Home-delivered meals have been shown to confer benefits conducive to successfully ageing in place. However, little is known about home-delivered, texture-modified meals designed for older community-dwelling people with dysphagia, despite recognition that such individuals are at significant nutritional risk. The purpose of this review is therefore to systematically identify, appraise, and synthesise any existing evidence relating to home-delivered, texture-modified meals for community-dwelling persons with dysphagia. A systematic search of the literature was performed across five relevant databases (CINAHL, Medline, Pub Med, Scopus, and Web of Science) to answer the research question, “What is currently known about home-delivered, texture-modified meals for community-dwelling individuals with dysphagia?”. Broad inclusion criteria and minimal limits were applied. Articles were included if they reported upon any outcomes specific to home-delivered, texture-modified meals. Following removal of duplicates, 521 articles were subjected to screening by title and abstract, and 40 to full-text review. No studies of specific relevance to the research question were returned. The findings of this systematic literature review indicate a true gap in the literature and a need to establish a baseline of evidence about home-delivered, texture-modified meals. Doing so will help to ensure that community-dwelling older persons with dysphagia have equitable access to safe and nutritionally adequate meals that support successful ageing in place.

Financial insecurity is a significant challenge for university students, affecting both wellbeing and study participation. Guided by a socio-ecological perspective, this study examines financial insecurity among university students as a multi-level issue shaped by individual, institutional, and broader structural conditions. A cross-sectional survey examined the prevalence of financial insecurity among Australian university students and its associations with demographic characteristics, health, academic outcomes, and awareness of support services. An online survey was distributed via universities and national student networks (September-October 2024). Financial status was self-reported as adequate ('comfortable'/'just getting by') or inadequate ('struggling'/'severely struggling'). Descriptive statistics, logistic regression, and content analysis were used to analyse quantitative and qualitative data. Of 838 respondents (61% female, 64% domestic), 32% reported inadequate financial status. Independent predictors included international student status, Indigenous identity, disability, and living alone. Financial insecurity was associated with higher odds of perceived poor academic outcomes (OR = 5.5, 95%CI: 3.9-7.6), poor-fair self-rated health (OR = 3.0, 95%CI: 2.4-4.1), and food insecurity (OR = 8.4, 95%CI: 5.7-12.4). Awareness of financial support services was low, with dissatisfaction more common among financially insecure students (OR = 2.1, 95%CI: 1.9-4.1). Findings inform a series of recommendations for universities and policymakers to strengthen student support and address systemic drivers of financial insecurity.

INTRODUCTION:Food insecurity among international students studying in Australian universities is a growing concern, but limited research has explored their experiences in regional contexts. This study explores food insecurity experiences among international students studying at a regional Australian university, focusing on challenges with food access and the effectiveness of available support services. METHODS:Student-led focus groups were employed to explore food insecurity experiences among a sample of international students. A semi-structured guide probed students about food access issues and perceptions of available support services, and student recommendations for improvement were explored. Audio recordings were transcribed, and data were thematically analysed using Braun and Clarke's six-phase framework. RESULTS:International students (n = 17) participated in four focus groups. Thematic analysis identified challenges affecting students' food security, including inadequate campus food options, the high cost of living, and a lack of culturally appropriate food choices in Australia. Students employed various coping strategies, such as using dietary supplements, meal prepping, and seeking discounted and/or frozen foods. International students encountered significant barriers to accessing support services, including inefficient pantry operations, perceived stigma, and poor communications about options. Based on these findings, participants suggested improvements in pantry management and expanded financial support for university students. CONCLUSIONS:This study highlights the significant challenges and coping strategies related to food insecurity among international students at a regional Australian university. SO WHAT?: Our findings emphasise the urgent need for tailored, culturally appropriate interventions and improved communication strategies that support international students' agency in accessing healthy, appropriate food.

Amidst a period of sustained inflation and rising living costs, food insecurity is a growing concern in Australia and is correlated with poor diet quality and increased rates of non-communicable diseases. Currently there is a gap in knowledge of the impact of increasing cost-of-living pressures on the affordability of a healthy diet. As affordability plays a key role in food security, this cross-sectional study aimed to examine the costs, affordability, and differential of habitual (unhealthy) and recommended (healthy) diets within the Illawarra region of Australia and compare results to 2022 findings. The Healthy Diets Australian Standardised Affordability and Pricing tool was applied in six locations in the Illawarra, with two randomly selected each from a low, moderate, and high socioeconomically disadvantaged area. Costs were determined for three reference households: a family of four, a single parent family, and a single male. Affordability was determined for the reference households at three levels of income: median gross, minimum-wage, and welfare dependent. Data was compared to data collected in 2022 using the same methods and locations. Recommended diets cost 10.3-36% less than habitual diets depending on household type, but remained unaffordable for welfare dependant households and family households from socioeconomically disadvantaged areas, where diets required 25.5-45.9% of household income. Due to income increases, affordability of both diets has marginally improved since 2022, requiring 0.5-4.8% less household income. This study provides updated evidence that supports the urgent need for policies, interventions, and monitoring to widely assess and improve healthy diet affordability and decrease food insecurity rates. Possible solutions include increasing welfare rates above the poverty line and utilising nudge theory in grocery stores.

Analysis of the nutritional adequacy of children's lunchboxes in school settings indicates suboptimal food provision. However, the quality and composition of packed lunches for children in alternative settings such as vacation care remains unexplored. This study investigated energy content, macronutrients and waste of 5- to 8-year-old children's lunches in vacation care centres. Participants (n = 130) were recruited from five vacation care centres in New South Wales, Australia. Packed lunch contents were determined on arrival at vacation care via photography and a standard weighed method. This was repeated after lunch to determine the consumption and waste for each child. Food composition analysis was conducted. The results show that discretionary foods were consumed in excess of the gender- and age-specific food group recommendations and fruit, vegetables, protein and dairy were consumed in amounts below the recommendations for one meal. Although packed lunch contents exceeded energy recommendations, consumption was close to the recommended intake. Energy from protein (12 %) was found to be below the acceptable macronutrient distribution range, but carbohydrate (56 %) and fat (33 %) fell within range. Grain foods were the primary source of protein (45.6 %) and discretionary foods were the primary source of carbohydrate (37.1 %) and fat (17.5 %). The study highlights that children's lunchboxes in vacation care settings met the energy requirements but were low in energy from protein. The reliance on discretionary foods is concerning and does not follow the Australian Guide to Heathy Eating for this age group.

Background/Objectives: Financial stress among university students has been widely documented, impacting academic performance, mental health, and overall well-being. This scoping review explores and synthesizes the existing evidence on the extent and impact of financial challenges experienced by university students in Australia and New Zealand and examines approaches implemented by universities in these countries to address these challenges. Methods: The Arksey and O’Malley framework was utilized for comprehensiveness, structure, and reproducibility. Four scientific databases (Scopus, ProQuest, Web of Science, and Informit) were searched until 30 June 2024, and 3542 articles were identified. Following extensive screening, 19 studies were included. The studies were summarized using a narrative synthesis approach. Results: This review suggests that financial stress continues to be experienced by Australian/New Zealand university students. Some studies indicate that over half (8–68%) of students face significant financial issues and 96% of students report high emotional stress. Some groups are more vulnerable than others. Notably, students from low socio-economic status (SES) backgrounds and international students have increased vulnerability due to factors such as inadequate financial support and limited access to job opportunities and support services. Support services available for students included emergency grants, food pantries (including international students), and community gardens but with limited impact in addressing underlying financial hardships. Conclusion: This review highlights the persistent financial challenges faced by vulnerable university students in Australia and New Zealand. It calls for comprehensive strategies to enhance support services and address structural issues in government and institutional policies. Addressing these needs will enable improved student academic success and mental and physical well-being in these vulnerable groups.

AIMS:Unpaid mandatory student placements are common among allied health disciplines. This qualitative study aimed to specifically explore the student dietitian experiences of and perspective on financial stress and food insecurity during unpaid mandatory student placements as well as describe any related impacts on their health and wellbeing. METHODS:Semi-structured interviews were undertaken with student dietitians living in Australia and New Zealand. Participants had self-nominated for interviews from a larger interprofessional mixed method study on student placement poverty. Inductive thematic analysis involving coding, categorisation, theme development and refinement was used to generate themes. RESULTS:A total of 11 interviews were undertaken. Most students were female, studying full-time and living in Queensland, New South Wales and New Zealand. All students had undertaken at least one unpaid placement. Thematic analysis of the student experience of placement generated five key themes and 18 subthemes. The key themes were (1) Overall Wellbeing on Placement, (2) Financial Security, (3) Social Support, (4) Income Sources and (5) Course Structure. Overall, unpaid placements had a significant impact on the ability of students to maintain their overall wellbeing whilst on placement. This included impacts on financial security. There was noted to be substantial cognitive dissonance between high levels of nutrition knowledge and the inability to maintain their own food security. CONCLUSION:These findings highlight that unpaid mandatory student placements (especially those requiring full-time attendance) represent a major challenge for student dietitians, with implications for student physical and mental wellbeing and future diversity within the profession of dietetics.

INTRODUCTION:Residents in the Fowler electorate of NSW, Australia experience high socioeconomic disadvantage and may therefore be vulnerable to food insecurity. This study aimed to assess the cost, cost differential and affordability of recommended and current diets for various household structures in this electorate. METHODS:This study applied the low socioeconomic group Healthy Diets Australian Standardised Affordability and Pricing protocol. Food and beverage prices, including both 'popular brand' and 'cheapest alternative' options, were collected from 43 outlets in five locations across Fowler using standardised recommended and current diet pricing tools. Fortnightly diet costs and the differential between both diets and pricing options were calculated for a family of four, a single-parent family and a single male. Diet affordability was assessed against low-minimum wage and welfare-dependent household incomes, characterising diet costs as causing 'food stress' or being 'unaffordable' if exceeding 25% and 30% of household income, respectively. RESULTS:Recommended diets were less expensive than current diets for all households by 9%-31%. Pricing 'cheapest alternatives' reduced both diet costs by 30%-34%. For 'popular brands', recommended and current diets required 13%-34% and 19%-42% of household income, respectively, while 'cheapest alternatives' required 9%-23% and 13%-28% of household income, respectively. Recommended and current diets priced with 'popular brands' were unaffordable or caused 'food stress' for many welfare-dependent and low-income families with children. CONCLUSION:Whilst recommended diets were less expensive than current diets, they were unaffordable or caused 'food stress' for many welfare-dependent and low-income families with children unless the households purchased the 'cheapest alternatives'. IMPLICATIONS FOR HEALTH PROMOTION:Targeted policy interventions to improve diet affordability for regions with high socioeconomic disadvantage are urgently required, including expansion of local-level food access initiatives and, more broadly, stronger fiscal policy measures to address dietary inequities.

Objective 'Placement poverty' refers to the financial burdens imposed upon students by the completion of mandatory professional placement. We aimed to identify the financial implications of mandatory professional placements on student wellbeing.Methods A cross-sectional online survey (August 2023 to January 2024) completed during students' most recent professional placement in the final year of their degree. Eligible participants were health or teaching students studying at Australian and New Zealand universities in degrees requiring mandatory professional placement. Questions included total and accommodation costs, financial support, impact of finances on placement preferences, presence of food insecurity, and implications for student wellbeing.Results Participants (n = 530) were mostly health professional (65%) students (median, 25; interquartile range (IQR), 22-30 years, 95.3% domestic, 88.3% full time, 2.0% New Zealand). Health students had higher total costs (in Australian dollars) for the recent placement ($1500; IQR, 600-3453) compared to teaching students ($1200; IQR, 600-2757) (P = 0.02), likely due to longer placement duration (6 weeks for health students). A higher proportion of health students required financial support (P = 0.0001). Placement preferences were always or sometimes (63.8%) determined by cost rather than learning opportunity. Food insecurity was experienced by most students (70.2%) (10.4% marginal, 32.1% moderate, 27.7% severe), with no difference by degree type. Thematic analysis identified themes of burnout, emotional distress, inability to focus on learning, postponing care of oneself, urgent need for financial support, unanticipated family and other circumstances, and worsened societal inequity.Conclusions Our study identified widespread financial difficulty in students undertaking placement that adversely impacted personal wellbeing. Strategies are needed to support wellbeing and ameliorate the financial burden.

Cellular senescence, a hallmark of aging, plays an important role in age-related conditions among older adults. Targeting senescent cells and its phenotype may provide a promising strategy to delay the onset or progression of Alzheimer’s disease (AD). In this review article, we investigated efficacy and safety of nutrition senotherapy in AD, with a focus on the role of polyphenols as current and potential nutrition senotherapeutic agents, as well as relevant dietary patterns. Promising results with neuroprotective effects of senotherapeutic agents such as quercetin, resveratrol, Epigallocatechin-gallate, curcumin and fisetin were reported from preclinical studies. However, in-human trials remain limited, and findings were inconclusive. In future, nutrition senotherapeutic agents should be studied both individually and within dietary patterns, through the perspective of cellular senescence and AD. Further studies are warranted to investigate bioavailability, dosing regimen, long term effects of nutrition senotherapy and provide better understanding of the underlying mechanisms. Collaboration between researchers needs to be established, and methodological limitations of current studies should be addressed.

Dysphagia commonly affects older adults, making them nutritionally vulnerable. There is significant variation in the reported prevalence of dysphagia in aged care. The aim of this systematic review and meta-analysis was to determine the prevalence of dysphagia in individuals living in residential aged care facilities using appropriate assessment methods, and in four subgroups at higher risk: individuals with nervous system diseases, dementia, malnutrition, and poor dentition. Scopus, Web of Science, Medline, and CINAHL Plus were searched, and study selection was conducted in Covidence. Meta-analysis using a random effects model was used to obtain the pooled prevalence of dysphagia. Seven studies were eligible for inclusion. Dysphagia prevalence ranged from 16 to 69.6%. The pooled prevalence of dysphagia was 56.11% (95% CI 39.363-72.172, p < 0.0001, I-2 = 98.61%). Sensitivity analysis examining the prevalence of dysphagia using only the CSE indicated a pooled prevalence of 60.90% (95% CI 57.557-64.211, p = 0.9994, I-2 = 0%). Only one study each reported on dysphagia prevalence in individuals with nervous system diseases (31%), poor dentition (92%), and dementia (68.4%), meaning that meta-analysis could not be completed. No studies reported on the prevalence of dysphagia in individuals with malnutrition. The prevalence of dysphagia is high amongst residents of aged care facilities. This evidence should be used to guide improvements in the health outcomes and quality of life of aged care residents. Future research should explore the prevalence in the subgroups at higher risk.

Abstract Background Major depressive disorder (MDD) is a significant cause of disability globally and an emerging body of evidence suggests that dietary components, including flavonoids, may impact depression‐related biochemical pathways. Further research that characterizes dietary intake of flavonoids in diverse population groups, including people with MDD and explores the relationship between flavonoid intake and depression is needed. This study aimed to determine dietary flavonoid and subclass intake and assess the association with depressive symptomatology in a sample of adults with and without MDD. Methodology Participants with and without MDD (determined using DSM 5) completed the Depression, Anxiety, and Stress Scale‐21 (DASS‐21). Diet history interviews were analyzed using PhenolExplorer to quantify flavonoid subclasses (flavan‐3‐ols, flavonols, anthocyanins, flavones, flavanones, isoflavones), and total flavonoid intake. Independent t‐tests and linear regression, adjusting for age, sex, and BMI were performed. Results Participants (n = 93; 75% female) had a mean age of 26.0 ± 8.2 years. Participants with MDD had significantly higher DASS‐depression scores (n = 44; DASS‐depression 27.3 ± 9.8) compared to participants without MDD (n = 49; DASS‐depression 3.1 ± 4.4; p < .001). Intakes of total flavonoids and subclasses were similar between groups, except for anthocyanins where participants with MDD reported lower intakes of anthocyanins compared to participants without MDD (median intake: 0.08 mg/day and 11.6 mg/day, respectively; p = .02). In the total sample, higher anthocyanin intake was associated with lower DASS‐depression score (B = ‐4.1; SE = 1.8; 95% CI [−7.7, −0.4]; p = .029). Conclusion Intake of total flavonoids and most subclasses were similar between people with and without MDD. However, a dietary deficit of anthocyanins (found in purple/red fruits and vegetables) was evident in participants with MDD, and higher anthocyanin intake was associated with lower depressive symptomatology in the total sample. Further research in larger samples is warranted to explore if the documented association is independent of MDD status.

Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5–90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0–32.26, p < 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39–65.28, p < 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.

ISSUE ADDRESSED This research aimed to develop and disseminate National Meal Guidelines for Australian home delivered and centre based meal programs. METHODS Development was led by a project group of dietitians and a steering group of representatives from the Australian Meals on Wheels Association. The process framework included three phases: (1) Review of existing standards and guidelines and systematic literature review, (2) stakeholder consultation conducted via six workshops, across six states (N=212) and surveys with service providers, health professionals (N=289) and customers (N=337), and (3) review of the draft guidelines by stakeholders. RESULTS The final guidelines address: nutritional needs of older adults; meal and menu planning including nutrient requirements for meal components; presentation and meal enjoyment; special diets; and enhancing the meal service. CONCLUSION These guidelines provide consistent guidance to services providing home delivered and centre based meal programs. Formal evaluation of their uptake and impact on service practices and customer nutrition and satisfaction is required. SO WHAT?: The National Meal Guidelines provide nationally consistent, evidence based guidance on menu planning and nutritional quality of meals to services providing home delivered and centre based meal programs. The guideline development framework outlined here also provides a process for future food service guideline development.

Research on the role of dietary anthocyanins in preventing cognitive decline in older adults shows promise. This study investigated the association between usual anthocyanin intake and indices of memory and cognition in 40 older adults diagnosed with mild cognitive impairment that were recruited to a randomized clinical trial. It was hypothesized that daily anthocyanin intake would be similar to healthy older adults and that higher anthocyanin intake would be associated with better cognitive performance. Cognitive performance was assessed using a battery of tests including the Rey Auditory Verbal Learning Test (RAVLT). Dietary intake was assessed through 3-day food records and anthocyanin intake was quantified using the PhenolExplorer food composition database. Multivariate linear regression compared differences in cognitive performance between higher (>10 mg/d) and lower consumers (<10 mg/d). Overall, participants had low median intake of anthocyanins (5.3; interquartile range [IQR], 32.1 mg/d), with the lower consumer group eating negligible anthocyanins (median, 0.13; IQR, 1.5 mg/d), and the higher consumer group eating above the national average (median, 35.5; IQR, 71.5 mg/d). On the RAVLT, the higher anthocyanin consumer group recalled a greater number of words after a short delay and a distracter task (B, 2.07; standard error [SE], 0.93; 95% confidence interval [CI], 0.18-3.96; P = .03) and longer delay of 20 minutes (B, 2.68; SE, 1.11; 95% CI, 0.43-4.94; P = .02); and forgot less words after a long delay of 20 minutes (B, -2.63; SE, 0.63; 95% CI, -3.90 to -1.35; P< .001). Further investigation of the protective role of the usual consumption of dietary anthocyanins for memory and cognition in pathological and normal aging appears warranted. Trial registration: This cross-sectional study uses baseline data from a randomized controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001184268).

OBJECTIVES:To explore the diabetes self-management expectations of older adults with diabetes, not yet accessing residential aged care services. Admission to residential aged care (RAC) can create many interruptions to usual food choices and diabetes self-management, and we know little about the concerns of the emerging ageing population.METHODS:This is a qualitative study employing focus groups and inductive thematic analysis involving 18 older adults with diabetes between the ages of 60 and 88, living in their own homes within an Australian city. Focus groups were recruited on a sequential basis and progressively analysed using an inductive process until data saturation was reached. Focus groups were digitally recorded and transcribed verbatim for thematic analysis.RESULTS:Three key themes were generated: autonomy, individualised dietary management and the food service system. Older adults speculated that they would want a collaborative approach to maintain their health in ageing and to self-manage their diabetes while feasible. Participants wanted autonomy over food choices, flexible meal timings and quality meals. There was a significant anxiety that aged care staff and existing food service systems in RAC could not support these preferences.CONCLUSIONS:Community-dwelling older adults with diabetes would highly value aged care services that facilitated autonomy, individualised nutrition support and flexibility, but feared this will not be feasible. The introduction of new diabetes and RAC guidelines may require an implementation plan to include the full food service system, from staff education to meal preparation, ordering and service.

This pilot study sought to determine whether a low, supplemental intake of fish oil would raise the Omega-3 Index (O3I) and improve physical fitness in healthy older adults. Participants (70 +/- 3 years) were randomised to 2 g/day of either sunola oil (control; n = 8, 62.5% female) (1700 mg/day oleic acid) or docosahexaenoic acid (DHA)-rich fish oil (FO; n = 9, 55.6% female) [delivering 560 mg/day DHA and 140 mg/day eicosapentaenoic acid (EPA)] for 16 weeks. The O3I, physical fitness, 400 m walking speed and heart rate (HR) parameters were assessed. O3I was increased after FO (mean +/- SD, control: pre 6.1 +/- 0.8, post 5.9 +/- 0.6; FO: pre 6.0 +/- 0.6, post 8.3 +/- 1.2 p < 0.05). Mean lowest overnight HR (control: pre 58 +/- 6, post 58 +/- 6; FO: pre 55 +/- 6, post 52 +/- 6 bpm, p < 0.05) and mean HR during fast walking (control: pre 120 +/- 6, post 124 +/- 7; FO: pre 122 +/- 6, post 115 +/- 6 bpm, p < 0.01) were reduced in the FO group without a change in walking speed (control: pre 1.55 +/- 0.17, post 1.58 +/- 0.20; FO: pre 1.59 +/- 0.15, post 1.59 +/- 0.18 m/s), HR variability or physical fitness. The changes in lowest resting HR and fast walking HR significantly correlated (inversely) with the changes in O3I. This nutritional approach of providing dietary achievable DHA offers a potential opportunity to reduce cardiovascular strain during physical activity in the older adult.

This article will describe an approach to curriculum reconciliation that aspires to be the first step towards recognising that Indigenous ways of knowing have equal value and status as the dominant institutional systems of knowledge. Specifically, curriculum reconciliation is considered in the context of building knowledge-based relationships between disciplinary knowledges and the relevant Indigenous knowledges in science, medicine and health. Approaches to cultural education in the tertiary sector will be explored and consideration will be given to the particular challenges inherent in science, medicine and health education for curriculum reconciliation. The constraints of academic systems, as evidenced in the literature, will be acknowledged with the aim to provide guidance for curriculum reconciliation in science, medicine and health education that endeavours to establish the intrinsic value of Aboriginal knowledge relative to Country, to be understood alongside, not as an alternative to, or in opposition to, 'Western' scientific and/or medical knowledge.