview assisted 24 HR and using the novel labelled images. Participant's acceptability perceptions of the mFR24 were asked via an online survey using a 5-point Likert scale to rate their agreement with statements including how easy it was to find and remember foods and amounts consumed, and if they would be willing to use the mFR24 again. Participants (n = 134) were mainly female (57%), under 35 years (63%), held a bachelor degree or higher (75%), identified as Asian (67%), in full time employment (46%) or a student (34%). Two thirds (68%) of participants reported usually taking photos of their food, 90% agreed it was 'easy' to record their intake using the app. When undertaking the 24 HR, participants agreed using labelled images of their food and beverages made it easy to remember foods (95.4%) and amounts eaten (93.2%). The majority (88.6%) were willing to undertake the mFR24 method again. Age, gender, previous weight loss history and usually taking food photos were not found to be associated with the ease of mFR24 use. Labelled image based mFR24 method of dietary intake assessment hold promise for being an easy and acceptable population dietary assessment method to inform dietary guideline advice. Investigating the accuracy of the labelled image mFR24 will be the next step in the investigation of the novel mFR24. This study was funded by an Australian Research Council Discovery Project 190,101,723. The mobile food record is funded by NIH, NCI (1U01CA130784-01); NIH, NIDDK (1R01-DK073711-01A1).

Abstract Background Acute rheumatic fever triggered by pharyngeal and skin Group A Streptococcal infections (GAS) disproportionately affects indigenous Māori schoolchildren. This stepped-wedged study in Whakatāne, New Zealand compared whole-school-cluster allocated Streptococcus salivarius probiotic effectiveness on GAS pharyngeal prevalence (carriage and pharyngitis) following antibiotics, compared to antibiotics-alone for GAS positive children. Each of two clusters followed a sequence with a different Streptococcus salivarius exposure period over ten winter weeks in 2015. Method Both clusters had high Māori schoolchildren rolls (99% and 81%) at high risk of acute rheumatic fever. The parents/guardians of 60% of eligible schoolchildren consented. Schoolchildren had pharyngeal swabs and sore-throat questionnaires administered by external student-nurses, informing GAS prevalence (primary outcome) and pharyngitis (secondary outcome). GAS positive schoolchildren’s usual care was 10 days once-daily oral amoxicillin. One whole cluster then commenced S. salivarius daily for 30 days. The other initial control cluster had S. salivarius six weeks later, after both clusters were re-swabbed, and GAS positive schoolchildren treated. Student-nurses and laboratory scientists assessing outcomes were blinded to prior S. salivarius exposure. S. salivarius and control period findings were compared. Results Per-protocol efficacy, informed by study swabs, showed Odds of pharyngeal GAS prevalence reduced substantially, but not significantly 0.6 (95% CI 0.29–1.21) for added S. salivarius, (n 235) compared to antibiotics-alone (n 106). Subgroup analysis of 197 originally GAS negative schoolchildren’s swabs found significantly reduced Odds of GAS prevalence with S. salivarius 0.42 (95% CI 0.19–0.94). compared to controls (n 80). Intention to treat analysis utilizing study swabs showed S. salivarius effectively reduced GAS prevalence from 15.5–7.4%, Odds 0.52 (95% CI 0.28–0.97) (n 309) compared to antibiotics-alone (n 157). Intention to treat sub-analysis utilizing all swabs for 260 GAS negative schoolchildren, demonstrated S. salivarius effectiveness Odds 0.52 (95% CI 0.27-1.00) compared to 131 controls. GAS pharyngitis declined from 10/128 to 2/128 over three months Odds 0.19 (95%CI 0.04–0.87) following antibiotics and S. salivarius. Conclusion Whole-cluster S. salivarius probiotic, given after antibiotic treatment of schoolchildren with pharyngeal GAS, significantly reduces GAS pharyngeal prevalence, carriage, and pharyngitis, by limiting GAS negative schoolchildren acquiring Group A Streptococcus. Trial registration ACTRN12615000402549

Modern deep learning techniques have enabled advances in image-based dietary assessment such as food recognition and food portion size estimation. Valuable information on the types of foods and the amount consumed are crucial for prevention of many chronic diseases. However, existing methods for automated image-based food analysis are neither end-to-end nor are capable of processing multiple tasks (e.g., recognition and portion estimation) together, making it difficult to apply to real life applications. In this paper, we propose an image-based food analysis framework that integrates food localization, classification and portion size estimation. Our proposed framework is end-to-end, i.e., the input can be an arbitrary food image containing multiple food items and our system can localize each single food item with its corresponding predicted food type and portion size. We also improve the single food portion estimation by consolidating localization results with a food energy distribution map obtained by conditional GAN to generate a four-channel RGB-Distribution image. Our end-to-end framework is evaluated on a real life food image dataset collected from a nutrition feeding study.

Accurate assessment of dietary intake requires improved tools to overcome limitations of current methods including user burden and measurement error. Emerging technologies such as image-based approaches using advanced machine learning techniques coupled with widely available mobile devices present new opportunity to improve the accuracy of dietary assessment that is cost-effective, convenient and timely. However, the quality and quantity of datasets are essential for achieving good performance for automated image analysis. Building a large image dataset with high quality groundtruth annotation is a challenging problem, especially for food images as the associated nutrition information needs to be provided or verified by trained dietitians with domain knowledge. In this paper, we present the design and development of an mobile, image-based dietary assessment system to capture and analyze dietary intake, which has been deployed in both controlled-feeding and community-dwelling dietary studies. Our system is capable of collect high quality food images in naturalistic settings and provide groudtruth annotations for developing new computational approaches.

BACKGROUND:The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use.OBJECTIVE:The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals.METHODS:Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests.RESULTS:Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021.CONCLUSIONS:This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology.TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/32891.

We aim to estimate food portion size, a property that is strongly related to the presence of food object in 3D space, from single monocular images under real life setting. Specifically, we are interested in end-to-end estimation of food portion size, which has great potential in the field of personal health management. Unlike image segmentation or object recognition where annotation can be obtained through large scale crowd sourcing, it is much more challenging to collect datasets for portion size estimation since human cannot accurately estimate the size of an object in an arbitrary 2D image without expert knowledge. To address such challenge, we introduce a real life food image dataset collected from a nutrition study where the groundtruth food energy (calorie) is provided by registered dietitians, and will be made available to the research community. We propose a deep regression process for portion size estimation by combining features estimated from both RGB and learned energy distribution domains. Our estimates of food energy achieved state-of-the-art with a MAPE of 11.47%, significantly outperforms non-expert human estimates by 27.56%.

BACKGROUND AND OBJECTIVES:As the incidence and prevalence of Alzheimer's disease increases, so does the body of epidemiological and clinical research that suggests a relationship between dietary fatty acids, in particular saturates, and cognitive decline. In this study, we investigated the association between serum apolipoprotein B48 (apoB48), saturated fatty acid intake and consumption behaviour, and cognitive performance, in healthy, older aged Australians.METHODS AND STUDY DESIGN:We retrospectively analysed fasted serum apoB48 concentrations, food frequency questionnaire, and cognitive performance data collected from 147 participants (98F|49M) over the age of 50. We used Spearman's correlations and a nested domain model to evaluate the relationship between serum apoB48, dietary behaviour and measures of cognitive performance.RESULTS:Overall, we found that higher fasted apoB48 concentrations, and/or dietary behaviours which led to increased dietary consumption of diets high in saturated fatty acids, were inversely associated with cognition. Interestingly however, dietary behaviour patterns of saturated fatty acid consumption and serum apoB48 were linked with better secondary memory and perceptual speed, respectively.CONCLUSIONS:This is the first time that fasted apoB48 has been implicated as a biomarker for cognitive decline and Alzheimer's disease risk.

Deep learning based methods have achieved impressive results in many applications for image-based diet assessment such as food classification and food portion size estimation. However, existing methods only focus on one task at a time, making it difficult to apply in real life when multiple tasks need to be processed together. In this work, we propose an end-to-end multi-task framework that can achieve both food classification and food portion size estimation. We introduce a food image dataset collected from a nutrition study where the groundtruth food portion is provided by registered dietitians. The multi-task learning uses L2-norm based soft parameter sharing to train the classification and regression tasks simultaneously. We also propose the use of cross-domain feature adaptation together with normalization to further improve the performance of food portion size estimation. Our results outperforms the baseline methods for both classification accuracy and mean absolute error for portion estimation, which shows great potential for advancing the field of image-based dietary assessment.

Background: Acute rheumatic fever (ARF) predominantly affects indigenous Māori schoolchildren in Bay of Plenty region, and more so male Māori students, especially when socioeconomically deprived. We evaluated the effectiveness of strategies for reducing ARF with group A streptococcal pharyngitis treatment in 2011–18. Methods: We retrospectively assessed outcomes of 3 open cohorts of Māori schoolchildren receiving different interventions: Eastern Bay rural Cohort 1, mean deprivation decile 9.80, received school-based sore-throat programs with nurse and general practice (GP) support; Eastern Whakatane township/surrounds Cohort 2, mean deprivation 7.25, GP management; Western Bay Cohort 3, mean deprivation 5.98, received predominantly GP care, but 3 highest-risk schools received school-based programs. Cases were identified from ICD10 ARF-coded hospital discharges, notifications to Ministry of Health, and a secondary-prevention penicillin database. Primary outcomes were first-presentation ARF cohorts’ incidence preintervention (2000–10) and postintervention (2011–18) with cases over annual school rolls’ Māori students-year denominators. Results: Overall, ARF in Maori schoolchildren declined in the cohorts with school-based programs. Cohort 1 saw a postintervention (2011–18) decline of 60%, 148 to 59/100,000/year, rate ratio (RR) = 0.40(CI 0.22–0.73) P = 0.002. Males’ incidence declined 190 to 78 × 100,000/year RR = 0.41(CI 0.19–0.85) P = 0.013 and females too, narrowing gender disparities. Cohort 3 ARF incidence decreased 48%, 50 to 26/100,000/year RR = 0.52(CI 0.27–0.99) P = 0.044. In contrast, ARF doubled in Cohort 2 students with GP-only care without school-based programs increasing 30 to 69/100,000/year RR = 2.28(CI 0.99–5.27) P = 0.047, especially for males 39/100,000/year to 107/100,000/year RR = 2.71(CI 1.00–7.33) P = 0.0405. Conclusions: School-based programs with indigenous Māori health workers’ sore-throat swabbing and GP/Nurse support reduced first-presentation ARF incidence in Māori students in highest-risk settings.

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

Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21–79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.

There is limited information concerning the dietary intake of toddlers in Australia. Consequently, there is a need for studies investigating toddler intake that use dietary assessment measures that are valid and place a low participant burden on caregivers. The aim of this study was to determine the relative validity of a single 24-h dietary recall (24HR) in measuring the intake of five nutrients in a cohort of Australian toddlers compared to a combined 24HR and 2-day estimated food record (2DFR). A single 24HR and a 2DFR were collected from a cohort of Australian toddlers (n = 699) at approximately 12 months of age as part of the Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE) project. Relative validity of one day of dietary data (24HR) in assessing intake of energy, protein, calcium, iron, and added sugars was tested against three days of dietary data (24HR + 2DFR) using paired t-tests, Bland–Altman analysis, cross-classification, and weighted Kappa statistic. Classification analysis found good agreement between the 24HR and 24HR + 2DFR for all nutrients with the percentage classified in the same tertile at 57.9% and above. The weighted Kappa statistic found acceptable agreement for all nutrients. This study suggests that a 24HR is a valid assessment tool for estimating the relative intake of energy, protein, calcium, iron, and added sugars among Australian toddlers at the individual level.

Image‐based dietary assessment methods have the potential to address respondent burden and improve engagement in the task of recording for dietary interventions. The aim of this study was to assess factors associated with the willingness of adults to take images of food and beverages using a mobile food record (mFR) application. A combined sample of 212 young adults and 73 overweight and obese adults completed a 4‐day mobile food record on two occasions and a follow‐up usability questionnaire. About 74% of participants stated they would record using the mFR for a longer period compared with a written record (29.4 ± 69.3 vs. 16.1 ± 42.6 days respectively; p < 0.0005). Multivariable logistic regression was used to identify those who were more likely to record mFR in the top tertile (≥14 days). After adjusting for age and gender, those with a BMI ≥ 25 were 1.68 times more likely (Odds Ratio 95% Confidence Interval: 1.02–2.77) than those with BMI < 25 to state a willingness to record with the mFR for ≥ 14 days. The greater willingness of overweight and obese individuals to record dietary intake using an mFR needs further examination to determine if this translates to more accurate estimates of energy intake.

Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18–30 years).

Cost effective population-based monitoring tools are needed for nutritional surveillance and interventions. The aim was to evaluate the relative validity of two new brief instruments (three item: VEG3 and five item: VEG5) for estimating usual total vegetable intake in comparison to a 7-day dietary record (7DDR). Sixty-four Australian adult volunteers aged 30 to 69 years (30 males, mean age ± SD 56.3 ± 9.2 years and 34 female mean age ± SD 55.3 ± 10.0 years). Pearson correlations between 7DDR and VEG3 and VEG5 were modest, at 0.50 and 0.56, respectively. VEG3 significantly (p < 0.001) underestimated mean vegetable intake compared to 7DDR measures (2.9 ± 1.3 vs. 3.6 ± 1.6 serves/day, respectively), whereas mean vegetable intake assessed by VEG5 did not differ from 7DDR measures (3.3 ± 1.5 vs. 3.6 ± 1.6 serves/day). VEG5 was also able to correctly identify 95%, 88% and 75% of those subjects not consuming five, four and three serves/day of vegetables according to their 7DDR classification. VEG5, but not VEG3, can estimate usual total vegetable intake of population groups and had superior performance to VEG3 in identifying those not meeting different levels of vegetable intake. VEG5, a brief instrument, shows measurement characteristics useful for population-based monitoring and intervention targeting.

The multiple-pass 24-h dietary recall is used in most national dietary surveys. Our purpose was to assess if adolescents’ accuracy of recall improved when a 5-step multiple-pass 24-h recall was repeated. Participants (n = 24), were Chinese-American youths aged between 11 and 15 years and lived in a supervised environment as part of a metabolic feeding study. The 24-h recalls were conducted on two occasions during the first five days of the study. The four steps (quick list; forgotten foods; time and eating occasion; detailed description of the food/beverage) of the 24-h recall were assessed for matches by category. Differences were observed in the matching for the time and occasion step (p < 0.01), detailed description (p < 0.05) and portion size matching (p < 0.05). Omission rates were higher for the second recall (p < 0.05 quick list; p < 0.01 forgotten foods). The adolescents over-estimated energy intake on the first (11.3% ± 22.5%; p < 0.05) and second recall (10.1% ± 20.8%) compared with the known food and beverage items. These results suggest that the adolescents’ accuracy to recall food items declined with a second 24-h recall when repeated over two non-consecutive days.

Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.

BACKGROUND:Increasing intakes of fruits and vegetables intake, in tandem with reducing consumption of energy-dense and nutrient poor foods and beverages are dietary priorities to prevent chronic disease. Although most adults do not eat enough fruit and vegetables, teenagers and young adults tend to have the lowest intakes. Young adults typically consume a diet which is inconsistent with the dietary recommendations. Yet little is known about the best approaches to improve dietary intakes and behaviours among this group. This randomised controlled trial aims to evaluate the effectiveness of using a mobile device to assess dietary intake, provide tailored dietary feedback and text messages to motivate changes in fruit, vegetable and junk food consumption among young adults.METHODS/DESIGN:The CHAT project will involve the development of the mobile device food record (MDFR), and evaluation of dietary feedback and implementation of a 6-month intervention in young adults aged 18 to 30 years. The participants will be randomly assigned to one of three groups (1) Intervention Group 1: MDFR + Text Messages + Dietary Feedback; (2) Intervention Group 2: MDFR + Dietary Feedback; (3) Control Group 3: MDFR, no feedback. All groups will undertake a 3-day dietary record using the MDFR but only the Intervention Groups 1 and 2 will receive tailored dietary feedback at baseline and at 6-months which will consist of assessment of serves of fruits, vegetables and junk food in comparison to dietary recommendations. Tailored nutrition text messages will be sent to Intervention Group 1 over the 6 months. Data will be collected at baseline and again at the 6-month completion.DISCUSSION:This trial will test if applications running on mobile devices have potential to assess diet, provide tailored feedback and nutrition messages as an effective way of improving fruit and vegetable consumption and reducing energy-dense nutrient poor foods in young adults. The CHAT project will assess the impact of the intervention on behavioural intention to eat a more healthful diet. This innovative approach if successful may provide a means to deliver a low cost health promotion program that has the potential to reach large groups, particularly young adults.TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry ACTRN12612000250831.